Relation Between the Level of American Indian and Alaska Native Diabetes Education Program Services and Quality-of-Care Indicators

PubMed Central

Noonan, Carolyn; Goldberg, Jack H.; Valdez, S. Lorraine; Brown, Tammy L.; Manson, Spero M.; Acton, Kelly

2008-01-01

Objectives. We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. Methods. In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care. Results. Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05). Conclusions. System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs. PMID:18511737

Barriers and facilitators to intraorganizational collaboration in public health: Relational coordination across public health services targeting individuals and populations.

PubMed

McCullough, J Mac; Eisen-Cohen, Eileen; Lott, Breanne

2018-05-09

Modern public health emphasizes population-focused services, which may require collaborative work both across and within organizations. Studies have explored interorganizational collaborations, but there are little data regarding collaborations within public health organizations. We measured intraorganizational collaboration and identified barriers and facilitators to collaboration within a large public health department through a mixed-methods study. Our study occurred at the Maricopa County (Arizona) Department of Public Health, the third largest local public health jurisdiction in the United States. To measure collaboration, we surveyed staff using the relational coordination tool. To identify barriers and facilitators to collaboration, we performed key informant interviews with department personnel. Relational coordination scores varied according to the focus of the service; clinical services had significantly lower levels of relational coordination than population-focused services (p < .01). We found high levels of mutual respect and lower levels of shared knowledge across services. Facilitators to collaboration included purposive cross-program meetings around specific topics, the organization's structure and culture, and individuals' social identities. Barriers included raised expectations for collaboration, low slack resources, member's self-interest, and trust. The relational coordination of services varied significantly according to the focus of the service. Population-focused public health services had higher levels of relational coordination than individually focused services. Collaboration was facilitated and impeded by both well-known and potentially emergent factors, such as purposive cross-service meetings and organizational culture. Population-focused services possessed higher levels of collaboration than individually focused services. Intraorganizational collaboration for improved population health relies on deliberate support from senior management and structured activities to increase shared knowledge and mutual respect.

Teledermatology: quality assessment by user satisfaction and clinical efficiency.

PubMed

Klaz, Itay; Wohl, Yonit; Nathansohn, Nir; Yerushalmi, Nir; Sharvit, Sharon; Kochba, Ilan; Brenner, Sarah

2005-08-01

The Israel Defense Forces implemented a pilot teledermatology service in primary clinics. To assess user satisfaction and clinical short-term effectiveness of a computerized store and forward teledermatology service in urban and rural units. A multi-center prospective uncontrolled cohort pilot trial was conducted for a period of 6 months. Primary care physicians referred patients to a board-certified dermatologist using text email accompanied by digital photographs. Diagnosis, therapy and management were sent back to the referring PCP. Patients were asked to evaluate the level of the CSAFTD service, effect of the service on accessibility to dermatologists, respect for privacy, availability of drugs, health improvement and overall satisfaction. PCPs assessed the quality of the teledermatology consultations they received, the contribution to their knowledge, and their overall satisfaction. Tele-diagnosis alone was possible for 95% (n=413) of 435 CSAFTD referrals; 22% (n=95) of referrals also required face-to-face consultation, Satisfaction with CSAFTD was high among patients in both rural and urban clinics, with significantly higher scores in rural units. Rural patients rated the level of service, accessibility and overall satisfaction higher than did urban patients. PCPs were satisfied with the quality of the service and its contribution to their knowledge. Rural physicians rated level of service and overall satisfaction higher than did urban physicians. Tele-referrals were completed more efficiently than referral for face-to-face appointments. CSAFTD provided efficient, high quality medical service to rural and urban military clinics in the IDF.

Who benefits from public health financing in Zimbabwe? Towards universal health coverage.

PubMed

Shamu, Shepherd; January, James; Rusakaniko, Simbarashe

2017-09-01

Zimbabwe's public health financing model is mostly hospital-based. Financing generally follows the bigger and higher-level hospitals at the expense of smaller, lower-level ones. While this has tended to perpetuate inequalities, the pattern of healthcare services utilisation and benefits on different levels of care and across different socioeconomic groups remains unclear. The purpose of this study was therefore to assess the utilisation of healthcare services and benefits at different levels of care by different socioeconomic groups. We conducted secondary data analysis of the 2010 National Health Accounts survey, which had 7084 households made up of 26,392 individual observations. Results showed significant utilisation of health services by poorer households at the district level (concentration index of -0.13 [CI:-0.2 to -0.06; p < .05]), but with mission hospitals showing equitable utilisation by both groups. Provincial and higher levels showed greater utilisation by richer households (0.19; CI: 0.1-0.29; p < .05). The overall results showed that richer households benefited significantly more from public health funds than poorer households (0.26; CI: 0.2-0.4; p < .05). Richer households disproportionately benefited from public health subsidies overall, particularly at secondary and tertiary levels, which receive more funding and provide a higher level of care.

Facilitators and Barriers of Drop-In Center Use Among Homeless Youth.

PubMed

Pedersen, Eric R; Tucker, Joan S; Kovalchik, Stephanie A

2016-08-01

Drop-in centers for homeless youth address basic needs for food, hygiene, and clothing but can also provide critical services that address youth's "higher level" needs (e.g., substance use treatment, mental health care, HIV-related programs). Unlike other services that have restrictive rules, drop-in centers typically try to break down barriers and take a "come as you are" approach to engaging youth in services. Given their popularity, drop-in centers represent a promising location to deliver higher level services to youth that may not seek services elsewhere. A better understanding of the individual-level factors (e.g., characteristics of homeless youth) and agency-level factors (e.g., characteristics of staff and environment) that facilitate and impede youth engagement in drop-in centers will help inform research and outreach efforts designed to engage these at-risk youth in services. Thus, the goal of this review was to develop a preliminary conceptual model of drop-in center use by homeless youth. Toward this goal, we reviewed 20 available peer-reviewed articles and reports on the facilitators and barriers of drop-in center usage and consulted broader models of service utilization from both youth and adult studies to inform model development. Copyright © 2016 Society for Adolescent Health and Medicine. 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.

Parenting and proximity to social services: Lessons from Los Angeles County in the community context of child neglect.

PubMed

Maguire-Jack, Kathryn; Klein, Sacha

2015-07-01

Using a sample of 438 parents in Los Angeles County, CA, this study examines the role of proximity to social services in child neglect. In an extension of social disorganization theory, it seeks to understand the potential sources of support in neighborhoods for families. It uses ordinary least squares regression to examine driving distance from parents' residences to four types of services (child care, domestic violence, mental health/substance abuse, and poverty). The results show an association between proximity to mental health and substance abuse services and parents' self-reported neglectful behaviors. Additionally, higher levels of socioeconomic disadvantage (poverty, unemployment, and low education), having older children, respondents being male, and respondents being older parents are associated with higher levels of child neglect, while being white is associated with lower levels. Overall, the findings suggest a potentially protective role of geographic access to mental health and substance abuse services in child maltreatment. Additional research on the pathways through which proximity to services influences child neglect is needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Parenting and Proximity to Social Services: Lessons from Los Angeles County in the Community Context of Child Neglect

PubMed Central

Maguire-Jack, Kathryn; Klein, Sacha

2015-01-01

Using a sample of 438 parents in Los Angeles County, CA, this study examines the role of proximity to social services in child neglect. In an extension of social disorganization theory, it seeks to understand the potential sources of support in neighborhoods for families. It uses ordinary least squares regression to examine driving distance from parents’ residences to four types of services (child care, domestic violence, mental health/substance abuse, and poverty). The results show an association between proximity to mental health and substance abuse services and parents’ self-reported neglectful behaviors. Additionally, higher levels of socioeconomic disadvantage (poverty, unemployment, and low education), having older children, respondents being male, and respondents being older parents are associated with higher levels of child neglect, while being white is associated with lower levels. Overall, the findings suggest a potentially protective role of geographic access to mental health and substance abuse services in child maltreatment. Additional research on the pathways through which proximity to services influences child neglect is needed. PMID:26026359

The Impact of Local Environmental Health Capacity on Foodborne Illness Morbidity in Maryland

PubMed Central

Resnick, Beth A.; Fox, Mary A.; McGready, John; Yager, James P.; Burke, Thomas A.

2011-01-01

Objectives. We evaluated the relationship between local food protection capacity and service provision in Maryland's 24 local food protection programs (FPPs) and incidence of foodborne illness at the county level. Methods. We conducted regression analyses to determine the relationship between foodborne illness and local FPP characteristics. We used the Centers for Disease Control and Prevention's FoodNet and Maryland Department of Health and Mental Hygiene outbreak data set, along with data on Maryland's local FPP capacity (workforce size and experience levels, budget) and service provision (food service facility inspections, public notification programs). Results. Counties with higher capacity, such as larger workforce, higher budget, and greater employee experience, had fewer foodborne illnesses. Counties with better performance and county-level regulations, such as high food service facility inspection rates and requiring certified food manager programs, respectively, had lower rates of illness. Conclusions. Counties with strong local food protection capacity and services can protect the public from foodborne illness. Research on public health services can enhance our understanding of the food protection infrastructure, and the effectiveness of food protection programs in preventing foodborne illness. PMID:21750282

Left Behind: The Status of Black Women in Higher Education Administration

ERIC Educational Resources Information Center

Miles, Sandra

2012-01-01

This quantitative study examines the current status of Black women higher education administrators in comparison to other higher education administrators of another race and/or gender. Specifically, years of service, social support, highest degree attained, income level, and current title held was analyzed to evaluate the actual levels of…

CALL CENTER SUPPORT AND TODAY’S WARFIGHTER

DTIC Science & Technology

2016-02-01

COR and Contractor Relationship……………………………………………..12 Figure 5: TFSC Customer Satisfaction Survey and Product Delivery Increase…………14 Figure 6: TFSC...practices can the TFSC adopt to provide higher levels of service and increased customer satisfaction ?” During development, this paper will employ a...higher levels of service and increased customer satisfaction ?” For the purpose of this paper, the private industry partner that was chosen for

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

PubMed

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

2016-06-08

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

Self-reported assistive technology outcomes and personal characteristics in college students with less-apparent disabilities.

PubMed

Malcolm, Matt P; Roll, Marla C

2017-11-20

The impact of assistive technology (AT) services for college students with less-apparent disabilities is under-reported. Using the Canadian Occupational Performance Measure (COPM), we assessed student Performance and Satisfaction ratings of common academic tasks at the start and end of a semester during which 105 student-clients with less-apparent disabilities received AT services. We examined if COPM scores related to personal characteristics of gender, class-level (e.g., Sophomore), and STEM education; if personal characteristics predicted a student's follow-through with an AT service referral (n=231); and if personal characteristics and initial COPM scores predicted dropout from AT services (n=187). COPM ratings significantly increased in all academic tasks (p<.001). Gender predicted initial Satisfaction (male ratings > female ratings; p=.01), and Performance changes (females were more likely to have a service-meaningful change; p=.02). Higher class-level predicted better follow-through with a referral for AT services (p=.006). Increasing class-level (p=.05) and higher initial studying (p<.006) and reading (p<.029) ratings predicted a lower likelihood for dropout. These findings demonstrate that college students with less-apparent disabilities experience substantial improvements in their self-ratings of academic performance and satisfaction following AT services. Gender, class-level, and initial self-perceived reading and studying abilities may influence if and how the student participates with AT services.

Support Services for Students with Asperger's Syndrome in Higher Education

ERIC Educational Resources Information Center

Smith, Caroline P.

2007-01-01

The study examines the following research question: "What are the needs of students with Asperger's Syndrome (AS), and what are the services and accommodations available to them at the post-secondary level?" An increasing number of individuals diagnosed with AS are entering institutions of higher education. This study is exploratory in nature,…

Indicators for evaluating cancer organizations' support services: performance and associations with empowerment.

PubMed

Lauzier, Sophie; Campbell, H Sharon; Livingston, Patricia M; Maunsell, Elizabeth

2014-10-15

Community-based cancer organizations provide services to support patients. An anticipated benefit of these services is patient empowerment. However, this outcome has not been evaluated because of the lack of validated health-related empowerment questionnaires in the cancer context. In this validation study, the authors assessed the extent to which 16 indicators used by the Canadian Cancer Society (CCS) and the Cancer Council Victoria, Australia (CCV) to evaluate their services were associated with health-related empowerment. Cancer patients/survivors who were diagnosed < 3 years earlier and who used CCS programs completed a questionnaire that included the 16 CCS-CCV indicators and 5 scales from the Health Education Impact Questionnaire (heiQ) measuring key dimensions of empowerment. To determine whether the CCS-CCV indicators captured empowerment, differences in heiQ scores were compared between 2 groups: those with higher levels of agreement (agreeing or agreeing strongly) with an indicator and those with lower levels of agreement (agreeing slightly or disagreeing to any degree). Participation was 72% (207 of 289 eligible CCS users). Compared with participants who had lower levels of agreement on CCS-CCV indicators, those who had higher levels of agreement were more likely to report higher levels of empowerment on the different heiQ scales. For 15 of 16 indicators, these differences were significant (Wilcoxon rank-sum test; P < .10) on ≥ 1 of 5 heiQ scales and for 10 of 16 indicators on ≥ 3 of 5 heiQ scales. Two indicators were associated significantly with all 5 heiQ scales (cope better and feel more in control). Using CCS-CCV indicators to evaluate community-based cancer organizations' services will help determine whether these services are reaching one of their important goals: namely empowering patients. © 2014 American Cancer Society.

76 FR 57980 - Senior Executive Service Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

... DEFENSE NUCLEAR FACILITIES SAFETY BOARD Senior Executive Service Performance Review Board AGENCY... the Defense Nuclear Facilities Safety Board (DNFSB) Senior Executive Service (SES) Performance Review... summary rating of the senior executive's performance, the executive's response, and the higher level...

78 FR 55244 - Senior Executive Service Performance Review Board; Membership

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-10

... DEFENSE NUCLEAR FACILITIES SAFETY BOARD Senior Executive Service Performance Review Board... the membership of the Defense Nuclear Facilities Safety Board (DNFSB) Senior Executive Service (SES... rating of a senior executive's performance, the executive's response, and the higher level official's...

Environmental and occupational exposure to benzene in Thailand.

PubMed

Navasumrit, Panida; Chanvaivit, Sirirat; Intarasunanont, Pornpat; Arayasiri, Manaswee; Lauhareungpanya, Narumon; Parnlob, Varaporn; Settachan, Daam; Ruchirawat, Mathuros

2005-05-30

Exposure to benzene in air is a concern in Thailand, particularly since it was observed that the incidence of blood-related cancers, such as leukemia and lymphoma, has increased in the past few decades. In Bangkok, the mean atmospheric levels of benzene on main roads and in schools were 33.71 and 8.25 ppb, respectively, while in gasoline service stations and petrochemical factories the mean ambient levels were 64.78 and 66.24 ppb, respectively. Cloth vendors (22.61 ppb) and grilled-meat vendors (28.19 ppb) working on the roadsides were exposed to significantly higher levels of benzene than the control group (12.95 ppb; p<0.05). Bangkok school children (5.50 ppb) were exposed to significantly higher levels of benzene than provincial school children (2.54 ppb; p<0.01). Factory workers (73.55 ppb) and gasoline service attendants (121.67 ppb) were exposed to significantly higher levels of benzene than control workers (4.77 ppb; p<0.001). In accordance with the increased benzene exposures, levels of urinary trans,trans-muconic acid (MA) were significantly increased in all benzene-exposed groups. In school children, the levels of MA were relatively high, taking into account the much lower level of exposure. Blood benzene levels were also significantly increased in Bangkok school children (77.97 ppt; p<0.01), gasoline service attendants (641.84 ppt; p<0.05) and factory workers (572.61 ppt; p<0.001), when compared with the respective controls. DNA damage, determined as DNA strand breaks, was found to be elevated in gasoline service attendants, petrochemical factory workers, and Bangkok school children (p<0.001). The cytogenetic challenge assay, which measures DNA repair capacity, showed varying levels of significant increases in the numbers of dicentrics and deletions in gasoline service attendants, petrochemical factory workers and Bangkok school children, indicating a decrease in DNA repair capacity in these subjects.

The Association Between Higher Social Support and Lower Depressive Symptoms Among Aging Services Clients is Attenuated at Higher Levels of Functional Impairment

PubMed Central

Van Orden, Kimberly A.; Yan, Li; Podgorski, Carol A.; Conwell, Yeates

2015-01-01

Objective Adults seeking services from the Aging Services Provider Network (ASPN) are at risk for depression. ASPN clients also have high prevalence of both functional impairments and social morbidities. Study of the relationships between these factors may inform the development of interventions for depression in this service setting. Methods We interviewed 373 older adults accessing ASPN services and assessed depression symptom severity, functional impairment (instrumental activities of daily living and activities of daily living), and social support. Results Lower social support and greater functional impairment were associated with greater depressive symptoms. At a high level of functional impairment, the inverse associations between indices of social support and depressive symptoms were attenuated. Conclusions Results suggest that older adults with more severe functional impairment may benefit somewhat less from increased social support with respect to depression symptom severity. PMID:25663607

Factors associated with the use of home-visit nursing services covered by the long-term care insurance in rural Japan: a cross-sectional study.

PubMed

Kashiwagi, Masayo; Tamiya, Nanako; Sato, Mikiya; Yano, Eiji

2013-01-02

In Japan, there is a large increase in the number of elderly persons who potentially need home-visit nursing services (VNS). However, the number of persons using the VNS has increased only little in comparison to the number of individuals who use home social services, which are also covered by the Long-Term Care Insurance (LTCI) system. This cross-sectional study investigated the predictors of the VNS used under the LTCI system in Japan. We used 1,580 claim data from all the users of community-based services and 1,574 interview survey data collected in 2001 from the six municipal bodies in Japan. After we merged the two datasets, 1,276 users of community-based services under the LTCI were analyzed. Multiple logistic regression models stratified by care needs levels were used for analysis. Only 8.3% of the study subjects were VNS users. Even among study participants within the higher care-needs level, only 22.0% were VNS users. In the lower care level group, people with a higher care level (OR: 3.50, 95% CI: 1.50-8.93), those whose condition needed long term care due to respiratory or heart disease (OR: 4.31, 95% CI: 1.88-89.20), those whose period of needing care was two years or more (OR: 2.01, 95% CI: 1.14-3.48), those whose service plan was created by a medical care management agency (OR: 2.39, 95% CI: 1.31-4.33), those living with family (OR: 1.86, 95% CI: 1.00-3.42), and those who use home-help services (OR: 2.12, 95% CI: 1.17-3.83) were more likely to use the VNS. In the higher care level group, individuals with higher care level (OR: 3.63, 95% CI: 1.56-8.66), those with higher income (OR: 3.79, 95% CI: 1.01-14.25), and those who had regular hospital visits before entering the LTCI (OR: 2.36, 95% CI: 1.11-5.38) were more likely to use the VNS. Our results suggested that VNS use is limited due to management by non-medical care management agencies, due to no caregivers being around or a low income household. The findings of this study provide valuable insight for LTCI policy makers: the present provision of VNS should be reconsidered.

The Delivery of Recreation Programs: Students Gain Entry Level Management Skills through Service Learning

ERIC Educational Resources Information Center

Zimmermann, Jo An M.; Dupree, Jessica; Hodges, Jan S.

2014-01-01

Service learning is a well established pedagogy within higher education. Specifically, service learning allows students to engage in "real world" activities to practice skills and reflect upon their own competence. To enhance the effectiveness of service learning, instructors need to consider a multitude of learning influences. This…

Organizational restructuring, government control and loss of legitimacy following an organizational crisis: the case of Israel's nonprofit human services.

PubMed

Mano, Rita; Rosenberg, Dennis

2014-01-01

The study explores organizational restructuring following the occurrence of a crisis. Restructuring activities following an intervention are considered here to be indicators of an organization's loss of legitimacy because they have lost their independent status, a basic characteristic of nonprofit human settings. The study shows that according to the Resource Based View of organization restructuring--experienced as downsizing, neglecting and abandoning of projects--organizations are affected by (a) government intervention in decision making; (b) higher demands for accountability; and (c) higher evaluations of performance gaps. On the basis of the study of a sample of 138 Nonprofit Human Services in Israel, the results show that the higher the level of restructuring, the higher the level of legitimacy. However, organization location in metropolitan areas moderates the link between restructuring and legitimacy loss. We conclude that Israel's nonprofit human services being overly dependent on goverhment funding are more prone to restructuring and losing legitimacy following organizational crisis.

Outsourcing in Higher Education: An Empirical Examination

ERIC Educational Resources Information Center

Gupta, Atul; Herath, S. Kanthi; Mikouiza, Nathalie C.

2005-01-01

Purpose: To measure the degree of implementation and satisfaction level with the outsourcing initiatives from higher education institutions. Design/methodology/approach: Uses a survey questionnaire to measure the levels of satisfaction with the institutions' services and the questionnaire was based on six factors that are deemed significant in…

Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey

PubMed Central

2013-01-01

Background The patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia. Methods A stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables. Results The overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose–response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services. Conclusions An examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity. PMID:23631501

Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey.

PubMed

Perkins, David; Fuller, Jeffrey; Kelly, Brian J; Lewin, Terry J; Fitzgerald, Michael; Coleman, Clare; Inder, Kerry J; Allan, John; Arya, Dinesh; Roberts, Russell; Buss, Richard

2013-04-30

The patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia. A stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables. The overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose-response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services. An examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity.

Occupation is related to Weight and Lifestyle Factors among Employees at Worksites Involved in a Weight Gain Prevention Study

PubMed Central

Gans, Kim M.; Salkeld, Judith; Risica, Patricia Markham; Lenz, Erin; Burton, Deborah; Mello, Jennifer; Bell, Johanna P.

2015-01-01

Objective To examine the relationship between job type, weight status and lifestyle factors that are potential contributors to obesity including, diet, physical activity and perceived stress among employees enrolled in the Working on Wellness (WOW) project. Methods Randomly selected employees at 24 worksites completed a baseline survey (n=1700); some also an in-person survey and anthropometric measures (n=1568). Employees were classified by US Labor standards as: white collar (n=1297), blue collar (n=303), or service worker (n=92), 8 unknown. Associations were analyzed using Chi-Square, GLM procedures, and adjusted for demographics using Logistic Regression. Results In unadjusted models, BMI of service workers was higher than white collar workers; F&V intake was higher for service and blue collar than white collar; white collar workers reported highest stress levels in job and life. However, in models adjusted for demographics, the only significant difference was to physical activity (i.e., MET/min per week), with blue collar workers reporting higher levels of physical activity than service workers, who reported higher levels than the white collar workers. Conclusions Future research should further examine the relationship between health and job status to corroborate the results of the current study and to consider designing future worksite health promotion interventions that are tailored by job category. PMID:26461872

Occupation Is Related to Weight and Lifestyle Factors Among Employees at Worksites Involved in a Weight Gain Prevention Study.

PubMed

Gans, Kim M; Salkeld, Judith; Risica, Patricia Markham; Lenz, Erin; Burton, Deborah; Mello, Jennifer; Bell, Johanna P

2015-10-01

To examine the relationship between job type, weight status, and lifestyle factors that are potential contributors to obesity including, diet, physical activity (PA), and perceived stress among employees enrolled in the Working on Wellness project. Randomly selected employees at 24 worksites completed a baseline survey (n = 1700); some also an in-person survey and anthropometric measures (n = 1568). Employees were classified by US labor standards as white collar (n = 1297), blue collar (n = 303), or service worker (n = 92), and 8 unknown. Associations were analyzed using chi-square and general linear model procedures and adjusted for demographics using logistic regression. In unadjusted models, body mass index of service workers was higher than white collar workers; fruit and vegetable intake was higher for service and blue collar than white collar; white collar workers reported highest stress levels in job and life. Nevertheless, in models adjusted for demographics, the only significant difference was for PA (ie, metabolic equivalent [MET]/min/wk), with blue collar workers reporting higher levels of PA than service workers, who reported higher levels than the white collar workers. Future research should further examine the relationship between health and job status to corroborate the results of the current study and to consider designing future worksite health promotion interventions that are tailored by job category.

Improving the Service with the Servqual Method

NASA Astrophysics Data System (ADS)

Midor, Katarzyna; Kučera, Marian

2018-03-01

At the time when economy is growing, there is strong competition in the market, and customers have increasingly higher expectations as regards quality of service and products. Under such conditions, organizations need to improve. One of the areas of improvement for an organization is to research the level of customer satisfaction. The article presents results of customer satisfaction surveys conducted by the Servqual method in a pharmaceutical service company. Use of this method allowed to improve the services provided by that pharmaceutical wholesaler, identify areas that need to be improved as soon as possible in order to improve the level of service provided.

Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation

PubMed Central

2012-01-01

Purpose A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a “real-lifeâ application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. Key messages (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. Conclusion (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care. PMID:22506504

Facilitators and barriers of drop-in center use among homeless youth

PubMed Central

Pedersen, Eric R.; Tucker, Joan S.; Kovalchik, Stephanie A.

2016-01-01

Drop-in centers for homeless youth address basic needs for food, hygiene, and clothing, but can also provide critical services that address youth’s “higher-level” needs (e.g., substance use treatment, mental health care, HIV-related programs). Unlike other services that have restrictive rules, drop-in centers typically try to break down barriers and take a “come as you are” approach to engaging youth in services. Given their popularity, drop-in centers represent a promising location to deliver higher level services to youth that may not seek services elsewhere. A better understanding of the individual-level factors (e.g., characteristics of homeless youth) and agency-level factors (e.g., characteristics of staff and environment) that facilitate and impede youth engagement in drop-in centers will help inform research and outreach efforts designed to engage these at-risk youth in services. Thus, the goal of this review was to develop a preliminary conceptual model of drop-in center use by homeless youth. Towards this goal, we reviewed 20 available peer-reviewed papers and reports on the facilitators and barriers of drop-in center usage and consulted broader models of service utilization from both youth and adult studies to inform model development. PMID:27238839

Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation.

PubMed

Turner-Stokes, Lynne; Poppleton, Rob; Williams, Heather; Schoewenaars, Katie; Badwan, Derar

2012-01-01

A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a "real-life" application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.

Do Mental Health Outpatient Services Meet Users' Needs? Trial to Identify Factors Associated with Higher Needs for Care.

PubMed

Dobrzynska, Ewelina; Rymaszewska, Joanna; Biecek, Przemyslaw; Kiejna, Andrzej

2016-05-01

The study was conducted to investigate the extent to which services meet patients' needs and identify the factors associated with higher needs. 174 outpatients were assessed using CANSAS, BPRS and GSDS. The total number of unmet needs in persons with psychotic, eating, personality and affective disorders was higher than in patients with anxiety disorders. Being single, positive symptoms, depression/anxiety, hospitalizations and high social disability accounted for 50 % of the variance in level of unmet need. Persons with eating and personality disorders reported similar level of unmet needs to those with psychotic and affective disorders. The best correlates of unmet needs were depression/anxiety and social disability.

A Comparative Examination of Pre-Service Teacher Self-Efficacy Related to Literacy Instruction

ERIC Educational Resources Information Center

Helfrich, Sara R.; Clark, Sarah K.

2016-01-01

This study investigated differences in self-efficacy to teach literacy between two groups of pre-service teachers. The authors hypothesized that pre-service teachers enrolled in one program focusing on fewer grade levels (K-3) and requiring more literacy-focused courses would have higher self-efficacy than pre-service teachers enrolled in another…

The effect of poverty and caregiver education on perceived need and access to health services among children with special health care needs.

PubMed

Porterfield, Shirley L; McBride, Timothy D

2007-02-01

We examined the association between several variables and the use of specialist physician services, developmental therapies, and prescription medications among children with special health care needs (N=38866). We used a bivariate probit model to estimate whether a given child needed specialized services and whether that child accessed those services; we controlled for activity limitations and severity of special needs. Variables included family income, mother's (or other caregiver's) educational level, health insurance coverage, and perceived need for specialized services. We used data from the 2001 National Survey of Children with Special Health Care Needs. Lower-income and less-educated parents were less likely than higher-income and more-educated parents to say their special needs children needed specialized health services. The probability of accessing specialized health services-when needed-increased with both higher family income and insurance coverage. Children with special health care needs have less access to health services because their parents do not recognize the need for those services. An intervention in the form of information at the family level may be an appropriate policy response.

[Analysis of the factors related to the needs of patients with cancer].

PubMed

Lee, Jung A; Lee, Sun Hee; Park, Jong Hyock; Park, Jae Hyun; Kim, Sung Gyeong; Seo, Ju Hyun

2010-05-01

Limited research has investigated the specific needs of patients with cancer. This study was performed to explore patients needs and the related factors. The data were collected by 1 National Cancer Center and 9 regional cancer centers in Korea. An interview survey was performed with using a structured questionnaire for the subjects (2,661 patients who gave written informed consent to participate) survey 4 months after diagnosis and review of medical records. Data were analyzed using t-test, ANOVA and multiple regression analysis. When comparing the relating factors related with patient needs to the sociodemographic characteristics, the female group showed a higher level of recognition for physical symptoms, social support needs. The younger group showed a significantly higher level of recognition for health care staff, psychological problems, information and education, social support, hospital services needs. In addition, the higher educated group showed a higher level of recognition for health care staff, physical symptoms, social support needs. The higher income and office workers group showed a higher level of recognition for hospital services needs. When comparing the relating factors related with patient needs to the cancer, the breast cancer group showed a higher level of recognition for all needs excluding physical symptoms, accessibility and financial support needs. The combined radiotherapy with surgery and chemotherapy group showed a higher level of recognition for psychological problems, information and education, social support needs. This study showed that needs on patient with cancer was significantly influenced by female, higher education, lower income, having religion, office worker, liver cancer, breast cancer, colon cancer, chemotherapy, and combined therapy.

Cardiologist service volume, percutaneous coronary intervention and hospital level in relation to medical costs and mortality in patients with acute myocardial infarction: a nationwide study.

PubMed

Liu, C-Y; Lin, Y-N; Lin, C-L; Chang, Y-J; Hsu, Y-H; Tsai, W-C; Kao, C-H

2014-07-01

We explore whether cardiologist service volume, hospital level and percutaneous coronary intervention (PCI) are associated with medical costs and acute myocardial infarction (AMI) mortality. From the 1997-2010 Taiwan National Health Insurance Research Database of the National Health Research Institute, we identified AMI patients and performed multiple regression analyses to explore the relationships among the different hospital levels and treatment factors. We identified 2942 patients with AMI in medical centers and 4325 patients with AMI in regional hospitals. Cardiologist service volume, performing PCI and medical costs per patient were higher in medical centers than in regional hospitals (P < 0.0001). However, the two hospital levels did not differ significantly in in-hospital mortality (P = 0.1557). Post hoc analysis showed significant differences in in-hospital mortality rate and in medical costs among the eight groups subdivided on the basis of hospital level, cardiologist service volume, and whether PCI was performed (P < 0.001 and P = 0.001, respectively). These results highlight the importance of encouraging hospitals to develop PCI capability and increase their cardiologist service volume after taking medical costs into account. Transferring AMI patients to hospitals with higher cardiologist service volume and PCI performed can also be very important. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Understanding levels of morbidity and hospitalization in Kerala, India.

PubMed Central

Dilip, T. R.

2002-01-01

The prevalence of ailments and hospitalization in Kerala was examined using data from the 52 nd National Sample Survey Data on Health Care in Kerala in 1995-6. The survey included 24401 people from 4928 households. Age and seasonality had considerable effects on the morbidity of individuals. The burden of ill health was higher in rural areas than in urban areas. People who were more likely to have a better lifestyle had a higher level of morbidity and hospitalization. Regional differences were seen, with levels of morbidity and hospitalization higher in the comparatively developed regions of Southern Kerala than in Northern Kerala. Factors like physical accessibility of health care services and capacity to seek health care services could create artificial differences in morbidity and hospitalization among different subgroups of the population in Kerala. PMID:12378294

Contingent valuation and pharmacists' acceptable levels of compensation for medication therapy management services.

PubMed

Wang, Junling; Hong, Song Hee

2015-01-01

Pharmacists' acceptable level of compensation for medication therapy management (MTM) services needs to be determined using various economic evaluation techniques. Using contingent valuation method, determine pharmacists' acceptable levels of compensation for MTM services. A mailing survey was used to elicit Tennessee (U.S.) pharmacists' acceptable levels of compensation for a 30-minute MTM session for a new patient with 2 medical conditions, 8 medications, and an annual drug cost of $2000. Three versions of a series of double-bounded, closed-ended, binary discrete choice questions were asked of pharmacists for their willingness to accept (WTA) for an original monetary value ($30, $60, or $90) and then follow-up higher or lower value depending on their responses to the original value. A Kaplan-Meier approach was taken to analyze pharmacists' WTA, and Cox's proportional hazards model was used to examine the effects of pharmacist characteristics on their WTA. Three hundred and forty-eight pharmacists responded to the survey. Pharmacists' WTA for the given MTM session had a mean of $63.31 and median of $60. The proportions of pharmacists willing to accept $30, $60, and $90 for the given MTM session were 30.61%, 85.19%, and 91.01%, respectively. Pharmacists' characteristics had statistically significant association with their WTA rates. Pharmacists' WTA for the given MTM session is higher than current Medicare MTM programs' compensation levels of $15-$50 and patients' willingness to pay of less than $40. Besides advocating for higher MTM compensation levels by third-party payers, pharmacists also may need to charge patients to reach sufficient compensation levels for MTM services. Copyright © 2015 Elsevier Inc. All rights reserved.

Contingent Valuation and Pharmacists' Acceptable Levels of Compensation for Medication Therapy Management Services

PubMed Central

Wang, Junling; Hong, Song Hee

2012-01-01

Background Pharmacists' acceptable level of compensation for medication therapy management (MTM) services needs to be determined using various economic evaluation techniques. Objectives Using contingent valuation method, determine pharmacists' acceptable levels of compensation for MTM services. Methods A mailing survey was used to elicit Tennessee (US) pharmacists' acceptable levels of compensation for a 30-minute MTM session for a new patient with 2 medical conditions, 8 medications, and an annual drug cost of $2,000. Three versions of a series of double-bounded, closed-ended, binary discrete choice questions were asked of pharmacists for their willingness-to-accept (WTA) for an original monetary value ($30, $60, or $90) and then follow-up higher or lower value depending on their responses to the original value. A Kaplan-Meier approach was taken to analyze pharmacists' WTA, and Cox's proportional hazards model was used to examine the effects of pharmacist characteristics on their WTA. Results Three hundred and forty-eight pharmacists responded to the survey. Pharmacists' WTA for the given MTM session had a mean of $63.31 and median of $60. The proportions of pharmacists willing to accept $30, $60, and $90 for the given MTM session were 30.61%, 85.19%, and 91.01%, respectively. Pharmacists' characteristics had statistically significant association with their WTA rates. Conclusions Pharmacists' WTA for the given MTM session is higher than current Medicare MTM programs' compensation levels of $15 to $50 and patients' willingness-to-pay of less than $40. Besides advocating for higher MTM compensation levels by third-party payers, pharmacists also may need to charge patients to reach sufficient compensation levels for MTM services. PMID:22436583

Cost of curative pediatric services in a public sector setting.

PubMed

Krishnan, Anand; Arora, Narendra K; Pandav, Chandrakant S; Kapoor, Suresh K

2005-08-01

To estimate the cost of ambulatory (out-patient) and in-patient pediatric health services for the year 1999 provided by All India Institute of Medical Sciences (AIIMS) at all the three levels-primary, secondary and tertiary level. The costing module developed by Children's Vaccines Initiative (CVI) was used. This rapid assessment tool focuses on collection of data at macro level by using key informants like doctors, nursing staff, accountant, store keeper, engineer etc. Cost per beneficiary was estimated separately for in-patients and out-patients and was calculated by dividing the total cost of the services by the number of beneficiaries for the year 1999. For the out-patient, the beneficiaries were the total out-patient attendees and for the in-patient, it was the total pediatric admissions multiplied by mean duration of stay in days. The cost per out-patient visit was INR.20.2 (US0.44 dollars@1US dollars=INR.46) at primary level, higher than INR14.5 (US0.31 dollars) at the secondary level, while at tertiary level it was INR 33.8 (US 0.73 dollars). At the primary and secondary level, non-physician cost was more than the physician cost, and for tertiary level, physician cost was much higher than the other costs. There were no in-patient services at primary level. The cost of in-patient services at secondary level was estimated as INR 419.30 (US 9.1 dollars) per patient per day with a bed occupancy rate of 60%. Two-fifths of the cost was due to nursing and other supportive staff and one fifth due to the doctor costs and overhead costs. The unit cost of INR 928 (US 20.2 dollars) per patient per day incurred at AIIMS with a bed occupancy rate of 100% was almost twice that of secondary level. In contrast to the secondary level, almost half the total costs at tertiary level was due to the doctors costs. Effective use of resources at lower level of care especially ambulatory care at primary level and inpatient care at secondary level can result in much higher savings for the system and also, the society. These would need to be appropriately strengthened.

Problems in the Multi-Service Acquisition of Less-Than-Major Ground Communications-Electronics Systems.

DTIC Science & Technology

1981-06-01

eucation about nsiti-serviue program, especially at higher levels 1 1 2 4 Other 2 1 1 4 ,! provisioning. Two interviewees mentioned the need for a cost...generator project. Also, the Program Manager was only a Lieutenant Colonel. Colonel Haney felt that a higher [ I. rank would be required since the... higher than for the military in both services in all three categories. Table 3-4 illustrates average years of experience by system studied. Again

An Examination of "Self-Monitoring" and the "Influence of Others" as Determinants of Attitude to the Higher Education Application Service Process in the UK

ERIC Educational Resources Information Center

Clarke, Geraldine

2005-01-01

The paper presents empirical research that investigated significant dependent relationships between "type" of influencer, e.g., parent, sibling, friend and total number of influencers, and levels of satisfaction within the context of an extended service buying process, i.e., application to an institution of higher education. The type of…

A Comparative Study of Directly Selected, In-Service Promoted and Online Selected Subject Specialists Regarding Teaching Effectiveness in Kohat Division, Pakistan

ERIC Educational Resources Information Center

Suleman, Qaiser; Gul, Rizwana

2015-01-01

The main objective of the study was to compare the teaching effectiveness of directly selected, in-service promoted and online selected subject specialists teaching at higher secondary school level in Kohat Division, Pakistan. The target population of the study was the higher secondary school students in Kohat Division, Pakistan. A sample of 600…

Higher haemoglobin levels and dedicated trauma admission are associated with survival after severe traumatic brain injury.

PubMed

Baltazar, Gerard Anthony; Pate, Amy J; Panigrahi, Benita; Sharp, Audrey; Smith, Michael; Chendrasekhar, Akella

2015-01-01

Prevention of secondary brain injury is a key component of acute management of patients with severe traumatic brain injury (TBI). Haemoglobin concentration may have an impact on optimization of cerebral oxygenation. Patients with TBI may best be served by an organized trauma service. The objective is to determine if haemoglobin concentration or dedicated trauma admission has an impact on outcomes after severe TBI. This study retrospectively analysed consecutive patients with severe TBI admitted to a level-I trauma centre over 3 years. Patients <16 years-old and with length of stay (LOS) <24 hours were excluded. Data were collected on demographics; injury severity; LOS; admission service; survival to discharge; and haemoglobin levels from hospital days 1-7. Data were also collected on number of transfusions of packed red blood cells. The sample was stratified based on admission service and survival to discharge. Of 147 patients (age = 54.1 ± 3.7 years), overall mortality rate was 15.4% (n = 23). Overall, non-survivors had lower daily and 7-day mean haemoglobin levels (10.7 ± 0.9 vs. 12.9 ± 0.4 g dL(-1), p < 0.001). Non-surgical admissions had lower haemoglobin levels and a higher mortality rate (28.9% vs. 12.2%, p < 0.001) compared to dedicated trauma admissions. Among patients with severe TBI, higher haemoglobin levels and maintenance as a dedicated trauma admission are associated with higher survival to discharge.

General practitioner services in primary care groups in England: is there inequity between service availability and population need?

PubMed

Baker, D; Hann, M

2001-06-01

This study examined the coverage of minor surgery, child health surveillance and chronic disease management for asthma and diabetes in relation to population need and key organisational features of general practice in the 481 primary care groups (PCGs) in England. PCG-level summary scores were developed to estimate the relative availability of all four services and their relative importance in discriminating between high and low levels of service provision. The coverage of services was widespread and, in such circumstances, there was no systematic evidence of poorer service availability for PCGs with higher population need (the 'inverse care' law). Rather this relation was localised, being most predominant for PCGs covering London and its suburbs. In these PCGs, there was no association between indicators of lack of capacity, such as single-handed practice, and levels of service provision.

Empathy and avoidance in treating patients living with HIV/AIDS (PLWHA) among service providers in China

PubMed Central

Lin, Chunqing; Li, Li; Wan, Dai; Wu, Zunyou; Yan, Zhihua

2012-01-01

This study aims to investigate health care providers’ empathy levels and its association with avoidance in providing service to patients living with HIV/AIDS (PLWHA) in China. A total of 1760 health service providers were randomly sampled from 40 county hospitals in two provinces of China. Using a self-administered questionnaire, participants’ demographic characteristics, work history, empathy level, and avoidance attitudes toward PLWHA were collected in a cross-sectional survey. Empathy was higher among participants aged 31–40 years, those who had an associated medical degree, and those who had served in the medical profession for less than 20 years. Nurses, younger providers, and providers with lower education tended to avoid contact with PLWHA. Multiple linear regression model showed that a higher level of empathic attitude toward patients was significantly negatively associated with avoidance attitude toward PLWHA. Service providers’ empathy level plays an important role in providing quality care to HIV-infected patients. Future stigma reduction interventions should cultivate empathy as a platform for understanding, effective communication, and trusting provider–patient relationships. PLWHA could potentially benefit from attitudinal change in medical settings. PMID:22292939

Contract management survey 2002.

PubMed

Hoppszallern, Suzanna

2002-10-01

Spending on clinical contracts continues to outpace spending on business services, but may be leveling off. The 12th annual Contract Management Survey shows that the performance of clinical vendors is now comparable to business service vendors in meeting savings targets. Both business and clinical vendors are receiving higher marks from hospital leaders, but execs quickly respond to low marks by bringing the service back in-house of changing vendors. This report examines trends in outsourcing, satisfaction levels, the decision-making process, contract features and performance, and spending.

Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey

PubMed Central

Pachankis, John E.; Hatzenbuehler, Mark L.; Hickson, Ford; Weatherburn, Peter; Berg, Rigmor C.; Marcus, Ulrich; Schmidt, Axel J.

2016-01-01

Objective Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, needs and behaviours have rarely been examined, however. Design Data come from the European MSM Internet Survey (EMIS), which was administered between June and August 2010 across 38 European countries (N =174 209). Methods Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes held by the citizens of each country. We also assessed concealment, HIV status, number of past 12-month male sex partners, and eight HIV-preventive services, knowledge, and behavioural outcomes. Results MSM living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners but higher odds of sexual risk behaviour, unmet prevention needs, not using testing services, and not discussing their sexuality in testing services. Sexual orientation concealment mediated associations between country-level stigma and these outcomes. Conclusion Country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM’s public visibility, it also reduces MSM’s ability to access HIV-preventive services, knowledge and precautionary behaviours. These findings suggest that MSM in European countries with high levels of stigma are vulnerable to HIV infection. Although they have less opportunity to identify and contact other MSM, this might change with emerging technologies. PMID:26035323

Low Levels of Evidence on the Plastic Surgery In-Service Training Exam.

PubMed

Silvestre, Jason; Bilici, Nadir; Serletti, Joseph M; Chang, Benjamin

2016-06-01

The Plastic Surgery In-Service Training Exam is written by the American Society of Plastic Surgeons. Examinees reasonably infer that tested material reflects the Society's vision for the core curriculum in plastic surgery. The purpose of this study was to determine the levels of evidence on which credited answers to the examination questions are based. Two recent Plastic Surgery In-Service Training Exams (2014 and 2015) were analyzed. Questions were categorized using a taxonomy model. Recommended journal article references for Level III (decision-making) questions were assigned a level of evidence. Exam sections were analyzed for differences in question taxonomy distribution and level of evidence. To look for studies with higher levels of evidence, a PubMed search was conducted for a random sample of 10 questions from each section. One hundred three Level I (25.8 percent), 138 Level II (34.5 percent), and 159 Level III (39.8 percent) questions were analyzed (p < 0.001). The hand and lower extremity section had the highest percentage of Level III questions (50.0 percent; p = 0.005). Journal articles had a mean level of evidence of 3.9 ± 0.7. The number of articles with a low level of evidence (IV and V) (p = 0.624) and the percentage of questions supported by articles with a high level of evidence (I and II) (p = 0.406) did not vary by section. The PubMed search revealed no instances of a higher level of evidence than the recommended reading list. A significant percentage of Plastic Surgery In-Service Training Exam questions test clinical management, but most are supported with a low level of evidence. Although that is consistent with low level of evidence of plastic surgery literature, educators should recognize the potential for biases of question writers.

What calls for service tell us about suicide: A 7-year spatio-temporal analysis of neighborhood correlates of suicide-related calls.

PubMed

Marco, Miriam; Gracia, Enrique; López-Quílez, Antonio; Lila, Marisol

2018-04-30

Previous research has shown that neighborhood-level variables such as social deprivation, social fragmentation or rurality are related to suicide risk, but most of these studies have been conducted in the U.S. or northern European countries. The aim of this study was to analyze the spatio-temporal distribution of suicide in a southern European city (Valencia, Spain), and determine whether this distribution was related to a set of neighborhood-level characteristics. We used suicide-related calls for service as an indicator of suicide cases (n = 6,537), and analyzed the relationship of the outcome variable with several neighborhood-level variables: economic status, education level, population density, residential instability, one-person households, immigrant concentration, and population aging. A Bayesian autoregressive model was used to study the spatio-temporal distribution at the census block group level for a 7-year period (2010-2016). Results showed that neighborhoods with lower levels of education and population density, and higher levels of residential instability, one-person households, and an aging population had higher levels of suicide-related calls for service. Immigrant concentration and economic status did not make a relevant contribution to the model. These results could help to develop better-targeted community-level suicide prevention strategies.

Accessing disability services by people from culturally and linguistically diverse backgrounds in Australia.

PubMed

Zhou, Qingsheng

2016-01-01

To examine whether differences in access to specialist disability services by people from culturally and linguistically diverse (CALD) backgrounds when compared with those born in Australia represent a service gap or the healthy migrant effect. To use the latest disability statistics to measure the different rates of people with disability, and the rates of people with profound and severe disability, of people born in Australia and those born abroad; to compare the difference between those who mainly speak English with those who primarily speak a language other than English at home (LOTE); and examine the age-specific and standardised disability rates of these subgroups. The rate of access of specialist disability services by people with disability who were from CALD backgrounds is highly disproportionate to their presence in the community. As a whole, people from CALD backgrounds have a similar level of disability as Australia-born people. They have a greater rate of profound and severe disability and a higher level of need for assistance in undertaking core activities. For younger age cohorts targeted by specialist disability services, there is little difference in the level of need for assistance between people from CALD backgrounds and the rest of community. Those people who mainly speak LOTE at home have a relatively higher level of need for assistance than those who speak mainly English at home. The paper reveals a substantial gap in specialist disability services between people from CALD and the broader community. This cannot be explained by the difference in the level of need for assistance between Australia-born and overseas-born populations, therefore raises some policy questions as to the barriers to the use of such services and how to effectively narrow the service access gap and improve utilisation rates. The paper reveals a substantial accessibility gap in specialist disability services between people from culturally and linguistically diverse (CALD) backgrounds and the broader community in Australia. Rehabilitation is a large component of disability services. Therefore, understanding the gap, promoting the awareness of the services, developing appropriate and effective services to respond the need of people with disability from CALD backgrounds, are critically important to rehabilitation services and related research.

Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

PubMed

Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

2017-11-01

The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

Predictors of Outreach Meetings Among Substance Using Homeless Youth.

PubMed

Carmona, Jasmin; Slesnick, Natasha; Guo, Xiamei; Murnan, Aaron; Brakenhoff, Brittany

2017-01-01

Homeless youth have high rates of substance use and often lack connection to social services. Outreach is critical for connecting youth to services, but factors influencing their outreach engagement are unknown. This study examined predictors of meetings with outreach workers among 79 non-service connected, substance using homeless youth between 14 and 24 years of age. Results provide direction to service providers in that older age, higher levels of depressive symptoms, fewer drug-related problems, and no use of hard drugs within the prior 30 days predicted higher meeting attendance. Future research is needed testing strategies that overcome barriers to outreach engagement.

The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data.

PubMed

Edbrooke-Childs, Julian; Jacob, Jenna; Argent, Rachel; Patalay, Praveetha; Deighton, Jessica; Wolpert, Miranda

2016-04-01

Shared decision making (SDM) between service users and providers is increasingly being suggested as a key component of good healthcare. The aim of this research was to explore whether child- and parent-reported experience of SDM was associated with child- and parent-reported improvement in psychosocial difficulties and clinician-reported functioning at the end of treatment in child and adolescent mental health services (CAMHS). The sample comprised N = 177 children (62% female; 31% aged 6-12 and 69% aged 13-18) with a variety of mental health problems from 17 services where routinely collected data consisted of presenting problems at outset, child- and parent-reported change in symptoms between Time 1 and Time 2 (Strengths and Difficulties Questionnaire; SDQ), clinician-reported change in functioning between Time 1 and Time 2 (Children's Global Assessment Scale; CGAS), and experience of SDM at Time 2 (as measured by responses to the Experience of Service Questionnaire; ESQ). Analysis revealed that both child- and parent-reported experience of SDM were associated with higher levels of child- and parent-reported improvement in psychosocial difficulties. However, child-reported experience of SDM was only associated with higher levels of child-reported improvement when their parents also reported higher levels of SDM. In CAMHS, involving both children and parents in decision making may contribute to enhanced treatment outcomes. © The Author(s) 2015.

International note: Maternal warmth, behavioral control, and psychological control: Relations to adjustment of Ghanaian early adolescents.

PubMed

Salaam, Braima; Mounts, Nina S

2016-06-01

This investigation addressed the relation between maternal warmth, behavioral control, psychological control, and psychological adjustment in a sample of 119 Ghanaian adolescents (42% boys) living in an urban area (mean age = 14.19). Adolescents in the sample reported clinically elevated levels of depression and anxiety. Significant associations were found between warmth, behavioral control, and psychological control and adolescents' anxiety, physical aggression, relational aggression, positive friendship quality, and conflict with friends. Warmth moderated the effect of behavioral control on anxiety, physical aggression, and relational aggression such that higher levels of warmth in combination with higher levels of behavioral control were related to more positive adjustment. Higher levels of warmth in conjunction with higher psychological control were related to higher levels of anxiety. Boys who reported lower levels of warmth in combination with higher behavioral control reported higher levels of physical aggression. For boys reporting higher levels of warmth, higher behavioral control was associated with lower physical aggression. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Structural change and higher educated labour in Indonesia.

PubMed

Pasay, N H

1990-12-01

This paper describes an impending shortage of higher-educated labor in Indonesia. Dynamic change is occurring in both Indonesia's population and economy. Its rapidly growing population demands annual national economic growth of 2.2% to avoid declining per capita output. Accordingly, investments have surged in banking and manufacturing industries as Indonesia undergoes structural change from an agricultural to service-based economy. Plagued by a majority of low productivity, elementary-level educated workers, increased productivity is called for to ensure continued development. As the age structural shift progresses, many of these workers will be absorbed in the services sector. Jobs exist requiring workers of all skill levels. This paper is mainly concerned, however, with higher-educated labor's failure to be oriented to the research and development required for sustained economic growth and development, and their entry into clerical positions potentially filled by less educated and less skilled labor. The services sector, particularly public services, is responsible for absorbing much of this labor. As professional, technical, and managerial capabilities and qualifications become increasingly needed in the near future as sector investments take effect, a shortage of higher-educated labor will become apparent. Policy makers are advised to anticipate these shortages and contemplate investments in human capital to facilitate a more smooth adjustment to structural change.

Higher Reported Levels of Depression, Stress, and Anxiety Are Associated with Increased Endorsement of ADHD Symptoms by Postsecondary Students

ERIC Educational Resources Information Center

Harrison, Allyson G.; Alexander, Sandra J.; Armstrong, Irene T.

2013-01-01

This study examined the extent to which postsecondary students endorse symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) and whether experienced level of stress, depression, or anxiety are associated with higher reporting of ADHD symptoms. Students attending a combined health and counseling service completed the Conners Adult ADHD Rating…

42 CFR 405.506 - Charges higher than customary or prevailing charges or lowest charge levels.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Charges higher than customary or prevailing charges... prevailing charges or lowest charge levels. A charge which exceeds the customary charge of the physician or other person who rendered the medical or other health service, or the prevailing charge in the locality...

Is place of birth associated with mode of birth? The effect of hospital on caesarean section rates in a public metropolitan health service.

PubMed

Biro, Mary A; Knight, Michelle; Wallace, Euan; Papacostas, Kerrie; East, Christine

2014-02-01

The effects of place of birth on birth outcomes have been examined in several studies both locally and internationally. However, none has examined the impact on caesarean section rates of different level maternity hospitals operating within the one health service. This study aimed to examine the impact of place of (Hospital level 6; 4-5 or 4) on birth outcomes in a large metropolitan health service in Victoria. A cross-sectional study utilising data on births to low-risk first-time mothers during 2010-2011. Data were obtained from the Birthing Outcome System (BOS) database of Monash Health. Unadjusted and adjusted analyses were undertaken using logistic regression to examine the association between place of birth and caesarean section. In this group of low-risk nulliparae, there was evidence of a significant association between place of birth and caesarean section. The lower the acuity of the hospital, the higher the odds for the caesarean section. Compared with the level 6 hospital, the AdjOR for caesarean section at the level 4 hospital was 1.81 (95% CI: 1.37-2.41) and at the level 4-5 hospital, 1.30 (95% CI: 1.0-1.7). Low-risk nulliparae in spontaneous labour giving birth at the level 4 hospital in this health service are at significantly increased risk of caesarean section. This may have implications for the organisation and resource management of other level 4 public maternity units. Care in a tertiary (level 6) service may not necessarily equate to the higher rates of intervention reported by others. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

PubMed Central

Galvagno, Samuel M.; Haut, Elliott R.; Zafar, S. Nabeel; Millin, Michael G.; Efron, David T.; Koenig, George J.; Baker, Susan P.; Bowman, Stephen M.; Pronovost, Peter J.; Haider, Adil H.

2012-01-01

Context Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. Objective To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Design, Setting, and Participants Retrospective cohort study involving 223 475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007–2009 versions of the American College of Surgeons National Trauma Data Bank. Interventions Transport by helicopter or ground emergency services to level I or level II trauma centers. Main Outcome Measures Survival to hospital discharge and discharge disposition. Results A total of 61 909 patients were transported by helicopter and 161 566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17 775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score–matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14–1.17; P<.001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13–1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers by helicopter were discharged to rehabilitation compared with 12.7% transported by ground services (P < .001), and 9.3% transported by helicopter were discharged to intermediate facilities compared with 6.5% by ground services (P < .001). Fewer patients transported by helicopter left level II trauma centers against medical advice (0.5% vs 1.0%, P < .001). Conclusion Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders. PMID:22511688

The Effects of Different Teaching, Research, and Service Emphases on Individual and Organizational Outcomes in Higher Education Institutions

ERIC Educational Resources Information Center

Terpstra, David E.; Honoree, Andre L.

2009-01-01

The authors investigated the relative emphasis that educators give to teaching, research, and service in the business discipline and 4 other academic disciplines. The authors also investigated the effects of different faculty activity emphases on faculty teaching effectiveness, research performance, service levels, job and pay satisfaction,…

8 CFR 332.1 - Designation of service employees to administer oaths and conduct examinations and hearings.

Code of Federal Regulations, 2010 CFR

2010-01-01

... service employees to administer oaths and conduct examinations and hearings. (a) Examinations. All... section 335 of the Act. A district director may also designate other officers of the Service, who are classified at grade levels equal to or higher than the grade of the immigration examiners, to conduct the...

Student Learning Motivation as a Mediator of the Relationship between Service Quality and Student Performance

ERIC Educational Resources Information Center

Ibrahim, Hamdi H. M.

2016-01-01

Students look for evidence of service quality when selecting a university to attend. Student dissatisfaction with the quality of service may reduce student motivation in online higher-education settings, and low levels of motivation may lead to inferior student performance and a persistently high dropout rate. The purpose of this quantitative,…

Perceptions of biopsychosocial services needs among older adults with severe mental illness: met and unmet needs.

PubMed

Cummings, Sherry M; Cassie, Kimberly McClure

2008-05-01

This study sought to identify the psychiatric, physical, and social services needs experienced by older adults with severe mental illness (SMI) and to examine factors influencing their experience of need and service provision adequacy. Seventy-five older adults with SMI were recruited from a community mental health center to participate in the study. The typical client experienced a need for care in 10 areas, with the greatest needs occurring in the areas of psychological pain, physical illness, social contacts, looking after the home, and daily activities. The total number of unmet needs ranged from zero to 10, with the typical client having an average of 2.3 unmet needs (SD = 2.4). The highest proportions of unmet needs were in the areas of social contact, benefits, sight or hearing difficulties, and intimate relationships. Linear hierarchical regression analyses revealed that clients with lower income, greater impairments in independent daily living skills, and higher levels of depression experienced increased needs for care. Older clients who lived in private homes or apartments had higher levels of depression, and those who required assistance in the areas of intimate relationships and benefits experienced higher levels of unmet needs. Research and practice implications are discussed.

A comparison between antenatal care quality in public and private sector in rural Hebei, China.

PubMed

Chen, Li; Dai, Yaohua; Zhang, Yanfeng; Wu, Qiong; Rudan, Diana; Saftić, Vanja; van Velthoven, Michelle H M M T; Su, Jianqiang; Tan, Zangwen; Scherpbier, Robert W

2013-04-01

To evaluate the quality of antenatal care (ANC) in Hebei Province and compare it between the public and private sector and within the public sector. We conducted a Maternal, Newborn and Child Health Household Survey in 2010 using a two-stage sampling procedure and included 1079 mothers. The quality of ANC was assessed on the basis of the number of ANC visits, the time of the first ANC visit, 16 different ANC procedures, owning a maternal health care booklet, and the type of service provider. Almost all women (98%) received ANC services at least once, 80% at least four times, and 54% at least five times. About half of the women (46%) visited ANC facility within their first trimester. Neither public nor private sector provided all 16 standardized services, but significantly more women in public sector received ANC procedures. Most women received ANC in county or higher-level hospitals (75%) and very few in township hospitals (8%). Significantly fewer women were weighed and tested for HIV/AIDS in township than in county or higher-level hospitals. The quality of ANC in Hebei was poorer than required by China's national and World Health Organization norms. Although the public sector performed better than the private sector, the utilization and quality of care of ANC services in this sector varied and women generally visited county or higher-level health facilities.

5 CFR 850.101 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Employees' Retirement System (FERS) by using contemporary, automated business processes and supporting... employing more efficient and effective business systems to respond to increased customer demand for higher levels of customer service and online self-service tools. (b) The provisions of this part authorize...

Community pharmacists and mental illness: a survey of service provision, stigma, attitudes and beliefs.

PubMed

Giannetti, Vincent; Caley, Charles F; Kamal, Khalid M; Covvey, Jordan R; McKee, Jerry; Wells, Barbara G; Najarian, Dean M; Dunn, Tyler J; Vadagam, Pratyusha

2018-06-04

Background Half of Americans experience mental illness during their lifetime. Significant opportunity exists for community pharmacists to deliver services to these patients; however, personal and practice-related barriers may prevent full engagement. Objective To assess the demographics, practice characteristics, service provision, stigma, attitudes and beliefs of a national sample of community pharmacists towards individuals with mental illness. Setting National random sample of 3008 community pharmacists in the USA. Method 101-item cross-sectional mailed survey questionnaire on: (1) demographics, (2) knowledge and practice characteristics, (3) provision of clinical pharmacy services, and (4) comparative opinions. Main outcome measure Scaled measures of service provision (comfort, confidence, willingness and interest) and comparative opinions (stigma, attitudes and beliefs) of mental illness, four linear regression models to predict service provision. Results A total of 239 responses were received (response rate 7.95%). Across pharmacy services, ratings for willingness/interest were higher than those for comfort/confidence. Pharmacists who reported providing medication therapy management (MTM) services for patients reported higher comfort (18.36 vs. 17.46, p < 0.05), confidence (17.73 vs. 16.01, p < 0.05), willingness (20.0 vs. 18.62, p < 0.05) and interest (19.13 vs. 17.66, p < 0.05). Pharmacists with personal experience with mental illness also resulted in higher scores across all four domains of service provision, lower levels of stigma (18.28 vs. 20.76, p < 0.05) and more positive attitudes (52.24 vs. 50.53, p < 0.01). Regression analyses demonstrated increased frequency of MTM service delivery and more positive attitudes as significantly predictive across all four models for comfort, confidence, willingness and interest. Increased delivery of pharmacy services was significantly associated with both willingness and interest to provide mental illness-specific services. Conclusion Despite willingness/interest to provide services to patients with mental illness, decreased levels of comfort/confidence remain service-related barriers for community pharmacists.

Hospital level analysis to improve patient flow.

PubMed

Khanna, Sankalp; Boyle, Justin; Good, Norm; Bugden, Simon; Scott, Mark

2013-01-01

The complexity of hospital operations ensures that one-size-fits-all solutions seldom work. As hospitals turn to evidence based strategies to redesign flow, it is critical that they tailor the strategies to suit their individual service. This paper analyses the effect of hospital occupancy on inpatient and emergency department patient flow parameters at the Caboolture hospital in Queensland, Australia, and identifies critical levels, or choke points, that result in performance decline. The effect of weekdays and weekends on patient flow is also investigated. We compare these findings to a previous study that has analysed patient flow across Queensland hospitals grouped by size, and discover several differences in the interaction between rising occupancy and patient flow parameters including rates of patient flow, length of stay, and access block. We also identify significantly higher choke points for Caboolture hospital as compared to other similarly sized Queensland hospitals, which suggest that patient flow here can be redesigned to operate at higher levels of occupancy without degrading flow performance. The findings support arguments for hospitals to analyse patient flow at a service level to deliver optimum service improvement.

Association between attendance at religious services and self-reported health in 22 European countries.

PubMed

Nicholson, Amanda; Rose, Richard; Bobak, Martin

2009-08-01

There are consistent reports of protective associations between attendance at religious services and better self-rated health but existing data rarely consider the social or individual context of religious behaviour. This paper investigates whether attendance at religious services is associated with better self-rated health in diverse countries across Europe. It also explores whether the association varies with either individual-level (gender, educational, social contact) or country-level characteristics (overall level of religious practice, corruption, GDP). Cross-sectional data from round 2 of the European Social Survey were used and 18,328 men and 21,373 women from 22 European countries were included in multilevel analyses, with country as higher level. Compared to men who attended religious services at least once a week, men who never attended were almost twice as likely to describe their health as poor, with an age and education adjusted odds ratio of 1.83 [95% CI, 1.49-2.26]. A similar but weaker effect was seen in women, with an age and education adjusted odds ratio of 1.38 [1.19-1.61]. The associations were reduced only marginally in men by controlling for health status, social contact and country-level variables, but weakened in women. The relationships were stronger in people with longstanding illness, less than university education and in more affluent countries with lower levels of corruption and higher levels of religious belief. These analyses confirm that an association between less frequent attendance at religious services and poor health exists across Europe, but emphasise the importance of taking individual and contextual factors into account. It remains unclear to what extent the observed associations reflect reverse causality or are due to differing perceptions of health.

Examining the Effects of Religious Attendance on Resilience for Older Adults.

PubMed

Manning, Lydia K; Miles, Andrew

2018-02-01

Growing older often brings hardship, adversity, and even trauma. Resilience is a broad term used to describe flourishing despite adversity. To date, resilience and the connections to religion have not been well studied, despite compelling evidence that religious practice can promote psychological health. This research examines the role that religion plays in promoting resilience among older adults. Research questions include: (a) What is the relationship between religion and trait resilience? and (b) Does religion promote resilient reintegration following traumatic life events? Results indicate that religious service attendance is tied to higher levels of trait resilience and that both service attendance and trait resilience directly predict lower levels of depression and higher rates of resilient reintegration following traumatic life events. Findings suggest that religious service attendance has protective properties that are worthy of consideration when investigating resilience.

Higher-Level Vocational Education and Training Qualifications: Their Importance in Today's Training Market. A National Vocational Education and Training Research and Evaluation Program Report

ERIC Educational Resources Information Center

Foster, Sue; Delaney, Bernadette; Bateman, Andrea; Dyson, Chloe

2007-01-01

The relevance of higher-level vocational education and training qualifications to students and employers in six industry sectors; namely, disability services; nursing; engineering; electronics/electro-technology; multi-media; and design, is explored in this report. The report suggests possible improvements, including a greater emphasis on…

Respiratory Therapist Job Perceptions: The Impact of Protocol Use.

PubMed

Metcalf, Ashley Y; Stoller, James K; Habermann, Marco; Fry, Timothy D

2015-11-01

Demand for respiratory care services and staffing levels of respiratory therapists (RTs) is expected to increase over the next several years. Hence, RT job satisfaction will be a critical factor in determining recruitment and retention of RTs. Determinants of RT job satisfaction measures have received little attention in the literature. This study examines the use of respiratory care protocols and associated levels of RT job satisfaction, turnover intentions, and job stress. Four-hundred eighty-one RTs at 44 hospitals responded to an online survey regarding job satisfaction, turnover intentions, and job stress. Random coefficient modeling was used for analysis and to account for the nested structure of the data. Higher levels of RT protocol use were associated with higher levels of job satisfaction, lower rates of turnover intentions, and lower levels of job stress. In addition, RTs with greater experience had higher levels of job satisfaction, and RTs working at teaching hospitals had lower rates of turnover intentions. The study extends prior research by examining how the use of respiratory care protocols favorably affects RTs' perceptions of job satisfaction, turnover intention, and job stress. In a time of increasing demand for respiratory care services, protocols may enhance retention of RTs. Copyright © 2015 by Daedalus Enterprises.

Level of quality management in the Municipal Sports Services, contrast trough EFQM Excellence Model.

PubMed

Martínez-Moreno, Alfonso; Díaz Suárez, Arturo

2016-01-01

The quality management in the Municipal Sports Services is embedded in the servuction provided to the citizens, which are their internal customers who determine the quality improvement ensuring competitiveness with excellence criteria. The Model of the European Foundation for Quality Management enables the evaluation of organization progress towards achieving quality goals, from a structured, measurable and comparable methodology. The aim is to carry out a diagnosis of the level of implementation of quality in the Municipal Sports Services of the Region of Murcia, Spain. The sample of 287 workers of 30 sports services gets a high level of reliability at all scales, with a coefficient of variation of .985 (range .810-.943). The score in the criteria of Policy and Strategy, People Management, Alliances and Resources, Processes and People Results were significantly higher (p < .05) in the Municipalities with more than 25,000 inhabitants when compared with those less than 10,000 and with those from 10,000 to 25,000 inhabitants obtaining global ratings of 571 points, those less than 10,000, 590 points those from 10,000 to 25,000 and those higher than 25,000 reach 636, having a good level of quality in relation to the scale that determines the model.

Unmet needs for healthcare and social support services in patients with Huntington's disease: a cross-sectional population-based study.

PubMed

van Walsem, Marleen R; Howe, Emilie I; Iversen, Kristin; Frich, Jan C; Andelic, Nada

2015-09-28

In order to plan and improve provision of comprehensive care in Huntington's disease (HD), it is critical to understand the gaps in healthcare and social support services provided to HD patients. Research has described utilization of healthcare services in HD in Europe, however, studies systematically examining needs for healthcare services and social support are lacking. This study aims to identify the level and type of met and unmet needs for health and social care services among patients with HD, and explore associated clinical and socio-demographic factors. Eighty-six patients with a clinical diagnosis of HD living in the South-Eastern region of Norway were recruited. Socio-demographic and clinical characteristics were collected. The Needs and Provision Complexity Scale (NPCS) was used to assess the patients' needs for healthcare and social services. Functional ability and disease stage was assessed using the UHDRS Functional assessment scales. In order to investigate factors determining the level of total unmet needs and the level of unmet needs for Health and personal care and Social care and support services, multivariate logistic regression models were used. A high level of unmet needs for health and personal care and social support services were found across all five disease stages, but most marked in disease stage III. The middle phase (disease stage III) and advanced phase (disease stages IV and V) of HD increased odds of having a high level of total unmet needs by 3.5 times and 1.4 times respectively, compared with the early phase (disease stages I and II). Similar results were found for level of unmet needs in the domain Health and personal care. Higher education tended to decrease odds of high level of unmet needs in this domain (OR = 0.48) and increase odds of higher level of unmet needs in the domain of Social care and support (OR = 1.3). Patients reporting needs on their own tended to decrease odds of having unmet needs in Health and personal care (OR = 0.57). Needs for healthcare and social services in patients with HD should be assessed in a systematic manner, in order to provide adequate comprehensive care during the course of disease.

Lean and the Learning Organization in Higher Education

ERIC Educational Resources Information Center

Francis, David E.

2014-01-01

Canadian post-secondary institutions are seeking enhanced efficiencies due to ongoing funding shortfalls and expanding teaching, research, and service mandates. These institutions have considered or enacted Lean methodology based on results reported by public service and healthcare organizations worldwide. Lean requires a high level of…

[Factors associated with the seeking of legal induced abortion services in Mexico City in 2010].

PubMed

Figueroa-Lara, Alejandro; Aracena-Genao, Belkis; Reyes-Morales, Hortensia; Lamadrid-Figueroa, Héctor

2012-01-01

To identify factors associated with the seeking of the legal-interruption-pregnancy (LIP) services in Mexico City. We used a case-control design. Users who utilized the LIP were defined as cases, while users of the antenatal care service with gestational age 13 or more weeks and who reported having an unwanted pregnancy were defined as controls. Logistic regressions were fitted to estimate odds ratios. Higher level of education (OR=1.47, 95% CI:1.04-2.07), women's occupation (being student OR=7.31, 95% CI:1.58-33.95; worker OR=13.43, 95% CI:2.04-88.54), and number of previous abortions (OR=11.41, 95% CI:1.65-79.07) were identified as factors associated with the lookup of LIP. In Mexico City context, empowered women with a higher level of education, or having a work activity are the users of LIP services. Strategies for improving access of women with low empowerment conditions are needed.

Family-centred service coordination in childhood health and disability services: the search for meaningful service outcome measures.

PubMed

Trute, B; Hiebert-Murphy, D; Wright, A

2008-05-01

Potential service outcome measures were tested for their utility in the assessment of the quality of 'family centred' service coordination in the provincial network of children's disability services in Manitoba, Canada. This study is based on in-home survey data provided by 103 mothers at 6 and 18 months following assignment of a 'dedicated' service coordinator. Service outcome indicators included measures of parent self-esteem, parenting stress, family functioning and the need for family support resources. Hierarchical regression analyses showed no relationship between level of quality of family-centred service coordination and standardized psychosocial measures of parent and family functioning. However, family centredness of service coordination was found to predict significant reduction in level of family need for psychosocial support resources after 18 months of contact with a service coordinator. Outcome measures that are focused on specific and tangible results of service coordination appear to be of higher utility in service quality assessment than are more global, standardized measures of parent and family functioning.

Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain.

PubMed

Hansen, A B; Skurtveit, S; Borchgrevink, P C; Dale, O; Romundstad, P R; Mahic, M; Fredheim, O M

2015-11-01

Although persons with chronic pain are frequent users of the health care system, they report poor satisfaction with health care services. Participants with persistent opioid use in Nord-Trøndelag Health Study (HUNT)3 report severe pain in spite of treatment. The aim of the study was to test the hypothesis that subjects with persistent opioid use have both a higher consumption of health care services and a poorer satisfaction than the remaining subjects reporting chronic pain. This cross-sectional study was based on linkage of self-reported data from the substudy (10,238 were invited, 6927 met the inclusion criteria) of health care use in HUNT3; a population-based health survey during the years 2006-2008 and the complete national registers of the Norwegian Prescription Database and the Cancer Registry of Norway. Patients with chronic pain are stratified according to the level of opioid use as persistent users of opioids, intermittent users, and persons not using opioids. Persons with chronic non-malignant pain reported a higher consumption of all health care services compared to the control group. Consumption of health care services increased with increasing level of opioid use. Persons with persistent opioid use were highly satisfied with all health care services, although less satisfied than persons without chronic pain. Combined with previous findings of high levels of pain in spite of opioid treatment, the present findings indicate that symptomatic relief is not a prerequisite for patient satisfaction. The study shows higher patient satisfaction compared to previous studies. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Satisfaction of healthy pregnant women receiving short message service via mobile phone for prenatal support: A randomized controlled trial.

PubMed

Jareethum, Rossathum; Titapant, Vitaya; Chantra, Tienthai; Sommai, Viboonchart; Chuenwattana, Prakong; Jirawan, Chatchainoppakhun

2008-04-01

The main objective was to compare the satisfaction levels of antenatal care between healthy pregnant women who received short message service (SMS) via mobile phone for prenatal support, and those who did not. The second objective was to compare the confidence, anxiety levels and also pregnancy outcomes. A randomized controlled trial. 68 healthy pregnant women who attended the antenatal clinic and delivered at Siriraj Hospital, who met the inclusion criterias between May 2007 and October 2007, were enrolled and randomly allocated into two random groups. The study group received two SMS messages per week from 28 weeks of gestation until giving birth. The other group was pregnant women who did not receive SMS. Both groups had the same antenatal and perinatal care. The satisfaction, confidence and anxiety scores were evaluated using a questionnaire at the postpartum ward. The pregnancy outcomes were also compared in these two groups. The satisfaction levels of the women who received prenatal support in SMS messages, were significantly higher than those of who did not receive the messages both in the antenatal period (9.25 vs. 8.00, p < 0.001) and during labor (9.09 vs. 7.90, p = 0.007). In the SMS using group, the confidence level was'higher (8.91 vs. 7.79, p = 0.001) and the anxiety level was lower (2.78 vs. 4.93, p = 0.002) than the control group n the antenatal period, however no diference in pregnancy outcomes were found. The present study shows the higher satisfaction level of pregnant women who received SMS via mobile phone during their antenatal service when compared with the general antenatal care group. The study also show the higher confidence level and lower anxiety level in the antenatal period but no difference in pregnancy outcomes.

Area-level variations in cancer care and outcomes.

PubMed

Keating, Nancy L; Landrum, Mary Beth; Lamont, Elizabeth B; Bozeman, Samuel R; McNeil, Barbara J

2012-05-01

: Substantial regional variations in health-care spending exist across the United States; yet, care and outcomes are not better in higher-spending areas. Most studies have focused on care in fee-for-service Medicare; whether spillover effects exist in settings without financial incentives for more care is unknown. : We studied care for cancer patients in fee-for-service Medicare and the Veterans Health Administration (VA) to understand whether processes and outcomes of care vary with area-level Medicare spending. : An observational study using logistic regression to assess care by area-level measures of Medicare spending. : Patients with lung, colorectal, or prostate cancers diagnosed during 2001-2004 in Surveillance, Epidemiology, and End Results (SEER) areas or the VA. The SEER cohort included fee-for-service Medicare patients aged older than 65 years. : Recommended and preference-sensitive cancer care and mortality. : In fee-for-service Medicare, higher-spending areas had higher rates of recommended care (curative surgery and adjuvant chemotherapy for early-stage non-small-cell lung cancer and chemotherapy for stage III colon cancer) and preference-sensitive care (chemotherapy for stage IV lung and colon cancer and primary treatment of local/regional prostate cancer) and had lower lung cancer mortality. In the VA, we observed minimal variation in care by area-level Medicare spending. : Our findings suggest that intensity of care for Medicare beneficiaries is not driving variations in VA care, despite some overlap in physician networks. Although the Dartmouth Atlas work has been of unprecedented importance in demonstrating variations in Medicare spending, new measures may be needed to better understand variations in other populations.

Concerns and perceptions immediately following Superstorm Sandy: ratings for property damage were higher than for health issues

PubMed Central

Burger, Joanna; Gochfeld, Michael

2015-01-01

Governmental officials, health and safety professionals, early responders, and the public are interested in the perceptions and concerns of people faced with a crisis, especially during and immediately after a disaster strikes. Reliable information can lead to increased individual and community preparedness for upcoming crises. The objective of this research was to evaluate concerns of coastal and central New Jersey residents within the first 100 days of Superstorm Sandy’s landfall. Respondents living in central New Jersey and Jersey shore communities were differentially impacted by the storm, with shore residents having higher evacuation rates (47% vs. 13%), more flood waters in their homes, longer power outages (average 23 vs. 6 days), and longer periods without Internet (29 vs. 6 days). Ratings of concerns varied both among and within categories as a function of location (central vs. coastal New Jersey), stressor level (ranging from 1 to 3 for combinations of power outages, high winds, and flooding), and demographics. Respondents were most concerned about property damage, health, inconveniences, ecological services, and nuclear power plants in that order. Respondents from the shore gave higher ratings to the concerns within each major category, compared to those from central Jersey. Four findings have implications for understanding future risk, recovery, and resiliency: (1) respondents with the highest stressor level (level 3) were more concerned about water damage than others, (2) respondents with flood damage were more concerned about water drainage and mold than others, (3) respondents with the highest stressor levels rated all ecological services higher than others, and (4) shore respondents rated all ecological services higher than central Jersey residents. These data provide information to design future preparedness plans, improve resiliency for future severe weather events, and reduce public health risk. PMID:27011757

The Effect of Urban Basic Medical Insurance on Health Service Utilisation in Shaanxi Province, China: A Comparison of Two Schemes

PubMed Central

Gao, Jianmin; Yang, Xiaowei; Yan, Ju'e; Xue, Qinxiang; Chen, Gang

2014-01-01

Background Urban population in China is mainly covered by two medical insurance schemes: the Urban Employee Basic Medical Insurance (UEBMI) for urban employees in formal sector and the Urban Resident Basic Medical Insurance (URBMI) for the left urban residents, mainly the unemployed, the elderly and children. This paper studies the effects of UEBMI and URBMI on health services utilisation in Shaanxi Province, Western China. Methods Cross-sectional data from the 4th National Health Services Survey - Shaanxi Province was studied. The propensity score matching and the coarsened exact matching methods have been used to estimate the average medical insurance effect on the insured. Results Compared to the uninsured, robust results suggest that UEBMI had significantly increased the outpatient health services utilisation in the last two weeks (p<0.10), whilst the significant effect on hospitalisation was evident in the CEM method (p<0.10). The effect of URBMI was limited in that although being insured was associated with higher health services utilisation, compared with the uninsured, none of the improvement was statistically significant (p>0.10). It was also found that compared with the uninsured, basic medical insurance enrollees were more likely to purchase inpatient treatments in lower levels of hospitals, consistent with the incentive of the benefit package design. Conclusion Basic Medical insurance schemes have shown a positive but limited effect on increasing health services utilisation in Shaanxi Province. The benefit package design of higher reimbursement rates for lower level hospitals has induced the insured to use medical services in lower level hospitals for inpatient services. PMID:24740282

The effect of urban basic medical insurance on health service utilisation in Shaanxi Province, China: a comparison of two schemes.

PubMed

Zhou, Zhongliang; Zhou, Zhiying; Gao, Jianmin; Yang, Xiaowei; Yan, Ju'e; Xue, Qinxiang; Chen, Gang

2014-01-01

Urban population in China is mainly covered by two medical insurance schemes: the Urban Employee Basic Medical Insurance (UEBMI) for urban employees in formal sector and the Urban Resident Basic Medical Insurance (URBMI) for the left urban residents, mainly the unemployed, the elderly and children. This paper studies the effects of UEBMI and URBMI on health services utilisation in Shaanxi Province, Western China. Cross-sectional data from the 4th National Health Services Survey - Shaanxi Province was studied. The propensity score matching and the coarsened exact matching methods have been used to estimate the average medical insurance effect on the insured. Compared to the uninsured, robust results suggest that UEBMI had significantly increased the outpatient health services utilisation in the last two weeks (p<0.10), whilst the significant effect on hospitalisation was evident in the CEM method (p<0.10). The effect of URBMI was limited in that although being insured was associated with higher health services utilisation, compared with the uninsured, none of the improvement was statistically significant (p>0.10). It was also found that compared with the uninsured, basic medical insurance enrollees were more likely to purchase inpatient treatments in lower levels of hospitals, consistent with the incentive of the benefit package design. Basic Medical insurance schemes have shown a positive but limited effect on increasing health services utilisation in Shaanxi Province. The benefit package design of higher reimbursement rates for lower level hospitals has induced the insured to use medical services in lower level hospitals for inpatient services.

SPDF Data and Orbit Services Supporting Open Access, Use and Archiving of MMS Data

NASA Astrophysics Data System (ADS)

McGuire, R. E.; Bilitza, D.; Candey, R. M.; Chimiak, R.; Cooper, J. F.; Garcia, L. N.; Harris, B. T.; Johnson, R. C.; Kovalick, T. J.; Lal, N.; Leckner, H. A.; Liu, M. H.; Papitashvili, N. E.; Roberts, D. A.; Yurow, R. E.

2015-12-01

NASA's Space Physics Data Facility (SPDF) project is now serving MMS definitive and predictive interactive orbit plots, listings and conjunction calculations through our SSCWeb and 4D Orbit Viewer services. In March 2016 and in parallel with the MMS Science Data Center (SDC) at LASP, SPDF will begin publicly serving a complete set of MMS Level-2 and higher, survey and burst-mode science data products from all four spacecraft and all instruments. The initial Level-2 data available will be from September 2015 to early February 2016, with Level-2 products subsequently validated and publicly available with an approximate one month lag. All MMS Level-2 and higher data products are produced in standard CDF format with standard ISTP/SPDF metadata and will be served by SPDF through our CDAWeb data service, including our web services and associated APIs for IDL and Matlab users, and through direct FTP/HTTP directory browse and file downloads. SPDF's ingest, archival preservation and active serving of current MMS science data is part of our role as an active heliophysics final archive. SPDF's ingest of complete and current science data products from other active heliophysics missions with SPDF services will help enable coordinated and correlative MMS science analysis by the open international science community with current data from THEMIS, the Van Allen Probes and other missions including TWINS, Cluster, ACE, Wind, >120 ground magnetometer stations as well as instruments on the NOAA GOES and POES spacecraft. Please see the related Candey et.al. paper on "SPDF Ancillary Services and Technologies Supporting Open Access, Use and Archiving of MMS Data" for other aspects of what SPDF is doing. All SPDF data and services are available from the SPDF home page at http://spdf.gsfc.nasa.gov .

75 FR 25296 - Workforce Investment Act; Lower Living Standard Income Level

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-07

... period that does not exceed the higher level of the poverty line or 70 percent of the LLSIL. This... Services ``Poverty Guidelines.'' Congress has taken action to keep the 2009 HHS poverty guidelines in...

A smartphone-based system for automated detection of walking.

DOT National Transportation Integrated Search

2015-08-01

Walking is the most effective mode of travel to access transit: transit hubs with higher residential and employment densities have higher : ridership levels because they serve areas where a large population is within a short walk of transit service. ...

The effects of discrimination and acculturation to service seeking satisfaction for Latina and Asian American women: implications for mental health professions.

PubMed

Huang, Bu; Appel, Hoa; Ai, Amy L

2011-01-01

There is ample research showing that there are health disparities for minorities with respect to seeking mental health services in the United States. Although there are general barriers for minorities in seeking service health, minority women are more vulnerable due to their negative experiences and lower satisfaction in receiving health care, compared to men. This study utilized the National Latino and Asian American Study (NLAAS) data set, which is the first population-based mental health study on Latino and Asian Americans, to give a full description of Latina and Asian American women's experience in mental health service seeking and identifies the opportunities in increasing their satisfaction levels. The results showed that perceived discrimination attributed to gender or race/ethnicity is negatively predicting levels of satisfaction of mental health service seeking. Older age, higher education levels, longer duration in the United States, and better mental health, are positively related to satisfaction levels for Latina and Asian American women.

GATS and Higher Education: State of Play of the Liberalization Commitments

ERIC Educational Resources Information Center

Verger, Antoni

2009-01-01

Higher education is the education level under the most pressure to be internationally liberalized. Currently, the main global instrument to achieve this liberalization goal is the General Agreement on Trade in Services (GATS) of the World Trade Organization. In this paper, the process of trade liberalization of higher education in the GATS…

The Role of the A* Grade at a Level as a Predictor of University Performance in the United Kingdom

ERIC Educational Resources Information Center

Vidal Rodeiro, Carmen; Zanini, Nadir

2015-01-01

In summer 2010, the A* grade at A level was awarded for the first time. This grade was introduced to help higher education institutions to differentiate between the highest achieving candidates and to promote and reward greater stretch and challenge. Exploring data from the Higher Education Statistics Service and making use of multilevel…

Tertiary education and its association with mental health indicators and educational factors among Arctic young adults: the NAAHS cohort study.

PubMed

Bania, Elisabeth Valmyr; Kvernmo, Siv Eli

2016-01-01

Background Completed tertiary education is closely associated with employment and influences income, health and personal well-being. Objective The purpose of the study is to explore predictors for completed tertiary education among indigenous Sami and non-indigenous young people in relation to mental health indicators and educational factors in sociocultural rural and urban contexts across the Arctic part of Norway. Design The Norwegian Arctic Adolescent Health Study (NAAHS) is a cross-sectional, school-based survey that was conducted in 2003-2005. Of all 5,877 10th graders (aged 15-16 years) in north Norway, 83% from all 87 municipalities participated; 450 (9.2%) reported indigenous Sami ethnicity, and 304 (6.2%) reported Laestadian affiliation. Data from NAAHS were merged with registry data from the National Education Database and Norwegian Patient Register for 3,987 adolescents who gave their consent for follow-up studies. Results Completion of upper secondary school is the only common predictor of a completed tertiary education degree for both genders. Among females, conduct problems was a significant predictor of lower level education, typically vocational professions, while among males severe mental health problems requiring treatment by the specialist health care system reduced the opportunity to complete tertiary education at intermediate and higher level. Parental higher educational level was associated with less lower education among females and less higher education among males. Men residing in the northernmost and remote areas were less likely to complete education on higher level. Males' completion of higher level education was strongly but not significantly associated (p=0.057) with higher average marks in lower secondary school. Conclusions The gender differences found in this study emphasize the need for gender-specific interventions to encourage, support and empower young people to attend and complete tertiary education. Young females with conduct problems choose lower or intermediate education, and males in need of specialist mental health care have half the chance to complete intermediate tertiary education compared with males not in contact with the mental health service. Closer cooperation between low threshold social services, general practitioners, mental health services and higher study institutions can help young male adults complete tertiary education.

Assessing Restrictiveness: A Closer Look at the Foster Care Placements and Perceptions of Youth With and Without Disabilities Aging Out of Care

PubMed Central

Cunningham, Miranda; Dalton, Lawrence D.; Powers, Laurie E.; Geenen, Sarah; Orozco, Claudia Guadalupe

2014-01-01

The aim of the study was to examine the experience of restrictiveness among transition-aged youth with disabilities in foster care. Utilizing a sample of 207 youth, placement types were explored for differences in disability status, race and sex. Further, youth perceptions of restriction around communication, movement around one’s home, and access to the community were examined for youth receiving special education services (SPED), youth receiving developmental disability services (DD), and youth without disabilities. Youth with disabilities were more likely to be placed in more restrictive placement types and had significantly higher levels of perceived restriction around communication, movement, and community when compared to youth without disabilities. Additionally, males with disabilities experienced higher levels of restrictiveness, particularly those who received DD services, while White youth with disabilities also experienced greater community restrictiveness. PMID:24489523

Factors Associated With Emergency Department Visits: A Multistate Analysis of Adult Fee-for-Service Medicaid Beneficiaries.

PubMed

Agarwal, Parul; Bias, Thomas K; Madhavan, Suresh; Sambamoorthi, Nethra; Frisbee, Stephanie; Sambamoorthi, Usha

2016-04-27

The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.

77 FR 18865 - Workforce Investment Act of 1998 (WIA); Lower Living Standard Income Level (LLSIL)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... higher level of the poverty line or 70 percent of the LLSIL. This issuance provides the Secretary's annual LLSIL for 2012 and references the current 2012 Health and Human Services ``Poverty Guidelines...

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities.

PubMed

Hoy-Ellis, Charles P; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities.

Bowling Together.

ERIC Educational Resources Information Center

Campbell, David E.

2001-01-01

Using data from 1996 National Household Education Survey, reports that a higher percentage of students in private schools, especially Catholic schools, acquire civic engagement skills (voluntary community service, civic skills), have greater political knowledge, and have a higher level of political tolerance than do students in public schools.…

Managing Tensions in a Service-Learning Programme: Some Reflections

ERIC Educational Resources Information Center

Maistry, S. M.; Ramdhani, J.

2010-01-01

Service learning as a strategy for raising awareness amongst university students of their responsibilities to the community is rapidly gaining currency in higher education institutions in South Africa. High levels of unemployment and striking economic inequality have been an unfortunate feature of South African society for several decades. Since…

Going Online to Make Learning Count

ERIC Educational Resources Information Center

Brigham, Cathy; Klein-Collins, Rebecca

2011-01-01

Adult students often come to higher education with college-level learning that they have acquired outside of the classroom--from the workplace, military service, self-study, or hobbies. For decades, many forward-thinking colleges and universities have been offering services to evaluate that learning and award it college credit that counts towards…

A comparison between antenatal care quality in public and private sector in rural Hebei, China

PubMed Central

Chen, Li; Dai, Yaohua; Zhang, Yanfeng; Wu, Qiong; Rudan, Diana; Saftić, Vanja; van Velthoven, Michelle H.M.M.T.; Su, Jianqiang; Tan, Zangwen; Scherpbier, Robert W.

2013-01-01

Aim To evaluate the quality of antenatal care (ANC) in Hebei Province and compare it between the public and private sector and within the public sector. Methods We conducted a Maternal, Newborn and Child Health Household Survey in 2010 using a two-stage sampling procedure and included 1079 mothers. The quality of ANC was assessed on the basis of the number of ANC visits, the time of the first ANC visit, 16 different ANC procedures, owning a maternal health care booklet, and the type of service provider. Results Almost all women (98%) received ANC services at least once, 80% at least four times, and 54% at least five times. About half of the women (46%) visited ANC facility within their first trimester. Neither public nor private sector provided all 16 standardized services, but significantly more women in public sector received ANC procedures. Most women received ANC in county or higher-level hospitals (75%) and very few in township hospitals (8%). Significantly fewer women were weighed and tested for HIV/AIDS in township than in county or higher-level hospitals. Conclusion The quality of ANC in Hebei was poorer than required by China’s national and World Health Organization norms. Although the public sector performed better than the private sector, the utilization and quality of care of ANC services in this sector varied and women generally visited county or higher-level health facilities. PMID:23630142

Health care service utilization among patients with bladder pain syndrome/interstitial cystitis in a single payer healthcare system.

PubMed

Chung, Shiu-Dong; Liu, Shih-Ping; Li, Hsien-Chang; Lin, Herng-Ching

2014-01-01

This study aims to investigate the differences in the utilization of healthcare services between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and patients without using a population-based database in Taiwan. This study comprised of 350 patients with BPS/IC and 1,750 age-matched controls. Healthcare resource utilization was evaluated in the one-year follow-up period as follows: number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. A multivariate regression analysis was used to evaluate the relationship between BPS/IC and total costs of health care services. For urological services, patients with BPS/IC had a significantly higher number of outpatient visits (2.5 vs. 0.2, p<0.001) as well as significantly higher outpatient costs ($US166 vs. $US6.8, p<0.001) than the controls. For non-urologic services, patients with BPS/IC had a significantly high number of outpatient visits (35.0 vs. 21.3, p<0.001) as well as significantly higher outpatient cots ($US912 vs. $US675, p<0.001) as compared to the controls. Overall, patients with BPS/IC had 174% more outpatient visits and 150% higher total costs than the controls. Multiple-regression-analyses also showed that the patients with BPS/IC had significantly higher total costs for all healthcare services than the controls. This study found that patients with BPS/IC have a significantly higher number of healthcare related visits, and have significantly higher healthcare related costs than age-matched controls. The high level of healthcare services utilization accrued with BPS/IC was not necessarily exclusive for BPS/IC, but may have also been associated with medical co-morbidities.

Attitudes Toward Mental Health Services Among American Indians by Two Age Groups.

PubMed

Roh, Soonhee; Brown-Rice, Kathleen A; Lee, Kyoung Hag; Lee, Yeon-Shim; Yee-Melichar, Darlene; Talbot, Elizabeth P

2015-11-01

This study examined determinants of attitudes toward mental health services with a sample of American Indian younger-old-adults (aged 50-64, n = 158) and American Indian older-old adults (aged 65 and older, n = 69). Adapting Andersen's behavioral model of healthcare utilization, predisposing factors, mental health needs, and enabling factors were considered as potential predictors. Female and those with higher levels of social support tend to report more positive attitudes toward mental health services. Culture-influenced personal belief was associated with negative attitudes toward mental health services among American Indian younger-old -adults. Age and higher chronic medical conditions were significantly related to negative attitudes toward mental health services. Health insurance was positively associated with positive attitudes toward mental health services in the American Indian older-old adults. Findings indicate that practitioners should engage how culture, social support, and chronic conditions influence the response to mental health needs when working with older American Indians.

Clients' satisfaction with quality of childbirth services: A comparative study between public and private facilities in Limuru Sub-County, Kiambu, Kenya.

PubMed

Okumu, Clarice; Oyugi, Boniface

2018-01-01

This study intended to compare the clients' satisfaction with the quality of childbirth services in a private and public facility amongst mothers who have delivered within the last twenty four to seventy hours. This was a cross-sectional comparative research design with both quantitative and qualitative data collection and analysis methods. Data were collected through a focused group discussion guide and structured questionnaire collecting information on clients' satisfaction with quality of childbirth services. The study was conducted amongst women of reproductive age (WRA) between 15-49 years in Tigoni District hospital (public hospital) and Limuru Nursing home (private hospital). For quantitative data we conducted descriptive analysis and Mann-Whitney test using SPSS version 20.0 while qualitative data was manually analyzed manually using thematic analysis. A higher proportion of clients from private facility 98.1% were attended within 0-30 minutes of arrival to the facility as compared to 87% from public facility. The overall mean score showed that the respondents in public facility gave to satisfaction with the services was 4.46 out of a maximum of 5.00 score while private facility gave 4.60. The level of satisfaction amongst respondents in the public facility on pain relief after delivery was statistically significantly higher than the respondents in private facilities (U = 8132.50, p<0.001) while the level of satisfaction amongst respondents in the public facility on functional equipment was statistically significantly higher than the respondents in private facilities (U = 9206.50, p = 0.001). Moreover, level of satisfaction with the way staff responded to questions and concerns during labour and delivery was statistically significantly higher than the respondents in private facilities (U = 9964.50, p = 0.022). In overall, majority of clients from both public and private facilities expressed satisfaction with quality of services from admission till discharge in both public and private facilities and were willing to recommend other to come and deliver in the respective facilities.

Universities give record level of support to the UK economy

NASA Astrophysics Data System (ADS)

Banks, Michael

2009-08-01

Universities in the UK are providing record levels of services to businesses, according to a recent survey by the Department for Business, Innovation and Skills (BIS) and the Higher Education Funding Council for England. The survey concludes that the income earned by universities and higher-education colleges in the UK is now worth a total of £2.812bn - an increase of 6.5% from the previous year.

Respite service use among caregivers of older people: comparative analysis of family dementia caregivers with musculoskeletal and circulatory system disorder caregivers.

PubMed

Vecchio, Nerina; Fitzgerald, Janna A; Radford, Katrina; Kurrle, Susan

2018-01-01

To identify the main drivers of the use of respite services and the need for respite services among caregivers of people experiencing dementia relative to family caregivers of people with other health conditions. Based on nationally representative secondary data regression analysis was used to test the association between selected health conditions and the utilisation of and need for respite services. For a person living with dementia the odds of using respite care are higher than for a person with either a musculoskeletal or circulatory condition. Family caregivers of people living with dementia report the odds of the need for more respite as 5.3 times higher than for family caregivers of people with musculoskeletal conditions and 7.7 times higher than for family caregivers of people with circulatory conditions. The main reason for never using respite services is largely driven by the type of health condition, age of care recipient, existence of a spouse, and level of disability. Respite services that cater to the specific needs of families experiencing dementia at home should become a higher priority within the aged care sector. Alternative models of respite care that focus on prevention and early intervention would be cost effective.

Predictive factors for cosmetic surgery: a hospital-based investigation.

PubMed

Li, Jun; Li, Qian; Zhou, Bei; Gao, Yanli; Ma, Jiehua; Li, Jingyun

2016-01-01

Cosmetic surgery is becoming increasingly popular in China. However, reports on the predictive factors for cosmetic surgery in Chinese individuals are scarce in the literature. We retrospectively analyzed 4550 cosmetic surgeries performed from January 2010 to December 2014 at a single center in China. Data collection included patient demographics and type of cosmetic surgery. Predictive factors were age, sex, marital status, occupational status, educational degree, and having had children. Predictive factors for the three major cosmetic surgeries were determined using a logistic regression analysis. Patients aged 19-34 years accounted for the most popular surgical procedures (76.9 %). The most commonly requested procedures were eye surgery, Botox injection, and nevus removal. Logistic regression analysis showed that higher education level (college, P = 0.01, OR 1.21) was predictive for eye surgery. Age (19-34 years, P = 0.00, OR 33.39; 35-50, P = 0.00, OR 31.34; ≥51, P = 0.00, OR 16.42), female sex (P = 0.00, OR 9.19), employment (service occupations, P = 0.00, OR 2.31; non-service occupations, P = 0.00, OR 1.76), and higher education level (college, P = 0.00, OR 1.39) were independent predictive factors for Botox injection. Married status (P = 0.00, OR 1.57), employment (non-service occupations, P = 0.00, OR 1.50), higher education level (masters, P = 0.00, OR 6.61), and having children (P = 0.00, OR 1.45) were independent predictive factors for nevus removal. The principal three cosmetic surgeries (eye surgery, Botox injection, and nevus removal) were associated with multiple variables. Patients employed in non-service occupations were more inclined to undergo Botox injection and nevus removal. Cohort study, Level III.

Examining the Influence of Perceptions of a Supervisor's Leadership Style on Levels of Psychological Ownership among Entry Level Professionals

ERIC Educational Resources Information Center

Shouse, Reggie L.

2017-01-01

The purpose of this study was to explore the relationship between the perceived leadership behaviors of upper-level student affairs officers and levels of psychological ownership among entry-level employees working in student services roles in higher education in the United States. Specifically, this study identified whether there are leadership…

Beyond recidivism: changes in health and social service involvement following exposure to drug treatment court.

PubMed

Rezansoff, Stefanie N; Moniruzzaman, Akm; Clark, Elenore; Somers, Julian M

2015-10-31

The majority of Drug Treatment Court (DTC) research has examined the impact of DTCs on criminal recidivism. Comparatively little research has addressed the association between DTC participation and engagement with community-based health and social services. The present study investigated changes in participant involvement with outpatient healthcare and income assistance within a DTC cohort. We hypothesized that involvement with community-based (outpatient) health and social services would increase post-DTC participation, and that service levels would be higher among program graduates and offenders with histories of co-occurring mental and substance use disorders. Participants were 631 offenders at the DTC in Vancouver, Canada (DTCV). Administrative data representing hospital, outpatient medical care, and income assistance were examined one-year pre/post program to assess differences over time. Generalized estimating equations were used to investigate the association between changes in service use and program involvement. We also examined the relationship between level of service use and offender characteristics. Members of the cohort were disproportionately Aboriginal (33 %), had been sentenced 2.7 times in the 2 years preceding their index offence, and 50 % had been diagnosed with a non substance-related mental disorder in the five years preceding the index offence. The mean number of outpatient services post DTCV was 51, and the mean amount of social assistance paid was $5,897. Outpatient service use increased following exposure to DTCV (Adjusted Rate Ratio (ARR) = 1.45) and was significantly higher among women (ARR = 1.47), program graduation (ARR = 1.23), and those previously diagnosed with concurrent substance use and mental disorders (ARR = 4.92). Overall, hospital admissions did not increase post-program, although rates were significantly higher among women (ARR = 1.76) and those with concurrent disorders (ARR = 2.71). Income assistance increased significantly post program (ARR = 1.16), and was significantly higher among women (ARR = 1.03), and those diagnosed with substance use disorders (ARR = 1.42) and concurrent disorders (ARR = 1.72). These findings suggest that the DTCV was a catalyst for increased participant engagement with community health and social supports, and that rates of service use were consistently higher among women and individuals with concurrent disorders. Research is needed to investigate the potential link between health and social support and reductions in recidivism associated with DTCs.

Global drivers and tradeoffs of three urban vegetation ecosystem services.

PubMed

Dobbs, Cynnamon; Nitschke, Craig R; Kendal, Dave

2014-01-01

Our world is increasingly urbanizing which is highlighting that sustainable cities are essential for maintaining human well-being. This research is one of the first attempts to globally synthesize the effects of urbanization on ecosystem services and how these relate to governance, social development and climate. Three urban vegetation ecosystem services (carbon storage, recreation potential and habitat potential) were quantified for a selection of a hundred cities. Estimates of ecosystem services were obtained from the analysis of satellite imagery and the use of well-known carbon and structural habitat models. We found relationships between ecosystem services, social development, climate and governance, however these varied according to the service studied. Recreation potential was positively related to democracy and negatively related to population. Carbon storage was weakly related to temperature and democracy, while habitat potential was negatively related to democracy. We found that cities under 1 million inhabitants tended to have higher levels of recreation potential than larger cities and that democratic countries have higher recreation potential, especially if located in a continental climate. Carbon storage was higher in full democracies, especially in a continental climate, while habitat potential tended to be higher in authoritarian and hybrid regimes. Similar to other regional or city studies we found that the combination of environment conditions, socioeconomics, demographics and politics determines the provision of ecosystem services. Results from this study showed the existence of environmental injustice in the developing world.

Global Drivers and Tradeoffs of Three Urban Vegetation Ecosystem Services

PubMed Central

Dobbs, Cynnamon; Nitschke, Craig R.; Kendal, Dave

2014-01-01

Our world is increasingly urbanizing which is highlighting that sustainable cities are essential for maintaining human well-being. This research is one of the first attempts to globally synthesize the effects of urbanization on ecosystem services and how these relate to governance, social development and climate. Three urban vegetation ecosystem services (carbon storage, recreation potential and habitat potential) were quantified for a selection of a hundred cities. Estimates of ecosystem services were obtained from the analysis of satellite imagery and the use of well-known carbon and structural habitat models. We found relationships between ecosystem services, social development, climate and governance, however these varied according to the service studied. Recreation potential was positively related to democracy and negatively related to population. Carbon storage was weakly related to temperature and democracy, while habitat potential was negatively related to democracy. We found that cities under 1 million inhabitants tended to have higher levels of recreation potential than larger cities and that democratic countries have higher recreation potential, especially if located in a continental climate. Carbon storage was higher in full democracies, especially in a continental climate, while habitat potential tended to be higher in authoritarian and hybrid regimes. Similar to other regional or city studies we found that the combination of environment conditions, socioeconomics, demographics and politics determines the provision of ecosystem services. Results from this study showed the existence of environmental injustice in the developing world. PMID:25402184

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities

PubMed Central

Hoy-Ellis, Charles P.; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities. PMID:28366982

The Mwanje Project: Engaging Preservice Teachers in Global Service Learning

ERIC Educational Resources Information Center

Doppen, Frans H.; Tesar, Jennifer

2012-01-01

This article reports the findings of a study that engaged preservice social studies teachers at two institutions of higher education in Ohio and West Virginia in a service learning to benefit the Mwanje school in Malawi. The findings suggest that despite some initial levels of apprehension the project enhanced the student teachers' global…

Impact of Changes in Minnesota State Grants Implemented in Fiscal Year 2004.

ERIC Educational Resources Information Center

Setter, Gerald

2004-01-01

This report to the Minnesota Legislature outlines the estimated impact of recent changes made to the Minnesota State Grant Program on students. The Minnesota Higher Education Services Office is a cabinet-level state agency that provides prospective and current post-secondary students with financial aid programs, services and information. The…

Context, Communication and Commiseration: Psychological and Practical Considerations in Change Management

ERIC Educational Resources Information Center

Clarke, Hugh

2013-01-01

In this paper, the author draws upon his interest, as a psychotherapist, in working with change at a psychological and individual level, and on his experience of the radical changes currently taking place in higher education, specifically the University where he manages several services, including a Counselling Service. Through leading and…

Partisan Activism and Access to Welfare in Lebanon

PubMed Central

2014-01-01

How do welfare regimes function when state institutions are weak and ethnic or sectarian groups control access to basic services? This paper explores how people gain access to basic services in Lebanon, where sectarian political parties from all major religious communities are key providers of social assistance and services. Based on analyses of an original national survey (n= 1,911) as well as in-depth interviews with providers and other elites (n= 175) and beneficiaries of social programs (n= 135), I make two main empirical claims in the paper. First, political activism and a demonstrated commitment to a party are associated with access to social assistance; and second, higher levels of political activism may facilitate access to higher levels or quantities of aid, including food baskets and financial assistance for medical and educational costs. These arguments highlight how politics can mediate access to social assistance in direct ways and add new dimensions to scholarly debates about clientelism by focusing on contexts with politicized religious identities and by problematizing the actual goods and services exchanged. PMID:24904187

How neurocognition and social cognition influence functional change during community-based psychosocial rehabilitation for individuals with schizophrenia.

PubMed

Brekke, John S; Hoe, Maanse; Long, Jeffrey; Green, Michael F

2007-09-01

The purpose of this study was to assess how neurocognition and social cognition were associated with initial functional level and with rates of functional change in intensive community-based psychosocial rehabilitation interventions that have been shown to yield significant functional change for individuals diagnosed with schizophrenia. We also examined how service intensity was associated with rates of change and whether it served as a moderator of the relationship between functional change and both neurocognition and social cognition. The sample consisted of 125 individuals diagnosed with schizophrenia or schizoaffective disorder who were recruited upon admission to 1 of 4 community-based psychosocial rehabilitation facilities and were followed prospectively for 12 months. One hundred and two subjects completed the 12-month protocol. The findings suggested that (i) the initial level of psychosocial functioning was related to both social cognition and neurocognition at baseline, (ii) when significant rehabilitative change occurs, higher neurocognition and social cognition scores at baseline predicted higher rates of functional change over the subsequent 12 months, (iii) greater service intensity was related to higher rates of improvement in functional outcome over time, and (iv) service intensity moderated the relationship between neurocognition and initial functional level and moderated the relationship between social cognition and the rates of functional change at a trend level. These findings have relevance to our understanding of the heterogeneity in functional rehabilitative outcomes, to our understanding of the conditions of rehabilitative change and for the design of psychosocial interventions in the community.

Factors Influencing Utilization of Primary Health Care Services in Patients with Chronic Respiratory Diseases.

PubMed

Kurpas, D; Bujnowska-Fedak, M M; Athanasiadou, A; Mroczek, B

2015-01-01

The purpose of our study was to determine the factors affecting the level of services provided in primary health care among patients with chronic respiratory diseases. The study group consisted of 299 adults (median age: 65, min-max: 18-92 years) with mixed chronic respiratory diseases, recruited from patients of 135 general practitioners. In the analysis, in addition to the assessment of the provided medical services, the following were used: Patient Satisfaction Questionnaire, Camberwell Assessment of Needs Short Appraisal Schedule, Acceptance of Illness Scale, and WHO Quality of Life Instrument Short Form. Variables that determined the level of services were the following: age, place of residence, marital status, number of chronic diseases, and level of disease acceptance, quality of life, and health behaviors. The level of provided services correlated with variables such as gender, severity of somatic symptoms, level of satisfied needs, and satisfaction with health care. We concluded that in patients with mixed chronic respiratory diseases a higher level of health care utilization should be expected in younger patients, those living in the countryside, those having a partner, with multimorbidity, a low level of disease acceptance, those satisfied with their current quality of life, with positive mental attitudes, and maintaining health practices.

[Factors related to dissatisfaction and anger in parents of children treated at paediatric emergency services].

PubMed

Fernández-Castillo, A; Vílchez-Lara, M J

2015-01-01

Anger in patients and relatives is very frequent in health emergency services and is often associated with aggressiveness and emotional alterations. The aim of the present study is to explore anger in parents while their children are receiving care in paediatric emergency services, seeking the specific dimensions of dissatisfaction that may predict the onset of anger in parents. A cross-sectional descriptive study using a self-report questionnaire in 711 parents of children seen in paediatric emergency departments. The self-report questionnaires used were the State-Trait Anger Expression Inventory-2 (STAXI-2) and the Satisfaction with Healthcare Services Scale. The statistical analysis included descriptive, correlational, variance and multiple linear regression models. A total of 53 parents (7,5%) showed a moderate or high anger level. The mean score for satisfaction was 37.12 (SD=7.33). It was found that higher levels of overall satisfaction were significantly associated with lower levels of anger (r=-.29, p=.00). Among the variables studied, dissatisfaction with access to the service (β=-.172, p=.00), with the healthcare staff (β=-.121, p=.01), and perceived severity of the child's health status (β=.157, p=.00) predicted higher levels of anger. On the basis of our results, it is important to continue working to substantially improve access for patients and their families to the emergency department, as well as the information and communication process with the healthcare staff should be included in intervention initiatives. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Patterns and predictors of health service utilization in adolescents with pain: comparison between a community and a clinical pain sample.

PubMed

Toliver-Sokol, Marisol; Murray, Caitlin B; Wilson, Anna C; Lewandowski, Amy; Palermo, Tonya M

2011-07-01

There is limited research describing the patterns of healthcare utilization in adolescents with chronic pain. This study describes healthcare utilization in a clinical chronic pain sample, and compares the patterns of service use of this group to a community sample with intermittent pain complaints. We also investigated demographic and clinical factors that predicted healthcare visits and medication use in the clinical sample. Data on 117 adolescents (aged 12-18; n = 59 clinical pain sample, n = 58 community) were collected. Caregivers and adolescents reported on sociodemographics, medical visits, current medications, pain, activity limitations, and depression. As hypothesized, the clinical pain sample had higher rates of healthcare consultation on all types of medical visits (general, specialty care, complementary medicine, mental health, OT/PT), and higher medication use compared to the community sample. Regression analyses revealed that higher annual income, greater pain frequency, and higher levels of caregiver-reported activity limitations were associated with a greater number of healthcare visits for the total sample. Within the clinical pain sample, higher pain frequency and greater activity limitations (caregiver report) predicted more specialty care visits. Additionally, higher income and greater levels of depressive symptoms predicted a higher number of prescribed medications. This study contributes to the limited available data on health service and medication use in a clinical chronic pain sample versus a community sample of adolescents. We also identify clinical factors (pain frequency, parent-reported activity limitations, depressive symptoms) and demographic factors (gender, income) associated with healthcare utilization. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

The costs of public primary health care services in rural Indonesia.

PubMed Central

Berman, P.; Brotowasisto; Nadjib, M.; Sakai, S.; Gani, A.

1989-01-01

Described are the results of a cost study of national rural health services carried out in Indonesia between November 1986 and March 1987. Detailed costings of government inputs to all public health services below the district hospital level were made for 41 subdistricts in five provinces that were representative of the different regions of the country. The total costs of services as well as the average costs for specific service functions were estimated for the whole country as well as for the different provinces. The results indicate a low overall level of government spending on rural primary health care. Regional differences in this respect were not significant, suggesting that the government policy of encouraging regional balance in allocations has been successful. The average costs for most services were much greater than the charges made to patients, and this provided information on the current level of government subsidies. There was a large variability in the average costs, indicating that the existing system is inefficient, that some districts were able to attain much higher levels of efficiency than others within the existing constraints, and that improvements in this respect are possible. PMID:2517412

Prediction of community mental health service utilization by individual and ecological level socio-economic factors.

PubMed

Donisi, Valeria; Tedeschi, Federico; Percudani, Mauro; Fiorillo, Andrea; Confalonieri, Linda; De Rosa, Corrado; Salazzari, Damiano; Tansella, Michele; Thornicroft, Graham; Amaddeo, Francesco

2013-10-30

Individuals with a more deprived socioeconomic status (SES) are more likely to have higher rates of psychiatric morbidity and use of psychiatric services. Such service use is also influenced by socioeconomic factors at the ecological level. The aim of this article is to investigate the influence of these variables on service utilization. All patients in contact with three Italian community psychiatric services (CPS) were included. Community and hospital contacts over 6 months were investigated. Socio-economic characteristics were described using a SES Index and two new Resources Accessibility Indexes. Low SES was found to be associated with more community service contacts. When other individual and ecological variables were controlled for, SES was negatively associated only with the number of home visits, which was about half the rate in deprived areas. An association between service utilization and the resources of the catchment area was also detected. The economic crisis in Europe is increasing inequality of access, so paying attention to SES characteristics at both the individual and the ecological levels is likely to become increasingly important in understanding patterns of psychiatric service utilization and planning care accordingly. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Personal Norm of Reciprocity among mental health service users: conceptual development and measurement.

PubMed

Matejkowski, Jason; McCarthy, Kevin S; Draine, Jeffrey

2011-01-01

A measure of an individual's level of internalization of the norm of reciprocity may signal exchange preferences and indicate whether "active" or "passive" mental health services are preferable to consumers. We evaluated the psychometric properties of one such measure, the Personal Norm of Reciprocity (PNR) scale. We recruited 70 persons receiving mental health services and 65 comparison participants to complete questionnaires assessing reciprocity tendencies and correlates of mental illness. Two of three subscales of a shortened PNR showed evidence of reliability and validity. Consumers endorsed higher levels of the reciprocity norm than persons not seeking services. Persons in "active" service settings displayed greater rigidity in application of the reciprocity norm than individuals in "passive" service settings or comparison participants. The shortened PNR can be a useful measure of individual reciprocity preferences. Measurement of the internalization of the norm of reciprocity may assist practitioners in identifying what types of services are more likely to retain and benefit mental health service consumers.

Knowledge of Alzheimer's disease, feelings of shame, and awareness of services among Korean American elders.

PubMed

Yuri Jang; Kim, Giyeon; Chiriboga, David

2010-06-01

To explore predictors of knowledge of Alzheimer's disease (AD), feelings of shame if a family member were to have AD, and awareness of AD-related services among Korean American elders. Using data from 675 Korean American elders (mean age = 70.2, SD = 6.87), the study estimates hierarchical linear or logistic regression models. Greater knowledge of AD is predicted by higher levels of education and acculturation. Feelings of shame associated with family members having AD are more likely to be reported by individuals with lower levels of education, acculturation, and knowledge of AD. Those who are married have greater levels of education and acculturation, and those who have a family member with AD are more aware of AD-related services. The study findings underscore the pivotal role of education and acculturation in predicting knowledge of AD, feelings of shame, and awareness of AD-related services.

Mental Health Treatment Involvement and Religious Coping among African American, Hispanic, and White Veterans of the Wars of Iraq and Afghanistan

PubMed Central

Greenawalt, David S.; Tsan, Jack Y.; Kimbrel, Nathan A.; Meyer, Eric C.; Kruse, Marc I.; Tharp, David F.; Gulliver, Suzy Bird; Morissette, Sandra B.

2011-01-01

Although racial/ethnic differences have been found in the use of mental health services for depression in the general population, research among Veterans has produced mixed results. This study examined racial/ethnic differences in the use of mental health services among 148 Operation Enduring/Iraqi Freedom (OEF/OIF) Veterans with high levels of depression and posttraumatic stress disorder (PTSD) symptoms and evaluated whether religious coping affected service use. No differences between African American, Hispanic, and Non-Hispanic white Veterans were found in use of secular mental health services or religious counseling. Women Veterans were more likely than men to seek secular treatment. After controlling for PTSD symptoms, depression symptom level was a significant predictor of psychotherapy attendance but not medication treatment. African American Veterans reported higher levels of religious coping than whites. Religious coping was associated with participation in religious counseling, but not secular mental health services. PMID:21785719

Human service work, gender and antidepressant use: a nationwide register-based 19-year follow-up of 752 683 women and men.

PubMed

Buscariolli, André; Kouvonen, Anne; Kokkinen, Lauri; Halonen, Jaana I; Koskinen, Aki; Väänänen, Ari

2018-06-01

To examine antidepressant use among male and female human service professionals. A random sample of individuals between 25 years and 54 years of age (n=752 683; 49.2% women; mean age 39.5 years). Information about each individual's filled antidepressant prescriptions from 1995 to 2014 was provided by the Social Insurance Institution. First, antidepressant use in five broad human service categories was compared with that in all other occupations grouped together, separately for men and women. Then, each of the 15 human service professions were compared with all other occupations from the same skill/education level (excluding other human services professions). Cox models were applied and the results are presented as HRs for antidepressant use with 95% CIs. The hazard of antidepressant use was higher among men working in human service versus all other occupations with the same skill/occupational level (1.22, 95% CI 1.18 to 1.27), but this was not the case for women (0.99, 95% CI 0.98 to 1.01). The risks differed between professions: male health and social care professionals (including medical doctors, nurses, practical nurses and home care assistants), social workers, childcare workers, teachers and psychologists had a higher risk of antidepressant use than men in non-human service occupations, whereas customer clerks had a lower risk. Male human service professionals had a higher risk of antidepressant use than men working in non-human service occupations. Gendered sociocultural norms and values related to specific occupations as well as occupational selection may be the cause of the elevated risk. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Organizational effects on patient satisfaction in hospital medical-surgical units.

PubMed

Bacon, Cynthia Thornton; Mark, Barbara

2009-05-01

The purpose of this study was to examine the relationships between hospital context, nursing unit structure, and patient characteristics and patients' satisfaction with nursing care in hospitals. Although patient satisfaction has been widely researched, our understanding of the relationship between hospital context and nursing unit structure and their impact on patient satisfaction is limited. The data source for this study was the Outcomes Research in Nursing Administration Project, a multisite organizational study conducted to investigate relationships among nurse staffing, organizational context and structure, and patient outcomes. The sample for this study was 2,720 patients and 3,718 RNs in 286 medical-surgical units in 146 hospitals. Greater availability of nursing unit support services and higher levels of work engagement were associated with higher levels of patient satisfaction. Older age, better health status, and better symptom management were also associated with higher levels of patient satisfaction. Organizational factors in hospitals and nursing units, particularly support services on the nursing unit and mechanisms that foster nurses' work engagement and effective symptom management, are important influences on patient satisfaction.

[The patient and family satisfaction with the department of mental health in Rome].

PubMed

Cozza, M; Amara, M; Butera, N; Infantino, G; Monti, A M; Provénzano, R

1997-01-01

Satisfaction's measurement with Mental Health Services in patients and their relatives. Satisfaction scale administration to the patients who were treated in community-based psychiatric service from 1.1.1996 to 31.3.1996 and the relatives who were primarily involved in caring for the patient. The ASL Rome "C" community-based psychiatric service. Verona Service Satisfaction Scale-54, a multidimensional instrument which measure satisfaction with community-based psychiatric service. Main results (301 scales for patients, 163 scales for relatives), pointed out for patients a higher satisfaction for the technical and interpersonal skills of psychiatrists and psychologists (score of specific items > 4). Lowest scores of satisfaction were towards the appearance, comfort level and physical layout of the facility (score 2.95) and towards the response of the service to emergencies during the night, weekend and Bank Holidays (score 2.87). Relatives were not particularly keen for the item regarding help to find open employment (score 2.76). Furthermore patients and their relatives gave a negative evaluation of the publicity and information offered by Mental Health Services. Dimension's analysis reaches the same conclusions deduced items's average score. The result of this study emphasizes the patients higher degree of satisfaction than the relatives. The above results point out three aspects to be improved by the Mental Health Service in order to satisfy the demands of the patients and relatives: 1. appearance, comfort level and physical layout of the facility, 2. publicity and information, 3. social activities and social skills.

The Potential Impact of Revising the Title I Comparability Requirement to Focus on School-Level Expenditures. A Policy Brief from the U.S. Department of Education, Policy and Program Studies Service

ERIC Educational Resources Information Center

Office of Planning, Evaluation and Policy Development, US Department of Education, 2011

2011-01-01

The "Elementary and Secondary Education Act of 1965" ("ESEA") requires that school districts provide services to higher-poverty, Title I schools, from state and local funds, that are at least comparable to services in lower-poverty, non-Title I schools. The current Title I comparability requirement allows school districts to…

Family Characteristics and Children's Receipt of Autism Services in Low-Resourced Families.

PubMed

Karp, Elizabeth A; Dudovitz, Rebecca; Nelson, Bergen B; Shih, Wendy; Gulsrud, Amanda; Orlich, Felice; Colombi, Costanza; Kuo, Alice A

2018-04-01

Parents of children with autism spectrum disorder (ASD) face competing demands when caring for their child and fulfilling family commitments. It remains unknown whether family obligations and parental stress might decrease the use of intervention services for young children with ASD. The current study is a secondary analysis of baseline date from a published randomized control trial with 147 low-resourced caregiver-child dyads. Demographic information, data on service use, maternal employment, parent's perception of their child's development, and parental stress were collected for primary caregivers of 2- to 5-year-old children with ASD from 5 sites. Multiple logistic regressions of accessing any intervention services or more than 1 services on familial characteristics were performed, controlling for demographic and contextual variables. Twenty-five percent of children were receiving no intervention service; 26% were receiving 1 service; and 49% were receiving 2 or more services. Perceived developmental delay and not having a sibling in the home were associated with higher odds of receiving intervention services. Children were more likely to receive more than 1 service if their parents had at least a college education and low levels of stress. Factors including perceived developmental level, parental stress, and caring for siblings may play a role in accessing services for children with ASD. Results reveal that competing family needs may be barriers to service use. Mothers of children with ASD with multiple children in the home, low levels of education, and high levels of stress may need additional supports or alternative service delivery models. Copyright © 2018 by the American Academy of Pediatrics.

Support services for higher degree research students: a survey of three Australian universities

NASA Astrophysics Data System (ADS)

Silva, Pujitha; Woodman, Karen; Taji, Acram; Travelyan, James; Samani, Shamim; Sharda, Hema; Narayanaswamy, Ramesh; Lucey, Anthony; Sahama, Tony; KDV Yarlagadda, Prasad

2016-09-01

A survey was conducted across three Australian universities to identify the types and format of support services available for higher degree research (HDR, or MA and Ph.D.) students. The services were classified with regards to availability, location and accessibility. A comparative tool was developed to help institutions categorise their services in terms of academic, administrative, social and settlement, language and miscellaneous (other) supports. All three universities showed similarities in the type of academic support services offered, while differing in social and settlement and language support services in terms of the location and the level of accessibility of these services. The study also examined the specific support services available for culturally and linguistically diverse (CALD) students. The three universities differed in their emphases in catering to CALD needs, with their allocation of resources reflecting these differences. The organisation of these services within the universities was further assessed to determine possible factors that may influence the effective delivery of these services, by considering HDR and CALD student specific issues. The findings and tools developed by this study may be useful to HDR supervisors and university administrators in identifying key support services to better improve outcomes for the HDR students and universities.

Effect of Women's autonomy on maternal health service utilization in Nepal: a cross sectional study.

PubMed

Adhikari, Ramesh

2016-05-13

Women's role has been a priority area not only for sustainable development, but also in reproductive health since ICPD 1994. However, very little empirical evidence is available about women's role on maternal health service utilization in Nepal. This paper explores dimensions of women's autonomy and their relationship to utilization of maternal health services. The analysis uses data from the Nepal Demographic and Health Survey, 2011. The analysis is confined to women who had given birth in the 5 years preceding the survey (n = 4,148). Women's autonomy related variables are taken from the standard DHS questionnaire and measured based on decision in household about obtaining health care, large household purchases and visit to family or relative. The net effect of women's autonomy on utilization of maternal health services after controlling for the effect of other predictors has been measured through multivariate logistic regression analysis. The findings indicate only about a half of the women who had given birth in the past 5 years preceding the survey had 4 or more ANC check up for their last birth. Similarly, 40 % of the women had delivered their last child in the health facilities. Furthermore, slightly higher than two-fifth women (43 %) had postnatal check up for their last child. Only slightly higher than a fourth woman (27 %) had utilized all the services (adequate ANC visit, delivered at health institution and post natal check up) for their last child. This study found that many socio-demographic variables such as age of women, number of children born, level of education, ethnicity, place of residence and wealth index are predicators of utilizing the maternal health services of recent child. Notably, higher level autonomy was associated with higher use of maternal health services [adjusted odds ratio (aOR) =1.40; CI 1.18-1.65]. Utilization of maternal health services for the recent child among women is very low. The study results suggest that policy actions that increase women's autonomy at home could be effective in helping assure good maternal health.

Factors Associated with Service Use among Immigrants in the Child Welfare System

ERIC Educational Resources Information Center

Rajendran, Khushmand; Chemtob, Claude M.

2010-01-01

This study investigated child, caregiver, and caseworker factors associated with greater use of family support services by immigrant families in the U.S. child welfare system. Among child factors, higher levels of internalizing behavior problems (Odds Ratio (O.R.) = 3.60), externalizing behavior problems (O.R. = 2.62) and a history of neglect…

Tertiary education and its association with mental health indicators and educational factors among Arctic young adults: the NAAHS cohort study

PubMed Central

Bania, Elisabeth Valmyr; Kvernmo, Siv Eli

2016-01-01

Background Completed tertiary education is closely associated with employment and influences income, health and personal well-being. Objective The purpose of the study is to explore predictors for completed tertiary education among indigenous Sami and non-indigenous young people in relation to mental health indicators and educational factors in sociocultural rural and urban contexts across the Arctic part of Norway. Design The Norwegian Arctic Adolescent Health Study (NAAHS) is a cross-sectional, school-based survey that was conducted in 2003–2005. Of all 5,877 10th graders (aged 15–16 years) in north Norway, 83% from all 87 municipalities participated; 450 (9.2%) reported indigenous Sami ethnicity, and 304 (6.2%) reported Laestadian affiliation. Data from NAAHS were merged with registry data from the National Education Database and Norwegian Patient Register for 3,987 adolescents who gave their consent for follow-up studies. Results Completion of upper secondary school is the only common predictor of a completed tertiary education degree for both genders. Among females, conduct problems was a significant predictor of lower level education, typically vocational professions, while among males severe mental health problems requiring treatment by the specialist health care system reduced the opportunity to complete tertiary education at intermediate and higher level. Parental higher educational level was associated with less lower education among females and less higher education among males. Men residing in the northernmost and remote areas were less likely to complete education on higher level. Males’ completion of higher level education was strongly but not significantly associated (p=0.057) with higher average marks in lower secondary school. Conclusions The gender differences found in this study emphasize the need for gender-specific interventions to encourage, support and empower young people to attend and complete tertiary education. Young females with conduct problems choose lower or intermediate education, and males in need of specialist mental health care have half the chance to complete intermediate tertiary education compared with males not in contact with the mental health service. Closer cooperation between low threshold social services, general practitioners, mental health services and higher study institutions can help young male adults complete tertiary education. PMID:28156413

Some Resentments and Fears of Pre Service Teachers

ERIC Educational Resources Information Center

Welter, Paul R.

1971-01-01

Typescript excerpts from group counseling sessions suggest that schools of education need to pitch their teaching and testing at higher cognitive levels. Giving primary attention to the bare knowledge or memory level is not only ineffective but also an unnecessary source of resentment among students. (Author)

Psychologists in Academic Administration: A Call to Action and Service.

PubMed

Schmaling, Karen B; Linton, John C

2017-06-01

Academic psychologists' backgrounds may prepare them for many aspects of academic administration such as: understanding and working with people; prioritizing others' needs and institutional needs; and managing projects and budgets, e.g., for research grants or training programs. Contemporary academic health centers also may provide opportunities for psychologists to serve in academic health administration. This article encourages psychologists to consider preparing for and seeking administrative and higher-level leadership roles. Six psychologists serving diverse administrative roles-from vice chairs in medical school departments to presidents of universities with academic health centers-reflected on: their paths to administration; their preparation for administrative roles; and the commonalities and differences between the work and skills sets of psychologist health service providers and the work and skill sets required for higher level administrative and leadership roles.

Dental health services utilization and associated factors in children 6 to 12 years old in a low-income country.

PubMed

Medina-Solis, Carlo Eduardo; Maupomé, Gerardo; del Socorro, Herrera Miriam; Pérez-Núñez, Ricardo; Avila-Burgos, Leticia; Lamadrid-Figueroa, Hector

2008-01-01

To determine the factors associated with the dental health services utilization among children ages 6 to 12 in León, Nicaragua. A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression. The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child's oral health, higher socioeconomic level, and higher oral health needs. Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used.

Healthcare utilization and expenditure analysis between individuals with intellectual disabilities and the general population in Taiwan: a population-based nationwide child and adolescent study.

PubMed

Chiang, Po-Huang; Chang, Yu-Chia; Lin, Jin-Ding; Tung, Ho-Jui; Lin, Lan-Ping; Hsu, Shang-Wei

2013-09-01

This study examines differences in outpatient-visit frequency and medical expenditures between (1) children and adolescents in Taiwan with intellectual disabilities and (2) children and adolescents in Taiwan's general population. A cross-sectional study was conducted to analyze data from 2007 provided by Taiwan's National Health Insurance program. A total of 236,045 beneficiaries younger than 19 years made use of outpatient services; among them, 35,802 had a principal diagnosis of mental retardation (intellectual disability). The average number of ambulatory visits was 14.9 ± 12.4, which is much higher than in the United States and other developed countries. The mean number of annual visits of the individuals with intellectual disabilities was significantly higher than that of the general population in Taiwan (20.1 ± 20.0 vs. 14.0 ± 12.2); age, gender, urbanization level of residential area, and copayment status affected outpatient visit frequency. The mean annual outpatient costs were NTD6371.3 ± NTD11989.1 for the general population and NTD19724.9 ± NTD40469.9 for those with intellectual disabilities (US $1 equals approximately NTD30). Age, gender, urbanization level of residential area, and copayment status were the determinants that accounted for this difference in cost. Children and adolescents with intellectual disabilities had higher use rates of rehabilitative and psychiatric services than the general population. We conclude that individuals with intellectual disabilities had higher demands than the general population for healthcare services, especially for rehabilitative and psychiatric services. Copyright © 2013 Elsevier Ltd. All rights reserved.

Exploring the Association between Macroeconomic Indicators and Dialysis Mortality

PubMed Central

Stel, Vianda S.; Caskey, Fergus J.; Stengel, Benedicte; Elliott, Robert F.; Covic, Adrian; Geue, Claudia; Cusumano, Ana; MacLeod, Alison M.; Jager, Kitty J.

2012-01-01

Summary Background and objectives Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population. Design, setting, participants, & measurements Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003–2005. General population age and health, macroeconomic indices, and renal service organization data were collected from secondary sources and questionnaires. Linear modeling with log–log transformation of the outcome variable was applied to establish factors associated with survival on dialysis. Results Two-year survival on dialysis ranged from 62.3% in Iceland to 89.8% in Romania. A higher gross domestic product per capita (hazard ratio=1.02 per 1000 US dollar increase), a higher percentage of gross domestic product spent on healthcare (1.10 per percent increase), and a higher intrinsic mortality of the dialysis population (i.e., general population-derived mortality risk of the dialysis population in that country standardized for age and sex; hazard ratio=1.04 per death per 10,000 person years) were associated with a higher mortality of the dialysis population. The incidence of dialysis and renal service indicators were not associated with mortality on dialysis. Conclusions Macroeconomic factors and the intrinsic mortality of the dialysis population are associated with international differences in the mortality on dialysis. Renal service organizational factors and incidence of dialysis seem less important. PMID:22837275

Exploring the association between macroeconomic indicators and dialysis mortality.

PubMed

Kramer, Anneke; Stel, Vianda S; Caskey, Fergus J; Stengel, Benedicte; Elliott, Robert F; Covic, Adrian; Geue, Claudia; Cusumano, Ana; Macleod, Alison M; Jager, Kitty J

2012-10-01

Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population. Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003-2005. General population age and health, macroeconomic indices, and renal service organization data were collected from secondary sources and questionnaires. Linear modeling with log-log transformation of the outcome variable was applied to establish factors associated with survival on dialysis. Two-year survival on dialysis ranged from 62.3% in Iceland to 89.8% in Romania. A higher gross domestic product per capita (hazard ratio=1.02 per 1000 US dollar increase), a higher percentage of gross domestic product spent on healthcare (1.10 per percent increase), and a higher intrinsic mortality of the dialysis population (i.e., general population-derived mortality risk of the dialysis population in that country standardized for age and sex; hazard ratio=1.04 per death per 10,000 person years) were associated with a higher mortality of the dialysis population. The incidence of dialysis and renal service indicators were not associated with mortality on dialysis. Macroeconomic factors and the intrinsic mortality of the dialysis population are associated with international differences in the mortality on dialysis. Renal service organizational factors and incidence of dialysis seem less important.

Behavioral Health and Adjustment to College Life for Student Service Members/Veterans.

PubMed

Schonfeld, Lawrence; Braue, Lawrence A; Stire, Sheryl; Gum, Amber M; Cross, Brittany L; Brown, Lisa M

2015-01-01

Increasing numbers of student service members/veterans (SSM/Vs) are enrolling in college. However, little is known about how their previous military experience affects their adjustment to this new role. The present study tested the hypothesis that SSM/Vs who report adjustment problems in college have a higher incidence of posttraumatic stress disorder (PTSD), depression, and other behavioral health problems compared with those who do not report adjustment problems. SSM/Vs (N = 173) at a large, southeastern, public university completed online surveys that included well-validated screens measuring substance use, depression, PTSD, and other mental disorders. Those reporting difficulties adjusting to university life (28%) reported significantly higher frequencies of behavioral and health problems while in the military, and significantly higher levels of PTSD, depression, and mental health disorders, but no difference in substance use. Implications for improved behavioral health screening and coordination of university behavioral health services with veterans' health systems are discussed.

[Estimation on value of water and soil conservation of agricultural ecosystems in Xi' an metropolitan, Northwest China].

PubMed

Yang, Wen-yan; Zhou, Zhong-xue

2014-12-01

With the urban eco-environment increasingly deteriorating, the ecosystem services provided by modern urban agriculture are exceedingly significant to maintain and build more suitable environment in a city. Taking Xi' an metropolitan as the study area, based on remote sensing data, DEM data and the economic and social statistics data, the water and soil conservation service of the agricultural ecosystems was valued employing the remote sensing and geographic information system method, covering the reduction values on land waste, soil fertility loss and sediment loss from 2000 to 2011, and analyzed its changes in time and space. The results showed that during the study period, the total value of water and soil conservation service provided by agricultural systems in Xi' an metropolitan was increased by 46,086 and 33.008 billion yuan respectively from period of 2000 to 2005 and from 2005 to 2011. The cultivated land (including grains, vegetables and other farming land), forest (including orchard) and grassland provided higher value on the water and soil conservation service than waters and other land use. Ecosystem service value of water and soil conserva- tion provided by agriculture was gradually decreasing from the southern to the northern in Xi' an metropolitan. There were significantly positive relationship between the ecosystem service value and the vegetation coverage. Forest, orchard and grassland distributed intensively in the southern which had higher vegetation coverage than in northern where covered by more cultivated land, sparse forest and scattered orchard. There were significantly negative correlation between the urbanization level and the value of water and soil conservation. The higher level of urbanization, the lower value there was from built-up area to suburban and to countryside within Xi' an metropolitan.

Hypothetical Insurance and Higher Education

ERIC Educational Resources Information Center

Colburn, Ben; Lazenby, Hugh

2016-01-01

What level of government subsidy of higher education is justified, in what form, and for what reasons? We answer these questions by applying the hypothetical insurance approach, originally developed by Ronald Dworkin in his work on distributive justice. On this approach, when asking how to fund and deliver public services in a particular domain,…

Personal Assistant Support for Students with Severe Physical Disabilities in Postsecondary Education

ERIC Educational Resources Information Center

Hedrick, Bradley N.; Stumbo, Norma J.; Martin, Jay K.; Martin, Liam G.; Nordstrom, David L.; Morrill, Joshua H.

2012-01-01

The purpose of this exploratory research is to document the level of personal assistance support provided to students with severe physical disabilities by disability support services in higher education institutions across the United States. A national survey was conducted of members of the Association of Higher Education And Disability (AHEAD)…

2008-09 Financial Aid Report

ERIC Educational Resources Information Center

Nevada System of Higher Education, 2010

2010-01-01

The mission of the Nevada System of Higher Education (NSHE) is to provide higher education services to the citizens of the State at an excellent level of quality consistent with the state's resources. The information in this report is provided by the financial aid officers at each NSHE institution. Each fall, institutions submit a detailed…

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

PubMed Central

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

2018-01-01

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

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

PubMed

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

2018-01-01

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

77 FR 26948 - Airworthiness Directives; Fokker Services B.V. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-08

... sliding member cracks is high compressive stress during braking at higher deceleration levels outside the regular fatigue load spectrum. Starting at deceleration stress levels somewhat below limit load, the high compressive stress locally exceeds the elasticity limit of the material, leaving a residual tensile stress at...

Development and evaluation of theory-based diabetes support services.

PubMed

Guo, Sophie Huey-Ming; Lin, Yung-Hsiu; Chen, Rong-Rong; Kao, Shu-Fen; Chang, Her-Kun

2013-01-01

Technology-enabled support services for diabetes can fulfill patient demand to care for diabetes independently. Patients benefit from such services after greater adoption of the services in healthcare systems. Unfortunately, conventional service development fails to thoroughly understand patient care support, making it difficult to achieve the desired design, and posing substantial challenges in adopting these services. Thus, previously developed services in many cases are not as patients expected, as evidenced by their low acceptance among patients. To solve this problem, adequate strategies must be developed by incorporating theoretical knowledge as a solid foundation in order to improve service design. This study develops technology-enabled diabetes support services based on the self-care theory. A set of self-care service scenarios is also established and combined with theoretical concepts. The developed services consist of a nurse-led consultation service and a mobile application service. Additionally, user acceptance is confirmed by assessing patient perceptions of the diabetes support services in a group of patients with diabetes (N=27). Results of analysis reveal that patients respond favorably toward the services. Patient preference and perceived ease of use attest to their intention to use the services. Greater adoption of the services can be anticipated, owing to a higher levels of preference and higher perceived ease of use. This study demonstrated that the self-care theory can be linked to nursing informatics research and chronic care clinical practices.

Reliability theory for repair service organization simulation and increase of innovative attraction of industrial enterprises

NASA Astrophysics Data System (ADS)

Dolzhenkova, E. V.; Iurieva, L. V.

2018-05-01

The study presents the author's algorithm for the industrial enterprise repair service organization simulation based on the reliability theory, as well as the results of its application. The monitoring of the industrial enterprise repair service organization is proposed to perform on the basis of the enterprise's state indexes for the main resources (equipment, labour, finances, repair areas), which allows quantitative evaluation of the reliability level as a resulting summary rating of the said parameters and the ensuring of an appropriate level of the operation reliability of the serviced technical objects. Under the conditions of the tough competition, the following approach is advisable: the higher efficiency of production and a repair service itself, the higher the innovative attractiveness of an industrial enterprise. The results of the calculations show that in order to prevent inefficient losses of production and to reduce the repair costs, it is advisable to apply the reliability theory. The overall reliability rating calculated on the basis of the author's algorithm has low values. The processing of the statistical data forms the reliability characteristics for the different workshops and services of an industrial enterprise, which allows one to define the failure rates of the various units of equipment and to establish the reliability indexes necessary for the subsequent mathematical simulation. The proposed simulating algorithm contributes to an increase of the efficiency of the repair service organization and improvement of the innovative attraction of an industrial enterprise.

Facility and market factors affecting transitions from nursing home to community.

PubMed

Arling, Greg; Abrahamson, Kathleen A; Cooke, Valerie; Kane, Robert L; Lewis, Teresa

2011-09-01

Research into nursing home transitions has given limited attention to the facility or community contexts. To identify facility and market factors affecting transitions of nursing home residents back to the community. Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional conditions. Facility discharge rates were adjusted using Empirical Bayes estimation. Annual cohort of first-time admissions (N=24,648) to 378 Minnesota nursing facilities in 75 nursing home markets from July 2005 to June 2006. Community discharge within 90 days of admission; facility occupancy, payer mix, ownership, case-mix acuity, size, admissions from hospitals, nurse staffing level, and proportion of admissions preferring or having support to return to the community; and nursing market population size, average occupancy, market concentration, and availability of home and community-based services. Rates of community discharge (Empirical Bayes residual) were highest in facilities with more residents preferring community discharge, more Medicare days, higher nurse staffing levels, and higher occupancy. In addition, facilities had higher community discharge rates if they were located in markets with a greater ratio of home and community-based services recipients to nursing home residents and with larger populations. State Medicaid programs should undertake system-level interventions that encourage nursing facilities to reduce unused bed capacity, balance the mix of payers, invest in nurse staffing, and take other steps to promote community discharges. In addition, states should increase home and community-based services, particularly in markets with low community discharge rates.

Disability inclusion in higher education in Uganda: Status and strategies.

PubMed

Emong, Paul; Eron, Lawrence

2016-01-01

Uganda has embraced inclusive education and evidently committed itself to bringing about disability inclusion at every level of education. Both legal and non-legal frameworks have been adopted and arguably are in line with the intent of the Convention on the Rights of Persons with Disabilities (CRPD) on education. The CRPD, in Article 24, requires states to attain a right to education for persons with disabilities without discrimination and on the basis of equal opportunities at all levels of education. Despite Uganda's robust disability legal and policy framework on education, there is evidence of exclusion and discrimination of students with disabilities in the higher education institutions. The main objective of this article is to explore the status of disability inclusion in higher education and strategies for its realisation, using evidence from Emong's study, workshop proceedings where the authors facilitated and additional individual interviews with four students with disabilities by the authors. The results show that there are discrimination and exclusion tendencies in matters related to admissions, access to lectures, assessment and examinations, access to library services, halls of residence and other disability support services. The article recommends that institutional policies and guidelines on support services for students with disabilities and special needs in higher education be developed, data on students with disabilities collected to help planning, collaboration between Disabled Peoples Organisations (DPO's) strengthened to ensure disability inclusion and the establishment of disability support centres.

Clients’ satisfaction with quality of childbirth services: A comparative study between public and private facilities in Limuru Sub-County, Kiambu, Kenya

PubMed Central

2018-01-01

Background This study intended to compare the clients’ satisfaction with the quality of childbirth services in a private and public facility amongst mothers who have delivered within the last twenty four to seventy hours. Methods This was a cross-sectional comparative research design with both quantitative and qualitative data collection and analysis methods. Data were collected through a focused group discussion guide and structured questionnaire collecting information on clients’ satisfaction with quality of childbirth services. The study was conducted amongst women of reproductive age (WRA) between 15–49 years in Tigoni District hospital (public hospital) and Limuru Nursing home (private hospital). For quantitative data we conducted descriptive analysis and Mann-Whitney test using SPSS version 20.0 while qualitative data was manually analyzed manually using thematic analysis. Results A higher proportion of clients from private facility 98.1% were attended within 0–30 minutes of arrival to the facility as compared to 87% from public facility. The overall mean score showed that the respondents in public facility gave to satisfaction with the services was 4.46 out of a maximum of 5.00 score while private facility gave 4.60. The level of satisfaction amongst respondents in the public facility on pain relief after delivery was statistically significantly higher than the respondents in private facilities (U = 8132.50, p<0.001) while the level of satisfaction amongst respondents in the public facility on functional equipment was statistically significantly higher than the respondents in private facilities (U = 9206.50, p = 0.001). Moreover, level of satisfaction with the way staff responded to questions and concerns during labour and delivery was statistically significantly higher than the respondents in private facilities (U = 9964.50, p = 0.022). Conclusion In overall, majority of clients from both public and private facilities expressed satisfaction with quality of services from admission till discharge in both public and private facilities and were willing to recommend other to come and deliver in the respective facilities. PMID:29538385

Predictors of posttraumatic stress symptoms among runaway youth utilizing two service sectors.

PubMed

Thompson, Sanna J; Maccio, Elaine M; Desselle, Sherry K; Zittel-Palamara, Kimberly

2007-08-01

Youth who run away often experience situations that produce symptoms of traumatic distress. This exploratory study assessed predictors of trauma symptomatology among runaway youth who had been admitted to youth emergency shelter services or juvenile detention. Findings demonstrated high levels of trauma-related symptoms for both groups. Worry about family, greater runaway episodes, and living with a father who abused alcohol/drugs significantly predicted higher posttraumatic stress symptoms in detained youth, whereas only worry about family relationships predicted higher trauma symptom scores among youth in emergency shelter care. Findings suggest distressful family life may induce complex emotional responses in youth. Although services to runaway youth must continue to focus on safe, short-term residential care, trauma issues must be acknowledged.

Measuring the cost-effectiveness of a national health communication program in rural Bangladesh.

PubMed

Hutchinson, Paul; Lance, Peter; Guilkey, David K; Shahjahan, Mohammad; Haque, Shahida

2006-01-01

In this article we examine the cost-effectiveness of the Smiling Sun multichannel media campaign, which was undertaken in Bangladesh from 2001 to 2003 and involved a nationally broadcast television serial drama supported by radio, television, newspaper, and billboard advertisements and local promotion activities. The goal was to encourage the use of a package of family health services at NGO (nongovernmental organization) Service Delivery Program (NSDP) providers. This analysis relates the costs of the Smiling Sun campaign at the national and local level to measures of change in the use of health services, namely, antenatal care and childhood immunizations. Effectiveness is measured using data from cross-sectional surveys conducted in 2001 and 2003 in NSDP catchment areas in rural Bangladesh. The statistical approach, bivariate probit estimation, controls for nonrandom exposure to the program's media messages, advertisements, and signs. Using national-level data, we find that the Smiling Sun campaign was both effective and cost-effective, inducing higher levels of service utilization for only $0.05 per additional antenatal care (ANC) user and only $0.30 and $0.36 for each additional child vaccinated for measles and DPT3, respectively. With respect to local promotion activities, the cost per attributable behavior change was considerably higher--nearly $8 per new ANC user, $37 per new DPT3 vaccination, and $32 per new measles vaccination.

[Health status comparative analysis of the emercom of Russia Federal fire service employees and contract servicemen in the Russian Army].

PubMed

Koteev, P K; Kireev, S G; Golovinova, V Iu

2013-08-01

Results of health status comparative analysis of the emercom of Russia Federal fire service employees and contract servicemen in the Russian Army are submitted as following. The emercom of russia firemen's average annual rate of primary morbidity is 459,1, that of labor losses' days 8430,8, of disability 0,9, and mortality cases 0,7. The russian army contract servicemen's average annual rate of primary morbidity during the covered period comes to 410,3, that of discharges 7,4, and mortality cases 1,3. The results of comparative analysis show that the rate of contract servicemen's primary morbidity is lower than that of emercom of Russia firemen below 10.6% (p < 0.001), whereas their discharge level is higher above 87% (p < 0.001). In the course of comparison of the emercom of Russia Federal fire service employees' and the Russian Army contract servicemen's primary morbidity structure it was revealed that the indexes of the diseases of respiratory system, traumas and poisoning are higher among the first ones. On the contrary, their indexes were lower in the sphere of circulatory system, skin and hypodermic cellulose diseases. The indexes of circulatory system diseases in the disability (discharge level) structure of the emercom of Russia Federal fire service employees were higher than those of other diseases. It is expedient to use the results of this research in forming of priority assignments and conducting of a complex of curative and prophylactic measures organized by the medical service of the emercom of Russia.

The effects of health sector market factors and vulnerable group membership on access to alcohol, drug, and mental health care.

PubMed

Stockdale, Susan E; Tang, Lingqi; Zhang, Lily; Belin, Thomas R; Wells, Kenneth B

2007-06-01

This study adapts Andersen's Behavioral Model to determine if health sector market conditions affect vulnerable subgroups' use of alcohol, drug, and mental health services (ADM) differently than the general population, focusing specifically on community-level predisposing and enabling characteristics. Wave 2 data (2000-2001) from the Health Care for Communities study, supplemented with cases from wave 1 (1997-1998), were merged with area characteristics taken from Census, Area Resource File (ARF), and other data sources. The study used four-level hierarchical logistic regression to examine access to ADM care from any provider and specialty ADM access. Interactions between community-level predisposing and enabling vulnerability characteristics with individual race/ethnicity, age, income category, and insurance type were explored. Nonwhites, the poor, uninsured, and elderly had lower likelihoods of service use, but interactions between race/ethnicity, income, age and insurance status with community-level vulnerability factors were not statistically significant for any service use. For ADM specialty care, those with Medicare, Medicaid, private fully managed, and private partially managed insurance, the likelihood of utilization was higher in areas with higher HMO penetration. However, for those with other insurance or no insurance plan, the likelihood of utilization was lower in areas with higher HMO penetration. Community-level enabling factors explain part of the effect of disadvantaged status but, with the exception of the effect of HMO penetration on the relationship between insurance and specialty care use, do not modify any of the residual individual-level effects of disadvantage. Interventions targeting both structural and individual levels may be necessary to address the problem of health disparities. More research with longitudinal data is necessary to sort out the causal direction of social context and ADM access outcomes, and whether policy interventions to change health sector market conditions can shift ADM treatment utilization.

[Use of an index of social welfare for health planning at a municipal level].

PubMed

Ochoa-Díaz López, H; Sánchez-Pérez, H J; Martínez-Guzmán, L A

1996-01-01

This paper analyzes the relationship between a living standards index for small areas based on census data and information on morbidity and health care utilization. The information was gathered through a health interview survey of a random sample of 1 238 households from rural areas of Tlaxcala, Mexico. The population from localities with lower living standards showed significantly higher prevalences of morbidity and worse self-reported health status measures, as compared to localities with higher living standards. On the contrary, higher living standards were related with a greater utilization of health services. The approach proved to be useful in discriminating localities and areas of high and low prevalence of morbidity and utilization of health care services, which in turn could be used to identify those areas where needs are greatest. The implications of the results for health planning and resource allocation (based on population health needs and underlying social conditions) at the local level are discussed.

Dispensing Equipment Testing with Mid-Level Ethanol/Gasoline Test Fluid: Summary Report

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

Boyce, K.; Chapin, J. T.

The National Renewable Energy Laboratory's (NREL) Nonpetroleum-Based Fuel Task addresses the hurdles to commercialization of biomass-derived fuels and fuel blends. One such hurdle is the unknown compatibility of new fuels with current infrastructure, such as the equipment used at service stations to dispense fuel into automobiles. The U.S. Department of Energy's (DOE) Vehicle Technology Program and the Biomass Program have engaged in a joint project to evaluate the potential for blending ethanol into gasoline at levels higher than nominal 10 volume percent. This project was established to help DOE and NREL better understand any potentially adverse impacts caused by amore » lack of knowledge about the compatibility of the dispensing equipment with ethanol blends higher than what the equipment was designed to dispense. This report provides data about the impact of introducing a gasoline with a higher volumetric ethanol content into service station dispensing equipment from a safety and a performance perspective.« less

Risk of HIV infection among indoor and street sex workers and their use of health services in Belgrade, Serbia.

PubMed

Ilić, Dragan; Sipetić, Sandra; Bjegović, Vesna

2010-01-01

HIV in Serbia is most often transmitted through sexual contact, and therefore numerous prevention activities are geared towards sex workers (SW). To analyse the differences in knowledge, attitudes and risky behaviour between indoor and street SW in Belgrade; to examine the accessibility of health services to this vulnerable group. In this behavioural cross-sectional study, 113 street and 78 indoor SW were included. The sampling method used was snowball samples. Data were gathered through structured questionnaires. Around 15% of respondents used drugs intravenously. Around 60% of SW used a condom during the last sexual intercourse with their private partner, and around 90% with a commercial partner. Indoor SW had lower levels of education more often than outdoor SW, and they used marijuana, sedatives and painkillers on a daily basis. A significantly higher number of indoor SW were informed about HIV, HBV and HCV testing, and that the risk for HIV infection is not lower ifa condom is used exclusively for vaginal sex. Indoor SW reported using health services and testing and counselling for HIV, HBV and HCV more frequently than outdoor SW. Outdoor SW had significantly more sex partners in the previous month than indoor SW. Indoor SW recognized more frequently that providing sex services posed a higher risk for HIV infection. The results of this research study show that even though outdoor SW had higher levels of education than indoor SW, their level of knowledge about HIV transmission was lower and they reported more risky behaviour than indoor SW. Data show that both groups reported not taking care of their health.

Live-In Versus Live-Out Home Care in Israel: Satisfaction With Services and Caregivers' Outcomes.

PubMed

Ayalon, Liat; Green, Ohad

2015-08-01

The present study provides a preliminary examination of the relationship between the type of home care services (live-in vs. live-out; i.e., round the clock vs. several hours per week), the caregiver's satisfaction with services, and the caregiver's burden, distress, well-being, and subjective health status within the conceptual framework of caregiving outcomes proposed by Yates and colleagues (Yates, M. E., Tennstedt, S., & Chang, B. H. [1999]. Contributors to and mediators of psychological well-being for informal caregivers. Journal of Gerontology: Psychological Sciences, 54, P12 -P22. doi:10.1093/geronb/54B.1.P12). A random stratified sample of family caregivers of older adults more than the age of 70 who receive live-in (442) or live-out (244) home care services through the financial assistance of the National Insurance institute of Israel was selected. A path analysis was conducted. Satisfaction with services was higher among caregivers under the live-in home care arrangement and positively related to well-being. Among caregivers, live-in home care was directly associated with higher levels of subjective health and indirectly associated with better well-being via satisfaction with services. The present study emphasizes the potential benefits of live-in home care services for caregivers of older adults who suffer from high levels of impairment and the importance of assessing satisfaction with services as a predictor of caregivers' outcomes. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Focus on vulnerable populations and promoting equity in health service utilization--an analysis of visitor characteristics and service utilization of the Chinese community health service.

PubMed

Dong, Xiaoxin; Liu, Ling; Cao, Shiyi; Yang, Huajie; Song, Fujian; Yang, Chen; Gong, Yanhong; Wang, Yunxia; Yin, Xiaoxu; Xu, Xing; Xie, Jun; Sun, Yi; Lu, Zuxun

2014-05-26

Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors. The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs. The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened.

The impact of employee level and work stress on mental health and GP service use: an analysis of a sample of Australian government employees.

PubMed

Parslow, Ruth A; Jorm, Anthony F; Christensen, Helen; Broom, Dorothy H; Strazdins, Lyndall; D' Souza, Rennie M

2004-09-30

This study sought to identify the extent to which employee level and work stressors were associated with mental health problems experienced by Australian government employees, and with their use of primary care services. 806 government employees aged between 40 and 44 years were surveyed as part of an epidemiological study conducted in Australia. Data collected from participants included sociodemographic attributes, physical health, psychological measures and work stressors relating to job control, job demands, job security and skills discretion at work. For 88% of these participants, information on visits made to general practitioners (GPs) for the six months before and after their survey interview was obtained from health insurance records. When work stress and personal factors were taken into account, men at more junior levels reported better mental health, more positive affect and used fewer GP services. Women at middle-management levels obtained less GP care than their more senior counterparts. Both men and women who reported higher levels of work stress were found to have poorer mental health and well-being. The impact of such stressors on GP service use, however, differed for men and women. Measures of work stress and not employee level affect the mental health and well-being of government employees. For governments with responsibility for funding health care services, reducing work stress experienced by their own employees offers potential benefits by improving the health of their workforce and reducing outlays for such services.

Ecological concerns following Superstorm Sandy: stressor level and recreational activity levels affect perceptions of ecosystem

PubMed Central

2015-01-01

Coastal habitats are vulnerable to storms, and with increasing urbanization, sea level rise, and storm frequency, some urban populations are at risk. This study examined perceptions of respondents in coastal and central New Jersey to Superstorm Sandy, including: 1) concerns about ecological resources and effects (open-ended question), 2) information sources for ecology of the coast (open-ended), and 3) ratings of a list of ecological services as a function of demographics, location (coastal, central Jersey), stressor level (power outages, high winds, flooding) and recreational rates. “Wildlife” and “fish” were the ecological concerns mentioned most often, while beaches and dunes were most often mentioned for environmental concerns. Television, radio, and web/internet were sources trusted for ecological information. The data indicate 1) stressor level was a better predictor of ratings of ecological services than geographical location, but days engaged in recreation contributed the most to variations in ratings, 2) ecological services were rated the highest by respondents with the highest stressor levels, and by those from the coast, compared to others, 3) Caucasians rated ecological services higher than all others, and 4) recreational rates were highest for coastal respondents, and ratings for ecological services increased with recreational rates. Only 20 % of respondents listed specific ecological services as one of their three most important environmental concerns. These data will be useful for increasing preparedness, enhancing educational strategies for shore protection, and providing managers and public policy makers with data essential to developing resiliency strategies. PMID:27011729

Help-Seeking among Male Employees in Japan: Influence of Workplace Climate and Distress

PubMed Central

Maekawa, Yumiko; Ramos-Cejudo, Juan; Kanai, Atsuko

2016-01-01

Objectives: Although using mental health services is an effective way to cope with work-related stressors and diseases, many employees do not utilize these services despite service improvements in recent years. The present study aimed to investigate the interaction effects of workplace climate and distress on help-seeking attitudes, and elucidate the reasons for mental health service underutilization in Japan. Methods: A questionnaire was distributed to 650 full-time male Japanese employees. Hierarchical multiple regression analysis was used to investigate interaction effects of workplace climate and distress on help-seeking. Results: Results showed that the association between workplace climate and help-seeking attitudes differed depending on employee distress level. For employees experiencing low levels of distress, openness to seeking treatment increased with a higher evaluation of the mental health services available at the workplace. However, the same did not hold true for employees experiencing high levels of distress. Instead, openness to seeking treatment decreased with perceived risk for career disadvantage for high distress employees. Additionally, negative values for seeking treatment in highly distressed employees decreased only when services were perceived as valuable, and the risk to their career was perceived as low. Conclusions: Overall, these findings indicate that distress distorts the perception of social support, which may lead to underutilization of available services. Assessing employees' distress levels and tailoring adequate interventions could facilitate help-seeking in male employees. PMID:27725378

Resilience, Stress, Stigma, and Barriers to Mental Healthcare in U.S. Air Force Nursing Personnel.

PubMed

Hernandez, Stephen H A; Morgan, Brenda J; Parshall, Mark B

Stigma may deter military service members from seeking mental health (MH) services. Previously, substantial proportions of U.S. Air Force (USAF) registered nurses and medical technicians reported concerns about stigma with accessing MH services; in particular, that unit members might lose confidence in them or perceive them as weak, unit leadership might treat them differently, or accessing care might affect career advancement. This study assessed the extent to which stigma and barriers to accessing MH services as perceived by USAF nursing personnel are associated with resilience, stress, previous deployment, or demographic characteristics. An anonymous, online survey was administered to active-duty USAF registered nurses and medical technicians at three locations (N = 250). The survey included demographic items, the Stigma and Barriers to Care scales, Conner-Davidson Resilience Scale, and Perceived Stress Questionnaire. Mean resilience was high, and perceived stress was moderate. About half of participants agreed that unit members might have less confidence in me (54%) or unit leadership might treat me differently (58%). Many also had concerns that it would harm my career (47%), I would be seen as weak (47%), or there would be difficulty getting time off work for treatment (45%). Stigma was positively correlated with perceived stress (r = .40, p < .01) and negatively correlated with resilience (r = -.24, p < .01). Officers had significantly higher stigma and resilience scores and lower stress scores compared with enlisted personnel, but those differences were small. This study validated previous findings that substantial percentages of USAF nursing personnel have concerns that accessing MH services may adversely affect their careers and how they are viewed by unit leaders and peers. In addition, higher levels of concern about stigma were associated with higher levels of stress and lower levels of resilience. Limitations included a low response rate (18%) and self-selection biases.

Variation in teenage mothers' experiences of child care and other components of welfare reform: selection processes and developmental consequences.

PubMed

Yoshikawa, H; Rosman, E A; Hsueh, J

2001-01-01

Developmental evaluations of the current wave of welfare reform programs present challenges with regard to (1) assessing child outcomes; (2) accounting for heterogeneity among low-income families in both baseline characteristics and involvement in self-sufficiency activities and supports, and (3) development of alternatives to experimental approaches to causal inference. This study (N = 1,079) addresses these challenges by examining effects on 4- to 6-year-old children of different patterns of child care, self-sufficiency activities, and other service utilization indicators among experimental-group mothers in a 16-site welfare reform program. Outcomes in areas of cognitive ability and behavior problems were investigated. The study identified seven subgroups of participants engaging in different patterns of service utilization and activity involvement. A two-stage simultaneous equation methodology was used to account for selection, and effects on child cognitive ability of participation in specific patterns of services and activities were found. For example, children of mothers characterized by high levels of involvement in center-based child care, education, and job training showed higher levels of cognitive ability than children of mothers in groups characterized by high involvement in center-based care and education, or center-based care and job training. In addition, children of mothers in groups with high levels of involvement in any of these activities showed higher levels of cognitive ability than those with low levels of involvement. The bulk of selection effects occurred through site-level differences, rather than family-level socio-economic status or maternal depression indicators. Implications for welfare reform program and policy concerns are discussed.

Trends in characteristics of children served by the Children's Mental Health Initiative: 1994-2007.

PubMed

Walrath, Christine; Garraza, Lucas Godoy; Stephens, Robert; Azur, Melissa; Miech, Richard; Leaf, Philip

2009-11-01

Data from 14 years of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program were used to understand the trends of the emotional and behavioral problems and demographic characteristics of children entering services. The data for this study were derived from information collected at intake into service in 90 sites who received their initial federal funding between 1993 and 2004. The findings from this study suggest children entering services later in a site's funding cycle had lower levels of behavioral problems and children served in sites funded later in the 14 year period had higher levels of behavioral problems. Females have consistently entered services with more severe problems and children referred from non-mental health sources, younger children, and those from non-white racial/ethnic backgrounds have entered system of care services with less severe problems. The policy and programming implications, as well as implications for local system of care program development and implementation are discussed.

Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.

PubMed

Riley, Andrew R; Grennan, Allison; Menousek, Kathryn; Hoffses, Kathryn W

2018-03-01

Integration of psychological services into pediatric primary care is increasingly common, but models of integration vary with regard to their level of coordination, colocation, and integration. High-integration models may provide some distinct advantages, such as preventative care and brief consultation for subclinical behavior concerns; however, psychologists face barriers to seeking reimbursement for these services. Alternatives to traditional psychotherapy and psychological testing codes, specifically Health & Behavior (H&B) codes, have been proposed as 1 method for supporting integrated care. The aim of this study was to investigate the relationships between psychologists' reported billing practices, reimbursement rates, and model of integration in pediatric primary care. As part of a larger survey study, 55 psychologists working in pediatric primary care reported on characteristics of their practice's model of integration, billing practices, and frequency of reimbursement for consultative services. Compared with those who categorized their integrated care model as colocated, psychologists who endorsed working in integrated models reported a significantly higher usage of H&B codes and more frequent reimbursement for consultations. Overall, use of H&B codes was associated with higher reported levels of coordination and integration. Survey results showed a clear pattern of higher integration being associated with greater utilization of H&B codes and better reimbursement for consultation activities. These results underscore the importance of establishing and maintaining billing and reimbursement systems that adequately support integrated care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Management Development of Internal Evaluation in the Islamic Republic of Iran (Case Study)

ERIC Educational Resources Information Center

Keshavarz, Mohsen

2011-01-01

During the last two decades, many higher education systems in the world have attempted to evaluate and improve the quality of education, research and services at the university and higher education level. Countries which have been successful in these attempts have initiated continuous evaluation and applied internal evaluation as a basis for…

Developing Reflective Cyber Communities in the Blogosphere: A Case Study in Taiwan Higher Education

ERIC Educational Resources Information Center

Sun, Yu-Chih

2010-01-01

The purpose of this study is to highlight the possibilities and challenges that underlie efforts to integrate blogs into teacher-education programs in Taiwan higher education. The participants were 12 pre-service teachers undertaking Master's level study in Teaching English to Speakers of Other Languages. The outcomes of the blogging project were…

Marketing Higher Education in the 80's: "Aim for Service, Not Success, and Success Will Follow." Residual Marketing.

ERIC Educational Resources Information Center

Allen, Johnny Mac

Increasing competition in higher education for college students has given the term "enrollment management" wide acceptance in academia. Many factors are important to the success of enrollment management, including an informed enrollment management team of upper-level administrators committed to adopting a new philosophy in addition to…

Assessing the Utilization Level of E-Learning Resources among ODL Based Pre-Service Teacher Trainees

ERIC Educational Resources Information Center

Olaniran, Sunday O.; Duma, M. A. N.; Nzima, D. R.

2017-01-01

Electronic resources have become a dominant feature of higher education, both traditional and distance learning based. Unlike in the past when universities relied majorly on the physical library and hard copy of books, e-books accessible through e-libraries are the dominant features of this century's institutions of higher learning. This study…

Athletic Trainer Services in Public and Private Secondary Schools.

PubMed

Pike, Alicia M; Pryor, Riana R; Vandermark, Lesley W; Mazerolle, Stephanie M; Casa, Douglas J

2017-01-01

 The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored.  To compare the level of AT services in public and private secondary schools.  Concurrent mixed-methods study.  Public and private secondary schools in the United States.  A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private).  School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis.  A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators.  Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector.

Athletic Trainer Services in Public and Private Secondary Schools

PubMed Central

Pike, Alicia M.; Pryor, Riana R.; Vandermark, Lesley W.; Mazerolle, Stephanie M.; Casa, Douglas J.

2017-01-01

Context: The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored. Objective: To compare the level of AT services in public and private secondary schools. Design: Concurrent mixed-methods study. Setting: Public and private secondary schools in the United States. Patients or Other Participants: A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private). Main Outcome Measure(s): School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis. Results: A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators. Conclusions: Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector. PMID:28157403

Perceived overprotection: support gone bad?

PubMed

Cimarolli, Verena R; Reinhardt, Joann P; Horowitz, Amy

2006-01-01

This article focuses on the effects of perceived overprotection, a potentially problematic aspect of receiving support, on the ability to adjust to a chronic impairment, specifically, age-related vision loss. Perceived overprotection is an especially critical issue in this population of chronically ill older adults because of the safety issues associated with vision impairment and because perceptions on the part of the older adult that the support providers are overprotective may lead to excess disability. Participants were 584 older men and women with age-related vision impairment who applied for services at a vision rehabilitation agency. Path analysis was used to examine the effects of perceived overprotection on two positive indicators of adjustment: vision-specific adaptation and environmental mastery. Moreover, antecedents of perceived overprotection were examined. Higher levels of perceived overprotection were associated with less optimal adjustment to age-related vision loss, with lower scores on measures of vision-specific adaptation and environmental mastery. Higher levels of functional disability and instrumental support received were associated with higher levels of perceived overprotection. Findings indicate that support providers of older adults with visual impairment as well as vision rehabilitation service providers need to be aware of the detrimental impact of perceived overprotection.

Prevalence of dental caries in 5-year-old Greek children and the use of dental services: evaluation of socioeconomic, behavioural factors and living conditions.

PubMed

Mantonanaki, Magdalini; Koletsi-Kounari, Haroula; Mamai-Homata, Eleni; Papaioannou, William

2013-04-01

To assess dental caries and use of dental services experience in 5-year-old children attending public kindergartens in Attica, Greece and to examine the influence of certain socioeconomic factors and living conditions as well as dental behaviours and attitudes. In this cross-sectional study, a random and stratified sample of 605 Greek children was examined using decayed, missing, filled tooth surfaces and simplified debris indices. The use of dental services was measured by children's dental visits (any dental visit up to the age of 5 years). Care Index was also calculated. Risk indicators were assessed by a questionnaire. Zero-inflated Poisson and Logistic Regression Analysis were generated to test statistical significant associations. The prevalence of dental caries was 16.5%. Care Index was 32% and dental visits were reported for the 84% of the children. Medium Socio-Economic Level (SEL) was associated with no detectable caries. High SEL was related to decreased decayed, missing, filled teeth values, while female gender and rented houses had the opposite effect. The age of the mother (35-39 years) and the higher SEL were related to higher levels of dental services use. It is suggested that there are differences in the experience of dental caries and use of dental services among preschool children in Attica, which are related to demographic, socioeconomic factors and living conditions. Dental public polices should focus on groups with specific characteristics in order to improve oral health levels of disease-susceptible populations. © 2013 FDI World Dental Federation.

Are Women More Likely to Be Hired or Promoted into Management Positions?

ERIC Educational Resources Information Center

Lyness, Karen S.; Judiesch, Michael K.

1999-01-01

In a three-year study of 30,996 financial-services managers, logistic regression analyses showed that women were more likely to be promoted rather than hired into management positions. Relative to men, women in higher-level positions received fewer promotions than women in lower-level positions. (63 references) (SK)

76 FR 15342 - Workforce Investment Act; Lower Living Standard Income Level

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-21

... period that does not exceed the higher level of the poverty line or 70 percent of the LLSIL. This... Services ``Poverty Guidelines.'' DATES: Effective Date: This notice is effective on the date of publication... terms of the poverty line or LLSIL for State formula allotments. The Governor and State/local workforce...

78 FR 16871 - Workforce Investment Act of 1998 (WIA); Lower Living Standard Income Level (LLSIL)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-19

... higher level of the poverty line or 70 percent of the LLSIL. This issuance provides the Secretary's annual LLSIL for 2013 and references the current 2013 Health and Human Services ``Poverty Guidelines...) define the terms ``disadvantaged youth'' and ``disadvantaged adult'' in terms of the poverty line or...

Choosing wisely: prevalence and correlates of low-value health care services in the United States.

PubMed

Colla, Carrie H; Morden, Nancy E; Sequist, Thomas D; Schpero, William L; Rosenthal, Meredith B

2015-02-01

Specialty societies in the United States identified low-value tests and procedures that contribute to waste and poor health care quality via implementation of the American Board of Internal Medicine Foundation's Choosing Wisely initiative. To develop claims-based algorithms, to use them to estimate the prevalence of select Choosing Wisely services and to examine the demographic, health and health care system correlates of low-value care at a regional level. Using Medicare data from 2006 to 2011, we created claims-based algorithms to measure the prevalence of 11 Choosing Wisely-identified low-value services and examined geographic variation across hospital referral regions (HRRs). We created a composite low-value care score for each HRR and used linear regression to identify regional characteristics associated with more intense use of low-value services. Fee-for-service Medicare beneficiaries over age 65. Prevalence of selected Choosing Wisely low-value services. The national average annual prevalence of the selected Choosing Wisely low-value services ranged from 1.2% (upper urinary tract imaging in men with benign prostatic hyperplasia) to 46.5% (preoperative cardiac testing for low-risk, non-cardiac procedures). Prevalence across HRRs varied significantly. Regional characteristics associated with higher use of low-value services included greater overall per capita spending, a higher specialist to primary care ratio and higher proportion of minority beneficiaries. Identifying and measuring low-value health services is a prerequisite for improving quality and eliminating waste. Our findings suggest that the delivery of wasteful and potentially harmful services may be a fruitful area for further research and policy intervention for HRRs with higher per-capita spending. These findings should inform action by physicians, health systems, policymakers, payers and consumer educators to improve the value of health care by targeting services and areas with greater use of potentially inappropriate care.

Caseload management, work-related stress and case manager self-efficacy among Victorian mental health case managers.

PubMed

King, Robert

2009-05-01

In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy.

Determinants of microcomputer technology use: implications for education and training of health staff.

PubMed

Jayasuriya, R

1998-06-01

In hospitals and other Healthcare settings, increasingly, hands-on computer use is becoming an important behaviour for effective job performance. The literature has identified differences that relate to computer use between occupational categories in health services. The objectives of this study were to identify factors that determine computer acceptance among occupational groups in Community Health and to predict the factors that relate to computer use. A survey was administered to all Community Health staff in one health service area. Health administrators were found to have a significantly higher training in computers, a higher frequency of use and a higher level of skill for both applications (word processing (WP) and database (DB)) than nurses. The results of a regression analysis shows that about 55% of the variation in the use of WP is explained by computer skills, perceived usefulness (PU) and designation. In the case of DB use, PU was the only significant predictor explaining 53% of the variation. Both level of education and prior training were not significant predictors. The implication for health informatics education (and service training) of these findings is that, in the workplace, health professionals would use computers when they perceive it to be useful for performance in their jobs.

Going Beyond the Millennium Ecosystem Assessment: An Index System of Human Dependence on Ecosystem Services

PubMed Central

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

2013-01-01

The Millennium Ecosystem Assessment (MA) estimated that two thirds of ecosystem services on the earth have degraded or are in decline due to the unprecedented scale of human activities during recent decades. These changes will have tremendous consequences for human well-being, and offer both risks and opportunities for a wide range of stakeholders. Yet these risks and opportunities have not been well managed due in part to the lack of quantitative understanding of human dependence on ecosystem services. Here, we propose an index of dependence on ecosystem services (IDES) system to quantify human dependence on ecosystem services. We demonstrate the construction of the IDES system using household survey data. We show that the overall index and sub-indices can reflect the general pattern of households' dependences on ecosystem services, and their variations across time, space, and different forms of capital (i.e., natural, human, financial, manufactured, and social capitals). We support the proposition that the poor are more dependent on ecosystem services and further generalize this proposition by arguing that those disadvantaged groups who possess low levels of any form of capital except for natural capital are more dependent on ecosystem services than those with greater control of capital. The higher value of the overall IDES or sub-index represents the higher dependence on the corresponding ecosystem services, and thus the higher vulnerability to the degradation or decline of corresponding ecosystem services. The IDES system improves our understanding of human dependence on ecosystem services. It also provides insights into strategies for alleviating poverty, for targeting priority groups of conservation programs, and for managing risks and opportunities due to changes of ecosystem services at multiple scales. PMID:23717634

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

PubMed

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

2013-01-01

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

Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study

PubMed Central

Vestergaard, Mogens; Larsen, Karen Kjær; Fenger-Grøn, Morten

2018-01-01

Objectives Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental–physical multimorbidity. Design Population-based cohort study. Setting Primary healthcare in Denmark. Participants 118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers. Outcome measures General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers. Results Perceived stress levels were associated with primary care activity in a dose–response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services. Conclusion Persons with high stress levels generally had higher use of primary healthcare, 4–6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services. PMID:29478014

The care and course of diabetes: differences according to level of education.

PubMed

van der Meer, J B; Mackenbach, J P

1999-01-01

The objective of this study was to describe socioeconomic differences in the utilisation of health services among persons with diabetes and to link these differences with socioeconomic differences in the course of diabetes. A 2-year follow-up study (1991-1993) was done with data from a population-based survey in The Netherlands (city of Eindhoven and surroundings). Those reporting diabetes who also reported treatment with a diet, oral antidiabetics or insulin and who completed questionnaires in the years 1991 and 1993 (n = 173) were included in the analysis. Main outcome measures were: (1) the odds ratios according to level of education of utilisation of 11 types of service or medical checks in 1991, relevant for diabetes; and (2) odds ratios according to level of education of the difference between 1991 and 1993 in the prevalence of symptoms of diabetic complications. Controlling for severity of diabetes, contact rates with the general practitioner were significantly (P < 0.05) higher among those with primary education, compared to those with an educational level of intermediate vocational training or higher. Rates of checks by a specialist, influenza vaccination and many other checks were statistically significantly lower among those with a low educational level, although the group with the lowest educational level did not always show the lowest rates. Of symptoms indicating diabetes complications, the prevalence of pain in the legs and visual impairments developed more unfavourably among those with primary education. The prevalence of all symptoms together developed more unfavourably among those with primary education. A direct contribution of uptake of checks and services to the differential course of diabetes by education could not be demonstrated. People with diabetes with a low level of education have lower utilisation rates of checks and services relevant for diabetes care, and a worse outcome in terms of complications.

Involuntary smoking in the restaurant workplace. A review of employee exposure and health effects.

PubMed

Siegel, M

1993-07-28

To determine the relative exposure to environmental tobacco smoke for bar and restaurant employees compared with office employees and with nonsmokers exposed in the home (part 1) and to determine whether this exposure is contributing to an elevated lung cancer risk in these employees (part 2). MEDLINE and bibliographies from identified publications. In part 1, published studies of indoor air quality were included if they reported a mean concentration of carbon monoxide, nicotine, or particulate matter from measurements taken in one or more bars, restaurants, offices, or residences with at least one smoker. In part 2, published epidemiologic studies that reported a risk estimate for lung cancer incidence or mortality in food-service workers were included if they controlled, directly or indirectly, for active smoking. In part 1, a weighted average of the mean concentration of carbon monoxide, nicotine, and respirable suspended particulates reported in studies was calculated for bars, restaurants, offices, and residences. In part 2, the relative lung cancer risk for food-service workers compared with that for the general population was examined in the six identified studies. Levels of environmental tobacco smoke in restaurants were approximately 1.6 to 2.0 times higher than in office workplaces of other businesses and 1.5 times higher than in residences with at least one smoker. Levels in bars were 3.9 to 6.1 times higher than in offices and 4.4 to 4.5 times higher than in residences. The epidemiologic evidence suggested that there may be a 50% increase in lung cancer risk among food-service workers that is in part attributable to tobacco smoke exposure in the workplace. Environmental tobacco smoke is a significant occupational health hazard for food-service workers. To protect these workers, smoking in bars and restaurants should be prohibited.

Assessing the Need for Higher Levels of Care Among Problem Gambling Outpatients.

PubMed

Ledgerwood, David M; Arfken, Cynthia L

2017-12-01

Most treatment for gambling disorder is provided on an outpatient basis. Only a small number of jurisdictions in North America provide higher levels of gambling treatment, such as residential or intensive outpatient (IOP) care, despite the potential need for these services. Further, there appear to be few guidelines for determining appropriate level of gambling treatment. The aim of the present study was to assess the appropriateness of higher levels of problem gambling care among clients receiving outpatient treatment. Problem gamblers and their therapists independently completed questionnaires that assessed the need and desire for residential and IOP treatment. About 42% of problem gambling outpatients noted that they would be "probably" or "definitely" willing to attend residential treatment, and about half indicated they would be equally likely to attend IOP. Therapists recommended about a third of their clients as appropriate for higher levels of care. For both client and therapist assessments, there was a significant association between desire or recommendation for level of treatment and severity of gambling and co-occurring problems. Further, therapist recommendations for level of care were significantly associated with client willingness to attend higher levels of treatment. Our data reveal the potential need for higher levels of care for problem gambling, as evaluated by clients and their therapists. Policy implications for the funding of residential and IOP treatment are discussed.

Early Performance Results from the GOES-R Product Generation System

NASA Astrophysics Data System (ADS)

Marley, S.; Weiner, A.; Kalluri, S. N.; Hansen, D.; Dittberner, G.

2013-12-01

Enhancements to remote sensing capabilities for the next generation of Geostationary Operational Environmental Satellite (GOES R-series) scheduled to be launched in 2015 require high performance computing capabilities to output meteorological observations and products at low latency compared to the legacy processing systems. GOES R-series (GOES-R, -S, -T, and -U) represents a generational change in both spacecraft and instrument capability, and the GOES Re-Broadcast (GRB) data which contains calibrated and navigated radiances from all the instruments will be at a data rate of 31 Mb/sec compared to the current 2.11 Mb/sec from existing GOES satellites. To keep up with the data processing rates, the Product Generation (PG) system in the ground segment is designed on a Service Based Architecture (SBA). Each algorithm is executed as a service and subscribes to the data it needs to create higher level products via an enterprise service bus. Various levels of product data are published and retrieved from a data fabric. Together, the SBA and the data fabric provide a flexible, scalable, high performance architecture that meets the needs of product processing now and can grow to accommodate new algorithms in the future. The algorithms are linked together in a precedence chain starting from Level 0 to Level 1b and higher order Level 2 products that are distributed to data distribution nodes for external users. Qualification testing for more than half the product algorithms has so far been completed the PG system.

Associations between state economic and health systems capacities and service use by children with special health care needs.

PubMed

Margolis, Lewis H; Mayer, Michelle; Clark, Kathryn A; Farel, Anita M

2011-08-01

To examine the relationship between measures of state economic, political, health services, and Title V capacity and individual level measures of the well-being of CSHCN. We selected five measures of Title V capacity from the Title V Information System and 13 state capacity measures from a variety of data sources, and eight indicators of intermediate health outcomes from the National Survey of Children with Special Health Care Needs. To assess the associations between Title V capacity and health services outcomes, we used stepwise regression to identify significant capacity measures while accounting for the survey design and clustering of observations by state. To assess the associations between economic, political and health systems capacity and health outcomes we fit weighted logistic regression models for each outcome, using a stepwise procedure to reduce the models. Using statistically significant capacity measures from the stepwise models, we fit reduced random effects logistic regression models to account for clustering of observations by state. Few measures of Title V and state capacity were associated with health services outcomes. For health systems measures, a higher percentage of uninsured children was associated with decreased odds of receipt of early intervention services, decreased odds of receipt of professional care coordination, and increased odds of delayed or missed care. Parents in states with higher per capita Medicaid expenditures on children were more likely to report receipt of special education services. Only two state capacity measures were associated explicitly with Title V: states with higher generalist physician to population ratios were associated with a greater likelihood of parent report of having heard of Title V and states with higher per capita gross state product were less likely to be associated with a report of using Title V services, conditional on having heard of Title V. The state level measure of family participation in Title V governance was negatively associated with receipt of care coordination and having used Title V services. The measures of state economic, political, health systems, and Title V capacity that we have analyzed are only weakly associated with the well-being of children with special health care needs. If Congress and other policymakers increase the expectations of the states in assuring that the needs of CSHCN and their families are addressed, it is essential to be cognizant of the capacities of the states to undertake that role.

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa

PubMed Central

2013-01-01

Background Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. Results The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa’s 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. Conclusion The results indicate that the model can accurately plot mortality and service delivery “hotspots’ at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems. PMID:23425437

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa.

PubMed

Sartorius, Kurt; Sartorius, Benn K D

2013-02-20

Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa's 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. The results indicate that the model can accurately plot mortality and service delivery "hotspots' at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems.

Utilization of maternal health services among adolescent women in Bangladesh: A scoping review of the literature.

PubMed

Shahabuddin, A S M; Delvaux, Thérèse; Abouchadi, Saloua; Sarker, Malabika; De Brouwere, Vincent

2015-07-01

To understand the health-seeking behaviour of adolescent women in Bangladesh with respect to the use of maternal health services. Literature review of seven electronic databases: PubMed, ISI Web of Knowledge, PsycINFO, Embase, CINAHL, POPLINE and Global Health. Studies published in English between 1990 and 2013 which describe Bangladeshi adolescent women's healthcare-seeking behaviour during pregnancy, delivery and post-partum were included. Twelve studies were included in this review. 11 used quantitative methods and one used a mixed-methods approach. All studies included married adolescent women only. Women with lower educational levels are less likely to seek skilled maternal health services than those with higher levels of education. Use of maternal health services is also less common among rural married adolescent women than women in urban areas. Being part of the richest bands of wealth, having had previous experiences of childbirth and higher women's autonomy positively influence the use of skilled maternal health services among married adolescent women in Bangladesh. Antenatal care is a key predictor of the use of skilled birth attendants for delivery and post-natal care. Maternal health-related programmes should be designed targeting rural and uneducated married adolescent women in Bangladesh. More qualitative investigations are required to broaden our understanding on maternal health-seeking behaviour of both married and unmarried adolescent women. © 2015 John Wiley & Sons Ltd.

Predictors for increasing eligibility level among home help service users in the Japanese long-term care insurance system.

PubMed

Kamiya, Kuniyasu; Sasou, Kenji; Fujita, Makoto; Yamada, Sumio

2013-01-01

This cross-sectional study described the prevalence of possible risk factors for increasing eligibility level of long-term care insurance in home help service users who were certified as support level 1-2 or care level 1-2 in Japan. Data were collected from October 2011 to November 2011. Variables included eligibility level, grip strength, calf circumference (CC), functional limitations, body mass index, memory impairment, depression, social support, and nutrition status. A total of 417 subjects (109 males and 308 females, mean age 83 years) were examined. There were 109 subjects with memory impairment. When divided by cut-off values, care level 2 was found to have higher prevalence of low grip strength, low CC, and depression. Some potentially modifiable factors such as muscle strength could be the risk factors for increasing eligibility level.

Diagnostic Imaging Services in Magnet and Non-Magnet Hospitals: Trends in Utilization and Costs.

PubMed

Jayawardhana, Jayani; Welton, John M

2015-12-01

The purpose of this study was to better understand trends in utilization and costs of diagnostic imaging services at Magnet hospitals (MHs) and non-Magnet hospitals (NMHs). A data set was created by merging hospital-level data from the American Hospital Association's annual survey and Medicare cost reports, individual-level inpatient data from the Healthcare Cost and Utilization Project, and Magnet recognition status data from the American Nurses Credentialing Center. A descriptive analysis was conducted to evaluate the trends in utilization and costs of CT, MRI, and ultrasound procedures among MHs and NMHs in urban locations between 2000 and 2006 from the following ten states: Arizona, California, Colorado, Florida, Iowa, Maryland, North Carolina, New Jersey, New York, and Washington. When matched by bed size, severity of illness (case mix index), and clinical technological sophistication (Saidin index) quantiles, MHs in higher quantiles indicated higher rates of utilization of imaging services for MRI, CT, and ultrasound in comparison with NMHs in the same quantiles. However, average costs of MRI, CT, and ultrasounds were lower at MHs in comparison with NMHs in the same quantiles. Overall, MHs that are larger in size (number of beds), serve more severely ill patients (case mix index), and are more technologically sophisticated (Saidin index) show higher utilization of diagnostic imaging services, although costs per procedure at MHs are lower in comparison with similar NMHs, indicating possible cost efficiency at MHs. Further research is necessary to understand the relationship between the utilization of diagnostic imaging services among MHs and its impact on patient outcomes. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Disability inclusion in higher education in Uganda: Status and strategies

PubMed Central

Emong, Paul

2016-01-01

Background Uganda has embraced inclusive education and evidently committed itself to bringing about disability inclusion at every level of education. Both legal and non-legal frameworks have been adopted and arguably are in line with the intent of the Convention on the Rights of Persons with Disabilities (CRPD) on education. The CRPD, in Article 24, requires states to attain a right to education for persons with disabilities without discrimination and on the basis of equal opportunities at all levels of education. Objectives Despite Uganda’s robust disability legal and policy framework on education, there is evidence of exclusion and discrimination of students with disabilities in the higher education institutions. The main objective of this article is to explore the status of disability inclusion in higher education and strategies for its realisation, using evidence from Emong’s study, workshop proceedings where the authors facilitated and additional individual interviews with four students with disabilities by the authors. Results The results show that there are discrimination and exclusion tendencies in matters related to admissions, access to lectures, assessment and examinations, access to library services, halls of residence and other disability support services. Conclusion The article recommends that institutional policies and guidelines on support services for students with disabilities and special needs in higher education be developed, data on students with disabilities collected to help planning, collaboration between Disabled Peoples Organisations (DPO’s) strengthened to ensure disability inclusion and the establishment of disability support centres. PMID:28730044

Prevalence of oral cancer self-examination among elderly people treated under Brazil's Unified Health System: household health survey.

PubMed

Martins, Andréa Maria Eleutério de Barros Lima; Souza, João Gabriel Silva; Haikal, Desireé Sant'Ana; de Paula, Alfredo Maurício Batista; Ferreira e Ferreira, Efigênia; Pordeus, Isabela Almeida

2015-04-01

The aim of this study was to examine the prevalence of oral cancer self-examinationamong the elderly and confirm whether prevalence was higher among users of the dental services provided by Brazil's Unified Health System (SUS, acronym in Portuguese). A transversal study of elderly people aged between 65 and 74 years living in a large-sized Brazilian municipality was conducted using simple random sampling. Logistic regression was conducted and results were corrected for sample design and unequal weighting using the SPSS(r) software. The study assessed 740 individuals. A total of 492 met the inclusion criteria, of which 101 (22.4%) reported having performed an oral cancer self-examination. Prevalence was higher among users of the dental services provided by the SUS, higher-income individuals, people with higher levels of education, individuals that used a removable dental prosthesis, and people who had not experienced discomfort attributed to oral condition, and lower among people who sought regular and periodic dental treatment and individuals who did not have a drinking habit. This type of self-care should be encouraged by public health policies which respond to the needs of the elderly, with emphasis on users of private and philanthropic services, and other services outside the public health network.

Satisfaction with the Overseas Education in China: A Survey on 44 Institutions of Higher Learning in Jiangsu Province

ERIC Educational Resources Information Center

Li, Xin-Chao; Zhu, Su-Jing; Thige, Joseph M.; Shi, Yun-Yu

2017-01-01

In order to fully grasp the service level, management quality and effectiveness of the overseas education in China, a satisfaction survey was carried out on 44 institutions of higher learning in Jiangsu province from 5 dimensions of school learning, school life, school administration, surrounding environment, and urban civility and environment.…

Who Listens to Trash Talk?: Education and Public Media Effects on Recycling Behavior.

ERIC Educational Resources Information Center

Martinez, Michael D.; Scicchitano, Michael J.

1998-01-01

Observes that research has shown a curvilinear relationship between education and media effects, with media having the greatest effect on people with moderate levels of education. Examines the effects of public service messages about recycling, and finds that the messages actually have greater impact on people with higher levels of education. (DSK)

Workplace harassment, services utilization, and drinking outcomes.

PubMed

Rospenda, Kathleen M

2002-04-01

Given the negative outcomes associated with sexual harassment (SH) and generalized nonsexual workplace harassment (GWH), this study examines the relationship between SH and GWH and help-seeking behavior in a sample of 2,038 university employees. Employees who experienced SH or GWH were more likely to report having sought mental health or health services to deal with workplace issues, compared with those who did not experience SH or GWH, controlling for job stress and prior services use. Women experiencing GWH were more likely to use services than men, but the same was not true for SH. Men experiencing SH who sought services exhibited higher levels of some alcohol outcomes, contrary to expectations. Implications for workplace interventions and for service providers are discussed.

Access to care for autism-related services.

PubMed

Thomas, Kathleen C; Ellis, Alan R; McLaurin, Carolyn; Daniels, Julie; Morrissey, Joseph P

2007-11-01

This paper identifies family characteristics associated with use of autism-related services. A telephone or in-person survey was completed during 2003-2005 by 383 North Carolina families with a child 11 years old or younger with ASD. Access to care is limited for racial and ethnic minority families, with low parental education, living in nonmetropolitan areas, and not following a major treatment approach. Service use is more likely when parents have higher stress. Families use a broad array of services; the mix varies with child ASD diagnosis and age group. Disparities in service use associated with race, residence and education point to the need to develop policy, practice and family-level interventions that can address barriers to services for children with ASD.

An Inventory of Innovative Financing Plans to Help Pay for Higher Education.

ERIC Educational Resources Information Center

Merisotis, Jamie P.

1989-01-01

Creative ideas recently emerging to help families cope with rising educational costs are reviewed, including state and federal level savings plans, alternative loan programs, guaranteed access plans, and public service proposals. (Author/MSE)

Workplace Stress, Organizational Factors and EAP Utilization.

PubMed

Azzone, Vanessa; McCann, Bernard; Merrick, Elizabeth Levy; Hiatt, Deirdre; Hodgkin, Dominic; Horgan, Constance

2009-01-01

This study examined relationships between workplace stress, organizational factors and use of EAP counseling services delivered by network providers in a large, privately-insured population. Claims data were linked to measures of workplace stress, focus on wellness/prevention, EAP promotion, and EAP activities for health care plan enrollees from 26 employers. The association of external environment and work organization variables with use of EAP counseling services was examined. Higher levels of EAP promotion and worksite activities were associated with greater likelihood of service use. Greater focus on wellness/prevention and unusual and significant stress were associated with lower likelihood of service use. Results provide stakeholders with insights on approaches to increasing utilization of EAP services.

Workplace Stress, Organizational Factors and EAP Utilization

PubMed Central

Azzone, Vanessa; McCann, Bernard; Merrick, Elizabeth Levy; Hiatt, Deirdre; Hodgkin, Dominic; Horgan, Constance

2013-01-01

This study examined relationships between workplace stress, organizational factors and use of EAP counseling services delivered by network providers in a large, privately-insured population. Claims data were linked to measures of workplace stress, focus on wellness/prevention, EAP promotion, and EAP activities for health care plan enrollees from 26 employers. The association of external environment and work organization variables with use of EAP counseling services was examined. Higher levels of EAP promotion and worksite activities were associated with greater likelihood of service use. Greater focus on wellness/prevention and unusual and significant stress were associated with lower likelihood of service use. Results provide stakeholders with insights on approaches to increasing utilization of EAP services. PMID:24058322

Use of Spatial Epidemiology and Hot Spot Analysis to Target Women Eligible for Prenatal Women, Infants, and Children Services

PubMed Central

Krawczyk, Christopher; Gradziel, Pat; Geraghty, Estella M.

2014-01-01

Objectives. We used a geographic information system and cluster analyses to determine locations in need of enhanced Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program services. Methods. We linked documented births in the 2010 California Birth Statistical Master File with the 2010 data from the WIC Integrated Statewide Information System. Analyses focused on the density of pregnant women who were eligible for but not receiving WIC services in California’s 7049 census tracts. We used incremental spatial autocorrelation and hot spot analyses to identify clusters of WIC-eligible nonparticipants. Results. We detected clusters of census tracts with higher-than-expected densities, compared with the state mean density of WIC-eligible nonparticipants, in 21 of 58 (36.2%) California counties (P < .05). In subsequent county-level analyses, we located neighborhood-level clusters of higher-than-expected densities of eligible nonparticipants in Sacramento, San Francisco, Fresno, and Los Angeles Counties (P < .05). Conclusions. Hot spot analyses provided a rigorous and objective approach to determine the locations of statistically significant clusters of WIC-eligible nonparticipants. Results helped inform WIC program and funding decisions, including the opening of new WIC centers, and offered a novel approach for targeting public health services. PMID:24354821

The impact of physician payment methods on raising the efficiency of the healthcare system: an international comparison.

PubMed

Simoens, Steven; Giuffrida, Antonio

2004-01-01

This article reviews policies on physician payment methods that Organisation for Economic Cooperation and Development (OECD) countries have implemented to promote an efficient deployment of physicians. Countries' experiences show that payment by fee-for-service, capitation and salary influences physician activity levels and productivity. However, the impact of these simple payment methods is complex and may be diluted by clinical, demographic, ethical and organisational factors. Policies that have attempted to curb health expenditure by controlling fee levels have sometimes been eroded by physicians increasing the volume of service supply, or providing services that attract higher fees. Flexible blended payment methods based on the combination of a fixed component, through either capitation or salary, and a variable component, through fee-for-service, may produce a desirable mix of incentives. Integrating such blended payment methods with mechanisms to monitor physician activity may offer potential success.

An Exploratory Study of Student Service Members/Veterans' Mental Health Characteristics by Sexual Orientation.

PubMed

Pelts, Michael D; Albright, David L

2015-01-01

Explore the mental health differences of student veterans by sexual orientation. Student service members/veterans (N = 702) from the Fall 2011 National College Health Assessment. Descriptive statistics and 2-sample proportion and mean tests were used to compare mental health characteristics. Student veterans who identify as lesbian, gay, bisexual, or unsure had higher levels of mental health symptoms and treatment. Results suggest a need for continued examination of student service members/veterans as related to disparities in mental health by sexual orientation.

Service-learning in nursing education: its impact on leadership and social justice.

PubMed

Groh, Carla J; Stallwood, Lynda G; Daniels, John J

2011-01-01

Although studies suggest that service-learning is positive for students, findings reported are primarily qualitative. A convenience sample of 306 senior-level nursing students completed the Service-Learning Self-Evaluation Tool (SLSET) pre- and post-service-learning experience over a six-year span. The constructs measured were leadership skills and social justice. Paired t-tests were calculated. Statistically significant differences were noted between pre- and post-service-learning experience, with students rating themselves higher on leadership and social justice items after the experience. Cronbach's alpha for leadership and social justice were greater than 0.80. Service-learning as an educational methodology that combines community service with academic learning objectives is a viable strategy for facilitating leadership skills and increased awareness of social justice issues in nursing students.

Offshoring of healthcare services: the case of US-India trade in medical transcription services.

PubMed

Kshetri, Nir; Dholakia, Nikhilesh

2011-01-01

- The issue of offshore outsourcing of healthcare services is a critical but little-examined problem in healthcare research. The purpose of this study is to contribute to filling this void. A library-based study was carried out of the development of the Indian medical transcription offshoring industry. Findings- Cost-saving potential and the degree of outsourceability are higher for medical transcription compared with most services. Offshoring experience, typically in a low-value BPO, helps to enhance productivity and international linkages required for the success of medical transcription. Research limitations/implications - An important area of future research concerns comparing India's factor endowments in medical transcription outsourcing with other services. Further research is also needed to examine how India differs from its regional competitors in terms of factors endowments associated with these services. Another extension would be to investigate the drivers of offshoring of higher value services such as radiological readings. Practical implications - ICT infrastructures needed for outsourcing require much less investment compared with leading capital-intensive industries. The development patterns of the Indian medical and offshoring industries indicate that India may attract higher skilled medical functions in the future. The Indian offshoring industry is shifting its focus from BPO to knowledge process outsourcing (KPO). Developing countries need to shift to greater automation and greater levels of skill training to retain and reinforce their comparative advantages. This paper's greatest value stems from the fact that it examines the drivers of a new but rapidly growing healthcare industry.

American Military Veteran Entrepreneurs: A Comprehensive Profile of Demographic, Service History, and Psychosocial Characteristics.

PubMed

Heinz, Adrienne J; Freeman, Michael A; Harpaz-Rotem, Ilan; Pietrzak, Robert H

2017-01-01

American military veterans are nearly twice as likely to be self-employed compared to non-veterans, and are majority owners in nine percent of all businesses nationwide. Despite their contribution to the broader economy and the potential for training programs to cultivate and foster successful self-employment and veteran-lead entrepreneurial ventures, research on veteran entrepreneurs remains limited. In order to gain a better understanding of the potential strengths and vulnerabilities of veteran entrepreneurs, the current study utilized data from a large, nationally representative sample to profile self-employed veterans (n=230) and compare them to veterans who work as employees (n=1,055) with respect to demographic, military service history, and psychosocial characteristics. Results indicated that self-employed veterans were older and more educated and more likely to utilize VA healthcare. Self-employed veterans were more likely to serve in Vietnam and to serve in the military for fewer years. No differences were noted in perceived military experience, level of combat exposure, or military branch served as a function of self-employment. Although reporting more lifetime traumas, self-employed veterans did not experience higher rates of current or lifetime psychopathology or lower perceived quality of life. Potential protective resilience-promoting factors may be associated with the higher levels of openness, extraversion, optimism, achievement-orientation (purpose in life), and greater need for autonomy and professional development observed among self-employed veterans. Moreover, self-employed veterans demonstrated higher levels of gratitude, community integration, and altruistic service to others. Findings have potential to inform human resources management strategies and vocational training and reintegration initiatives for veterans.

Caregiver stress: does states' expenditure on home- and community-based services matter?

PubMed

Hong, Michin; Casado, Banghwa Lee

2015-01-01

This study examined how state expenditure on home- and community-based services (HCBS) and individual factors are associated with caregiver stress. A total of 1,849 cases from the 2004 National Long-Term Care Survey were included. Gender, education, perceived physical strain, and economic hardship, as well as the number of limitations in instrumental activities of daily living (IADL) for the care recipient, were associated with caregiver stress. The cross-level interaction between service utilization and state expenditure on HCBS was significant, suggesting that living in states with a higher expenditure on HCBS is associated with reduced stress regardless of service utilization.

Equity and the utilization of health services: report of an eight-province survey in China.

PubMed

Henderson, G; Akin, J; Zhiming, L; Jin, S; Ma, H; Ge, K

1994-09-01

This paper investigates equity with respect to one component of welfare in China--the provision and use of health services. Based upon a large-scale survey of almost 16,000 individuals in eight provinces in China, we examine a sub-sample of working-age adults who have identified themselves as injured or ill during the four weeks prior to being interviewed. We found that, beyond the level of severity of the reported condition, very few individual-level factors are related to the use of services when ill or injured. Only gender (female) and employment in state-run enterprises are associated with higher patterns of use. These results suggest that China has achieved a very wide distribution of clinics and other services at the local level, and that they are widely used by those who identify need for them. It is rare to be over half an hour away by bike from some form of care and the majority of care appears to be reasonably inexpensive. This broad availability of services contrasts with recent reports from China stressing declining accessibility, and paints a picture of relatively equal access to health care.

Realizing ecosystem services: wetland hydrologic function along a gradient of ecosystem condition.

PubMed

McLaughlin, Daniel L; Cohen, Matthew J

2013-10-01

Wetlands provide numerous ecosystem services, from habitat provision to pollutant removal, floodwater storage, and microclimate regulation. Delivery of particular services relies on specific ecological functions, and thus to varying degree on wetland ecological condition, commonly quantified as departure from minimally impacted reference sites. Condition assessments are widely adopted as regulatory indicators of ecosystem function, and for some services (e.g., habitat) links between condition and function are often direct. For others, however, links are more tenuous, and using condition alone to enumerate ecosystem value (e.g., for compensatory mitigation) may underestimate important services. Hydrologic function affects many services cited in support of wetland protection both directly (floodwater retention, microclimate regulation) and indirectly (biogeochemical cycling, pollutant removal). We investigated links between condition and hydrologic function to test the hypothesis, embedded in regulatory assessment of wetland value, that condition predicts function. Condition was assessed using rapid and intensive approaches, including Florida's official wetland assessment tool, in 11 isolated forested wetlands in north Florida (USA) spanning a land use intensity gradient. Hydrologic function was assessed using hydrologic regime (mean, variance, and rates of change of water depth), and measurements of groundwater exchange and evapotranspiration (ET). Despite a wide range in condition, no systematic variation in hydrologic regime was observed; indeed reference sites spanned the full range of variation. In contrast, ET was affected by land use, with higher rates in intensive (agriculture and urban) landscapes in response to higher leaf area. ET determines latent heat exchange, which regulates microclimate, a valuable service in urban heat islands. Higher ET also indicates higher productivity and thus carbon cycling. Groundwater exchange regularly reversed flow direction at all sites in response to rainfall. This buffering effect on regional aquifer levels, an underappreciated service of isolated wetlands, was provided regardless of condition. Intensive landscapes may benefit most from the hydrologic services that wetlands provide because that is where certain services (floodwater storage, microclimate regulation) are realized. While the portfolio of wetland services clearly changes with disturbance, our results support a revised approach to wetland valuation that recognizes the services that accrue from sustained or enhanced functions in these "working wetlands."

CILogon-HA. Higher Assurance Federated Identities for DOE Science

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

Basney, James

The CILogon-HA project extended the existing open source CILogon service (initially developed with funding from the National Science Foundation) to provide credentials at multiple levels of assurance to users of DOE facilities for collaborative science. CILogon translates mechanism and policy across higher education and grid trust federations, bridging from the InCommon identity federation (which federates university and DOE lab identities) to the Interoperable Global Trust Federation (which defines standards across the Worldwide LHC Computing Grid, the Open Science Grid, and other cyberinfrastructure). The CILogon-HA project expanded the CILogon service to support over 160 identity providers (including 6 DOE facilities) andmore » 3 internationally accredited certification authorities. To provide continuity of operations upon the end of the CILogon-HA project period, project staff transitioned the CILogon service to operation by XSEDE.« less

Food Insecurity Associated with Self-Efficacy and Acculturation.

PubMed

Kamimura, Akiko; Jess, Allison; Trinh, Ha N; Aguilera, Guadalupe; Nourian, Maziar M; Assasnik, Nushean; Ashby, Jeanie

2017-02-01

Food insecurity is a significant public health issue that affects the physical and mental health of people of all ages. Higher levels of self-efficacy may reduce levels of food insecurity. In addition, acculturation is potentially an important factor for food insecurity among immigrant populations. The purpose of this study is to examine food insecurity associated with self-efficacy and acculturation among low-income primary care patients in the United States. A self-administered survey was administered in May and June 2015 to uninsured primary care patients (N = 551) utilizing a free clinic that provides free primary care services to low-income uninsured individuals and families in the United States. On average, participants reported low food security. Higher levels of self-efficacy were associated with lower levels of food insecurity. Higher levels of heritage language proficiency were related to lower levels of food insecurity. US-born English speakers, women, and unmarried individuals potentially have higher risks of food insecurity and may need interventions to meet their specific needs. Self-efficacy should be included in nutrition education programs to reduce the levels of food insecurity. Future studies should further examine why these groups have a high risk to better understand needs for interventions.

22 CFR 11.11 - Mid-level Foreign Service officer career candidate appointments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... GS-9, or in the Armed Forces as first lieutenant or lieutenant junior grade, or higher. Academic...) Written essay. Candidates who take the oral examination will be asked to write an essay during the...

The quality of family planning services and client satisfaction in the public and private sectors in Kenya.

PubMed

Agha, Sohail; Do, Mai

2009-04-01

To compare the quality of family planning services delivered at public and private facilities in Kenya. Data from the 2004 Kenya Service Provision Assessment were analysed. The Kenya Service Provision Assessment is a representative sample of health facilities in the public and private sectors, and comprises data obtained from a facility inventory, service provider interviews, observations of client-provider interactions and exit interviews. Quality-of-care indicators are compared between the public and private sectors along three dimensions: structure, process and outcome. Private facilities were superior to public sector facilities in terms of physical infrastructure and the availability of services. Public sector facilities were more likely to have management systems in place. There was no difference between public and private providers in the technical quality of care provided. Private providers were better at managing interpersonal aspects of care. The higher level of client satisfaction at private facilities could not be explained by differences between public and private facilities in structural and process aspects of care. Formal private sector facilities providing family planning services exhibit greater readiness to provide services and greater attention to client needs than public sector facilities in Kenya. Consistent with this, client satisfaction is much higher at private facilities. Technical quality of care provided is similar in public and private facilities.

Trends in Alcohol Services Utilization from 1991-1992 to 2001-2002: Ethnic Group Differences in the U.S. Population

PubMed Central

Chartier, Karen G.; Caetano, Raul

2011-01-01

Background During the early 1990s in the U.S., changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10-year period from 1991-1992 to 2001-2002 among U.S. Whites, Blacks and Hispanics. Method Data come from two household surveys of the U.S. adult population. The 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted face-to-face interviews with a multistage cluster sample of individuals 18 years of age and older in the continental United States. Treatment utilization represented both total utilization and the use of alcohol services. Data analyses were prevalence rates and multivariate logistic regressions for lifetime utilization with drinkers and individuals with alcohol use disorders (AUD). Results From 1991-1992 to 2001-2002, drinking-related emergency room and human services use increased for drinkers, while total utilization and the use of private health professional services and mutual aid decreased for individuals with AUDs. In drinkers and individuals with AUDs, Blacks and Hispanics were less likely than Whites to use private health professional care. Hispanics with AUDs were less likely than Whites with AUDs to use alcohol or drug programs. Ethnicity interacted with alcohol severity to predict alcohol services utilization. At higher levels of alcohol severity, Blacks and Hispanics were less likely than Whites to ever use treatment and to use alcohol services (i.e., human services for Hispanic drinkers, mental health services for Blacks with AUDs, and mutual aid for Hispanics with AUDs). Conclusions Our findings showed increases from 1991-1992 to 2001-2002 in alcohol services utilization for drinkers, but reductions in utilization for individuals with AUDs. Blacks and Hispanics, particularly those at higher levels of alcohol severity, underutilized treatment services compared to Whites. These utilization trends for Blacks and Hispanics may reflect underlying disparities in health care access for minority groups, and language and logistical barriers to utilizing services. PMID:21575015

Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

PubMed

Creanga, Andreea A; Gullo, Sara; Kuhlmann, Anne K Sebert; Msiska, Thumbiko W; Galavotti, Christine

2017-05-22

The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care. We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items. We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health services received. Quality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.

Differences regarding job satisfaction and job involvement of psychologists with different dominant career anchors.

PubMed

Bester, C L; Mouton, T

2006-08-01

In order to contribute to higher levels of job satisfaction, job involvement and productivity, a match or fit should be established between the dominant career anchor associated with a specific occupation and that of the employee. A career anchor is an individual's set of self-perceived talents, abilities, motives, needs and values that form the nucleus of one's occupational self-concept. Psychologists have always been part of the service orientated careers and therefore one would expect that it is likely that their dominant career anchor would be service orientation. If this is the case, psychologists with service as their dominant career anchor are supposed to have greater job satisfaction and job involvement compared to those with different career anchors. However, according to literature, this assumption is not necessarily correct. The primary goals of the current study were to determine whether in fact service is the dominant career anchor of psychologists in the Free State and whether there are significant differences regarding job satisfaction and job involvement between psychologists with and without service as their dominant career anchor. A third goal was to determine whether psychologists with different dominant career anchors differ significantly from one another regarding job satisfaction and job involvement. Questionnaires measuring career orientations, job satisfaction and job involvement were sent to 165 of the 171 registered psychologists in the Free State region. Only 75 psychologists (45,5%) responded which exceeded the traditional return rate of 20 to 30%. Due to the small sample of respondents, a nonparametric statistical test, namely the Mann Whitney U test was conducted to determine possible differences. An analysis of the data showed that 21 respondents had entrepreneurship as their dominant career orientation while 12 fell in the technical/functional, 12 in the challenging, 9 in the service and 8 in the autonomy categories of dominant career anchors. No significant differences regarding job satisfaction between psychologists with and without service as dominant career orientation could be determined. Both groups experienced a fairly high degree of job satisfaction and a higher level of intrinsic job satisfaction occurred compared to extrinsic job satisfaction. A significant difference between the two groups in terms of job involvement occurred. Psychologists with service as dominant career orientation showed a higher level of job involvement, although the degree of job involvement for both groups was fairly low. No significant differences regarding job satisfaction and job involvement among psychologists with different career orientations could be found.

Creating Linkages between the Labour Market and Agricultural Higher Education in Iran: Strategies and Mechanisms for Partnership

ERIC Educational Resources Information Center

Movahedi, Reza; Saadi, Heshmatollah; Farani, Ahmad Yaghoubi

2011-01-01

Employment of agriculture graduates in Iran is a major problem that needs to be addressed. There are three main issues: lack of robust strategies for linking agricultural higher education and the labour market, the lack of relevance of agricultural curricula to the real needs of the labour market, and diminishing levels of government services for…

Social Consciousness and Career Awareness: Emerging Link in Higher Education. ASHE-ERIC Higher Education Report No. 8, 1990.

ERIC Educational Resources Information Center

Swift, John S., Jr.

Contemporary college students' apparent lack of exposure to citizenship, lack of concern for others, and ignorance of how to be involved citizens has prompted a call for involving students in volunteer service at the national level or as part of the undergraduate experience. This monograph begins by discussing volunteer programs as they relate to…

Spillover effects of community uninsurance on working-age adults and seniors: an instrumental variables analysis.

PubMed

Gresenz, Carole Roan; Escarce, José J

2011-09-01

: Previous research suggests, but does not definitively establish, that a high level of uninsurance in a community may negatively affect access to and quality of health care for insured persons. : To assess the effect of the level of uninsurance in a community on access to and satisfaction with care-an important dimension of quality-among insured persons. : The 1996 to 2006 Medical Expenditure Panel Survey Household Component data linked to data from the Current Population Survey, Area Resource File, and the InterStudy Competitive Edge. Analyses include 86,928 insured adult respondents living in approximately 200 large metropolitan areas. : Measures of whether an individual had a usual source of care, had any delay/difficulty obtaining needed care, used office-based services, used prescription drug services, and used any medical services, and measures of satisfaction with care. : Among privately insured adults, a higher community uninsurance rate resulted in a lower probability of having a usual source of care, having an office-based visit, having any medical expenditures, and reporting being satisfied with the quality of care provided by the usual source of care. A higher community uninsurance rate also led to a higher probability of reporting difficulty obtaining needed care. Among Medicare enrollees, a higher community uninsurance rate resulted in lower reported satisfaction with care and higher probability of experiencing difficulty or delay in getting needed care. : Our results suggest substantial spillover effects of the community uninsurance rate on access to and satisfaction with health care among insured working-age adults and seniors. Consequently, new efforts to address the problem of the uninsured may bring significant benefits to persons who already have insurance.

Discrimination and Mental Health–Related Service Use in a National Study of Asian Americans

PubMed Central

Chen, Juan; Gee, Gilbert C.; Fabian, Cathryn G.; Takeuchi, David T.

2010-01-01

Objectives. We examined the association between perceived discrimination and use of mental health services among a national sample of Asian Americans. Methods. Our data came from the National Latino and Asian American Study, the first national survey of Asian Americans. Our sample included 600 Chinese, 508 Filipinos, 520 Vietnamese, and 467 other Asians (n=2095). We used logistic regression to examine the association between discrimination and formal and informal service use and the interactive effect of discrimination and English language proficiency. Results. Perceived discrimination was associated with more use of informal services, but not with less use of formal services. Additionally, higher levels of perceived discrimination combined with lower English proficiency were associated with more use of informal services. Conclusions. The effect of perceived discrimination and language proficiency on service use indicates a need for more bilingual services and more collaborations between formal service systems and community resources. PMID:20299649

Invisible Care: Friend and Partner Care Among Older Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults

PubMed Central

Shiu, Chengshi; Muraco, Anna; Fredriksen-Goldsen, Karen

2016-01-01

Objective Lesbian, gay, bisexual, and transgender (LGBT) older adult caregivers may encounter obstacles in obtaining health and aging services due to discrimination in service and legal systems. The caregiving relationships in LGBT communities also differ from the general population in that friends are providing a large portion of informal care. This article examines how the relational context of caregiving relates to caregiving demands and resources, which in turn, influence perceived stress and depressive symptomatology among older LGBT caregivers. Method Using data from the National Health, Aging, and Sexuality Study: Caring and Aging with Pride, this study examines 451 participants who are providing caregiving to partners and friends. Structural equation modeling was applied to estimate the associations among the caregiver–care recipient relationship and caregiving demands, resources, perceived stress, and depressive symptomatology. Results On average, as compared with those caring for partners, those who provided care to friends reported experiencing lower levels of caregiving demands and lower levels of social support. The lower caregiving demands correlated positively with both lower perceived stress and less severe depressive symptomatology; however, the lower levels of social support were related to higher perceived stress and higher depressive symptomatology. Conclusions Caregiving provided by friends, which has long been under recognized, plays an important role in the LGBT community. Because lower levels of caregiving demands are offset by less social support, LGBT friend-caregivers experience similar levels of perceived stress and depressive symptomatology to those providing care to spouses and partners. Policy and service reforms are needed to better acknowledge the continuum of informal caregiving relationships. PMID:28367277

Invisible Care: Friend and Partner Care Among Older Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults.

PubMed

Shiu, Chengshi; Muraco, Anna; Fredriksen-Goldsen, Karen

2016-01-01

Lesbian, gay, bisexual, and transgender (LGBT) older adult caregivers may encounter obstacles in obtaining health and aging services due to discrimination in service and legal systems. The caregiving relationships in LGBT communities also differ from the general population in that friends are providing a large portion of informal care. This article examines how the relational context of caregiving relates to caregiving demands and resources, which in turn, influence perceived stress and depressive symptomatology among older LGBT caregivers. Using data from the National Health, Aging, and Sexuality Study: Caring and Aging with Pride, this study examines 451 participants who are providing caregiving to partners and friends. Structural equation modeling was applied to estimate the associations among the caregiver-care recipient relationship and caregiving demands, resources, perceived stress, and depressive symptomatology. On average, as compared with those caring for partners, those who provided care to friends reported experiencing lower levels of caregiving demands and lower levels of social support. The lower caregiving demands correlated positively with both lower perceived stress and less severe depressive symptomatology; however, the lower levels of social support were related to higher perceived stress and higher depressive symptomatology. Caregiving provided by friends, which has long been under recognized, plays an important role in the LGBT community. Because lower levels of caregiving demands are offset by less social support, LGBT friend-caregivers experience similar levels of perceived stress and depressive symptomatology to those providing care to spouses and partners. Policy and service reforms are needed to better acknowledge the continuum of informal caregiving relationships.

[Factors related to the use of pediatric emergency services: results from the Spanish National Health Survey].

PubMed

Expósito-Ruiz, Manuela; Sánchez-López, Juan; Ruiz-Bailén, Manuel; Rodríguez-Del Águila, María Del Mar

2017-01-01

To determine the frequency of use of Spanish pediatric emergency services, and to describe user profiles and geographic variations. Descriptive study based on data from the Spanish National Health Survey. We calculated descriptive statistics and analyzed crude and adjusted odds ratios (ORs). Thirty-five percent of the 5495 respondents had come to an emergency department in the past year, and 88.1% of them had used the services of a Spanish national health service hospital. Factors associated with higher use of emergency services were male sex of the patient, (OR, 1.202; 95% CI, 1.047-1.381), a higher educational level of parents (OR, 1.255; 95% CI, 0.983-1.603), and younger age of the child (OR, 0.909; 95% CI, 0.894-0.924). Emergency department use varied widely from one Spanish community to another. There was a positive correlation between use and the presence of a foreign-born population (ρ=0.495, P=.031). The rate of emergency department use is high in Spain. Variability between geographic areas is considerable, and some variation is explained by population characteristics.

Enhancing recovery rates: lessons from year one of IAPT.

PubMed

Gyani, Alex; Shafran, Roz; Layard, Richard; Clark, David M

2013-09-01

The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Availability and distribution of safe abortion services in rural areas: a facility assessment study in Madhya Pradesh, India

PubMed Central

Chaturvedi, Sarika; Ali, Sayyed; Randive, Bharat; Sabde, Yogesh; Diwan, Vishal; De Costa, Ayesha

2015-01-01

Background Unsafe abortion contributes to a significant portion of maternal mortality in India. Access to safe abortion care is known to reduce maternal mortality. Availability and distribution of abortion care facilities can influence women's access to these services, especially in rural areas. Objectives To assess the availability and distribution of abortion care at facilities providing childbirth care in three districts of Madhya Pradesh (MP) province of India. Design Three socio demographically heterogeneous districts of MP were selected for this study. Facilities conducting at least 10 deliveries a month were surveyed to assess availability and provision of abortion services using UN signal functions for emergency obstetric care. Geographical Information System was used for visualisation of the distribution of facilities. Results The three districts had 99 facilities that conducted >10 deliveries a month: 74 in public and 25 in private sector. Overall, 48% of facilities reported an ability to provide safe surgical abortion service. Of public centres, 32% reported the ability compared to 100% among private centres while 18% of public centres and 77% of private centres had performed an abortion in the last 3 months. The availability of abortion services was higher at higher facility levels with better equipped and skilled personnel availability, in urban areas and in private sector facilities. Conclusions Findings showed that availability of safe abortion care is limited especially in rural areas. More emphasis on providing safe abortion services, particularly at primary care level, is important to more significantly dent maternal mortality in India. PMID:25797220

Inequalities in utilisation of general practitioner and specialist services in 9 European countries.

PubMed

Stirbu, Irina; Kunst, Anton E; Mielck, Andreas; Mackenbach, Johan P

2011-10-31

The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions. Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health. People with lower education used GP services equally often in most countries (except Belgium and Germany) compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension. We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases. © 2011 Stirbu et al; licensee BioMed Central Ltd.

A Cross-Age Study of an Understanding of Light and Sight Concepts in Physics

ERIC Educational Resources Information Center

Uzun, Salih; Alev, Nedim; Karal, Isik Saliha

2013-01-01

The aim of this study is to reveal the students' and pre-service teachers' understanding of light, sight and related concepts at different educational levels, from primary to higher education. A cross-sectional approach was used since the participants were of different age and educational level. The sample of this study consisted of 30 eighth…

Workplace Congruence and Occupational Outcomes among Social Service Workers.

PubMed

Graham, John R; Shier, Micheal L; Nicholas, David

2016-06-01

Workplace expectations reflect an important consideration in employee experience. A higher prevalence of workplace congruence between worker and employer expectations has been associated with higher levels of productivity and overall workplace satisfaction across multiple occupational groups. Little research has investigated the relationship between workplace congruence and occupational health outcomes among social service workers. This study sought to better understand the extent to which occupational congruence contributes to occupational outcomes by surveying unionised social service workers ( n = 674) employed with the Government of Alberta, Canada. Multiple regression analysis shows that greater congruence between workplace and worker expectations around workloads, workplace values and the quality of the work environment significantly: (i) decreases symptoms related to distress and secondary traumatic stress; (ii) decreases intentions to leave; and (iii) increases overall life satisfaction. The findings provide some evidence of areas within the workplace of large government run social welfare programmes that can be better aligned to worker expectations to improve occupational outcomes among social service workers.

Workplace Congruence and Occupational Outcomes among Social Service Workers

PubMed Central

Graham, John R.; Shier, Micheal L.; Nicholas, David

2016-01-01

Workplace expectations reflect an important consideration in employee experience. A higher prevalence of workplace congruence between worker and employer expectations has been associated with higher levels of productivity and overall workplace satisfaction across multiple occupational groups. Little research has investigated the relationship between workplace congruence and occupational health outcomes among social service workers. This study sought to better understand the extent to which occupational congruence contributes to occupational outcomes by surveying unionised social service workers (n = 674) employed with the Government of Alberta, Canada. Multiple regression analysis shows that greater congruence between workplace and worker expectations around workloads, workplace values and the quality of the work environment significantly: (i) decreases symptoms related to distress and secondary traumatic stress; (ii) decreases intentions to leave; and (iii) increases overall life satisfaction. The findings provide some evidence of areas within the workplace of large government run social welfare programmes that can be better aligned to worker expectations to improve occupational outcomes among social service workers. PMID:27559216

Women's autonomy and maternal healthcare service utilization in Ethiopia.

PubMed

Tiruneh, Fentanesh Nibret; Chuang, Kun-Yang; Chuang, Ying-Chih

2017-11-13

Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women's autonomy. We assessed whether women's autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women's decision-making power and permissive gender norms associated with wife beating. We used Spearman's correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women's autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Our study shows that women's autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.

Area-Level Socioeconomic Gradients in Overweight and Obesity in a Community-Derived Cohort of Health Service Users - A Cross-Sectional Study.

PubMed

Bonney, Andrew; Mayne, Darren J; Jones, Bryan D; Bott, Lawrence; Andersen, Stephen E J; Caputi, Peter; Weston, Kathryn M; Iverson, Don C

2015-01-01

Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities. The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable. The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males. It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.

Acceptance of Internet-Based Health Care Services Among Households in Poland: Secondary Analysis of a Population-Based Survey

PubMed Central

2012-01-01

Background Polish society is benefiting from growing access to the Internet, but the use of advanced e-services is still limited. The provision of Internet-based health services depends not only on the penetration of the Internet into society, but also on the acceptance of this technology by potential users. Objective The main objective of this study was focused on the assessment of predictors of acceptance of Internet use for provision of health services (eg, sociodemographic status, the use of information technologies, and consumption of health care services) among households in Poland. Methods The study was based on a secondary analysis of the dataset from the 2011 Social Diagnosis survey (a biannual survey conducted since 2001 about economic and non-economic aspects of household and individual living conditions in Poland). Analysis of the questionnaire results focused on the situations of the households included in the study. The predictors for 2 outcome variables describing the acceptance of households for Internet use for provision of a full health care service, or at least access to information and download of required forms, were assessed using multivariate logistic regression. Results After excluding those households that would not consider the use of health care services or for which predictor variables assumed missing values, the final analyses were conducted on data from 8915 households. Acceptance of the use of the Internet for provision of full health care services in Polish households was significantly higher among households in urban locations with ≥ 200,000 inhabitants than among households in rural areas; it was also higher with salaried employment as the source of income than with self-employment in agriculture (odds ratio [OR] = 0.53, 95% CI 0.40 - 0.70), retirement pension (OR = 0.46, 95% CI 0.39 - 0.54), disability pension (OR = 0.48, 95% CI 0.34 - 0.68), or with several simultaneous income sources (OR = 0.66; 95% CI 0.57 - 0.79). Furthermore, acceptance of Internet-based health care was higher in households with a higher monthly net income per capita (OR = 2.11, 95% CI 1.75 - 2.53 for households from the lowest and the highest income interval), among households with > 1 child aged < 15 years (OR = 1.38, 95% CI 1.20 - 1.59), among households with at least some books (with OR = 3.33, 95% CI 2.39 - 4.64 for household with no books and those with over 500 books). Acceptance was also higher in households with a computer (OR = 1.86, 95% CI 1.35 - 2.56), Internet access (OR = 1.95, 95% CI 1.37 - 2.76), and Internet access for a longer duration (OR = 1.36, 95% CI 1.06 - 1.75 and OR = 1.81, 95% CI 1.40 - 2.33 for households with access < 1 year versus those with access for 1-5 years and > 5 years, respectively). Greater self-declared confidence in using technology was also associated with higher acceptance of the Internet for health care services (OR = 2.94, 95% CI 2.21 - 3.91 for the least confident households versus those with the highest confidence). Furthermore, recent use of health care services increased acceptance of using the Internet for at least some health-related services (OR = 1.49, 95% CI 1.16 - 1.91), but not for full provision of online health care services (OR = 1.20, 95% CI 0.92 - 1.55). Neither the hospitalization of a member of a household nor the opinion about satisfying health care needs of a household affected the degree of acceptance. Conclusions The acceptance of health care services through the Internet is higher in households from larger cities, with stable income from an employee salary, as well as with higher income levels per capita. Furthermore, general computer and Internet use in the household influenced the perception of eHealth. Paradoxically, the use of health care services or the level of satisfaction with the coverage of the household’s health needs has a limited influence on acceptance of Internet-based health care services. PMID:23187116

Patterns and Predictors of Primary Mental Health Service Use Following Bushfire and Flood Disasters.

PubMed

Reifels, Lennart; Bassilios, Bridget; Spittal, Matthew J; King, Kylie; Fletcher, Justine; Pirkis, Jane

2015-06-01

To examine patterns and predictors of primary mental health care service use following 2 major Australian natural disaster events. Utilizing data from a national minimum dataset, descriptive and regression analyses were conducted to identify levels and predictors of the use of the Access to Allied Psychological Services (ATAPS) program over a 2-year period following 2 major Australian bushfire and flood/cyclone disasters. The bushfire disaster resulted in significantly greater and more enduring ATAPS service volume, while service delivery for both disasters peaked in the third quarter. Consumers affected by bushfires (IRR 1.51, 95% CI 1.20-1.89), diagnosed with depression (IRR 2.57, 95% CI 1.60-4.14), anxiety (IRR 2.06, 95% CI 1.21-3.49), or both disorders (IRR 2.15, 95% CI 1.35-3.42) utilized treatment at higher rates. The substantial demand for primary mental health care services following major natural disasters can vary in magnitude and trajectory with disaster type. Disaster-specific ATAPS services provide a promising model to cater for this demand in primary care settings. Disaster type and need-based variables as drivers of ATAPS use intensity indicate an equitable level of service use in line with the program intention. Established service usage patterns can assist with estimating capacity requirements in similar disaster circumstances.

A partial test of a hospital behavioral model.

PubMed

Hornbrook, M C; Goldfarb, M G

1983-01-01

The influence of hospital and community characteristics on the behavior of five dimensions of hospital output is examined in this article. These dimensions are the level of emergency stand-by capacity, total admissions, the diagnosis-mix of admissions and the hospital's 'style of practice' with regard to ancillary services and length of stay. A simultaneous equations model is estimated with data from a sample of 63 New England short-term general hospitals for 1970. The findings suggest that various types of short-term general hospitals have distinctive preferences for emergency capacity, volume, case mix and style of practice, and that style of practice may be more appropriately viewed as a rate of resource use per day. Specific findings of interest include the positive interdependence between protection against running out of emergency beds and length of stay, and between length of stay and ancillary service use. Hospitals that admit greater numbers of patients tend to treat more severely ill patients, and sicker patients tend to go to larger hospitals. Hospitals that provide more ancillary services tend to attract the more acutely ill patients. Relationships among other elements of the hospital's utility function represent trade-offs, i.e. substitution, in a constrained world. Among the exogenous factors, patient preferences and ability to pay have strong associations with the types of care provided by hospitals. Highly educated, high income communities, for example, tend to prefer risk averse, service intensive hospital output. Teaching hospitals are shown to prefer higher protection levels, service-intensive patterns of care, and higher admissions levels. Self-paying patients tend to be admitted for more discretionary types of diagnoses and to receive longer diagnosis-specific lengths of stay. A relatively greater supply of physician specialists in the market area is associated with increased use of ancillary services in the hospital. If replicated, these results have significant policy implications for reimbursing teaching hospitals; for defining accessibility of hospital care for the uninsured; for identifying the practice of 'skimming' by proprietary hospitals; and for specifying the role of community preferences in determining hospital performance, especially with respect to quality of care and level of emergency stand-by capacity.

Industry structures in private dental markets in Finland.

PubMed

Widström, E; Mikkola, H

2012-12-01

To use industrial organisation and organisational ecology research methods to survey industry structures and performance in the markets for private dental services and the effect of competition. Data on practice characteristics, performance, and perceived competition were collected from full-time private dentists (n = 1,121) using a questionnaire. The response rate was 59.6%. Cluster analysis was used to identify practice type based on service differentiation and process integration variables formulated from the questionnaire. Four strategic groups were identified in the Finnish markets: Solo practices formed one distinct group and group practices were classified into three clusters Integrated practices, Small practices, and Loosely integrated practices. Statistically significant differences were found in performance and perceived competitiveness between the groups. Integrated practices with the highest level of process integration and service differentiation performed better than solo and small practices. Moreover, loosely integrated and small practices outperformed solo practises. Competitive intensity was highest among small practices which had a low level of service differentiation and was above average among solo practises. Private dental care providers that had differentiated their services from public services and that had a high number of integrated service production processes enjoyed higher performance and less competitive pressures than those who had not.

Measuring socioeconomic differences in use of health care services by wealth versus by income.

PubMed

Allin, Sara; Masseria, Cristina; Mossialos, Elias

2009-10-01

We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator. We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries. We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences. We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population.

Responding to the Needs of Children and Families After a Disaster: Linkages Between Unmet Needs and Caregiver Functioning

PubMed Central

Kilmer, Ryan P.; Gil-Rivas, Virginia

2010-01-01

Disasters may negatively influence caregivers’ ability to respond to the needs of their families. In this context, service organizations’ response to families’ needs may affect caregivers’ symptoms and parenting. Interviews were conducted with caregivers affected by Hurricane Katrina approximately 12-months (T1; N = 68) and 2 years post-hurricane (T2; N = 52). Caregivers reported high levels of service needs and unmet needs for themselves and their child(ren) and family at both time points. Regression analyses indicated that after accounting for hurricane exposure: (a) child unmet service needs significantly contributed to T1 caregiver distress; (b) caregiver service needs and child unmet needs were associated with higher levels of posttraumatic stress symptoms (PTSS); and (c) caregiver unmet needs related to greater strain at T1. At T2, after accounting for T1 scores, service need variables did not contribute to distress or PTSS. Caregiver strain at T1 and T1 child service needs were associated with greater T2 strain. These findings highlight the importance of extending the availability of services beyond the initial post-disaster recovery period to better meet the needs of caregivers and families. PMID:20397998

Responding to the needs of children and families after a disaster: linkages between unmet needs and caregiver functioning.

PubMed

Kilmer, Ryan P; Gil-Rivas, Virginia

2010-01-01

Disasters may negatively influence caregivers' ability to respond to the needs of their families. In this context, service organizations' response to families' needs may affect caregivers' symptoms and parenting. Interviews were conducted with caregivers affected by Hurricane Katrina approximately 1 year (T(1); N = 68) and 2 years posthurricane (T(2); N = 52). Caregivers reported high levels of service needs and unmet needs for themselves and their child(ren) and family at both time points. Regression analyses indicated that after accounting for hurricane exposure: (a) child unmet service needs significantly contributed to T(1) caregiver distress, (b) caregiver service needs and child unmet needs were associated with higher levels of posttraumatic stress symptoms, and (c) caregiver unmet needs related to greater strain at T(1). At T(2), after accounting for T(1) scores, service need variables did not contribute to distress or posttraumatic stress symptoms. Caregiver strain at T(1) and T(1) child service needs were associated with greater T(2) strain. These findings highlight the importance of extending the availability of services beyond the initial postdisaster recovery period to better meet the needs of caregivers and families.

Factors Identified with Higher Levels of Career Satisfaction of Physicians in Andalusia, Spain

PubMed Central

Peña-Sánchez, Juan Nicolás; Lepnurm, Rein; Morales-Asencio, José Miguel; Delgado, Ana; Domagała, Alicja; Górkiewicz, Maciej

2014-01-01

The satisfaction of physicians is a worldwide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i) measure the career satisfaction of physicians; ii) identify differences in the dimensions of career satisfaction; and iii) test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain). Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians. PMID:26973935

Trauma and PTSD rates in an irish psychiatric population

PubMed Central

Wilson, Fiona E; Hennessy, Eilis; Dooley, Barbara; Kelly, Brendan D; Ryan, Dermot A

2013-01-01

Although Western mental health services are increasingly finding themselves concerned with assisting traumatized individuals migrating from other countries, trauma and posttraumatic stress disorder (PTSD) are under-detected and undiagnosed in psychiatric populations. This study examined and compared rates of traumatic experiences, frequency of traumatic events, trauma symptomatology levels, rates of torture, rates of PTSD and chart documentation of trauma and PTSD between (a) Irish and migrant service-users and (b) forced migrant and voluntary migrant service-users in Dublin, Ireland. Data were gathered from 178 psychiatric outpatients attending using a sociodemographic questionnaire, the Harvard Trauma Questionnaire-Revised Cambodian Version and the SCID-I/P. A substantial number of service-users had experienced at least one lifetime trauma (71.3%), and a high percentage of both the Irish (47.4%) and migrant groups (70.3%) of service-users had experienced two or more events. Overall, analyses comparing rates between Irish, forced migrant and voluntary migrant service-users found that forced migrants displayed more traumatic life events, posttraumatic symptoms, and higher levels of PTSD than their voluntary migrant and Irish counterparts, with over 50% experiencing torture prior to arrival in Ireland. The lifetime rate of PTSD in the overall sample was 15.7% but only 53.57% of cases were documented in patient charts. The results of this study are informative about the nature and extent of the problem of trauma and PTSD among migrant mental health service users as well as highlighting the under-detected levels of trauma among native-born service users. PMID:28228990

Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study.

PubMed

Prior, Anders; Vestergaard, Mogens; Larsen, Karen Kjær; Fenger-Grøn, Morten

2018-02-24

Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental-physical multimorbidity. Population-based cohort study. Primary healthcare in Denmark. 118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers. General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers. Perceived stress levels were associated with primary care activity in a dose-response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services. Persons with high stress levels generally had higher use of primary healthcare, 4-6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The State of Essential Newborn Care by Delivery Location in Bangladesh.

PubMed

Kim, Eunsoo Timothy; Singh, Kavita

2017-11-01

Introduction Essential newborn care (ENC) around the time of birth is critical in improving neonatal survival. There is currently a gap in our knowledge of the use of ENC by place of delivery in Bangladesh. This study assesses the provision of ENC and examines the odds of newborns receiving ENC by different levels of delivery care in Bangladesh. Methods Descriptive statistics and logistic regressions were performed on ENC practices from the 2011 Bangladesh Demographic and Health Survey dataset. ENC practices included nonapplication of substances to the cord; application of antiseptic to the cord; drying newborn within 5 min; wrapping newborn within 5 min; delaying first bath until the first 72 h; and breastfeeding within 1 h. Key predictors included home delivery with a lay attendant, delivery with primary healthcare services and delivery with higher-level healthcare services. Results Coverage of ENC practices was low. Women who delivered with primary and higher-level healthcare services generally reported greater odds of their newborns receiving recommended ENC than women who had home delivery with a lay attendant, the referent category. However, the odds of delayed first bath until 72 h and breastfeeding within 1 h were not statistically different for newborns who were delivered with primary healthcare services. Discussion These findings have significant public health implications as primary healthcare facilities are the first point of entry into the healthcare system. Provision of ENC, particularly delayed first bath until 72 h and breastfeeding within 1 h, should be encouraged for all healthy mother-newborn pairs in Bangladesh.

Community Determinants of Latinos’ Use of Mental Health Services

PubMed Central

Aguilera, Adrian; Regeser López, Steven

2014-01-01

Objective This study examined the role of community in understanding Latino adults’ (18–64 years of age) use of community mental health services. Methods Service utilization data from the Los Angeles County Department of Mental Health were analyzed from 2003 in two service provider areas. Demographic data, including foreign-born status, language, education, and income for the Latino population, were obtained from the 2000 U.S. Census. The study sample consisted of 4,133 consumers of mental health services in 413 census tracts from an established immigrant community and 4,156 consumers of mental health services in 204 census tracts from a recent immigrant community. Negative binomial regression analyses were conducted to examine associations between locales, community characteristics, and use of services. Results Community of residence and foreign-born status were significantly associated with Latinos’ service use. Latinos from the established immigrant community were more likely to use services than Latinos from the recent immigrant community. Across both communities, census tracts with a higher percentage of foreign-born noncitizen residents showed lower service use. Within the established immigrant community, as income levels increased there was little change in utilization. In contrast, in the recent immigrant community, as income levels increased utilization rates increased as well (β=.001, p<.001). Conclusions The findings point out the importance of locale and community determinants in understanding Latinos’ use of public mental health services. PMID:18378840

Projection of future pharmacy service fees using the dispensing claims in hospital and clinic outpatient pharmacies: national health insurance database between 2006 and 2012.

PubMed

Ha, Dongmun; Song, Inmyung; Lee, Eui-Kyung; Shin, Ju-Young

2018-05-03

Predicting pharmacy service fees is crucial to sustain the health insurance budget and maintain pharmacy management. However, there is no evidence on how to predict pharmacy service fees at the population level. This study compares the status of pharmacy services and constructs regression model to project annual pharmacy service fees in Korea. We conducted a time-series analysis by using sample data from the national health insurance database from 2006 and 2012. To reflect the latest trend, we categorized pharmacies into general hospital, special hospital, and clinic outpatient pharmacies based on the major source of service fees, using a 1% sample of the 2012 data. We estimated the daily number of prescriptions, pharmacy service fees, and drugs costs according to these three types of pharmacy services. To forecast pharmacy service fees, a regression model was constructed to estimate annual fees in the following year (2013). The dependent variable was pharmacy service fees and the independent variables were the number of prescriptions and service fees per pharmacy, ratio of patients (≥ 65 years), conversion factor, change of policy, and types of pharmacy services. Among the 21,283 pharmacies identified, 5.0% (1064), 4.6% (974), and 77.5% (16,340) were general hospital, special hospital, and clinic outpatient pharmacies, respectively, in 2012. General hospital pharmacies showed a higher daily number of prescriptions (111.9), higher pharmacy service fees ($25,546,342), and higher annual drugs costs ($215,728,000) per pharmacy than any other pharmacy (p <  0.05). The regression model to project found the ratio of patients aged 65 years and older and the conversion factor to be associated with an increase in pharmacy service fees. It also estimated the future rate of increase in pharmacy service fees to be between 3.1% and 7.8%. General hospital outpatient pharmacies spent more on annual pharmacy service fees than any other type of pharmacy. The forecast of annual pharmacy service fees in Korea was similar to that of Australia, but not that of the United Kingdom.

Phase Stability of a Powder Metallurgy Disk Superalloy

NASA Technical Reports Server (NTRS)

Gabb, Timothy P.; Gayda, John; Kantzos, P.; Telesman, Jack; Gang, Anita

2006-01-01

Advanced powder metallurgy superalloy disks in aerospace turbine engines now entering service can be exposed to temperatures approaching 700 C, higher than those previously encountered. They also have higher levels of refractory elements, which can increase mechanical properties at these temperatures but can also encourage phase instabilities during service. Microstructural changes including precipitation of topological close pack phase precipitation and coarsening of existing gamma' precipitates can be slow at these temperatures, yet potentially significant for anticipated disk service times exceeding 1,000 h. The ability to quantify and predict such potential phase instabilities and degradation of capabilities is needed to insure structural integrity and air worthiness of propulsion systems over the full life cycle. A prototypical advanced disk superalloy was subjected to high temperature exposures, and then evaluated. Microstructural changes and corresponding changes in mechanical properties were quantified. The results will be compared to predictions of microstructure modeling software.

Assessing the Effects of Service Quality of Government and Student Satisfaction in Education’s Field

NASA Astrophysics Data System (ADS)

Purwaningsih, D.

2017-03-01

The aim of the research is to analyze how the service quality of Indonesian government affect student’s satisfaction in the education field. Data collection was conducted in September 2016 through distributing questionnaires to 132 students at private universities in south Tangerang city. Sampling used incidental sampling method, while data analysis is descriptive, qualitative and quantitative, which were analyzed with the Importance Performance Analysis. The survey results revealed that the satisfaction level of the students of South Tangerang good enough to service of the Government in higher education sector with a value of 83.61 using Customer Satisfaction Index (CSI). Nevertheless, there are several factors that should be prioritized for immediate enhanced, namely: government’s ability to respond effectively to solve the problems in the academic world, fairness of the government in providing assistance to both state and private universities and attention of the government to higher education.

Technology requirements for post-1985 communications satellites

NASA Technical Reports Server (NTRS)

Burtt, J. E.; Moe, C. R.; Elms, R. V.; Delateur, L. A.; Sedlacek, W. C.; Younger, G. G.

1973-01-01

The technical and functional requirements for commercial communication satellites are discussed. The need for providing quality service at an acceptable cost is emphasized. Specialized services are postulated in a needs model which forecasts future demands. This needs model is based upon 322 separately identified needs for long distance communication. It is shown that the 1985 demand for satellite communication service for a domestic region such as the United States, and surrounding sea and air lanes, may require on the order of 100,000 MHz of bandwith. This level of demand can be met by means of the presently allocated bandwidths and developing some key technologies. Suggested improvements include: (1) improving antennas so that high speed switching will be possible; (2) development of solid state transponders for 12 GHz and possibly higher frequencies; (3) development of switched or steered beam antennas with 10 db or higher gain for aircraft; and (4) continued development of improved video channel compression techniques and hardware.

Incremental Costs and Performance Benefits of Various Features of Concrete Pavements

DOT National Transportation Integrated Search

2004-04-01

Various design features (such as dowel bars, tied shoulders, or drainable bases) may be added to a portland cement concrete (PCC) pavement design to improve its overall performance by maintaining a higher level of serviceability or by extending its s...

Aircraft Maintenance Expert Systems.

DTIC Science & Technology

1983-11-01

PARA 2 -104)) 44: (( JETCAL ANALYSIS SHOWS SYSTEM READS CORRECT) (REPLACE FAULTY PARTS)) 45: ((OVERTEMP EXCEEDED SERVICE LIMITS) 46: I(ENGINE CONTROL...CIRCUITS WITHIN LIMITS ON JETCAL ) (REPLACE FAULTY PARTS)) 47: (ADJUST EST AT AMPLIFIER AND CHECK TENP)) (SEND ENGINE TO HIGHER LEVEL MAINTENANCE)) 48: 2

A Study of Reasons for Not Reenlisting: First-Term Marines in Critical Occupations

DTIC Science & Technology

1989-12-01

civilian employers. Therefore, the higher quality people are less likely to reenlist at the end of their first-term when faced with widening gaps between...that there are quality Marines approaching the end of their enlistment and facing a 30 reenlistment decision. By being "quality" Marines, they meet the...establishes basic guidelines, the SRB program faces many refinements before arriving at the individual service level. 40 Li Additionally, each Service

Examining inequities in incidence of catastrophic health expenditures on different healthcare services and health facilities in Nigeria.

PubMed

Onwujekwe, Obinna; Hanson, Kara; Uzochukwu, Benjamin

2012-01-01

There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms.

Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria

PubMed Central

Onwujekwe, Obinna; Hanson, Kara; Uzochukwu, Benjamin

2012-01-01

Objective There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. Methods The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. Results The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. Conclusion The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms. PMID:22815828

Does competition by health maintenance organizations affect the adoption of cost-containment measures by fee-for-service plans?

PubMed

Joesch, J M; Wickizer, T M; Feldstein, P J

1998-06-01

How groups insured by fee-for-service health plans react to increased competition from health maintenance organizations (HMOs) is an unresolved question. We investigated whether groups insured by indemnity plans respond to HMO market competition by changing selected health insurance features, such as deductible amounts, stop loss levels, and coinsurance rates, or by adopting utilization management or preferred provider organization (PPO) benefit options. We collected benefit design data for the years 1985 through 1992 from 95 insured groups in 62 US metropolitan statistical areas. Multivariate hazard analysis showed that groups located in markets with higher rates of change in HMO enrollment were less likely to increase deductibles or stop loss levels. Groups located in markets with higher HMO enrollment were more likely to adopt utilization management or PPO benefit options. A group located in a market with an HMO penetration rate of 20% was 65% more likely to have included a PPO option as part of its insurance benefit plan than a group located in a market with an HMO penetration rate of 15% (p < 0.05). Concern about possible adverse selection effects may deter some fee-for-service groups from changing their health insurance coverage. Under some conditions, however, groups insured under fee-for-service plans do respond to managed care competition by changing their insurance benefits to achieve greater cost containment.

Next generation satellite communications networks

NASA Astrophysics Data System (ADS)

Garland, P. J.; Osborne, F. J.; Streibl, I.

The paper introduces two potential uses for new space hardware to permit enhanced levels of signal handling and switching in satellite communication service for Canada. One application involves increased private-sector services in the Ku band; the second supports new personal/mobile services by employing higher levels of handling and switching in the Ka band. First-generation satellite regeneration and switching experiments involving the NASA/ACTS spacecraft are described, where the Ka band and switching satellite network problems are emphasized. Second-generation satellite development is outlined based on demand trends for more packet-based switching, low-cost earth stations, and closed user groups. A demonstration mission for new Ka- and Ku-band technologies is proposed, including the payload configuration. The half ANIK E payload is shown to meet the demonstration objectives, and projected to maintain a fully operational payload for at least 10 years.

Daily Stressors and Adult Day Service Use by Family Caregivers: Effects on Depressive Symptoms, Positive Mood and DHEA-S

PubMed Central

Zarit, Steven H.; Whetzel, Courtney A.; Kim, Kyungmin; Femia, Elia E.; Almeida, David M.; Rovine, Michael J.; Klein, Laura Cousino

2014-01-01

Objectives This study examines effects of daily use of adult day services (ADS) programs by caregivers of individuals with dementia (IWD) on a salivary biomarker of stress reactivity, dehydroepiandrosterone-sulfate (DHEA-S), and whether these effects on DHEA-S are associated with daily variability in positive mood and depressive symptoms. Design We used a daily diary design of 8 consecutive days with alternation of intervention (ADS) and non-intervention days to evaluate within- and between-person effects of the intervention. Setting Caregivers were interviewed daily by telephone at home. Participants 151 family caregivers of IWD who were using ADS. Measurements Saliva samples were collected from caregivers 5 times a day for 8 consecutive days and were assayed for DHEA-S. Daily telephone interviews assessed daily stressors and mood. Results DHEA-S levels were significantly higher on days following ADS use. Daily DHEA-S levels covaried significantly with daily positive mood, but not depressive symptoms. Conclusions These results demonstrate an association of ADS use by family caregivers and higher DHEA-S levels on the next day. Prior research has found that higher DHEA-S levels are protective against the physiological damaging effects of stressor exposure and may reduce risks of illness. Regular use of ADS may help reduce depletion of DHEA-S and allow the body to mount a protective and restorative response to the physiological demands of caregiving. To our knowledge, this is the first study to examine DHEA-S levels across the day in connection with an intervention that affected daily exposure to stressors. PMID:24566240

Are reporting radiographers fulfilling the role of advanced practitioner?

PubMed

Milner, R C; Snaith, B

2017-02-01

Advanced practice roles are emerging in all disciplines at a rapid pace and reporting radiographers are ideally placed to work at such level. Advanced practitioners should demonstrate expert practice and show progression into three other areas of higher level practice. Most existing literature has focussed on the image interpretation aspect of the role, however there is little evidence that plain film reporting radiographers are undertaking activities beyond image interpretation and fulfilling the role of advanced practitioner. Letters were posted to every acute NHS trust in the UK, inviting reporting radiographers to complete an online survey. Both quantitative and qualitative information was sought regarding demographics and roles supplementary to reporting. A total of 205 responses were analysed; 83.3% of reporting radiographers describe themselves as advanced practitioner, however significantly less are showing progression into the four core functions of higher level practice. A total of 97.0% undertake expert practice, 54.7% have a leadership role, 19.8% provide expert lectures and 71.1% have roles encompassing service development or research, though most of these fall into the service development category. 34.5% felt that they were aware of the differences between extended and advanced practice though much less (9.3%) could correctly articulate the difference. Few individuals are aware of the difference between extended and advanced practice. Though the majority of plain film reporting radiographers identify themselves as advanced practitioners, significantly less evidence all four core functions of higher level practice. The number of individuals undertaking research and providing expert-level education is low. Copyright © 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Life after cancer: how does public stigma increase psychological distress of childhood cancer survivors?

PubMed

Kim, Min Ah; Yi, Jaehee

2014-12-01

Public stigma is a major source of stress for cancer survivors. However, factors that buffer or exacerbate the negative effects of public stigma on psychological distress have not been elucidated. This study examined how perceived public stigma affects psychological distress as mediated by cancer disclosure, internalized reactions to stigma, and social support availability. Cross-sectional study. The study was conducted in South Korea. The study sample was 223 adolescent and young adult survivors of childhood cancer diagnosed before the age of 19 and currently between 15 and 39 years old. Psychological distress was assessed using the Brief Symptom Inventory-18. Structural equation modeling was used with 1000 bootstrap samples. The goodness of model fit was acceptable. Public stigma perceived by cancer survivors influenced psychological distress via cancer disclosure, internalized shame, and social support availability. Higher levels of perceived public stigma predicted higher levels of internalized shame and self-blame and lower levels of social support availability, which subsequently increased psychological distress. Higher levels of perceived public stigma predicted lower levels of disclosure about cancer history and experiences. Cancer disclosure indirectly ameliorated psychological distress by reducing internalized shame. This study offers evidence that cognitive and social factors play important roles in mediating the effects of perceived public stigma on psychological distress in Korean cancer survivors. A greater understanding of factors that influence psychological distress may help psychosocial oncology service providers to identify childhood cancer survivors in need of psychosocial services and provide them with appropriate resources and interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

A hybrid of monopoly and perfect competition model for hi-tech products

NASA Astrophysics Data System (ADS)

Yang, P. C.; Wee, H. M.; Pai, S.; Yang, H. J.; Wee, P. K. P.

2010-11-01

For Hi-tech products, the demand rate, the component cost as well as the selling price usually decline significantly with time. In the case of perfect competition, shortages usually result in lost sales; while in a monopoly, shortages will be completely backordered. However, neither perfect competition nor monopoly exists. Therefore, there is a need to develop a replenishment model considering a hybrid of perfect competition and monopoly when the cost, price and demand are decreasing simultaneously. A numerical example and sensitivity analysis are carried out to illustrate this model. The results show that a higher decline-rate in the component cost leads to a smaller service level and a larger replenishment interval. When the component cost decline rate increases and the selling price decline rate decreases simultaneously, the replenishment interval decreases. In perfect competition it is better to have a high service level, while for the case with monopoly, keeping a low service level is better due to complete backordering.

Vitamin D in patients with intellectual and developmental disability in secure in-patient services in the North of England, UK.

PubMed

McKinnon, Iain; Lewis, Thomas; Mehta, Naomi; Imrit, Shahed; Thorp, Julie; Ince, Chris

2018-02-01

Aims and method To assess the benefits of the introduction of routine vitamin D serum sampling for all patients admitted to a secure in-patient hospital in the North of England providing medium security, low security and rehabilitation services for offenders with intellectual and developmental disability. The vitamin D levels of 100 patients were analysed at baseline. Those with insufficient or deficient levels were offered treatment and retested after 1 year. Vitamin D levels were analysed in the context of level of security, seasonality of test and co-prescription of psychotropic medications. Eighty-three per cent of patients had suboptimal vitamin D levels at initial test (41% deficient and 42% insufficient). This was seen among established patients and new admissions. Regression analysis of baseline vitamin D levels revealed no differences for levels of security, seasonality, whether patients were taking antipsychotic or anticonvulsant medication, or length of stay. Patients with deficiency or insufficiency were all offered supplementation. Those who opted in had significantly higher vitamin D levels at follow-up, compared with those who declined treatment. Clinical implications Established and newly admitted patients in our secure mental health services had substantial levels of vitamin D insufficiency. In the light of the morbidities that are associated with deficient vitamin D levels, routine screening and the offer of supplementation is advisable. Declaration of interest None.

American Military Veteran Entrepreneurs: A Comprehensive Profile of Demographic, Service History, and Psychosocial Characteristics

PubMed Central

Heinz, Adrienne J.; Freeman, Michael A.; Harpaz-Rotem, Ilan; Pietrzak, Robert H.

2017-01-01

American military veterans are nearly twice as likely to be self-employed compared to non-veterans, and are majority owners in nine percent of all businesses nationwide. Despite their contribution to the broader economy and the potential for training programs to cultivate and foster successful self-employment and veteran-lead entrepreneurial ventures, research on veteran entrepreneurs remains limited. In order to gain a better understanding of the potential strengths and vulnerabilities of veteran entrepreneurs, the current study utilized data from a large, nationally representative sample to profile self-employed veterans (n=230) and compare them to veterans who work as employees (n=1,055) with respect to demographic, military service history, and psychosocial characteristics. Results indicated that self-employed veterans were older and more educated and more likely to utilize VA healthcare. Self-employed veterans were more likely to serve in Vietnam and to serve in the military for fewer years. No differences were noted in perceived military experience, level of combat exposure, or military branch served as a function of self-employment. Although reporting more lifetime traumas, self-employed veterans did not experience higher rates of current or lifetime psychopathology or lower perceived quality of life. Potential protective resilience-promoting factors may be associated with the higher levels of openness, extraversion, optimism, achievement-orientation (purpose in life), and greater need for autonomy and professional development observed among self-employed veterans. Moreover, self-employed veterans demonstrated higher levels of gratitude, community integration, and altruistic service to others. Findings have potential to inform human resources management strategies and vocational training and reintegration initiatives for veterans. PMID:29290645

Is individual educational level related to end-of-life care use? Results from a nationwide retrospective cohort study in Belgium.

PubMed

Bossuyt, Nathalie; Van den Block, Lieve; Cohen, Joachim; Meeussen, Koen; Bilsen, Johan; Echteld, Michael; Deliens, Luc; Van Casteren, Viviane

2011-10-01

Educational level has repeatedly been identified as an important determinant of access to health care, but little is known about its influence on end-of-life care use. To examine the relationship between individual educational attainment and end-of-life care use and to assess the importance of individual educational attainment in explaining differential end-of-life care use. A retrospective cohort study via a nationwide sentinel network of general practitioners (GPs; SENTI-MELC Study) provided data on end-of-life care utilization. Multilevel analysis was used to model the association between educational level and health care use, adjusting for individual and contextual confounders based upon Andersen's behavioral model of health services use. A Belgian nationwide representative sample of people who died not suddenly in 2005-2007. In comparison to their less educated counterparts, higher educated people equally often had a palliative treatment goal but more often used multidisciplinary palliative care services (odds ratios [OR] for lower secondary education 1.28 [1.04-1.59] and for higher [secondary] education: 1.31 [1.02-1.68]), moved between care settings more frequently (OR: 1.68 [1.13-2.48] for lower secondary education and 1.51 [0.93-2.48] for higher [secondary] education) and had more contacts with the GP in the final 3 months of life. Less well-educated people appear to be disadvantaged in terms of access to specialist palliative care services, and GP contacts at the end of life, suggesting a need for empowerment of less well-educated terminally ill people regarding specialist palliative and general end-of-life care use.

Sentinel-1 Archive and Processing in the Cloud using the Hybrid Pluggable Processing Pipeline (HyP3) at the ASF DAAC

NASA Astrophysics Data System (ADS)

Arko, S. A.; Hogenson, R.; Geiger, A.; Herrmann, J.; Buechler, B.; Hogenson, K.

2016-12-01

In the coming years there will be an unprecedented amount of SAR data available on a free and open basis to research and operational users around the globe. The Alaska Satellite Facility (ASF) DAAC hosts, through an international agreement, data from the Sentinel-1 spacecraft and will be hosting data from the upcoming NASA ISRO SAR (NISAR) mission. To more effectively manage and exploit these vast datasets, ASF DAAC has begun moving portions of the archive to the cloud and utilizing cloud services to provide higher-level processing on the data. The Hybrid Pluggable Processing Pipeline (HyP3) project is designed to support higher-level data processing in the cloud and extend the capabilities of researchers to larger scales. Built upon a set of core Amazon cloud services, the HyP3 system allows users to request data processing using a number of canned algorithms or their own algorithms once they have been uploaded to the cloud. The HyP3 system automatically accesses the ASF cloud-based archive through the DAAC RESTful application programming interface and processes the data on Amazon's elastic compute cluster (EC2). Final products are distributed through Amazon's simple storage service (S3) and are available for user download. This presentation will provide an overview of ASF DAAC's activities moving the Sentinel-1 archive into the cloud and developing the integrated HyP3 system, covering both the benefits and difficulties of working in the cloud. Additionally, we will focus on the utilization of HyP3 for higher-level processing of SAR data. Two example algorithms, for sea-ice tracking and change detection, will be discussed as well as the mechanism for integrating new algorithms into the pipeline for community use.

Sexual harassment and generalized workplace abuse among university employees: prevalence and mental health correlates.

PubMed

Richman, J A; Rospenda, K M; Nawyn, S J; Flaherty, J A; Fendrich, M; Drum, M L; Johnson, T P

1999-03-01

This study hypothesized that interpersonal workplace stressors involving sexual harassment and generalized workplace abuse are highly prevalent and significantly linked with mental health outcomes including symptomatic distress, the use and abuse of alcohol, and other drug use. Employees in 4 university occupational groups (faculty, student, clerical, and service workers; n = 2492) were surveyed by means of a mailed self-report instrument. Cross-tabular and ordinary least squares and logistic regression analyses examined the prevalence of harassment and abuse and their association with mental health status. The data show high rates of harassment and abuse. Among faculty, females were subjected to higher rates; among clerical and service workers, males were subjected to higher rates. Male and female clerical and service workers experienced higher levels of particularly severe mistreatment. Generalized abuse was more prevalent than harassment for all groups. Both harassment and abuse were significantly linked to most mental health outcomes for men and women. Interpersonally abusive workplace dynamics constitute a significant public health problem that merits increased intervention and prevention strategies.

Sexual harassment and generalized workplace abuse among university employees: prevalence and mental health correlates.

PubMed Central

Richman, J A; Rospenda, K M; Nawyn, S J; Flaherty, J A; Fendrich, M; Drum, M L; Johnson, T P

1999-01-01

OBJECTIVES: This study hypothesized that interpersonal workplace stressors involving sexual harassment and generalized workplace abuse are highly prevalent and significantly linked with mental health outcomes including symptomatic distress, the use and abuse of alcohol, and other drug use. METHODS: Employees in 4 university occupational groups (faculty, student, clerical, and service workers; n = 2492) were surveyed by means of a mailed self-report instrument. Cross-tabular and ordinary least squares and logistic regression analyses examined the prevalence of harassment and abuse and their association with mental health status. RESULTS: The data show high rates of harassment and abuse. Among faculty, females were subjected to higher rates; among clerical and service workers, males were subjected to higher rates. Male and female clerical and service workers experienced higher levels of particularly severe mistreatment. Generalized abuse was more prevalent than harassment for all groups. Both harassment and abuse were significantly linked to most mental health outcomes for men and women. CONCLUSIONS: Interpersonally abusive workplace dynamics constitute a significant public health problem that merits increased intervention and prevention strategies. PMID:10076485

Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan.

PubMed

Alonge, O; Lin, S; Igusa, T; Peters, D H

2017-12-01

System dynamics methods were used to explore effective implementation pathways for improving health systems performance through pay-for-performance (P4P) schemes. A causal loop diagram was developed to delineate primary causal relationships for service delivery within primary health facilities. A quantitative stock-and-flow model was developed next. The stock-and-flow model was then used to simulate the impact of various P4P implementation scenarios on quality and volume of services. Data from the Afghanistan national facility survey in 2012 was used to calibrate the model. The models show that P4P bonuses could increase health workers' motivation leading to higher levels of quality and volume of services. Gaming could reduce or even reverse this desired effect, leading to levels of quality and volume of services that are below baseline levels. Implementation issues, such as delays in the disbursement of P4P bonuses and low levels of P4P bonuses, also reduce the desired effect of P4P on quality and volume, but they do not cause the outputs to fall below baseline levels. Optimal effect of P4P on quality and volume of services is obtained when P4P bonuses are distributed per the health workers' contributions to the services that triggered the payments. Other distribution algorithms such as equal allocation or allocations proportionate to salaries resulted in quality and volume levels that were substantially lower, sometimes below baseline. The system dynamics models served to inform, with quantitative results, the theory of change underlying P4P intervention. Specific implementation strategies, such as prompt disbursement of adequate levels of performance bonus distributed per health workers' contribution to service, increase the likelihood of P4P success. Poorly designed P4P schemes, such as those without an optimal algorithm for distributing performance bonuses and adequate safeguards for gaming, can have a negative overall impact on health service delivery systems. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

The cost structure of routine infant immunization services: a systematic analysis of six countries

PubMed Central

Geng, Fangli; Suharlim, Christian; Brenzel, Logan; Resch, Stephen C; Menzies, Nicolas A

2017-01-01

Abstract Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77–93% of national routine infant immunization costs. Labour and vaccine costs comprised 14–69% and 13–69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48–78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites. PMID:28575193

The cost structure of routine infant immunization services: a systematic analysis of six countries.

PubMed

Geng, Fangli; Suharlim, Christian; Brenzel, Logan; Resch, Stephen C; Menzies, Nicolas A

2017-10-01

Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77-93% of national routine infant immunization costs. Labour and vaccine costs comprised 14-69% and 13-69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48-78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

"Factors associated with non-small cell lung cancer treatment costs in a Brazilian public hospital".

PubMed

de Barros Reis, Carla; Knust, Renata Erthal; de Aguiar Pereira, Claudia Cristina; Portela, Margareth Crisóstomo

2018-02-17

The present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time. Estimates were obtained from the survey of direct medical cost per patient from the hospital's perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution. The average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient's survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R 2 of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%. Inequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population's hurdles to accessing cancer care services.

Why carers use adult day respite: a mixed method case study

PubMed Central

2014-01-01

Background We need to improve our understanding of the complex interactions between family carers’ emotional relationships with care-recipients and carers use of support services. This study assessed carer’s expectations and perceptions of adult day respite services and their commitment to using services. Methods A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation’s day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow’s hierarchy of needs during analysis. Results Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow’s hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. Conclusion The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers’ use of day respite services. PMID:24906239

Why carers use adult day respite: a mixed method case study.

PubMed

Stirling, Christine M; Dwan, Corinna A; McKenzie, Angela R

2014-06-06

We need to improve our understanding of the complex interactions between family carers' emotional relationships with care-recipients and carers use of support services. This study assessed carer's expectations and perceptions of adult day respite services and their commitment to using services. A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation's day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow's hierarchy of needs during analysis. Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow's hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers' use of day respite services.

Context-Awareness Based Personalized Recommendation of Anti-Hypertension Drugs.

PubMed

Chen, Dexin; Jin, Dawei; Goh, Tiong-Thye; Li, Na; Wei, Leiru

2016-09-01

The World Health Organization estimates that almost one-third of the world's adult population are suffering from hypertension which has gradually become a "silent killer". Due to the varieties of anti-hypertensive drugs, patients are interested in how these drugs can be selected to match their respective conditions. This study provides a personalized recommendation service system of anti-hypertensive drugs based on context-awareness and designs a context ontology framework of the service. In addition, this paper introduces a Semantic Web Rule Language (SWRL)-based rule to provide high-level context reasoning and information recommendation and to overcome the limitation of ontology reasoning. To make the information recommendation of the drugs more personalized, this study also devises three categories of information recommendation rules that match different priority levels and uses a ranking algorithm to optimize the recommendation. The experiment conducted shows that combining the anti-hypertensive drugs personalized recommendation service context ontology (HyRCO) with the optimized rule reasoning can achieve a higher-quality personalized drug recommendation service. Accordingly this exploratory study of the personalized recommendation service for hypertensive drugs and its method can be easily adopted for other diseases.

Is Profit Status of Inpatient Rehabilitation Facilities Independently Associated with 30-day Unplanned Hospital Readmission for Medicare Beneficiaries?

PubMed Central

Karmarkar, Amol; Lin, Yu-Li; Kuo, Yong-Fang; Ottenbacher, Kenneth J.; Graham, James E.

2017-01-01

Objective To investigate the effects of facility-level factors on 30-day unplanned risk-adjusted hospital readmission after Inpatient Rehabilitation Facilities (IRFs) discharge. Design We used the 100% Medicare claims data, covering 269,306 discharges from 1,094 IRFs between October 2010 and September 2011. We examined the association between hospital readmission and ten facility-level factors (number of discharges, disproportionate share percentage, profit status, teaching status, freestanding status, accreditation status, census region, stroke belt, location and median household income). Setting Discharge from IRFs. Participants Facilities (IRFs) serving Medicare fee-for-service beneficiaries. Intervention NA Main Outcome Measure(s) Risk Standardized Readmission Rate (RSRR) for 30-day hospital readmission. Results Profit status was the only IRF provider-level characteristic significantly associated with unplanned readmissions. For-profit IRFs had significantly higher RSRR (13.26 ± 0.51) as compared to non-profit IRFs (13.15 ± 0.47) (p<0.001). After controlling for all other facility characteristics (except for accreditation status due to collinearity), for-profit IRFs remained 0.1% point higher RSRR than non-profit IRFs, and census region was the only significant region-level characteristic, with the South showing the highest RSRR of all regions (p=0.005 for both, type III test). Conclusions Our findings support the inclusion of profit status on the IRF Compare website (a platform includes IRF comparators to indicate quality of services). For-profit IRFs had higher RSRR than non-profit IRFs for Medicare beneficiaries. The South had higher RSRR than other regions. The RSRR difference between for-profit and non-profit IRFs could be due to the combined effects of organizational and regional factors. PMID:28958606

The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies.

PubMed

Menzies, Nicolas A; Suharlim, Christian; Geng, Fangli; Ward, Zachary J; Brenzel, Logan; Resch, Stephen C

2017-10-06

Evidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. We developed a pooled dataset from individual EPIC country studies (316 sites). We regressed log total costs against explanatory variables describing service volume, quality, access, other site characteristics, and income level. We used Bayesian hierarchical regression models to combine data from different countries and account for the multi-stage sample design. We calculated output elasticity as the percentage increase in outputs (service volume) for a 1% increase in inputs (total costs), averaged across the sample in each country, and reported first differences to describe the impact of other predictors. We estimated average and total cost curves for each country as a function of service volume. Across countries, average costs per dose ranged from $2.75 to $13.63. Average costs per child receiving diphtheria, tetanus, and pertussis ranged from $27 to $139. Within countries costs per dose varied widely-on average, sites in the highest quintile were 440% more expensive than those in the lowest quintile. In each country, higher service volume was strongly associated with lower average costs. A doubling of service volume was associated with a 19% (95% interval, 4.0-32) reduction in costs per dose delivered, (range 13% to 32% across countries), and the largest 20% of sites in each country realized costs per dose that were on average 61% lower than those for the smallest 20% of sites, controlling for other factors. Other factors associated with higher costs included hospital status, provision of outreach services, share of effort to management, level of staff training/seniority, distance to vaccine collection, additional days open per week, greater vaccination schedule completion, and per capita gross domestic product. We identified multiple features of sites and their operating environment that were associated with differences in average unit costs, with service volume being the most influential. These findings can inform efforts to improve the efficiency of service delivery and better understand resource needs.

Communities and community genetics in Ethiopia.

PubMed

Tadesse, Luche; Tafesse, Fikru; Hamamy, Hanan

2014-01-01

The rates of congenital and genetic disorders in low and middle income countries are similar or might be higher than in high income countries due to a multitude of risk factors and the dearth of community genetic services. To direct effective preventive, diagnostic and counseling services, collecting data on the incidence and prevalence of various congenital and genetic disorders and their risk factors is a pre-requisite for establishing genetic services at the community level and mainly at the primary health care setting. This brief review is meant to assess the available epidemiological data in Ethiopia pertaining to congenital and genetic disorders on which the future community genetic services could be built. Existing epidemiological data on congenital and genetic disorders in Ethiopia is limited, and the few studies conducted revealed that folate and iodine deficiencies are prevalent among women in the reproductive age. Pregnant women's infection with syphilis and rubella is prevailing. Based on available data, cleft lip and palate, congenital heart diseases, club-foot, and gastro-intestinal malformations are the most common birth defects in Ethiopia. Community based studies to accurately demonstrate the incidence and prevalence levels of these disorders are almost unavailable. To plan for organization and implementation of community genetic services at the primary health care level in Ethiopia, conducting standardized epidemiological studies is currently highly recommended.

Quality of reproductive health services at commune health stations in Viet Nam: implications for national reproductive health care strategy.

PubMed

Ngo, Anh D; Hill, Peter S

2011-05-01

This paper presents a qualitative study conducted in 2009 of provider and patient perceptions of primary level reproductive health services provided by commune health stations (CHSs), and the implications for Viet Nam's 2011-2020 National Strategy for Reproductive Health Care. In the three provinces of Thai Nguyen, Thua Thien Hue, and Vinh Long, we interviewed the heads of CHSs, held focus group discussions with midwives and women patients, and observed facilities. Half the 30 CHSs visited were in poor physical condition; the rest were newly renovated. However, the model of service delivery was largely unchanged from ten years before. Many appeared to fall short in meeting patient expectations in terms of modern medical equipment and technology, range of drug supplies, and levels of staff expertise. As a result, many women were turning to private doctors and public hospitals, at least in urban areas, or seeking medication from pharmacies. To make CHS clinics sustainable, promotion of access to reproductive health services should be undertaken concurrently with quality improvement. A responsive payment scheme must also be developed to generate revenues. Efforts should be made to reduce the unnecessary use of more costly services from private clinics and higher level public facilities. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Communities and community genetics in Ethiopia

PubMed Central

Tadesse, Luche; Tafesse, Fikru; Hamamy, Hanan

2014-01-01

The rates of congenital and genetic disorders in low and middle income countries are similar or might be higher than in high income countries due to a multitude of risk factors and the dearth of community genetic services. To direct effective preventive, diagnostic and counseling services, collecting data on the incidence and prevalence of various congenital and genetic disorders and their risk factors is a pre-requisite for establishing genetic services at the community level and mainly at the primary health care setting. This brief review is meant to assess the available epidemiological data in Ethiopia pertaining to congenital and genetic disorders on which the future community genetic services could be built. Existing epidemiological data on congenital and genetic disorders in Ethiopia is limited, and the few studies conducted revealed that folate and iodine deficiencies are prevalent among women in the reproductive age. Pregnant women's infection with syphilis and rubella is prevailing. Based on available data, cleft lip and palate, congenital heart diseases, club-foot, and gastro-intestinalmalformations are the most common birth defects in Ethiopia. Community based studies to accurately demonstrate the incidence and prevalence levels of these disorders are almost unavailable. To plan for organization and implementation of community genetic services at the primary health care level in Ethiopia, conducting standardized epidemiological studies is currently highly recommended. PMID:25404975

Mental health, service use and social capital among Indian-Australians: findings of a wellbeing survey.

PubMed

Maheshwari, Rajesh; Steel, Zachary

2012-10-01

Indian-Australians represent a distinct immigrant group both demographically and culturally. Yet, despite an expanding body of research on transcultural mental health in Australia, there is a paucity of studies regarding mental health of Indian-Australians. This paper explores the extent of psychological morbidity and related service use in a representative sample of Indian-Australians. It further examines the association of mental health with social participation and networking in this ethnic community. Measures to assess current levels of psychological distress, functional disability, service use, and social capital were administered in a random sample of 71 Indian-Australian family groups living in Sydney. Amongst participants, 15% reported high to very high levels of psychological distress. Psychological distress was associated with increased days of functional disability and higher levels of functional impairment, and an increased likelihood of a GP consultation. However, 91% of participants with identifiable mental health needs did not seek any mental health consultation. Social capital was not found to be a significant predictor of psychological health or service use in this sample. Psychological morbidity in the Indian-Australian community is associated with high levels of functional disability, both in number of days and extent of severity, but only a small proportion seeks mental health help.

National Service Framework for Older People: stroke coordinators.

PubMed

McDonald, Paul S; Mayer, Peter; Dunn, Linda

The National Service Framework (NSF) for Older People aims to develop integrated stroke services with specialized treatment, carer involvement, secondary prevention and rehabilitation. There is an emphasis upon the role of stroke coordinators. The aim of this study was to examine the relationships between stroke coordinators and other agencies involved in stroke care, and to describe stroke coordinators' current roles. Interviews with 11 stroke coordinators across the West Midlands region took place and were evaluated using a grounded theory approach. The roles of stroke coordinators and the perceived levels of integration among stroke services varied between localities. In a few areas, a number of 'adhesive' factors helped bond the coordinator role to successful integration, while in most areas the absence of all or some of these factors made the role less effective. To meet the demands of the NSF, a stroke coordinator's role needs to be a high profile, corporate function, requiring a higher level of autonomy, accountability and responsibility, and demanding creativity and innovation from post holders.

Mapping regional livelihood benefits from local ecosystem services assessments in rural Sahel

PubMed Central

Sinare, Hanna; Enfors Kautsky, Elin; Ouedraogo, Issa; Gordon, Line J.

2018-01-01

Most current approaches to landscape scale ecosystem service assessments rely on detailed secondary data. This type of data is seldom available in regions with high levels of poverty and strong local dependence on provisioning ecosystem services for livelihoods. We develop a method to extrapolate results from a previously published village scale ecosystem services assessment to a higher administrative level, relevant for land use decision making. The method combines remote sensing (using a hybrid classification method) and interviews with community members. The resulting landscape scale maps show the spatial distribution of five different livelihood benefits (nutritional diversity, income, insurance/saving, material assets and energy, and crops for consumption) that illustrate the strong multifunctionality of the Sahelian landscapes. The maps highlight the importance of a diverse set of sub-units of the landscape in supporting Sahelian livelihoods. We see a large potential in using the resulting type of livelihood benefit maps for guiding future land use decisions in the Sahel. PMID:29389965

Mapping regional livelihood benefits from local ecosystem services assessments in rural Sahel.

PubMed

Malmborg, Katja; Sinare, Hanna; Enfors Kautsky, Elin; Ouedraogo, Issa; Gordon, Line J

2018-01-01

Most current approaches to landscape scale ecosystem service assessments rely on detailed secondary data. This type of data is seldom available in regions with high levels of poverty and strong local dependence on provisioning ecosystem services for livelihoods. We develop a method to extrapolate results from a previously published village scale ecosystem services assessment to a higher administrative level, relevant for land use decision making. The method combines remote sensing (using a hybrid classification method) and interviews with community members. The resulting landscape scale maps show the spatial distribution of five different livelihood benefits (nutritional diversity, income, insurance/saving, material assets and energy, and crops for consumption) that illustrate the strong multifunctionality of the Sahelian landscapes. The maps highlight the importance of a diverse set of sub-units of the landscape in supporting Sahelian livelihoods. We see a large potential in using the resulting type of livelihood benefit maps for guiding future land use decisions in the Sahel.

Cardio-Vascular Disease and Cancer

PubMed Central

Mitchell-Fearon, K.; Willie-Tyndale, D.; Waldron, N.; Holder-Nevins, D.; James, K.; Laws, H.; Eldemire-Shearer, D.

2015-01-01

Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services. PMID:28138475

Contamination revealed by indicator microorganism levels during veal processing

USDA-ARS?s Scientific Manuscript database

The United States Department of Agriculture (USDA) Food Safety Inspection Service (FSIS) has identified a higher percentage of non-O157 Shiga toxin-producing Escherichia coli positive samples collected from veal trimmings than from products produced from other cattle slaughter classes. During site ...

Modeling of the nearshore marine ecosystem with the AQUATOX model

EPA Science Inventory

Process-based models can be used to forecast the responses of coastal ecosystems to changes under future scenarios. However, most models applied to coastal systems do not include higher trophic levels, which are important providers of ecosystem services. AQUATOX is a mechanistic...

Combined effects of compact cevelopment, transportation investments, and road user pricing on vehicle miles traveled in urbanized areas

USGS Publications Warehouse

Ewing, Reid; Hamidi, Shima; Gallivan, Frank; Nelson, Arthur C.; Grace, James B.

2014-01-01

Vehicle miles traveled (VMT) is the primary determinant of traffic congestion, vehicle crashes, greenhouse gas emissions, and other effects of transportation. Two previous studies have sought to explain VMT levels in urbanized areas. This study updates and expands on previous work with more recent data, additional metrics, and structural equation modeling (SEM) to explain VMT levels in 315 urbanized areas. According to SEM, population, income, and gasoline prices are primary exogenous drivers of VMT. Development density is a primary endogenous driver. Urbanized areas with more freeway capacity are significantly less dense and have significantly higher VMT per capita. Areas with more transit service coverage and service frequency have higher development densities and per capita transit use, which leads to lower VMT per capita. The indirect effect of transit on VMT through land use, the so-called land use multiplier, is more than three times greater than the direct effect through transit ridership.

Effects of changes in micro- and macro-environmental factors on the supply of hospitals services.

PubMed

Kassaye, W W; Tseng, K C

1990-01-01

The failures, marketing difficulties and financial hardships hospitals have experienced raises a question as to whether they have been responsive to the changes in the micro and macro-environmental factors. To determine how responsive hospitals have been to these changes, we investigate the impact of a number of selected factors on the supply of hospital services during 1972 through 1978. The findings indicate that despite the fact that the economy went through recessionary periods, and the demographic distribution exhibited both a shift and a change in the aging and birth rates of the nation, the changes in hospitals' responsiveness have been less than satisfactory. It appears that hospitals readily respond to the changes in the micro-environment than to the changes in macro-environment. Their response to the changes in the macro-environment. Their response to the changes in the macro-environment may be characterized as an effort to create a higher level of production whose goal is to create a still higher level of needs and wants.

Gender differences in mental health: evidence from three organisations.

PubMed

Emslie, Carol; Fuhrer, Rebecca; Hunt, Kate; Macintyre, Sally; Shipley, Martin; Stansfeld, Stephen

2002-02-01

It is commonly observed that women report higher levels of minor psychiatric morbidity than men. However, most research fails to control for the gendered distribution of social roles (e.g. paid work and domestic work) and so does not compare men and women in similar positions. In this short report, we examine the distribution of minor psychiatric morbidity (measured by the 12 item General Health Questionnaire) amongst men and women working in similar jobs within three white-collar organisations in Britain, after controlling for domestic and socioeconomic circumstances. Data from self-completion questionnaires were collected in a Bank (n = 2,176), a University (n = 1,641) and the Civil Service (n = 6,171). In all three organisations women had higher levels of minor psychiatric morbidity than men, but the differences were not great; in only the Civil Service sample did this reach statistical significance. We conclude that generalisations about gender differences in minor psychiatric morbidity can be unhelpful, as these differences may vary depending on the context of the study.

Intelligent community management system based on the devicenet fieldbus

NASA Astrophysics Data System (ADS)

Wang, Yulan; Wang, Jianxiong; Liu, Jiwen

2013-03-01

With the rapid development of the national economy and the improvement of people's living standards, people are making higher demands on the living environment. And the estate management content, management efficiency and service quality have been higher required. This paper in-depth analyzes about the intelligent community of the structure and composition. According to the users' requirements and related specifications, it achieves the district management systems, which includes Basic Information Management: the management level of housing, household information management, administrator-level management, password management, etc. Service Management: standard property costs, property charges collecting, the history of arrears and other property expenses. Security Management: household gas, water, electricity and security and other security management, security management district and other public places. Systems Management: backup database, restore database, log management. This article also carries out on the Intelligent Community System analysis, proposes an architecture which is based on B / S technology system. And it has achieved a global network device management with friendly, easy to use, unified human - machine interface.

Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback.

PubMed

Bailie, Ross S; Togni, Samantha J; Si, Damin; Robinson, Gary; d'Abbs, Peter H N

2003-07-30

Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia. The intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management. Levels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period. Improvements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity.

Evaluation of care quality for disabled older patients living at home and in institutions.

PubMed

Chang, Shu-Ching; Shiu, Ming-Neng; Chen, Huey-Tzy; Ng, Yee-Yung; Lin, Li-Chan; Wu, Shiao-Chi

2015-12-01

This study aimed to evaluate the level of care quality received by disabled older patients residing at home vs. those residing in institutions. Taiwan has an aging society and faces issues of caring for disabled older patients, including increasing needs, insufficient resources and a higher economic burden of care. Retrospective study extracting patient data from Taiwan's National Health Insurance database. We enrolled 76,672 disabled older patients aged 65 years and older who resided at home or institutions and had submitted claims for coverage of National Health Insurance for home care received for the first time between 2004-2006. Propensity score matching was applied to create a home-care group and an institutional-care group with 27,894 patients each. Indicators of care quality (emergency services use, hospitalisation, infection, pressure ulcers, death) within the first year were observed. The home care group had significantly higher emergency services use, fewer hospital admissions and fewer infections, but had significantly higher occurrence of pressure ulcers. The institutional-care group had significantly lower time intervals between emergencies, fewer deaths, lower risk of emergencies and lower pressure ulcer risk. Males had significantly higher emergency services use than females, and higher risk of hospital admission and death. Care quality indicators for elder care are significantly different between home care and institutional care. The quality of home care is associated with higher emergency services use and pressure ulcer development, and institutional care is associated with number of infections and hospitalisations. Care quality indicators were significantly different between home-care and institutional-care groups and were closely associated with the characteristics of individual patients' in the specific settings. Nursing capabilities must be directed towards reducing unnecessary care quality-related events among high-risk disabled older patients. © 2015 John Wiley & Sons Ltd.

Determining factors for implant referral rates.

PubMed

Levin, Roger P

2002-01-01

The research findings indicate that the field of implant dentistry will only grow at a moderately low level unless certain changes are made. Findings indicated that the effort by the implant companies has been nothing short of dramatic, and yet almost 60% of restorative doctors do not participate annually in any implant case. There was no clear indication that younger restorative doctors will significantly increase the number of implant referrals, as their overall implant education has not dramatically differed from those dentists who graduated in earlier years. Once the research was completed, it became obvious to Levin Group that the driving force behind implant referral growth will be implant surgeons, because of their one-to-one relationship with restorative doctors. The Levin Group Implant Management and Marketing Consulting Program is based on approaching restorative doctors in several different levels, starting with awareness all the way through to case facilitation and long-term tracking and communication. Finally, a continuing marketing/education effort needs to be consistently in place with effective materials, not only to create a high level of awareness, but also to motivate restorative doctors to refer cases and then work through the case with the implant surgeon to a satisfactory completion for the restorative doctor, implant surgeon, and patient. While the surgical insertion of implants may seem to carry a high-profit margin relative to the restoration of implants, the truth is that the restoration of implants usually provides a 40% higher profit margin for the restorative doctor than traditional dental services. One of the key issues is that referring doctors have not necessarily learned how to set fees and present cases with regard to implant dentistry. The key factor here is to ensure that the patient understands that implant services involve higher fees than traditional services, because of the necessarily higher levels of experience, education, and cost associated with implant dentistry. It is also important to emphasize to patients that the quality of life far outweighs the differential in fees.

One network metric datastore to track them all: the OSG network metric service

NASA Astrophysics Data System (ADS)

Quick, Robert; Babik, Marian; Fajardo, Edgar M.; Gross, Kyle; Hayashi, Soichi; Krenz, Marina; Lee, Thomas; McKee, Shawn; Pipes, Christopher; Teige, Scott

2017-10-01

The Open Science Grid (OSG) relies upon the network as a critical part of the distributed infrastructures it enables. In 2012, OSG added a new focus area in networking with a goal of becoming the primary source of network information for its members and collaborators. This includes gathering, organizing, and providing network metrics to guarantee effective network usage and prompt detection and resolution of any network issues, including connection failures, congestion, and traffic routing. In September of 2015, this service was deployed into the OSG production environment. We will report on the creation, implementation, testing, and deployment of the OSG Networking Service. Starting from organizing the deployment of perfSONAR toolkits within OSG and its partners, to the challenges of orchestrating regular testing between sites, to reliably gathering the resulting network metrics and making them available for users, virtual organizations, and higher level services, all aspects of implementation will be reviewed. In particular, several higher-level services were developed to bring the OSG network service to its full potential. These include a web-based mesh configuration system, which allows central scheduling and management of all the network tests performed by the instances; a set of probes to continually gather metrics from the remote instances and publish it to different sources; a central network datastore (esmond), which provides interfaces to access the network monitoring information in close to real time and historically (up to a year) giving the state of the tests; and a perfSONAR infrastructure monitor system, ensuring the current perfSONAR instances are correctly configured and operating as intended. We will also describe the challenges we encountered in ongoing operations of the network service and how we have evolved our procedures to address those challenges. Finally we will describe our plans for future extensions and improvements to the service.

Quality of reproductive healthcare for adolescents: A nationally representative survey of providers in Mexico

PubMed Central

De Castro, Filipa; Barrientos-Gutiérrez, Tonatiuh; Leyva-López, Ahideé

2017-01-01

Objective Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world’s adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents. Methods This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015. Results At the national level 13.9% (95%CI: 6.9–26.0) of healthcare units provide low quality, 68.6% (95%CI: 58.4–77.3) medium quality and 17.5% (95%CI: 11.9–25.0) high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best. Conclusions The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care. PMID:28273129

Mental Health Care Providers' Views of Their Work with Consumers and Their Reports of Recovery-Orientation, Job Satisfaction, and Personal Growth.

PubMed

Osborn, Lawrence A; Stein, Catherine H

2016-10-01

The research examined the role of mental health care providers' perceptions of their professional relationships with consumers in understanding their reports of agency recovery-oriented services and their own sense of job satisfaction and personal growth. Multidisciplinary community mental health care providers (N = 105) responded to an online self-report questionnaire. Providers' reports of higher levels of working alliance and greater provider directiveness in working with consumers was significantly related to providers' reports of higher levels of agency recovery-orientation and higher levels of personal growth. Providers' reports of working alliance accounted for the largest proportion of variance in providers' reports of job satisfaction. Mental health providers' perceptions of relationships with consumers are central to understanding providers' views of agency recovery-orientation and sense of professional and personal well-being.

Less Physician Practice Competition Is Associated With Higher Prices Paid For Common Procedures.

PubMed

Austin, Daniel R; Baker, Laurence C

2015-10-01

Concentration among physician groups has been steadily increasing, which may affect prices for physician services. We assessed the relationship in 2010 between physician competition and prices paid by private preferred provider organizations for fifteen common, high-cost procedures to understand whether higher concentration of physician practices and accompanying increased market power were associated with higher prices for services. Using county-level measures of the concentration of physician practices and county average prices, and statistically controlling for a range of other regional characteristics, we found that physician practice concentration and prices were significantly associated for twelve of the fifteen procedures we studied. For these procedures, counties with the highest average physician concentrations had prices 8-26 percent higher than prices in the lowest counties. We concluded that physician competition is frequently associated with prices. Policies that would influence physician practice organization should take this into consideration. Project HOPE—The People-to-People Health Foundation, Inc.

Service system finance: implications for children with depression and manic depression.

PubMed

Glied, S; Neufeld, A

2001-06-15

An estimated 6.2% of children in the United States satisfy the criteria for a depression diagnosis, but approximately half of this group do not receive necessary treatment. Thus it is important to consider potential barriers to use through service system finance. This article reviews three major types of changes affecting access: parity legislation, managed care, and public contracting. How these developments will affect children with depression and manic depression (DMD) is unclear. To better understand the potential effects on children with DMD, this review uses new data from the Medical Expenditure Panel Survey to describe the service use patterns of this population. These children have higher levels of expenditures, higher rates of inpatient use, and higher rates of Medicaid payment than do other children with mental health diagnoses; they also are overrepresented among the costliest cases of mental illness in children. Children with DMD pay a relatively low out-of-pocket share, suggesting that parity efforts focusing only on copayments and deductibles will have little effect on the absolute out-of-pocket burden for these children. Because children with DMD are overrepresented among high utilizers of health services, health care rationing arrangements or techniques, such as utilization review and capitation, may place this population at particular risk.

Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China

PubMed Central

Zhang, Xinyu; Zhao, Lin; Cui, Zhuang; Wang, Yaogang

2015-01-01

Background This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China. Methods We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators. Results The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the “best practice frontier”. The other 8 (25.8%) provinces were technically inefficient. Conclusions Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces. PMID:26679187

Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China.

PubMed

Zhang, Xinyu; Zhao, Lin; Cui, Zhuang; Wang, Yaogang

2015-01-01

This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China. We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators. The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the "best practice frontier". The other 8 (25.8%) provinces were technically inefficient. Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces.

Familiarity with and intentions to use Internet-delivered mental health treatments among older rural adults.

PubMed

Handley, Tonelle; Perkins, David; Kay-Lambkin, Frances; Lewin, Terry; Kelly, Brian

2015-01-01

Older adults are the fastest growing age group in Australia, necessitating an increase in appropriate mental health services in the coming years. While Internet-delivered mental health treatments have been established as acceptable and efficacious among younger samples, little research has explored whether they would be similarly useful in older populations. The participants were part of the Australian Rural Mental Health study, which explores mental health and well-being in residents of non-metropolitan New South Wales. A postal survey was used to assess knowledge of and intentions to use Internet-delivered mental health treatments. Demographics, mental health, and frequency of Internet use were also measured. The survey was completed by 950 adults aged 50-93. The sample was largely unfamiliar with Internet mental health services, with 75% reporting that they had never heard of them and a further 20% not knowing any details of what they involved. Intentions to use these services were also low, at 13.5%; however, this increased with level of familiarity. Respondents with higher psychological distress, higher education, and more frequent Internet use were significantly more likely to consider using Internet treatments. Among older adults, overall awareness of Internet-delivered mental health treatments appears to be limited; however, higher familiarity contributes to higher intentions to use these treatments. Importantly, respondents with higher distress and greater computer literacy were more likely to consider mental health treatments delivered via the Internet. Future research exploring strategies to increase the promotion of these services to older samples may further improve their perceptions and use.

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh.

PubMed

Shawon, Md Shajedur Rahman; Adhikary, Gourab; Ali, Md Wazed; Shamsuzzaman, Md; Ahmed, Shahabuddin; Alam, Nurul; Shackelford, Katya A; Woldeab, Alexander; Lim, Stephen S; Levine, Aubrey; Gakidou, Emmanuela; Uddin, Md Jasim

2018-01-25

Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of sufficient funding and resources (antigen) for training programs. Our study suggested that health facilities suffered from lack of readiness in various aspects, most notably in diagnostic capacity. Conversely, with very few challenges, nearly all the health facilities designated to provide immunization services were ready to deliver routine childhood immunization services as well as newly introduced PCV and IPV.

The social causes of inequality in epilepsy and developing a rehabilitation strategy: a U.K.-based analysis.

PubMed

Ridsdale, Leone

2009-10-01

A rehabilitation approach has been adopted for many long-term neurologic conditions, but not for epilepsy. The disabilities associated with epilepsy are cognitive, psychological, and social, which are not as readily identified by medical doctors as are physical disabilities. A rehabilitation approach moves the emphasis from a medically driven process to a focus on the personal, social, and physical context of long-term illness. It is suggested that a missed opportunity for education and support for self-management occurs after diagnosis. This results in disadvantage to those whose educational level and knowledge of epilepsy are low. People who do not achieve epilepsy control may then experience higher levels of psychological distress, and a negative cycle of loss of self-efficacy, poor epilepsy control, social disadvantage, and disability. Rehabilitation services have benefited communities surrounding centers of excellence. Not so in epilepsy. Despite centers of excellence, areas with deprivation have higher than national average levels of patients reporting a seizure in the prior year, and higher emergency hospital admissions. Specialists working in partnership with general practitioners (GPs) and practice nurses can do more to increase participation and reduce distress for people with epilepsy. When available, GPs and nurses with special interest in epilepsy promote integrated services. Primary-secondary networks are likely to be more effective in preventing downward drift. This requires evaluation.

Wide variation in sexually transmitted infection testing and counselling at Aboriginal primary health care centres in Australia: analysis of longitudinal continuous quality improvement data.

PubMed

Nattabi, Barbara; Matthews, Veronica; Bailie, Jodie; Rumbold, Alice; Scrimgeour, David; Schierhout, Gill; Ward, James; Guy, Rebecca; Kaldor, John; Thompson, Sandra C; Bailie, Ross

2017-02-15

Chlamydia, gonorrhoea and syphilis are readily treatable sexually transmitted infections (STIs) which continue to occur at high rates in Australia, particularly among Aboriginal Australians. This study aimed to: explore the extent of variation in delivery of recommended STI screening investigations and counselling within Aboriginal primary health care (PHC) centres; identify the factors associated with variation in screening practices; and determine if provision of STI testing and counselling increased with participation in continuous quality improvement (CQI). Preventive health audits (n = 16,086) were conducted at 137 Aboriginal PHC centres participating in the Audit and Best Practice for Chronic Disease Program, 2005-2014. STI testing and counselling data were analysed to determine levels of variation in chlamydia, syphilis and gonorrhoea testing and sexual health discussions. Multilevel logistic regression was used to determine factors associated with higher levels of STI-related service delivery and to quantify variation attributable to health centre and client characteristics. Significant variation in STI testing and counselling exists among Aboriginal PHC centres with health centre factors accounting for 43% of variation between health centres and jurisdictions. Health centre factors independently associated with higher levels of STI testing and counselling included provision of an adult health check (odds ratio (OR) 3.40; 95% Confidence Interval (CI) 3.07-3.77) and having conducted 1-2 cycles of CQI (OR 1.34; 95% CI 1.16-1.55). Client factors associated with higher levels of STI testing and counselling were being female (OR 1.45; 95% CI 1.33-1.57), Aboriginal (OR 1.46; 95% CI 1.15-1.84) and aged 20-24 years (OR 3.84; 95% CI 3.07-4.80). For females, having a Pap smear test was also associated with STI testing and counselling (OR 4.39; 95% CI 3.84-5.03). There was no clear association between CQI experience beyond two CQI cycles and higher levels of documented delivery of STI testing and counselling services. A number of Aboriginal PHC centres are achieving high rates of STI testing and counselling, while a significant number are not. STI-related service delivery could be substantially improved through focussed efforts to support health centres with relatively lower documented evidence of adherence to best practice guidelines.

A Secure Authenticated Key Exchange Protocol for Credential Services

NASA Astrophysics Data System (ADS)

Shin, Seonghan; Kobara, Kazukuni; Imai, Hideki

In this paper, we propose a leakage-resilient and proactive authenticated key exchange (called LRP-AKE) protocol for credential services which provides not only a higher level of security against leakage of stored secrets but also secrecy of private key with respect to the involving server. And we show that the LRP-AKE protocol is provably secure in the random oracle model with the reduction to the computational Difie-Hellman problem. In addition, we discuss about some possible applications of the LRP-AKE protocol.

Coordination between child welfare agencies and mental health providers, children's service use, and outcomes

PubMed Central

Bai, Yu; Wells, Rebecca; Hillemeier, Marianne M.

2009-01-01

Objective Interorganizational relationships (IORs) between child welfare agencies and mental health service providers may facilitate mental health treatment access for vulnerable children. This study investigates whether IORs are associated with greater use of mental health services and improvement in mental health status for children served by the child welfare system. Methods This was a longitudinal analysis of data from a 36 month period in the National Survey of Child and Adolescent Well-Being (NSCAW). The sample consisted of 1,613 children within 75 child welfare agencies who were 2 years or older and had mental health problems at baseline. IOR intensity was measured as the number of coordination approaches between each child welfare agency and mental health service providers. Separate weighted multilevel logistic regression models tested associations between IORs and service use and outcomes, respectively. Results Agency level factors accounted for 9% of the variance in the probability of service use and 12% of mental health improvement. Greater intensity of IORs was associated with higher likelihood of both service use and mental health improvement. Conclusions Having greater numbers of ties with mental health providers may help child welfare agencies improve children's mental health service access and outcomes. Practice Implications Policymakers should develop policies and initiatives to encourage a combination of different types of organizational ties between child welfare and mental health systems. For instance, information sharing at the agency level in addition to coordination at the case level may improve the coordination necessary to serve these vulnerable children. PMID:19473702

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long-term care institution residents.

PubMed

Lin, Jesun; Hsiao, Chih-Tung; Glen, Robert; Pai, Jar-Yuan; Zeng, Sin-Huei

2014-06-01

To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long-term care institutions. The five-point Likert scale questionnaire administered through facetoface interviews. Fourteen long-term care institutions located in central and southern Taiwan stratified according to services and accommodation population. One hundred and eighty long-term institutional care residents. Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). Student's t-test on institutional location shows a significant difference between overall satisfaction for central and southern institution long-term care recipients. The correlation test revealed that the higher a resident's level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index-of-model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long-term care institutions, is also an important factor in residents' overall satisfaction. The primary goal of long-term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost-effective but high-quality care. On the basis of the results of in-depth interviews with long-term institutional care residents, this study suggests long-term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents. © 2012 John Wiley & Sons Ltd.

Effect of Disease Improvement with Self-Measurement Compliance (Measurement Frequency Level) in SmartCare Hypertension Management Service.

PubMed

Lee, Chang-Hee; Chang, Byeong-Yun

2016-03-01

This study's purpose was to analyze the effect of the SmartCare pilot project, which was conducted in 2011 in South Korea. Recent studies of telehealth mostly compare the intervention group and the control group. Therefore, it is necessary to analyze the disease improvement effect depending on the self-measurement compliance (measurement frequency level) of patients who are receiving the hypertension management services. In the SmartCare center, health managers (nurses, nutritionists, and exercise prescribers) monitored the measurement data transmitted by participants through the SmartCare system. The health managers provided the prevention, consultation, and education services remotely to patients. Of the 231 participants who were enrolled in the study, the final analysis involved 213 individuals who completed their blood pressure measurements and SmartCare services until the end of a 6-month service period. The evaluated measurement group was classified into three groups (Low, Middle, and High) by evenly dividing the monthly average frequency of measurement for 6 months. The evaluation indices were systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and body mass index (BMI); this information was transmitted through the SmartCare system. For changes in the evaluation indices after 6 months compared with the initial baseline, in the Low Group, SBP and DBP slightly decreased, and weight and BMI slightly increased (difference not statistically significant). In the Middle Group, SBP and DBP decreased slightly (difference not statistically significant); however, both weight and BMI decreased (difference statistically significant). In the High Group, SBP, DBP, weight, and BMI decreased (difference statistically significant). Patients who received the SmartCare services with higher measurement frequency levels at home showed greater effectiveness regarding the provided services compared with those patients with lower levels of BP, weight, and BMI control.

Acoustic pollution in hospital environments

NASA Astrophysics Data System (ADS)

Olivera, J. M.; Rocha, L. A.; Rotger, V. I.; Herrera, M. C.

2011-12-01

There are many different services within a hospital. This means different types of noise which can be considered as acoustic pollution. Knowing that preterm infants exposed to high amounts of noise in the NICU are at a much higher risk because of their neurologic immaturity and physiologic instability, that excessive levels of noise also affect the persons and it can also impede some studies on patients, it was proposed to evaluate the Sound Pressure Level in some services of the Instituto de Maternidad, Tucumán, Argentina. There were evaluated the Level III NICU, the laundry service, a physical space destined for a service of evoked potential and a neonatal incubator under working conditions. The measurements were performed with a type II sonometer (CENTER 322) and it was also used an incubator analyzer (FLUKE INCU) for the incubator. The average values obtained were of 63.6 dBA for the NICU, 82.5dBA for the laundry room, 52.7 dBA for the evoked potential room and 62.8 dBA in the inside of the incubator under 64 dBA in the outside. The reports were documented in compliance with the appropriate standards.

A Decade of Counseling Services in One College of Veterinary Medicine: Veterinary Medical Students' Psychological Distress and Help-Seeking Trends.

PubMed

Drake, Adryanna A S; Hafen, McArthur; Rush, Bonnie R

Much has been discussed about the high prevalence of psychological distress among veterinary medical students. Studies investigating general samples of veterinary medical students indicate that, on average, depression and anxiety symptoms are present at higher rates than in comparison samples. However, little is known about veterinary medical students who seek counseling. This study intends to expand the literature on veterinary student well-being, as the first to examine a sample of veterinary medical students seeking counseling services. It offers an overview of student distress and help-seeking trends from a decade of counseling services provided in one College of Veterinary Medicine (CVM) in the US. The sample includes data from 279 participants. Results indicate a steady increase in students seeking counseling over the last decade. First-year students sought services at higher rates but second-year students experienced the greatest distress when compared to other cohorts. Students seeking counseling services experienced levels of overall distress, symptoms of anxiety and depression, and social role concerns that were, on average, above cut-off scores. Physical health was significantly associated with student distress, suggesting opportunities for intervention.

[Association between Service Utilization Patterns and Frailty in the Elderly Certified at the Support Level in the Long-term Care Insurance System].

PubMed

Yoshiyuki, Noriko; Kono, Ayumi; Soga, Tomoko; Kanaya, Yukiko; Hotta, Kuniko

2016-01-01

This cross-sectional study clarified the association between service utilization patterns and frailty in the elderly certified at the support level in Japan's long-term care insurance (LTCI) system. We analyzed 710 subjects who completed in-home assessments and interviews from 1,033 elderly aged 65 and over living in Izumiotsu who had been certified at the LTCI support level in August 2014. The long-term service utilization data were collected from the local governmental office. Frailty was examined by the in-home structured assessment conducted by local health and welfare professionals. As frailty indicators, we measured subjects' frailty using the Kaigo-Yobo-Checklist (CL frailty), handgrip strength, body mass index, depression, and cognitive function. Long-term service utilization patterns were classified into five patterns: (1) home helper service only, (2) day care service only, (3) home helper and day care service, (4) one or more other services (using at least one other service regardless of home helper or day care), and (5) no service utilization. Odds ratios (ORs) of each frailty indicator were estimated by service utilization patterns by using logistic regression analyses adjusted for demographic characteristics, with the other services group as the reference category. Out of 710 subjects (100%), the proportions of the service utilization patterns were as follows: home helper service only, 17.9%; day care service only, 15.6%; home helper and day care service, 13.1%; one or more other services, 27.0%; and no service utilization, 26.3%. The logistic regression analyses showed that compared with the one or more other services group, the day care service only group had lower odds of CL frailty (OR=0.57, 95% confidence interval (CI)=0.34 to 0.95) and lower odds of low handgrip strength (OR=0.59, 95% CI=0.35 to 1.00). The no service utilization group had lower odds of CL frailty (OR=0.50, 95% CI=0.32 to 0.79) and lower odds of low handgrip strength (OR=0.58, 95% CI=0.37 to 0.91). The home helper service only group had higher odds of low handgrip strength (OR=1.91, 95% CI=1.11 to 3.29). Long-term service utilization patterns of the elderly certified at the support level in the LTCI system were associated with frailty. Classifying frailty characteristics by long-term service utilization patterns may be considered as a method to provide community-based resources and support for older adults in the community.

The Internationalization of Industry. Annex B. Offshore Production in the International Semiconductor Industry,

DTIC Science & Technology

1981-11-01

essence of these arrangements is specialization based in international differentials in * 379 the costs of labor services. The availability of low...of electronic equipment vary with the complexity and cost of the equipment, a differentiated market for chips of varying densities, for use in...level of chip density, while more complex products will be most economically produced with higher levels of chip density. Thuse a differentiated

Assessing care-givers' satisfaction with child immunisation services in Zambia: Evidence from a national survey.

PubMed

Chama-Chiliba, Chitalu Miriam; Masiye, Felix; Mphuka, Chrispin

2017-10-09

The main aim of this study was to assess care-giver satisfaction with vaccination services in public health facilities in Zambia, and examine its determinants. This study used data from a recent population-based household survey, conducted from May to August 2015. Respondent satisfaction with vaccination services received during the last visit was measured on a five point Likert scale ranging from 1 to 5. We used an ordered logistic regression model to analyse the significance of perceived quality of vaccination services, immunisation delivery mode and a range of individual characteristics in predicting care-giver satisfaction. Findings show that one in five care givers were unsatisfied with the vaccination services that they had received, with rural populations showing a significantly higher level of satisfaction. Poor quality of care, defined by long waiting times, poor quality of communication between health staff and care givers, long distance to vaccination sites, mode of delivery, and personal characteristics were among major factors driving care-giver satisfaction ratings. We also find that receiving a vaccination at outreach mode of delivery was associated with higher odds of greater satisfaction compared to on-facility vaccination services. The odds of satisfaction were lower for respondents living further away from a health facility, which emphasizes the importance of access in seeking vaccination services. These findings suggest that major improvements in quality of vaccination and service organisation will be needed to increase client satisfaction and service utilisation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Female labour supply and nursing home prices.

PubMed

Bauer, Thomas K; Stroka, Magdalena A

2013-09-01

Long term care in Germany is provided in nursing homes, by professional ambulatory services and by the patient's relatives at home, with the latter being predominantly provided by women. Given an increasing labour market participation of women, long term care at home by female relatives might become less frequent in the future which in turn may result in rising demand for and hence rising prices for long term care services. This paper builds upon the existing literature on the determinants of nursing home prices and investigates whether the labour market participation and the education level of women are correlated with the prices of nursing homes. To the best of our knowledge, this is the first study using panel data approaches in this field of research. Based on a full sample of nursing homes in Germany for the years 2001, 2003, 2005 and 2007, our empirical results suggest that a high share of full-time employed women aged 50-65 at the district level is not associated with higher prices of nursing homes. Furthermore, we find only weak evidence for a positive correlation of prices with the local average of women's educational level and a negative correlation with part-time employment indicating that price levels are lower in regions with higher shares of part-time employed women.

GP utilisation by education level among adults with COPD or asthma: a cross-sectional register-based study.

PubMed

Hetlevik, Øystein; Melbye, Hasse; Gjesdal, Sturla

2016-06-09

There is a marked socioeconomic gradient in the prevalence of chronic obstructive pulmonary disease (COPD) and asthma, but a large proportion of patients remain undiagnosed. It is a challenge for general practitioners (GPs) to both identify patients and contribute to equity and high quality in services delivered. The aim of this study was to identify patients with COPD and asthma diagnoses recorded by GPs and explore their utilisation of GP services by education level. This was a cross-sectional, national, register-based study from Norwegian general practice in the period 2009-2011. Based on claims from GPs, the number of patients aged ⩾40 years with a diagnosis of COPD or asthma and their GP services utilisation were estimated and linked to the national education database. Multivariate Poisson and logistic regression models were used to explore the variations in GP utilisation. In the population aged ⩾40 years, 2.8% had COPD and 3.8% had asthma according to GPs' diagnoses. COPD was four times more prevalent in patients with basic education than higher education; this increase was ⩽80% for asthma. Consultation rates were 12% higher (P<0.001) for COPD and 25% higher (P<0.001) for asthma in patients with low versus high education in the age group of 40-59 years after adjusting for comorbidity, and patient and GP characteristics. Approximately 25% of COPD patients and 20% of asthma patients had ⩾1 spirometry test in general practice in 2011, with no significant education differences in adjusted models. The higher consultation rate in lower-education groups indicates that GPs contribute to fair distribution of healthcare.

Gender differences in living with schizophrenia. A cross-sectional European multi-site study.

PubMed

Thornicroft, Graham; Leese, Morven; Tansella, Michele; Howard, Louise; Toulmin, Hilary; Herran, Andres; Schene, Aart

2002-10-01

The EPSILON project (European Psychistric Services: Inputs Linked to Outcomes and Needs) is a cross-sectional study of the clinical and social characteristics, needs, satisfaction with services, quality of life, and service utilisation and costs for people with schizophrenia in five European sites (Amsterdam, Copenhagen, London, Santander, and Verona). This study examined five hypotheses: (1) Men will have more total needs and more unmet needs for: 'accommodation', 'substance misuse', 'psychotic symptoms', 'harm to others', and 'sexual expression', whereas women will have more total needs and more unmet needs in the domains of 'childcare' and 'harm to self'. (2) Caregivers of male patients will show higher rates of psychological distress, and higher scores for 'supervision' and 'urging' than caregivers of female patients. (3) Male and female patients will show similar levels of satisfaction with services, both in total scores and subscores. (4) Male patients will show lower objective quality of life, but similar subjective quality of life compared with women. (5) Service utilization for men and women will differ, and patterns will vary by site. The results confirmed hypotheses 1 (in part) and 3, but failed to support hypotheses 2, 4 and 5. Graphical models were used to generate hypotheses for future research. The implications for planning separate services for male and female schizophrenic patients are discussed.

Relationship between mathematical abstraction in learning parallel coordinates concept and performance in learning analytic geometry of pre-service mathematics teachers: an investigation

NASA Astrophysics Data System (ADS)

Nurhasanah, F.; Kusumah, Y. S.; Sabandar, J.; Suryadi, D.

2018-05-01

As one of the non-conventional mathematics concepts, Parallel Coordinates is potential to be learned by pre-service mathematics teachers in order to give them experiences in constructing richer schemes and doing abstraction process. Unfortunately, the study related to this issue is still limited. This study wants to answer a research question “to what extent the abstraction process of pre-service mathematics teachers in learning concept of Parallel Coordinates could indicate their performance in learning Analytic Geometry”. This is a case study that part of a larger study in examining mathematical abstraction of pre-service mathematics teachers in learning non-conventional mathematics concept. Descriptive statistics method is used in this study to analyze the scores from three different tests: Cartesian Coordinate, Parallel Coordinates, and Analytic Geometry. The participants in this study consist of 45 pre-service mathematics teachers. The result shows that there is a linear association between the score on Cartesian Coordinate and Parallel Coordinates. There also found that the higher levels of the abstraction process in learning Parallel Coordinates are linearly associated with higher student achievement in Analytic Geometry. The result of this study shows that the concept of Parallel Coordinates has a significant role for pre-service mathematics teachers in learning Analytic Geometry.

Integrating Strategic Marketing on an Institutional Level.

ERIC Educational Resources Information Center

Liu, Sandra S.

1998-01-01

Higher education differs from other service enterprises in its social responsibility and the context for decision making. An integrated marketing strategy based on the identified positioning of the institution plays a crucial role in successful enrollment and long-term institutional development. Marketing can make a significant contribution to…

Role Orientation of Certified Athletic Trainers at Institutions of Higher Education

ERIC Educational Resources Information Center

Brumels, Kirk; Beach, Andrea

2008-01-01

Objective: This study examined the role orientation hierarchy among teaching, research, service, and administrative responsibilities of certified athletic trainers (ATCs) employed at the collegiate level. Design and Setting: Four single response role orientation questions regarding their actual, ideal, promoted, and most appropriate role…

48 CFR 2909.506 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CONTRACTOR QUALIFICATIONS Organizational and Consultant Conflicts of Interest 2909.506 Procedures. (a) If a... conflict of interest and requests higher level review as referred to in FAR 9.506, the matter must be... Director, Division of Acquisition Management Services. (b) Referrals must be made by the HCA concerned and...

Quality choice in Medicaid markets. The case of nursing homes.

PubMed

McKay, N L

1989-01-01

This article examines whether private patients, who typically pay a price higher than the Medicaid reimbursement rate, receive the same or higher quality services than Medicaid patients in the same health care facility. Because the mix of patients will affect the firm's cost only when Medicaid and private patients receive different levels of quality, the cost function can be used to test for the presence of quality differences. Estimates of a cost function for Texas nursing home in 1983 indicate that the mix of patients does not affect the firm's cost. Thus, private and Medicaid patients in the same nursing home receive the same level of quality.

Measuring Socioeconomic Differences in Use of Health Care Services by Wealth Versus by Income

PubMed Central

Allin, Sara; Masseria, Cristina

2009-01-01

Objectives. We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator. Methods. We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries. Results. We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences. Conclusions. We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population. PMID:19150899

Are the poor differentially benefiting from provision of priority public health services? A benefit incidence analysis in Nigeria

PubMed Central

2012-01-01

Background The paper presents evidence about the distribution of the benefits of public expenditures on a subset of priority public health services that are supposed to be provided free of charge in the public sector, using the framework of benefit incidence analysis. Methods The study took place in 2 rural and 2 urban Local Government Areas from Enugu and Anambra states, southeast Nigeria. A questionnaire was used to collect data on use of the priority public health services by all individuals in the households (n=22,169). The level of use was disaggregated by socio-economic status (SES), rural-urban location and gender. Benefits were valued using the cost of providing the service. Net benefit incidence was calculated by subtracting payments made for services from the value of benefits. Results The results showed that 3,281 (14.8%) individuals consumed wholly free services. There was a greater consumption of most free services by rural dwellers, females and those from poorer SES quintiles (but not for insecticide-treated nets and ante-natal care services). High levels of payment were observed for immunisation services, insecticide-treated nets, anti-malarial medicines, antenatal care and childbirth services, all of which are supposed to be provided for free. The net benefits were significantly higher for the rural residents, males and the poor compared to the urban residents, females and better-off quintiles. Conclusion It is concluded that coverage of all of these priority public health services fell well below target levels, but the poorer quintiles and rural residents that are in greater need received more benefits, although not so for females. Payments for services that are supposed to be delivered free of charge suggests that there may have been illegal payments which probably hindered access to the public health services. PMID:23158434

Dissatisfaction with cardiovascular health and primary health care services: Southern Mani, isolated area in Europe. A case study.

PubMed

Mariolis, Anargiros; Mihas, Constantinos; Alevizos, Alevizos; Mariolis-Sapsakos, Theodoros; Sergentanis, Theodoros N; Kalogerakos, Nikolaos; Virvilis, Christos; Fourkas, Constantinos; Skandalakis, Panayiotis; Stefanadis, Christodoulos

2008-01-01

Access to local providers of primary health care (PHC) services and their utilisation is a challenge faced by the authorities of developed as well as developing countries. The aim of our study was to assess and evaluate the level of satisfaction with the currently provided cardiovascular and PHC services in the southernmost region of continental Greece (and of the European Union), Southern Mani. The sample (422 individuals, 375 of whom finally participated: 187 men and 188 women, response ratio: 88.86%), was selected between January-December 2006, using stratified randomisation by sex and age. Participants were asked to fill in a validated questionnaire containing socio-demographic data and items about the health needs/level of satisfaction with cardiovascular health and PHC services, as well as two indices for cardiovascular health: i) frequency of international normalised ratio (INR) measurement in case of atrial fibrillation, and ii) history of timely thrombolysis in case of acute myocardial infarction. The majority of the responders stated that their level of satisfaction with PHC services was "low" or "very low" (total: 52.80%), while the percentage of dissatisfaction with cardiovascular health services was 56.0%. In addition, most of the participants expressed a strong wish for improvement of PHC services (71.33%). The level of satisfaction with PHC services was higher than with cardiovascular health services (2.49 +/- 1.26 vs. 2.38 +/- 1.24; p < 0.001). Satisfaction scores for both cardiovascular health and PHC services were negatively associated with the distance from the nearest PHC Unit. Only 11.1% of patients (95% CI: 0.3%-48.2%) reported annual testing of prothrombin time more than once, while among those with a history of acute myocardial infarction, none reported timely thrombolysis (0%, one-sided 97.5% CI: 0%-41.0%). It is evident that a large portion of the Southern Mani population perceives the provided cardiovascular health and PHC services as problematic, while the distance from the nearest PHC unit seems to be one of the most important factors and predictors of dissatisfaction. The provision of efficient PHC services in isolated areas is a matter that should be re-evaluated.

Medicare costs and surgeon supply in hospital service areas.

PubMed

Ricketts, Thomas C; Belsky, Daniel W

2012-03-01

To quantify the correlates of variations of Medicare per beneficiary costs at the hospital service area level and determine whether physician supply and the specialty of physicians has a significant relationship with cost variation. The American Medical Association Masterfile data on physician and surgeon location, characteristics and specialty; Census derived sociodemographic data from 2006 ZIP code level Claritas PopFacts database; and Medicare per beneficiary costs from the Dartmouth Atlas of Health Care project. A correlational analysis using bivariate plots and fixed effects linear regression models controlling for hospital service area sociodemographics and the number and characteristics of the physician supply. Data were aggregated to the Dartmouth hospital service area level from ZIP code level files. We found that costs are strongly related to the sociodemographic character of the hospital service areas and the overall supply of physicians but a mixed correlation to the specialist supply depending on the interaction of the proportion of the physician supply who are international medical graduates. The ratio of general surgeons and surgical subspecialists to population are associated with lower costs in the models, again with difference depending on the influence of international medical graduates. There is a strong association between higher costs and the local proportion of physician supply made up of graduates of non-US or Canadian medical schools and female graduates. These results suggest that strategies to reduce overall costs by changing physician supply must consider more than just overall numbers.

How Do Health Insurer Market Concentration and Bargaining Power with Hospitals Affect Health Insurance Premiums?

PubMed Central

Trish, Erin E.; Herring, Bradley J.

2017-01-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006–2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans’ transactions with employers and the other concentration measure representing insurers’ bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. PMID:25910690

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

PubMed

Trish, Erin E; Herring, Bradley J

2015-07-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans' transactions with employers and the other concentration measure representing insurers' bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. Copyright © 2015 Elsevier B.V. All rights reserved.

HIV testing service awareness and service uptake among female heads of household in rural Mozambique: results from a province-wide survey.

PubMed

Paulin, Heather N; Blevins, Meridith; Koethe, John R; Hinton, Nicole; Vaz, Lara M E; Vergara, Alfredo E; Mukolo, Abraham; Ndatimana, Elisée; Moon, Troy D; Vermund, Sten H; Wester, C William

2015-02-12

HIV voluntary counseling and testing (VCT) utilization remains low in many sub-Saharan African countries, particularly in remote rural settings. We sought to identify factors associated with service awareness and service uptake of VCT among female heads of household in rural Zambézia Province of north-central Mozambique which is characterized by high HIV prevalence (12.6%), poverty, and suboptimal health service access and utilization. Our population-based survey of female heads of household was administered to a representative two-stage cluster sample using a sampling frame created for use on all national surveys and based on census results. The data served as a baseline measure for the Ogumaniha project initiated in 2009. Survey domains included poverty, health, education, income, HIV stigma, health service access, and empowerment. Descriptive statistics and logistic regression were used to describe service awareness and service uptake of VCT. Of 3708 women surveyed, 2546 (69%) were unaware of available VCT services. Among 1162 women who were aware of VCT, 673 (58%) reported no prior testing. In the VCT aware group, VCT awareness was associated with higher education (aOR = 2.88; 95% CI = 1.61, 5.16), higher income (aOR = 1.41, 95% CI = 1.06, 1.86), higher numeracy (aOR = 1.05, CI 1.03, 1.08), more children < age 5 in the home (aOR = 1.53; 95% CI = 1.07, 2.18), closer proximity to a health facility (aOR = 1.05; 95% CI = 1.03, 1.07), and mobile phone ownership (aOR = 1.37; 95% CI = 1.03, 1.84) (all p-values < 0.04). Having a higher HIV-associated stigma score was the factor most strongly associated with being less likely to test. (aOR = 0.41; 95% CI = 0.23, 0.71; p<0.001). Most women were unaware of available VCT services. Even women who were aware of services were unlikely to have been tested. Expanded VCT and social marketing of VCT are needed in rural Mozambique with special attention to issues of community-level stigma reduction.

Interoperability Across the Stewardship Spectrum in the DataONE Repository Federation

NASA Astrophysics Data System (ADS)

Jones, M. B.; Vieglais, D.; Wilson, B. E.

2016-12-01

Thousands of earth and environmental science repositories serve many researchers and communities, each with their own community and legal mandates, sustainability models, and historical infrastructure. These repositories span the stewardship spectrum from highly curated collections that employ large numbers of staff members to review and improve data, to small, minimal budget repositories that accept data caveat emptor and where all responsibility for quality lies with the submitter. Each repository fills a niche, providing services that meet the stewardship tradeoffs of one or more communities. We have reviewed these stewardship tradeoffs for several DataONE member repositories ranging from minimally (KNB) to highly curated (Arctic Data Center), as well as general purpose (Dryad) to highly discipline or project specific (NEON). The rationale behind different levels of stewardship reflect resolution of these tradeoffs. Some repositories aim to encourage extensive uptake by keeping processes simple and minimizing the amount of information collected, but this limits the long-term utility of the data and the search, discovery, and integration systems that are possible. Other repositories require extensive metadata input, review, and assessment, allowing for excellent preservation, discovery, and integration but at the cost of significant time for submitters and expense for curatorial staff. DataONE recognizes these different levels of curation, and attempts to embrace them to create a federation that is useful across the stewardship spectrum. DataONE provides a tiered model for repositories with growing utility of DataONE services at higher tiers of curation. The lowest tier supports read-only access to data and requires little more than title and contact metadata. Repositories can gradually phase in support for higher levels of metadata and services as needed. These tiered capabilities are possible through flexible support for multiple metadata standards and services, where repositories can incrementally increase their requirements as they want to satisfy more use cases. Within DataONE, metadata search services support minimal metadata models, but significantly expanded precision and recall become possible when repositories provide more extensively curated metadata.

Welfare dynamics, support services, mothers' earnings, and child cognitive development: implications for contemporary welfare reform.

PubMed

Yoshikawa, H

1999-01-01

This prospective longitudinal study, using data from the National Longitudinal Survey of Youth (NLSY; N = 614), addresses the gap in the research literature regarding the effects of welfare reform on children. Key questions addressed include whether welfare dynamics and support services relevant to welfare reform, both measured across the first 5 years of life, are associated with mothers' earnings in the 6th year and three child cognitive outcomes in the 7th and 8th years: Peabody Individual Achievement Test (PIAT) math and reading scores, and the Peabody Picture Vocabulary Test (PPVT). Welfare dynamics are represented by total time on welfare, degree of cycling on and off welfare, and degree to which welfare and work are combined. Support services measured include three forms of child care (relative, babysitter, and center-based), as well as three forms of human capital supports (child support, job training, and education). Controlling for a range of background factors and for different patterns of welfare use across the first 5 years, small positive associations with mother's earnings were found for child support, education, and job training. Small positive associations also were found between child support and both math and reading scores. Finally positive associations of medium effect size were found between center care and both mothers' earnings and child PPVT scores. Although effect sizes are generally small, the results suggest the potential value of welfare reform approaches that emphasize long-term human capital development. Interactions between welfare dynamics and support services suggest subgroup differences. Specifically, positive effects of support services on earnings are strongest among mothers with higher levels of human capital (higher levels of work while on welfare, lower total time on welfare). Babysitter care appears to have negative effects on both reading and math scores of children whose mothers report low levels of work while on welfare. Implications for welfare reform policy are discussed.

78 FR 58289 - Information Collection; Submission for OMB Review, Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-23

... (ICR) entitled President's Higher Education Community Service Honor Roll Application for review and... application for the President's Higher Education Community Service Honor Roll, which is used by higher... Community Service. Title: President's Higher Education Community Service Honor Roll. OMB Number: 3045-0120...

Predicting the Trajectories of Perceived Pain Intensity in Southern Community-Dwelling Older Adults: The Role of Religiousness.

PubMed

Sun, Fei; Park, Nan Sook; Wardian, Jana; Lee, Beom S; Roff, Lucinda L; Klemmack, David L; Parker, Michael W; Koenig, Harold G; Sawyer, Patricia L; Allman, Richard M

2013-11-01

This study focuses on the identification of multiple latent trajectories of pain intensity, and it examines how religiousness is related to different classes of pain trajectory. Participants were 720 community-dwelling older adults who were interviewed at four time points over a 3-year period. Overall, intensity of pain decreased over 3 years. Analysis using latent growth mixture modeling (GMM) identified three classes of pain: (1) increasing ( n = 47); (2) consistently unchanging ( n = 292); and (3) decreasing ( n = 381). Higher levels of intrinsic religiousness (IR) at baseline were associated with higher levels of pain at baseline, although it attenuated the slope of pain trajectories in the increasing pain group. Higher service attendance at baseline was associated with a higher probability of being in the decreasing pain group. The increasing pain group and the consistently unchanging group reported more negative physical and mental health outcomes than the decreasing pain group.

Daily stressors and adult day service use by family caregivers: effects on depressive symptoms, positive mood, and dehydroepiandrosterone-sulfate.

PubMed

Zarit, Steven H; Whetzel, Courtney A; Kim, Kyungmin; Femia, Elia E; Almeida, David M; Rovine, Michael J; Klein, Laura Cousino

2014-12-01

This study examines effects of daily use of adult day service (ADS) programs by caregivers of individuals with dementia (IWD) on a salivary biomarker of stress reactivity, dehydroepiandrosterone-sulfate (DHEA-S), and whether these effects on DHEA-S are associated with daily variability in positive mood and depressive symptoms. We used a daily diary design of 8 consecutive days with alternation of intervention (ADS) and nonintervention days to evaluate within- and between-person effects of the intervention. Family caregivers (N = 151) of IWD who were using ADS were interviewed daily by telephone at home. Saliva samples were collected from caregivers five times a day for 8 consecutive days and were assayed for DHEA-S. Daily telephone interviews assessed daily stressors and mood. DHEA-S levels were significantly higher on days after ADS use. Daily DHEA-S levels covaried significantly with daily positive mood but not with depressive symptoms. These results demonstrate an association of ADS use by family caregivers and higher DHEA-S levels on the next day. Prior research has found that higher DHEA-S levels are protective against the physiologic damaging effects of stressor exposure and may reduce risks of illness. Regular use of ADS may help reduce depletion of DHEA-S and allow the body to mount a protective and restorative response to the physiologic demands of caregiving. To our knowledge, this is the first study to examine DHEA-S levels across the day in connection with an intervention that affected daily exposure to stressors. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Birth control practices and levels of development in India.

PubMed

Karan, P P; Bladen, W A; Singh, G

1978-11-01

The paper examines the acceptance of birth control practices in India, and examines the relationhsip of these patterns to levels of economic development. A study of selected couples with markedly low incomes revealed that fertility tended to increase until a certain level of per capita income was reached. From this level onward, fertility and desired family size goals declined with increasing economic status. The study reveals an association in India between those less developed states and poor acceptance of family planning. The level of medical and administrative personnel for family planning services is superior in the more developed states and, logically, adoption of family planning practices is also higher. In higher-income states, characterized by relatively higher spatial mobility and literacy rates, the spread of family planning practices is relatively rapid. In less developed states, characterized by poorly developed centralized systems of communication and distribution, a lower spatial mobility of people, and a lower diffusion of knowledge through personal contact, family planning methods tend to spread very slowly or become less and less popular. A classification of Indian states as related to their acceptance of formal family planning policy and governmental efforts has been helpful in developing regionally-oriented program strategies for the future. Such strategies would take into account varying socioeconomic, cultural and administrative infrastructure differences in order to better assure delivery of services. As India also faces a shortage of trained physicians and personnel for the National Family Planning program, a regionally-based spatial allocation policy must be formulated that will divert some family planning personnel from states with high-acceptance patterns to the more densely populated, less developed regions of the country.

The optimal design of service level agreement in IAAS based on BDIM

NASA Astrophysics Data System (ADS)

Liu, Xiaochen; Zhan, Zhiqiang

2013-03-01

Cloud Computing has become more and more prevalent over the past few years, and we have seen the importance of Infrastructure-as-a-service (IaaS). This kind of service enables scaling of bandwidth, memory, computing power and storage. But the SLA in IaaS also faces complexity and variety. Users also consider the business of the service. To meet the most users requirements, a methodology for designing optimal SLA in IaaS from the business perspectives is proposed. This method is different from the conventional SLA design method, It not only focuses on service provider perspective, also from the customer to carry on the design. This methodology better captures the linkage between service provider and service client by considering minimizing the business loss originated from performance degradation and IT infrastructure failures and maximizing profits for service provider and clients. An optimal design in an IaaS model is provided and an example are analyzed to show this approach obtain higher profit.

Associations between Depressive State and Impaired Higher-Level Functional Capacity in the Elderly with Long-Term Care Requirements.

PubMed

Ogata, Soshiro; Hayashi, Chisato; Sugiura, Keiko; Hayakawa, Kazuo

2015-01-01

Depressive state has been reported to be significantly associated with higher-level functional capacity among community-dwelling elderly. However, few studies have investigated the associations among people with long-term care requirements. We aimed to investigate the associations between depressive state and higher-level functional capacity and obtain marginal odds ratios using propensity score analyses in people with long-term care requirements. We conducted a cross-sectional study based on participants aged ≥ 65 years (n = 545) who were community dwelling and used outpatient care services for long-term preventive care. We measured higher-level functional capacity, depressive state, and possible confounders. Then, we estimated the marginal odds ratios (i.e., the change in odds of impaired higher-level functional capacity if all versus no participants were exposed to depressive state) by logistic models using generalized linear models with the inverse probability of treatment weighting (IPTW) for propensity score and design-based standard errors. Depressive state was used as the exposure variable and higher-level functional capacity as the outcome variable. The all absolute standardized differences after the IPTW using the propensity scores were < 10% which indicated negligible differences in the mean or prevalence of the covariates between non-depressive state and depressive state. The marginal odds ratios were estimated by the logistic models with IPTW using the propensity scores. The marginal odds ratios were 2.17 (95%CI: 1.13-4.19) for men and 2.57 (95%CI: 1.26-5.26) for women. Prevention of depressive state may contribute to not only depressive state but also higher-level functional capacity.

Resilience of Professional Counselors Following Hurricanes Katrina and Rita

ERIC Educational Resources Information Center

Lambert, Simone F.; Lawson, Gerard

2013-01-01

Professional counselors who provided services to those affected by Hurricanes Katrina and Rita completed the K6+ (screen for severe mental illness), the Posttraumatic Growth Inventory, and the Professional Quality of Life Scale. Results indicated that participants who survived the hurricanes had higher levels of posttraumatic growth than…

Lexical Profiles of Thailand University Admission Tests

ERIC Educational Resources Information Center

Cherngchawano, Wirun; Jaturapitakkul, Natjiree

2014-01-01

University Admission Tests in Thailand are important documents which reflect Thailand's education system. To study at a higher education level, all students generally need to take the University Admission Tests designed by the National Institute of Educational Testing Service (NIETS). For the English test, vocabulary and reading comprehension is…

Key Challenges to Collegiate Music Education Programs in North America

ERIC Educational Resources Information Center

Jones, Patrick M.

2012-01-01

Higher education is the linchpin of music education in North America. It is primarily in collegiate institutions that music teachers are educated throughout the life cycles of their careers. This begins with preservice programs, typically at the baccalaureate level, and continues with in-service professional development and graduate degree…

Student Satisfaction and the Customer Focus in Higher Education

ERIC Educational Resources Information Center

Mark, Eddie

2013-01-01

Advocating a customer focus, the Total Quality Management model of leadership has led to success in raising performance levels throughout various manufacturing and service industries. Many education stakeholders, however, are resistant to the notion that postsecondary students benefit from being treated like customers. While many critics oppose…

Behavioral, Psychological, and Demographic Predictors of Physical Fitness.

ERIC Educational Resources Information Center

Conway, Terry L.

Achieving higher levels of physical fitness has become a goal of many Americans both for personal reasons (e.g., improved health, appearance, and perceived well-being) and for organizational reasons (e.g., corporate cost-savings with healthy employees, operational readiness for the military services). Understanding the factors which have an impact…

Peer Effects in Academic Cheating

ERIC Educational Resources Information Center

Carrell, Scott E.; Malmstrom, Frederick V.; West, James E.

2008-01-01

Using self-reported academic cheating from the classes of 1959 through 2002 at the three major United States military service academies (Air Force, Army, and Navy), we measure how peer cheating influences individual cheating behavior. We find higher levels of peer cheating result in a substantially increased probability that an individual will…

Accountability and Professionalism: A Contradiction in Terms?

ERIC Educational Resources Information Center

Cheng, Ming

2012-01-01

Declining trust in public services has led to increasing calls for higher education to be "accountable" for the quality of its teaching and learning provision. However, increasing levels of quality evaluation have led academics to feel that their professionalism is under attack. Reflecting on this history and various dimensions of…

Renewing Our Commitment to Kids: Collaborative Consultation

ERIC Educational Resources Information Center

Strickler, Amy; Pfeifer, Doug; Cameron, Alex; Robinson, Anna; Price, Camile; David, Megan

2014-01-01

Children with serious emotional and behavioral problems often present challenges that far exceed what seems to be manageable. Despite the best intentions and efforts, youth move through multiple failed services because of the lack of progress, the "failure to adjust," and a presumed need for a higher level of care. Renewing Our…

Weathering the Recession in College Health

ERIC Educational Resources Information Center

Christmas, William A.

2010-01-01

The current global recession has increased personal stress levels throughout our society. With dwindling resources, institutions of higher learning are especially prone to budgetary cutbacks during such periods. Based on 22 years of experience as a health service director, the author offers some personal insights in the hope that they will help…

Help-Seeking by Young People with Depressive Disorders

ERIC Educational Resources Information Center

Sawyer, Michael G.; Sawyer, Alyssa C. P.; La Greca, Annette M.

2012-01-01

Depressive disorders commonly occur for the first time during adolescence and often become a recurring source of distress and impairment. Unfortunately, only a small proportion of adolescents with depressive disorders receive help from professional services, and there is evidence that adolescents with higher levels of depressive symptoms may be…

Prevention Service System Transformation Using "Communities That Care"

ERIC Educational Resources Information Center

Brown, Eric C.; Hawkins, J. David; Arthur, Michael W.; Briney, John S.; Fagan, Abigail A.

2011-01-01

This study examines prevention system transformation as part of a community-randomized controlled trial of Communities That Care (CTC). Using data from surveys of community leaders, we examine differences between CTC and control communities 4.5 years after CTC implementation. Significantly higher levels of adopting a science-based approach to…

Organizational and individual factors influencing job satisfaction and burnout of mental health workers.

PubMed

Martin, U; Schinke, S P

1998-01-01

Job satisfaction and burnout are important areas of study because of the financial and social effects of job satisfaction and the damaging physical/psychological impacts of burnout. Two hundred family/children and psychiatric workers of seven social service organizations were surveyed. Instruments used were the Minnesota Satisfaction Questionnaire, the Maslach Burnout Inventory, and the Staff Burnout Scale for Health Professionals. Reported levels of job satisfaction and burnout are within normal limits. Psychiatric and family/children workers report equal job satisfaction levels, but the latter group reports significantly higher burnout levels. Both groups are particularly satisfied with the amount of praise delivered by supervisors and are reportedly dissatisfied with salary levels and promotional opportunities. These three factors are strongly associated with job satisfaction and burnout levels of both groups. Findings have practical implications for social service administrators and practitioners. Correlates of satisfaction and burnout can be altered in order to maintain employee satisfaction and reduce burnout, absenteeism and turnover.

Where Are They Now: Emily Burnett Aims Even Higher Thanks to Internship Experience | Poster

Cancer.gov

Emily Burnett, a five-time intern with NCI at Frederick’s Occupational Health Services (OHS), says the Werner H. Kirsten Student Intern Program program helped shape her current career trajectory. When she began her first OHS internship in 2015, her heart was set on becoming a nurse. However, after working with mentor Sarah Hooper and secondary mentor Patricia Claude, she decided to pursue a “higher level of medicine”—physician’s assistant.

Multiple sclerosis rehabilitation outcomes: analysis of a national casemix data set from Australia.

PubMed

Khan, F; Turner-Stokes, L; Stevermuer, T; Simmonds, F

2009-07-01

To examine the outcomes of inpatient rehabilitation for persons with multiple sclerosis (pwMS), using the Australian Rehabilitation Outcomes Centre (AROC) database. Deidentified data from the AROC database were analyzed for all rehabilitation admissions during 2003-2007, using four classes for functional level. The outcomes included Functional Independence Measure (FIM) scores and efficiency, hospital length of stay (LOS), and discharge destination. Of 1010 case episodes, 70% were women, admitted from home (n = 851) and discharged into the community (n = 890), and 97% (n = 986) were in the higher three classes for functional level (classes 216, 217, and 218). Majority of the more disabled pwMS were treated in the public hospital system, with a longer LOS compared with private facilities (P < 0.001). The FIM for classes 216-218 showed significant functional improvement during the admission (P < 0.001), and those in higher classes showed less change (likely due to higher FIM admission scores). FIM efficiency was significantly higher in class 217 than other classes (P < 0.001). The year-on-year trend was toward reducing hospital LOS and FIM efficiency, but these did not reach significance (P = 0.107, P = 0.634). The AROC data set is useful for describing rehabilitation outcomes for pwMS. However, additional information needs to be collected to evaluate nature of services provided and service implications.

Urinary 1-hydroxypyrene and malondialdehyde in male workers in Chinese restaurants

PubMed Central

Pan, C-H; Chan, C-C; Huang, Y-L; Wu, K-Y

2008-01-01

Objectives: To assess internal dose and oxidative stress in male restaurant workers exposed to polycyclic aromatic hydrocarbons (PAHs) from cooking oil fumes (COFs) in Chinese restaurants. Methods: The study participants included 288 male restaurant workers (171 kitchen and 117 service staff) in Chinese restaurants in Taiwan. Airborne particulate PAHs were measured over 12 h on each of two consecutive work days and then identified using high performance liquid chromatography. Urinary 1-hydroxypyrene (1-OHP) measurements were used to indicate COF exposure, and urinary malondialdehyde (MDA) was adopted as an oxidative stress marker. Multiple regression models were used to assess the relationship between MDA and 1-OHP levels after adjusting for key personal covariates. Results: Summed particulate PAH levels in kitchens (median 23.9 ng/m3) were significantly higher than those in dining areas (median 4.9 ng/m3). For non-smoking kitchen staff, mean MDA and 1-OHP levels were 344.2 (SD 243.7) and 6.0 (SD 8.0) μmol/mol creatinine, respectively. These levels were significantly higher than those for non-smoking service staff, which were 244.2 (SD 164.4) and 2.4 (SD 4.3) μmol/mol creatinine, respectively. Urinary 1-OHP levels were significantly associated with work in kitchens (p<0.05). Furthermore, urinary MDA levels were significantly associated with urinary 1-OHP levels (p<0.001) and working hours per day (p<0.05). Conclusions: These findings indicate that urinary 1-OHP and MDA levels reflect occupational exposure to PAHs from COFs and oxidative stress in workers in Chinese restaurants. PMID:18940956

Urinary 1-hydroxypyrene and malondialdehyde in male workers in Chinese restaurants.

PubMed

Pan, C-H; Chan, C-C; Huang, Y-L; Wu, K-Y

2008-11-01

To assess internal dose and oxidative stress in male restaurant workers exposed to polycyclic aromatic hydrocarbons (PAHs) from cooking oil fumes (COFs) in Chinese restaurants. The study participants included 288 male restaurant workers (171 kitchen and 117 service staff) in Chinese restaurants in Taiwan. Airborne particulate PAHs were measured over 12 h on each of two consecutive work days and then identified using high performance liquid chromatography. Urinary 1-hydroxypyrene (1-OHP) measurements were used to indicate COF exposure, and urinary malondialdehyde (MDA) was adopted as an oxidative stress marker. Multiple regression models were used to assess the relationship between MDA and 1-OHP levels after adjusting for key personal covariates. Summed particulate PAH levels in kitchens (median 23.9 ng/m(3)) were significantly higher than those in dining areas (median 4.9 ng/m(3)). For non-smoking kitchen staff, mean MDA and 1-OHP levels were 344.2 (SD 243.7) and 6.0 (SD 8.0) mumol/mol creatinine, respectively. These levels were significantly higher than those for non-smoking service staff, which were 244.2 (SD 164.4) and 2.4 (SD 4.3) mumol/mol creatinine, respectively. Urinary 1-OHP levels were significantly associated with work in kitchens (p<0.05). Furthermore, urinary MDA levels were significantly associated with urinary 1-OHP levels (p<0.001) and working hours per day (p<0.05). These findings indicate that urinary 1-OHP and MDA levels reflect occupational exposure to PAHs from COFs and oxidative stress in workers in Chinese restaurants.

Permanent Supportive Housing for Transition-Age Youths: Service Costs and Fidelity to the Housing First Model.

PubMed

Gilmer, Todd P

2016-06-01

Permanent supportive housing (PSH) programs are being implemented nationally and on a large scale. However, little is known about PSH for transition-age youths (ages 18 to 24). This study estimated health services costs associated with participation in PSH among youths and examined the relationship between fidelity to the Housing First model and health service outcomes. Administrative data were used in a quasi-experimental, difference-in-differences design with a propensity score-matched contemporaneous control group to compare health service costs among 2,609 youths in PSH and 2,609 youths with serious mental illness receiving public mental health services in California from January 1, 2004, through June 30, 2010. Data from a survey of PSH program practices were merged with the administrative data to examine changes in service use among 1,299 youths in 63 PSH programs by level of fidelity to the Housing First model. Total service costs increased by $13,337 among youths in PSH compared with youths in the matched control group. Youths in higher-fidelity programs had larger declines in use of inpatient services and larger increases in outpatient visits compared with youths in lower-fidelity programs. PSH for youths was associated with substantial increases in costs. Higher-fidelity PSH programs may be more effective than lower-fidelity programs in reducing use of inpatient services and increasing use of outpatient services. As substantial investments are made in PSH for youths, it is imperative that these programs are designed and implemented to maximize their effectiveness and their impact on youth outcomes.

Perception of security by health workforce at workplace in Nepal.

PubMed

Prajapati, R; Baral, B; Karki, K B; Neupane, M

2013-05-01

In Nepal, the relationship of health worker and patient or community people is now deteriorating and the security and safety of health worker is becoming emerging issues. The poor relationship between community people and health worker is hampering the health service especially in rural setting. This study was aimed at finding the security perception and situation of health workforce in Nepal. A cross-sectional descriptive study was conducted using both quantitative and qualitative methods. Out of 404 sample health institutions, 747 health workforce from 375 health institutions were interviewed (<10% non-response rate) using the probability proportionate to size method as per World Health Organization (WHO) guidelines. Nearly 168 (23%) of health workers felt some level of insecurity at their workplace. Mostly, doctors felt insecure at their workplace 24 (30%) and argued with service users , 26 (32.50%). Feeling of security was highest in central region 160 (83.30%). Nationwide, 121 (16%) of health workers faced some level of arguments with service users, which was highest in Tarai 64 (18.08%). Of the total harassment, both gender based and sexual harassment was higher among female health workers [20 (62.5%) and 13 (56.5%) respectively]. Only, 230 (30.7%) of health workers who suffered from workplace accidents got compensation and treatment. Higher proportions of health workers feel insecurity at workplace whereas provision of compensation was minimal. There is a need of strict implementation of Security of the Health Workers and Health Organizations Act, 2066 (2009) for effective health service delivery.

Urban caregiver empowerment: Caregiver nativity, child asthma symptoms and emergency department use

PubMed Central

Coutinho, Maria Teresa; Kopel, Sheryl J.; Williams, Brittney; Dansereau, Katie; Koinis-Mitchell, Daphne

2016-01-01

Introduction This study examines the associations between caregiver empowerment, child asthma symptoms, and emergency department use in a sample of school aged urban children with asthma. We examined differences in caregiver empowerment, and in the associations among caregiver empowerment, proportion of days with child asthma symptoms, and emergency department use as a function of caregiver nativity. Methods Participants for this study were part of a larger longitudinal study and included Latino, African American and non-Latino White urban caregivers and their children with asthma (ages 7–9; N=130). Caregiver empowerment was assessed within family, asthma services, and community domains. Results Children whose caregivers reported greater empowerment within the family (knowledge and ability to care for their family) presented with fewer asthma symptoms. Children whose caregivers reported greater empowerment within asthma services (ability to collaborate with asthma providers and healthcare system), presented with more asthma symptoms. Foreign-born caregivers endorsed greater empowerment within the family, while US-born caregivers reported greater empowerment within asthma services. For foreign-born caregivers, higher levels of empowerment in the family were associated with fewer child asthma symptoms. For US-born caregivers, higher levels of empowerment in asthma services were associated with more child asthma symptoms. Discussion Results suggest that caregivers who feel more confident and better able to manage problems within their family may better manage their child's asthma more effectively navigate the asthma healthcare system and manage their child's asthma. PMID:27632543

ATTITUDINAL PROFILE OF MILITARY NURSING SERVICE OFFICERS.

PubMed

Goel, D S; Kumari, Renu; Saldanha, D; Kaushik, A; Gupta, Lalit

2000-04-01

A questionnaire designed to assess attitudinal profile was mailed to nursing officers in five representative military hospitals. 158 (77.83%) of 203 addressees responded. Cluster analysis indicated higher level of commitment in nursing officers with over 16 years service as compared to those with less than 5 years. Self-image and job-satisfaction, however tended to be eroded with increasing length of service which was also associated with a more authoritarian attitude, relatively less materialistic outlook and (paradoxically) greater negative attitude towards authority figures. Marriage and having children did not influence any parameter. The feeling of sexual harassment increased with seniority in service, as also a perceived erosion in the authority of the principal matron. Relatively junior nursing officers appeared dissatisfied with "too much paper work" and a felt deterioration in working environment as well as the image of Military Nursing Service.

Can Family Planning Service Statistics Be Used to Track Population-Level Outcomes?

PubMed

Magnani, Robert J; Ross, John; Williamson, Jessica; Weinberger, Michelle

2018-03-21

The need for annual family planning program tracking data under the Family Planning 2020 (FP2020) initiative has contributed to renewed interest in family planning service statistics as a potential data source for annual estimates of the modern contraceptive prevalence rate (mCPR). We sought to assess (1) how well a set of commonly recorded data elements in routine service statistics systems could, with some fairly simple adjustments, track key population-level outcome indicators, and (2) whether some data elements performed better than others. We used data from 22 countries in Africa and Asia to analyze 3 data elements collected from service statistics: (1) number of contraceptive commodities distributed to clients, (2) number of family planning service visits, and (3) number of current contraceptive users. Data quality was assessed via analysis of mean square errors, using the United Nations Population Division World Contraceptive Use annual mCPR estimates as the "gold standard." We also examined the magnitude of several components of measurement error: (1) variance, (2) level bias, and (3) slope (or trend) bias. Our results indicate modest levels of tracking error for data on commodities to clients (7%) and service visits (10%), and somewhat higher error rates for data on current users (19%). Variance and slope bias were relatively small for all data elements. Level bias was by far the largest contributor to tracking error. Paired comparisons of data elements in countries that collected at least 2 of the 3 data elements indicated a modest advantage of data on commodities to clients. None of the data elements considered was sufficiently accurate to be used to produce reliable stand-alone annual estimates of mCPR. However, the relatively low levels of variance and slope bias indicate that trends calculated from these 3 data elements can be productively used in conjunction with the Family Planning Estimation Tool (FPET) currently used to produce annual mCPR tracking estimates for FP2020. © Magnani et al.

Services provided by community pharmacies in Wayne County, Michigan: a comparison by ZIP code characteristics.

PubMed

Erickson, Steven R; Workman, Paul

2014-01-01

To document the availability of selected pharmacy services and out-of-pocket cost of medication throughout a diverse county in Michigan and to assess possible associations between availability of services and price of medication and characteristics of residents of the ZIP codes in which the pharmacies were located. Cross-sectional telephone survey of pharmacies coupled with ZIP code-level census data. 503 pharmacies throughout the 63 ZIP codes of Wayne County, MI. The out-of-pocket cost for a 30 days' supply of levothyroxine 50 mcg and brand-name atorvastatin (Lipitor-Pfizer) 20 mg, availability of discount generic drug programs, home delivery of medications, hours of pharmacy operation, and availability of pharmacy-based immunization services. Census data aggregated at the ZIP code level included race, annual household income, age, and number of residents per pharmacy. The overall results per ZIP code showed that the average cost for levothyroxine was $10.01 ± $2.29 and $140.45 + $14.70 for Lipitor. Per ZIP code, the mean (± SD) percentages of pharmacies offering discount generic drug programs was 66.9% ± 15.0%; home delivery of medications was 44.5% ± 22.7%; and immunization for influenza was 46.7% ± 24.3% of pharmacies. The mean (± SD) hours of operation per pharmacy per ZIP code was 67.0 ± 25.2. ZIP codes with higher household income as well as higher percentage of residents being white had lower levothyroxine price, greater percentage of pharmacies offering discount generic drug programs, more hours of operation per week, and more pharmacy-based immunization services. The cost of Lipitor was not associated with any ZIP code characteristic. Disparities in the cost of generic levothyroxine, the availability of services such as discount generic drug programs, hours of operation, and pharmacy-based immunization services are evident based on race and household income within this diverse metropolitan county.

Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil.

PubMed

Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Lima, Margareth Guimarães; Araújo, Silvânia Suely Caribé de; Silva, Marta Maria Alves da; Freitas, Maria Imaculada de Fátima; Barros, Marilisa Berti de Azevedo

2017-06-01

To assess whether sex, education level, and health insurance affect the use of health services among the adult Brazilian population with chronic noncommunicable diseases (NCD). Data from a cross-sectional survey were analyzed, the National Health Survey (PNS). Frequency of use of services in the population that referred at least one NCD were compared with the frequency from a population that did not report NCD, according to sex, education level, health insurance, and NCD number (1, 2, 3, 4, or more). The prevalence and prevalence ratios were calculated crude and adjusted for sex, age, region, and 95% confidence intervals. The presence of a noncommunicable disease was associated with increase in hospitalizations in the last 12 months, in 1.7 times (95%CI 1.53-1.9). Failing to perform usual activities in the last two weeks for health reasons was 3.1 times higher in NCD carriers (95%CI 2.78-3.46); while the prevalence of medical consultation in the last 12 months was 1.26 times higher (95%CI 1.24-1.28). NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. Analisar se sexo, escolaridade e posse de plano de saúde influenciam a utilização de serviços de saúde entre a população adulta brasileira portadora de doenças crônicas não transmissíveis (DCNT). Foram analisados dados de inquérito transversal, a Pesquisa Nacional de Saúde (PNS). Foram comparadas as frequências de uso de serviços na população que referiu pelo menos uma DCNT, com aquelas que não relatam DCNT, segundo sexo, escolaridade, posse de plano de saúde e número de DCNT (1, 2, 3, 4 ou mais). Foram calculadas as prevalências e razões de prevalência (RP) brutas e ajustadas por sexo, idade e região e respectivos intervalos de confiança de 95%. A presença de doença crônica associou-se ao aumento de internação nos últimos 12 meses, em 1,7 vezes (IC95% 1,53-1,9). Deixar de realizar atividades habituais nas duas últimas semanas por motivo de saúde foi 3,1 vezes maior em portadores de DCNT (IC95% 2,78-3,46), e a prevalência de consulta médica nos últimos 12 meses foi 1,26 vezes maior (IC95% 1,24-1,28). Portadores de DCNT utilizam mais os serviços de saúde, assim como as mulheres, pessoas com maior número de DCNT, com planos de saúde e elevada escolaridade. Portadores de DCNT têm maior utilização de serviços de saúde, assim como as mulheres, pessoas com maior número de comorbidades, com planos de saúde e elevada escolaridade.

Availability of limited service food outlets surrounding schools in British Columbia.

PubMed

Black, Jennifer L; Day, Meghan

2012-06-05

The purpose of this study was to provide a descriptive profile of the availability of limited service food outlets surrounding public schools in British Columbia, Canada. Data from the 2010 Canadian Business Data Files were used to identify limited service food outlets including fast food outlets, beverage and snack food stores, delis and convenience stores. The number of food outlets within 800 metres of 1,392 public schools and the distance from schools to the nearest food outlets were assessed. Multivariate regression models examined the associations between food outlet availability and school-level characteristics. In 2010, over half of the public schools in BC (54%) were located within a 10-12 minute walk from at least one limited service food outlet. The median closest distance to a food outlet was just over 1 km (1016 m). Schools comprised of students living in densely populated urban neighbourhoods and neighbourhoods characterized by lower socio-economic status were more likely to have access to limited service food outlets within walking distance. After adjusting for school-level median family income and population density, larger schools had higher odds of exposure to food vendors compared to schools with fewer students. The availability of and proximity to limited service food outlets vary widely across schools in British Columbia and school-level characteristics are significantly associated with food outlet availability. Additional research is needed to understand how food environment exposures inside and surrounding schools impact students' attitudes, food choices and dietary quality.

Assessing the role of appropriate primary health care on the use of dental services by Brazilian low-income preschool children.

PubMed

Baldani, Márcia Helena; Rocha, Juliana Schaia; Fadel, Cristina Berger; Nascimento, Antonio Carlos; Antunes, José Leopoldo Ferreira; Moysés, Samuel Jorge

2017-11-21

This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.

Factors influencing the mammography utilization among Taiwanese women with intellectual disabilities, a nationwide population-based study.

PubMed

Lai, Hsien-Tang; Kung, Pei-Tseng; Tsai, Wen-Chen

2014-12-01

Women with intellectual disabilities (ID) have cognitive impairment and communication difficulties; for both caregivers and clinical personnel, discovering the early symptoms of breast cancer among women with ID is challenging. The mammography utilization rate of women with ID was significantly lower than that of women in the general population. This study employed a 2008 database of people with disabilities in Taiwan as a research target and analyzed the mammography utilization rate of women with ID aged 50–69 years. In addition, relevant factors influencing mammography utilization among women with ID were also investigated. A total of 4370 participants were recruited and the majority were illiterate or had elementary-level educations (82.27%). The majority of the participants had ID that was more severe than mild (83.80%). The mammography utilization rate of women with ID was 4.32%, which was significantly lower than that of women in the general population (12%). The mammography utilization rate among women with ID who were married, had higher education levels, and had been diagnosed with cancer, diabetes, or mild ID was significantly higher. However, the mammography utilization rate among women with ID, who had elementary-level educations or were illiterate, was only 4.03%. The utilization rate among women with profound ID was only 2.65%. Women with ID who had undergone pap smears or had utilized adult preventive health services demonstrated a significantly higher mammography utilization rate. This study identified that education level, a diagnosis of diabetes, and the application of pap smears or adult preventive health services were primary factors that influenced the mammography utilization rate among women with ID. This study also observed that in Taiwan, the mammography utilization rate of women with ID was lower than that of pap smears and adult preventive health services, and was only half of that of people with disabilities. An unequal situation existed in regard to the acceptance of breast cancer screening among women with ID, and a different form of strategic planning must be adopted in public health policy. Because ID differs from other disabilities and most women with ID are illiterate, tailored courses are required to train primary caregivers and clinical personnel in providing knowledge and services. The objectives are to diagnose breast cancer at an early stage to decrease the risk of mortality and ensure their rights to health.

Health care and social service providers' descriptions of pacific islander mothers' breastfeeding patterns.

PubMed

Flood, Jeanie L; Dodgson, Joan E

2010-01-01

Despite recommendations and numerous health benefits attributed to breastfeeding, rates in the United States are below desired levels, particularly within vulnerable populations. In Hawaií, breastfeeding rates are higher than national averages except in Native Hawaiian and other Pacific Islander populations. Health care and social service providers are integral to successful breastfeeding promotion efforts. They are in an ideal position to reflect on the context in which their clients live and on its relationship to breastfeeding activities. The aim of this study was to describe health care and social service providers' perceptions of the influences on the breastfeeding patterns of Pacific Islander women. Focus ethnographic methods were used to collect interview data from health care and social service providers (N=20) serving Native Hawaiian and Pacific Islander women in one rural community. An iterative analysis process of coding and categorizing, followed by conceptual abstraction into patterns, was completed. Four patterns emerged: shaped by connections, lived unfamiliarity, stressed by circumstance, and missed opportunities. Participants' insights concerning the needs of this population yielded population-specific issues and health care system issues affecting breastfeeding promotion. A number of gaps in breastfeeding services were identified. Sociocultural, maternal knowledge, and workload barriers to successful breastfeeding predominated providers' perspectives. Broader system and community level issues were implied, but not directly addressed. The nature of successful breastfeeding support and promotion requires inclusion of this broader level perspective.

Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use

PubMed Central

O'Connor, Katherine; Kim, Sunkyung; Kelley, Maureen; Odhiambo, Aloyce; Faith, Sitnah; Otieno, Ronald; Nygren, Benjamin; Kamb, Mary; Quick, Robert

2017-01-01

Reducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ≥ 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9–4.5), health facility delivery (OR = 5.3, 95% CI = 3.4–8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9–4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1–2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5–7.1) than women with less education. For women who lived ≤ 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5–4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0–2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing (P = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women. PMID:28193744

Exploring the relationship between population density and maternal health coverage.

PubMed

Hanlon, Michael; Burstein, Roy; Masters, Samuel H; Zhang, Raymond

2012-11-21

Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score's calculation discounts a nation's uninhabited territory under the assumption those areas are irrelevant to service delivery. We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations' Millennial Development Goals.

Using willingness to pay to investigate regressiveness of user fees in health facilities in Tanzania.

PubMed

Bonu, Sekhar; Rani, Manju; Bishai, David

2003-12-01

The study uses data from the Tanzania Human Resources Development Survey (1994) on willingness to pay (WTP) for desired quality of health care at lower-level health facilities to assess potential regressiveness of user fees - a disproportionately higher negative effect of user fees on utilization of health services among the poor compared with the rich. Despite reports of extensive bypassing of the lower-level health facilities in Tanzania, the WTP for quality health care at these health facilities is surprisingly large. WTP was lower among the poor, female and elderly respondents. Almost one-quarter of the poorest 40% of the population was not willing to pay even when the quality of services met their expectations. The results suggest that: the utilization of health services at lower-level health facilities can be increased by improving the quality of care; and the implementation of uniform user charges in the public facilities may be regressive, adversely affecting utilization among the poor, women and the elderly. An effective system of exemptions and waivers will be required for the very poor who may not be able to pay even when quality of services is improved. The findings of the study have policy implications for the Tanzanian government's recent attempts to expand cost-sharing through community health funds at lower-level health facilities, being introduced since 1998.

The Impact of Perceived Need and Relational Factors on Mental Health Service Use Among Generations of Asian Americans.

PubMed

Lee, Minsun; Takeuchi, David; Gellis, Zvi; Kendall, Philip; Zhu, Lin; Zhao, Shanyang; Ma, Grace X

2017-08-01

The present study examined generational differences in the patterns and predictors of formal and informal mental health service utilization among a nationally representative sample of 1850 Asian Americans from the National Latino and Asian American Study. We focused on the effects of perceived need and relational factors on service utilization among 1st-, 1.5-, and 2nd-generation Asian Americans. Results of hierarchical logistic regression showed significant intergenerational differences. Specifically, 1.5-generation Asian Americans exhibited distinctive pattern of service use, with perceived need being associated with a higher likelihood of using formal mental health services, but only for those with high level of social support. First- and second-generation Asian Americans, on the other hand, perceived need was independently associated with formal service use, and a significant predictor of informal service use for first generation. Greater family conflict was also associated with greater use of formal and informal services for both first- and second generations. However, family cohesion was associated with only informal service use among first -generation Asian Americans. Implications for mental health service policy were discussed.

State funding for local public health: observations from six case studies.

PubMed

Potter, Margaret A; Fitzpatrick, Tiffany

2007-01-01

The purpose of this study is to describe state funding of local public health within the context of state public health system types. These types are based on administrative relationships, legal structures, and relative proportion of state funding in local public health budgets. We selected six states representing various types and geographic regions. A case study for each state summarized available information and was validated by state public health officials. An analysis of the case studies reveals that the variability of state public health systems--even within a given type--is matched by variability in approaches to funding local public health. Nevertheless, some meaningful associations appear. For example, higher proportions of state funding occur along with higher levels of state oversight and the existence of local service mandates in state law. These associations suggest topics for future research on public health financing in relation to local accountability, local input to state priority-setting, mandated local services, and the absence of state funds for public health services in some local jurisdictions.

Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE

PubMed Central

Guillén, Montserrat; Crimmins, Eileen M.

2013-01-01

Differences in health care utilization of immigrants 50 years of age and older relative to the native-born populations in eleven European countries are investigated. Negative binomial and zero-inflated Poisson regression are used to examine differences between immigrants and native-borns in number of doctor visits, visits to general practitioners, and hospital stays using the 2004 Survey of Health, Ageing, and Retirement in Europe database. In the pooled European sample and in some individual countries, older immigrants use from 13 to 20% more health services than native-borns after demographic characteristics are controlled. After controlling for the need for health care, differences between immigrants and native-borns in the use of physicians, but not hospitals, are reduced by about half. These are not changed much with the incorporation of indicators of socioeconomic status and extra insurance coverage. Higher country-level relative expenditures on health, paying physicians a fee-for-service, and physician density are associated with higher usage of physician services among immigrants. PMID:21660564

Quantifying and Mapping the Supply of and Demand for Carbon Storage and Sequestration Service from Urban Trees.

PubMed

Zhao, Chang; Sander, Heather A

2015-01-01

Studies that assess the distribution of benefits provided by ecosystem services across urban areas are increasingly common. Nevertheless, current knowledge of both the supply and demand sides of ecosystem services remains limited, leaving a gap in our understanding of balance between ecosystem service supply and demand that restricts our ability to assess and manage these services. The present study seeks to fill this gap by developing and applying an integrated approach to quantifying the supply and demand of a key ecosystem service, carbon storage and sequestration, at the local level. This approach follows three basic steps: (1) quantifying and mapping service supply based upon Light Detection and Ranging (LiDAR) processing and allometric models, (2) quantifying and mapping demand for carbon sequestration using an indicator based on local anthropogenic CO2 emissions, and (3) mapping a supply-to-demand ratio. We illustrate this approach using a portion of the Twin Cities Metropolitan Area of Minnesota, USA. Our results indicate that 1735.69 million kg carbon are stored by urban trees in our study area. Annually, 33.43 million kg carbon are sequestered by trees, whereas 3087.60 million kg carbon are emitted by human sources. Thus, carbon sequestration service provided by urban trees in the study location play a minor role in combating climate change, offsetting approximately 1% of local anthropogenic carbon emissions per year, although avoided emissions via storage in trees are substantial. Our supply-to-demand ratio map provides insight into the balance between carbon sequestration supply in urban trees and demand for such sequestration at the local level, pinpointing critical locations where higher levels of supply and demand exist. Such a ratio map could help planners and policy makers to assess and manage the supply of and demand for carbon sequestration.

Owens-Illinois liquid solar collector materials assessment

NASA Technical Reports Server (NTRS)

Nichols, R. L.

1978-01-01

From the beginning, it was noted that the baseline drawings for the liquid solar collector exhibited a distinct weakness concerning materials specification where elastomers, plastics, and foam insulation materials were utilized. A relatively small effort by a competent design organization would alleviate this deficiency. Based on results obtained from boilout and stagnation tests on the solar simulator, it was concluded that proof testing of the collector tubes prior to use helps to predict their performance for limited service life. Fracture mechanics data are desirable for predicting extended service life and establishing a minimum proof pressure level requirement. The temperature capability of this collector system was increased as the design matured and the coating efficiency improved. This higher temperature demands the use of higher temperature materials at critical locations in the collector.

Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09.

PubMed

Bradley, Elizabeth H; Canavan, Maureen; Rogan, Erika; Talbert-Slagle, Kristina; Ndumele, Chima; Taylor, Lauren; Curry, Leslie A

2016-05-01

Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Satisfaction and burden of mental health personnel: data from healthcare services for substance users and their families.

PubMed

Hilgert, Juliana B; Bidinotto, Augusto B; Pachado, Mayra P; Fara, Letícia S; von Diemen, Lisia; De Boni, Raquel B; Bozzetti, Mary C; Pechansky, Flávio

2018-06-11

To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families. Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected. Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened. This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

Health Risk Assessment of Ambient Air Concentrations of Benzene, Toluene and Xylene (BTX) in Service Station Environments

PubMed Central

Edokpolo, Benjamin; Yu, Qiming Jimmy; Connell, Des

2014-01-01

A comprehensive evaluation of the adverse health effects of human exposures to BTX from service station emissions was carried out using BTX exposure data from the scientific literature. The data was grouped into different scenarios based on activity, location and occupation and plotted as Cumulative Probability Distributions (CPD) plots. Health risk was evaluated for each scenario using the Hazard Quotient (HQ) at 50% (CEXP50) and 95% (CEXP95) exposure levels. HQ50 and HQ95 > 1 were obtained with benzene in the scenario for service station attendants and mechanics repairing petrol dispensing pumps indicating a possible health risk. The risk was minimized for service stations using vapour recovery systems which greatly reduced the benzene exposure levels. HQ50 and HQ95 < 1 were obtained for all other scenarios with benzene suggesting minimal risk for most of the exposed population. However, HQ50 and HQ95 < 1 was also found with toluene and xylene for all scenarios, suggesting minimal health risk. The lifetime excess Cancer Risk (CR) and Overall Risk Probability for cancer on exposure to benzene was calculated for all Scenarios and this was higher amongst service station attendants than any other scenario. PMID:24945191

Assessment of antiretroviral treatment (ART) care service provision in Tigray Region health centers, North Ethiopia.

PubMed

Tessema, Shewaye Belay; Adane, Mesafint Molla

2015-09-10

Client satisfaction is a vital component and main concern intertwined with strategic decisions in service provisions. To improve efficiency of services, eliciting the opinion of users about the available services and identifying factors associated with dissatisfaction is very critical. Thus, the main objective of this study was to assess the perceived levels of clients' satisfaction with health services at ART clinic level in health centres of Tigray Region in Ethiopia. Cross sectional study was conducted from May to June 2013 in Tigray Region ART clinics. A total of 714 ART care user were included in the study using both purposive and probability sampling technique. Data was collected by using structured questionnaire and the collected data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Crude and Adjusted logistic regression analyses were carried out to identify the associated factors underlying perceived levels of clients' overall satisfaction. Finally, the results were presented with table as well as odds ratio (OR) and 95% confidence interval (CI). A total of 714 study participants were enrolled in this study. An overall satisfaction level of 89.6% was reported by ART care service users. Higher scores of satisfaction of services provisions were reported for courtesy and respect (95.80%) followed by privacy (93.28%). On the other hand, respondents' dissatisfaction was rated 35.32% for toilet cleanliness followed by 26.19% for availability of additional drugs. As for overall satisfaction and associated factors, adjusted logistic regression analyses showed that marital status [AOR = 2.01 (95% CI: 1.11, 3.60)], educational status [AOR = 3.13 (95% CI: 1.15, 8.53)], travel distance to reach health centre [AOR = 3.59 (95% CI: 1.23, 10.50)], toilet cleanliness [AOR = 2.22 (95% CI :1.62, 6.32)], and ART drug availability [AOR = 2.60 (95% CI :1.18, 6.52)] were found to have influence on overall ART service satisfaction status. This study revealed high level of client satisfaction rate and were associated with preventable and modifiable factors such as marital status, educational status, travel distance to reach health centre, toilet cleanliness and ART drug availability. Therefore, countermeasures such as increasing access to ART service, availing clean toilet and ART drugs may further increase client satisfaction level in the region.

Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data.

PubMed

Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna

2018-02-01

To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Health care utilization, somatic and mental health distress, and well-being among widowed and non-widowed female survivors of war.

PubMed

Morina, Nexhmedin; Emmelkamp, Paul M G

2012-05-11

The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population.

Health care utilization, somatic and mental health distress, and well-being among widowed and non-widowed female survivors of war

PubMed Central

2012-01-01

Background The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. Methods 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Results Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. Conclusion War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population. PMID:22578096

Risk management for optimal land use planning integrating ecosystem services values: A case study in Changsha, Middle China.

PubMed

Liang, Jie; Zhong, Minzhou; Zeng, Guangming; Chen, Gaojie; Hua, Shanshan; Li, Xiaodong; Yuan, Yujie; Wu, Haipeng; Gao, Xiang

2017-02-01

Land-use change has direct impact on ecosystem services and alters ecosystem services values (ESVs). Ecosystem services analysis is beneficial for land management and decisions. However, the application of ESVs for decision-making in land use decisions is scarce. In this paper, a method, integrating ESVs to balance future ecosystem-service benefit and risk, is developed to optimize investment in land for ecological conservation in land use planning. Using ecological conservation in land use planning in Changsha as an example, ESVs is regarded as the expected ecosystem-service benefit. And uncertainty of land use change is regarded as risk. This method can optimize allocation of investment in land to improve ecological benefit. The result shows that investment should be partial to Liuyang City to get higher benefit. The investment should also be shifted from Liuyang City to other regions to reduce risk. In practice, lower limit and upper limit for weight distribution, which affects optimal outcome and selection of investment allocation, should be set in investment. This method can reveal the optimal spatial allocation of investment to maximize the expected ecosystem-service benefit at a given level of risk or minimize risk at a given level of expected ecosystem-service benefit. Our results of optimal analyses highlight tradeoffs between future ecosystem-service benefit and uncertainty of land use change in land use decisions. Copyright © 2016 Elsevier B.V. All rights reserved.

Personal goals as predictors of intended classroom goals: comparing elementary and secondary school pre-service teachers.

PubMed

Daniels, Lia M; Frenzel, Anne C; Stupnisky, Robert H; Stewart, Tara L; Perry, Raymond P

2013-09-01

The literature documents fewer classroom mastery goal structures in secondary school compared to elementary. However, little is known about how personal achievement goals may influence classroom goal structures. This is especially true at the level of pre-service teachers. Our objective was to investigate if pre-service teachers' personal goals predicted their intended classroom goal structures. Participants were 125 elementary and 175 secondary school pre-service teachers from two Western Canadian universities. Structural equation modelling was used to examine if the structural relationships and latent means of personal and intended classroom goal structures differed for elementary and secondary school pre-service teachers. The results revealed that personal goals predicted the goal structures that pre-service teachers intended to establish; however, the relationships and means differed between elementary and secondary school pre-service teachers. Specifically, personal mastery-approach goals positively predicted classroom mastery goals much more strongly at the elementary than the secondary level. Furthermore, elementary pre-service teachers had significantly higher latent mean scores on personal mastery-approach goals than their secondary counterparts. It seems possible that the currently documented differences between classroom goal structures noted for elementary compared to secondary school may be based on the personal goals endorsed as pre-service teachers. The results are further discussed in terms of alignment with research on practising teachers' personal and classroom goals and implications for teacher education. © 2012 The British Psychological Society.

Do Socioeconomic Inequalities in Neonatal Mortality Reflect Inequalities in Coverage of Maternal Health Services? Evidence from 48 Low- and Middle-Income Countries.

PubMed

McKinnon, Britt; Harper, Sam; Kaufman, Jay S

2016-02-01

To examine socioeconomic and health system determinants of wealth-related inequalities in neonatal mortality rates (NMR) across 48 low- and middle-income countries. We used data from Demographic and Health Surveys conducted between 2006 and 2012. Absolute and relative inequalities for NMR and coverage of antenatal care, facility-based delivery, and Caesarean delivery were measured using the Slope Index of Inequality and Relative Index of Inequality, respectively. Meta-regression was used to assess whether variation in the magnitude of NMR inequalities was associated with inequalities in coverage of maternal health services, and whether country-level economic and health system factors were associated with mean NMR and socioeconomic inequality in NMR. Of the three maternal health service indicators examined, the magnitude of socioeconomic inequality in NMR was most strongly related to inequalities in antenatal care. NMR inequality was greatest in countries with higher out-of-pocket health expenditures, more doctors per capita, and a higher adolescent fertility rate. Determinants of lower mean NMR (e.g., higher government health expenditures and a greater number of nurses/midwives per capita) differed from factors associated with lower NMR inequality. Reducing the financial burden of maternal health services and achieving universal coverage of antenatal care may contribute to a reduction in socioeconomic differences in NMR. Further investigation of the mechanisms contributing to these cross-national associations seems warranted.

Blood lead levels in children aged 24 to 36 months in Vancouver.

PubMed Central

Jin, A; Hertzman, C; Peck, S H; Lockitch, G

1995-01-01

OBJECTIVES: To determine the blood lead levels in children and to identify risk factors for elevated levels. DESIGN: Cross-sectional study. SETTING: Vancouver. PARTICIPANTS: Random sample of children aged 24 to 36 months, born and still resident in Vancouver. The sample was stratified proportionally by the median annual family income in the census tract where each family resided. OUTCOME MEASURES: Blood lead levels and risk factors for elevated blood lead levels, determined from a questionnaire administered to parents. RESULTS: Of the children in the sample, 42% (178/422) were ineligible or could not be located. Of the remaining children, 73% (177/244) participated and adequate blood specimens were obtained from 172. The mean blood lead level was 0.29 mumol/L (standard deviation 0.13 mumol/L). (A blood lead level of 1 mumol/L is equivalent to 20.7 micrograms/dL.) The lowest level was 0.06 mumol/L, and the highest was 0.85 mumol/L. Of children with adequate samples, 8.1% (14/172) had blood lead levels of 0.48 mumol/L or higher, and 0.6% (1/172) had a level higher than 0.72 mumol/L. The logarithms of the levels were normally distributed, with a geometric mean (GM) of 0.26 mumol/L (geometric standard deviation 1.56). Of approximately 70 possible predictors of blood lead levels analysed, those that showed a statistically significant association (p < 0.05) with increased blood lead levels were soldering performed in the home as part of an electronics hobby (GM blood lead level 0.34 mumol/L, 95% confidence interval [CI] 0.27 to 0.39 mumol/L), aboriginal heritage (GM blood lead level 0.33 mumol/L, 95% CI 0.28 to 0.39 mumol/L), dwelling built before 1921 (GM blood lead level 0.32 mumol/L, 95% CI 0.28 to 0.37 mumol/L), age of water service connection to dwelling (predicted blood lead level 0.00087 mumol/L [95% CI 0.00005 to 0.00169 mumol/L] higher per year since service connection) and decreased stature (predicted blood lead level 0.018 mumol/L [95% CI 0.0353 to 0.0015 mumol/L] higher for every standard deviation below the age-specific mean height). CONCLUSIONS: This study found much lower blood lead levels in children than those found in previous Canadian studies. The authors believe that this result is not an artefact due to differences in population sampling or methods of collection of blood specimens. The study showed no clear risk factors for elevated blood lead levels: although a few factors had a statistically significant association with increased blood lead levels, the differences in levels were small and unimportant. PMID:7712420

Funding of tribal health programs linked to lower rates of hospitalization for conditions sensitive to ambulatory care.

PubMed

Korenbrot, Carol; Kao, Chi; Crouch, James A

2009-01-01

To determine first whether higher funding of Tribally Operated Health Programs (TOHP) is associated with reduced hospitalizations for ambulatory care sensitive conditions (HASC) of the American Indian/Alaska Natives (AIAN) who use them after adjusting for characteristics of TOHP service areas; and then whether improved ambulatory care with higher levels of funding mediates the association. Records in the Indian Health Service (IHS) for California of an annual average 42,153 AIAN users of TOHP from 1998 to 2002 were linked with state hospital discharge records. We analyzed 3181 HASC for AIAN users of 20 TOHP in multilevel Poisson regression models to determine the association of HASC rates adjusted for individual age and gender with the Federal Disparity Index for IHS funding of TOHP. Higher IHS funding of TOHP was associated with lower HASC rates for the AIAN who use them. For TOHP with less than 60% of health care costs funded, the HASC rate dropped 12% for every increase of 10% in funding. Even adjusting for characteristics of the service areas, the effect was only slightly reduced to a value of 9% to 11%. None of the available indicators of ambulatory care tested were found to mediate the effects. Our findings are consistent with a policy of IHS funding of all TOHP at a level of at least 60% of the health care costs of the AIAN who use the programs, instead of the current policy of 40%. Additional research is needed to understand what ambulatory care characteristics are improved by the funding.

Expanding co-payment for methadone maintenance services in Vietnam: the importance of addressing health and socioeconomic inequalities.

PubMed

Tran, Bach Xuan; Nguyen, Quyen Le; Nguyen, Long Hoang; Phan, Huong Thu Thi; Le, Huong Thi; Tran, Tho Dinh; Vu, Thuc Thi Minh; Latkin, Carl A

2017-07-12

Ensuring high enrollment while mobilizing resources through co-payment services is critical to the success of the methadone maintenance treatment (MMT) program in Vietnam. This study assessed the willingness of patients to pay (WTP) for different MMT services delivery models and determined its associated factors. A facility based survey was conducted among 1016 MMT patients (98.7% male, 42% aged 35 or less, and 67% living with spouse) in five MMT clinics in Hanoi and Nam Dinh province in 2013. Socioeconomic, HIV and health status, history of drug use and rehabilitation, and MMT experience were interviewed. WTP was assessed using contingent valuation method, including a set of double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay. 95.5% patients were willing to pay for MMT at the monthly mean price of US$ 32 (95%CI = 28-35). Higher WTP was associated with higher level of educational attainment, higher income, male sex, and had high expenses on opiates prior to MMT. Patients who reported having any problem in Pain/ Discomfort, and who did not have outpatient care last year were willing to pay less for MMT than others. High level of WTP supports the co-payment policies as a strategy to mobilize resources for the MMT program in Vietnam. However, it is necessary to ensure equalities across patient groups by acknowledging socioeconomic status of different settings and providing financial supports for disadvantaged patients with severe health status.

Age-friendly environments and life satisfaction among South Korean elders: person-environment fit perspective.

PubMed

Park, Sojung; Lee, Sangchul

2017-07-01

Drawing on the person-environment (P-E) fit perspective, this study examined the role of environment on the well-being of vulnerable older adults in a non-western context. Using the indicators from the World Health Organization's (WHO) framework for age friendly cities (ACF), we examined life satisfaction among South Korean older adults, exploring the extent to which multidimensional environmental characteristics are associated with low socioeconomic status (SES). Using the regionally representative data from the Seoul City-wide needs assessment of middle- and old-aged adults, an analytic sample (N = 1657) focused on community-living individuals aged 65 and older. Multilevel regression models examined interaction between SES subgroups and varying aspects of the environment (i.e. physical, social, and service environment) as related to life satisfaction. Consistent with the environmental docility hypothesis, members of the most vulnerable subgroup in the Korean context - older adults who are living alone and poor - are more likely to have higher life satisfaction when they have higher levels of support in physical and social environments. Interestingly, a higher level of support in the service environment was related to lower life satisfaction for this subgroup. This study provides an empirical foundation for efforts to identify age-friendly environmental characteristics as modifiable environmental resources that can improve older adults' psychological well-being. As the first attempt to use WHO ACF indicators within the P-E fit perspective in a non-Western context, our study provides a foundation for designing support services or programs that effectively meet the needs of vulnerable older adults.

Community integration 2 years after moderate and severe traumatic brain injury.

PubMed

Sandhaug, Maria; Andelic, Nada; Langhammer, Birgitta; Mygland, Aase

2015-01-01

The aim of this study was to examine community integration by the Community Integration Questionnaire (CIQ) 2 years after injury in a divided TBI sample of moderately and severely injured patients. The second aim was to identify social-demographic, injury-related and rehabilitation associated predictors of CIQ. A cohort study. Outpatient follow-up. Fifty-seven patients with moderate (n = 21) or severe (n = 36) TBI were examined with the Community Integration Questionnaire (CIQ) at 2 years after injury. Possible predictors were analysed in a regression model using CIQ total score at 2 years as the outcome measure. The Community Integration Questionnaire. At 2 years follow-up, there was significant difference between the moderately and severely injured patients in the productivity scores (p < 0.003), while difference in the total CIQ scores approached the significance level (p = 0.074). Significant predictors of a higher CIQ score were living with a spouse, higher Glasgow Coma Scale (GCS) in the acute phase, shorter Post-Traumatic Amnesia (PTA), longer rehabilitation stay (LOS) and use of rehabilitation service. Use of rehabilitation service (B = 7.766) and living with a spouse (B = 4.251) had the largest influence. This means that living with a spouse, better score on the GCS scale, shorter PTA, longer LOS and use of rehabilitation service after discharge equated to better community integration 2 years after TBI Conclusions: Two years after TBI the moderately injured patients have a higher productivity level than the severely injured patients. Marital status, injury severity and rehabilitation after injury were associated with community integration 2 years after TBI.

[Quality of service provided to heart surgery patients of the Unified Health System-SUS].

PubMed

Borges, Juliana Bassalobre Carvalho; Carvalho, Sebastião Marcos Ribeiro de; Silva, Marcos Augusto de Moraes

2010-01-01

To evaluate the service quality provided to heart surgery patients during their hospital stay, identifying the patient's expectations and perceptions. To associate service quality with: gender, age and the use of extracorporeal circulation. We studied 82 elective heart surgery patients (52.4% females and 47.6% males), operated by midsternal thoracotomy, age: 31 to 83 years (60.4 +/- 13.2 years); period: March to September 2006. Service quality was evaluated in two instances: the expectations at pre-operative and the perceptions of the service received on the 6th post-operative; through the application of the modified SERVQUAL scale (SERVQUAL-Card). The result was obtained by the difference of the sum of the scores on perception minus those of the expectations, and through statistical analysis. The SERVQUAL-Card scale was statistically validated, showing adequate level of internal consistency. We found a higher frequency of myocardial revascularization 55 (67.0%); first heart surgery 72 (87.8%) and the use of ECC 69 (84.1%). We noticed high mean values for expectations and perceptions with significant results (P<0.05). We observed a significant relationship between the quality of service with: gender, in empathy (P= 0.04) and age, in reliability (P = 0.02). There was no significant association between ECC and quality of service. Service quality was satisfactory. The patient demonstrated a high expectation to hospital medical service. Women present a higher perception of quality in empathy and younger people in reliability. The use of ECC is not related to service quality in this sample. The data obtained in this study suggest that the quality of this health service can be monitored through the periodical application of the SERVQUAL scale.

Satisfaction With Medication Therapy Management Services at a University Ambulatory Care Clinic.

PubMed

Kim, Shiyun; Martin, Michelle T; Pierce, Andrea L; Zueger, Patrick

2016-06-01

A survey was issued to patients enrolled in the Medication Therapy Management Clinic (MTMC) at University of Illinois Hospital and Health Sciences (June 2011-January 2012) in order to assess satisfaction with pharmacy services provided by pharmacists. A 23-item survey was offered to 65 patients in the MTMC program before or after clinic visits. Since there is a paucity of data indicating the level of satisfaction with MTM services provided by pharmacists, this survey may contribute to the process of building a greater collaboration between the pharmacist and patient. Sixty-two of 65 patients completed the survey; satisfaction with MTMC pharmacists was demonstrated to be significantly positively correlated with overall satisfaction with the MTMC. Patient satisfaction is not significantly different according to age, gender, ethnicity, or number of disease states. Satisfaction with the pillbox service is not significantly different between younger and older patients. It was also noted that patients taking a greater number of medications had higher levels of satisfaction. Most patients indicated that they were satisfied with the MTMC pharmacists and services; further study linking patient satisfaction with MTM services to improved patient outcomes may allow our MTMC to serve as a model for other pharmacist-managed MTMCs serving similar patient populations. © The Author(s) 2014.

Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?

PubMed

Hajizadeh, Mohammad; Nghiem, Hong Son

2011-12-01

Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian-regardless of their employment status-can better protect households from catastrophic health spending.

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long‐term care institution residents

PubMed Central

Lin, Jesun; Hsiao, Chih‐Tung; Glen, Robert; Pai, Jar‐Yuan; Zeng, Sin‐Huei

2012-01-01

Abstract Objective  To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long‐term care institutions. Design  The five‐point Likert scale questionnaire administered through facetoface interviews. Setting  Fourteen long‐term care institutions located in central and southern Taiwan stratified according to services and accommodation population. Participants  One hundred and eighty long‐term institutional care residents. Main outcome measures  Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). Results  Student’s t‐test on institutional location shows a significant difference between overall satisfaction for central and southern institution long‐term care recipients. The correlation test revealed that the higher a resident’s level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index‐of‐model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long‐term care institutions, is also an important factor in residents’ overall satisfaction. Conclusion  The primary goal of long‐term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost‐effective but high‐quality care. On the basis of the results of in‐depth interviews with long‐term institutional care residents, this study suggests long‐term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents. PMID:22429448

Pattern of optometry practice and range of services in India.

PubMed

Thite, Nilesh; Jaggernath, Jyoti; Chinanayi, Farai; Bharadwaj, Shrikant; Kunjeer, Gauri

2015-05-01

This study was conducted to evaluate the range of services provided by optometrists in various modes of optometric practice in India. An online questionnaire was administered to 1674 optometrists to collect information on the range of optometric services offered. Data were analyzed based on variables including sex, educational qualification, and modes of practice. Two-sample Wilcoxon rank sum tests, χ tests, and Fisher exact text were used to conduct inferential statistics. A total of 563 valid and completed survey questionnaires were received from graduates of 41 optometry institutes working across 23 states of India. Of these, 225 (40.0%) were female, 288 (51.2%) had completed postgraduate education, and 340 (60.5%) were involved in more than one mode of practice. The top three modes of practice were hospital-based practice (44.8%), academia (42.8%), and optical retail (33.0%). Of the 441, out of 563 (78.3%) respondents involved in patient care, the majority (98.4%) performed refraction and routine eye examination, 70.3% dispensed contact lenses, and 66.9% practiced optical dispensing. Lower involvement was seen in providing binocular-vision (45.1%) and low-vision services (30.2%). Higher education was associated with advanced level of practice (p < 0.05) except clinical investigative procedures. There was a significant association between postgraduate studies and involvement in academics and research (p < 0.01). Most optometrists are engaged in multiple modes of practice, with optical practice, hospital-based practice, and academia being the leading modes. Optometrists need to be more involved in providing the core optometric services of binocular vision and low vision. Higher education has an impact on the level of optometric practice.

Unmet need for healthcare services in adolescents and young adults with cancer and their parent carers.

PubMed

Sawyer, Susan M; McNeil, Robyn; McCarthy, Maria; Orme, Lisa; Thompson, Kate; Drew, Sarah; Dunt, David

2017-07-01

Cancer in adolescents in and young adults (AYA) has the potential to disrupt health, well-being and developmental trajectories. This study aimed to describe the healthcare support service needs of AYAs with cancer and parent carers and to explore the association of unmet need and emotional distress. As part of a national Australian survey of 15-25 year olds with cancer and a nominated parent carer, 196 AYAs reported total and unmet need for 10 clinical services and 204 parents reported on their child's and their own healthcare service needs. Proportions of total and unmet need for specific clinical services are reported. The association of unmet service needs and distress (measured using the Posttraumatic Stress Disorder Checklist) was also examined. AYAs and parent carers expressed high total need for clinical services during treatment. Leading AYA unmet needs were for an exercise therapist (37%), genetic counsellor (30%), dietitian (26%), peer support group (26%) and educational and vocational advisor (24%). After treatment, AYAs and parents had fewer total needs. However, 60% of AYA and 38% of parents had two or more unmet needs, similar to during treatment. Female gender and receiving treatment in an adult setting were significantly associated with unmet need for clinical services. After treatment, higher distress levels in AYAs and parents were associated with two or more unmet service needs. AYAs and parents had high levels of total and unmet service need, which were associated with greater emotional distress. These results highlight opportunities to re-orientate services to better meet AYA and parent needs.

Availability of tobacco cessation services in substance use disorder treatment programs: Impact of state tobacco control policy.

PubMed

Abraham, Amanda J; Bagwell-Adams, Grace; Jayawardhana, Jayani

2017-08-01

Given the high prevalence of smoking among substance use disorder (SUD) patients, the specialty SUD treatment system is an important target for adoption and implementation of tobacco cessation (TC) services. While research has addressed the impact of tobacco control on individual tobacco consumption, largely overlooked in the literature is the potential impact of state tobacco control policies on availability of services for tobacco cessation. This paper examines the association between state tobacco control policy and availability of TC services in SUD treatment programs in the United States. State tobacco control and state demographic data (n=51) were merged with treatment program data from the 2012 National Survey of Substance Abuse Treatment Services (n=10.413) to examine availability of TC screening, counseling and pharmacotherapy services in SUD treatment programs using multivariate logistic regression models clustered at the state-level. Approximately 60% of SUD treatment programs offered TC screening services, 41% offered TC counseling services and 26% offered TC pharmacotherapy services. Results of multivariate logistic regression showed the odds of offering TC services were greater for SUD treatment programs located in states with higher cigarette excise taxes and greater spending on tobacco prevention and control. Findings indicate cigarette excise taxes and recommended funding levels may be effective policy tools for increasing access to TC services in SUD treatment programs. Coupled with changes to insurance coverage for TC under the Affordable Care Act, state tobacco control policy tools may further reduce tobacco use in the United States. Published by Elsevier Ltd.

Methodological advances in unit cost calculation of psychiatric residential care in Spain.

PubMed

Moreno, Karen; Sanchez, Eduardo; Salvador-Carulla, Luis

2008-06-01

The care of the severe mentally ill who need intensive support for their daily living (dependent persons), accounts for an increasingly large proportion of public expenditure in many European countries. The main aim of this study was the design and implementation of solid methodology to calculate unit costs of different types of care. To date, methodologies used in Spain have produced inaccurate figures, suggesting few variations in patient consumption of the same service. An adaptation of the Activity-Based-Costing methodology was applied in Navarre, a region in the North of Spain, as a pilot project for the public mental health services. A unit cost per care process was obtained for all levels of care considered in each service during 2005. The European Service Mapping Schedule (ESMS) codes were used to classify the services for later comparisons. Finally, in order to avoid problems of asymmetric cost distribution, a simple Bayesian model was used. As an illustration, we report the results obtained for long-term residential care and note that there are important variations between unit costs when considering different levels of care. Considering three levels of care (Level 1-low, Level 2-medium and Level 3-intensive), the cost per bed in Level 3 was 10% higher than that of Level 2. The results obtained using the cost methodology described provide more useful information than those using conventional methods, although its implementation requires much time to compile the necessary information during the initial stages and the collaboration of staff and managers working in the services. However, in some services, if no important variations exist in patient care, another method would be advisable, although our system provides very useful information about patterns of care from a clinical point of view. Detailed work is required at the beginning of the implementation in order to avoid the calculation of distorted figures and to improve the levels of decision making within the Health Care Service. IMPLICATIONS FOR HEALTH CARE POLICY AND FORMULATIONS: As other European countries, Spain has adopted a new care system for the dependent population. To finance this new system, reliable figures must be calculated for each type of user in order to establish tariffs or public prices. This study provides a useful management tool to assist in decision making. The methodology should be implemented in other regions of Spain and even in other countries in order to compare our results and validate the cost system designed.

"We don't need no education": Video game preferences, video game motivations, and aggressiveness among adolescent boys of different educational ability levels.

PubMed

Nije Bijvank, Marije; Konijn, Elly A; Bushman, Brad J

2012-02-01

This research focuses on low educational ability as a risk factor for aggression and violent game play. We propose that boys of lower educational ability are more attracted to violent video games than other boys are, and that they are also higher in trait aggressiveness and sensation seeking. Participants were Dutch boys in public schools (N = 830, age-range 11-17). In the Netherlands, standardized tests are used to place students into lower, medium, and higher educational ability groups. Results showed that boys in the lower educational ability group preferred to play violent, stand-alone games, identified more with video game characters, and perceived video games to be more realistic than other boys did. Lower levels of education were also related to higher levels of aggressiveness and sensation seeking. Higher educational ability boys preferred social, multiplayer games. Within a risk and resilience model, boys with lower educational ability are at greater risk for aggression. Copyright © 2011 The Foundation for Professionals in Services for Adolescents. All rights reserved.

The role of romantic attachment security and dating identity exploration in understanding adolescents' sexual attitudes and cumulative sexual risk-taking.

PubMed

McElwain, Alyssa D; Kerpelman, Jennifer L; Pittman, Joe F

2015-02-01

This study addressed how two normative developmental factors, attachment and identity, are associated with adolescents' sexual attitudes and sexual risk-taking behavior. The sample consisted of 2029 adolescents (mean age = 16.2 years) living in the Southeast United States. Path analysis was used to test the hypotheses. Higher levels of attachment anxiety predicted more dating identity exploration and less healthy sexual attitudes. Higher levels of attachment avoidance predicted less dating identity exploration and indirectly predicted less healthy sexual attitudes through dating identity exploration. Females with dating or sexual experience showed the weakest associations between the attachment dimensions and dating identity exploration. More dating identity exploration predicted healthier sexual attitudes; this association was strongest for non-virgins. Finally, higher levels of attachment avoidance were associated with higher cumulative sexual risk scores, but only among non-virgin males. Results are interpreted in light of theory and research on attachment, identity exploration, and adolescent sexual relationships. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Degradation of soil fertility can cancel pollination benefits in sunflower.

PubMed

Tamburini, Giovanni; Berti, Antonio; Morari, Francesco; Marini, Lorenzo

2016-02-01

Pollination and soil fertility are important ecosystem services to agriculture but their relative roles and potential interactions are poorly understood. We explored the combined effects of pollination and soil fertility in sunflower using soils from a trial characterized by different long-term input management in order to recreate plausible levels of soil fertility. Pollinator exclusion was used as a proxy for a highly eroded pollination service. Pollination benefits to yield depended on soil fertility, i.e., insect pollination enhanced seed set and yield only under higher soil fertility indicating that limited nutrient availability may constrain pollination benefits. Our study provides evidence for interactions between above- and belowground ecosystem services, highlighting the crucial role of soil fertility in supporting agricultural production not only directly, but also indirectly through pollination. Management strategies aimed at enhancing pollination services might fail in increasing yield in landscapes characterized by high soil service degradation. Comprehensive knowledge about service interactions is therefore essential for the correct management of ecosystem services in agricultural landscapes.

Multiperspective analysis of workforce challenges and their effects on consumer and family quality of life.

PubMed

Larson, Sheryl A; Hewitt, Amy S; Lakin, K Charlie

2004-11-01

The impacts of direct support professional turnover, wages, and vacancy rates as reported in interviews with 372 adult service recipients and 20 county managers and surveys of 183 families, 520 service coordinators, 228 direct support professionals, and 184 residential and 82 vocational managers were examined. Direct support professional turnover, wages, and vacancy rates were reported to be barriers to high quality supports, serving people waiting for services, and providing in-home or respite services. Higher direct support professional turnover was associated with lower wages and supports in urban counties. Multivariate analyses of covariance revealed a complex pattern of significant associations between quality of life outcomes; level of mental retardation, medical status, site size (for vocational settings); and direct support professional vacancy rates, average wage, and turnover rates.

Urban ecosystem services: tree diversity and stability of tropospheric ozone removal.

PubMed

Manes, Fausto; Incerti, Guido; Salvatori, Elisabetta; Vitale, Marcello; Ricotta, Carlo; Costanza, Robert

2012-01-01

Urban forests provide important ecosystem services, such as urban air quality improvement by removing pollutants. While robust evidence exists that plant physiology, abundance, and distribution within cities are basic parameters affecting the magnitude and efficiency of air pollution removal, little is known about effects of plant diversity on the stability of this ecosystem service. Here, by means of a spatial analysis integrating system dynamic modeling and geostatistics, we assessed the effects of tree diversity on the removal of tropospheric ozone (O3) in Rome, Italy, in two years (2003 and 2004) that were very different for climatic conditions and ozone levels. Different tree functional groups showed complementary uptake patterns, related to tree physiology and phenology, maintaining a stable community function across different climatic conditions. Our results, although depending on the city-specific conditions of the studied area, suggest a higher function stability at increasing diversity levels in urban ecosystems. In Rome, such ecosystem services, based on published unitary costs of externalities and of mortality associated with O3, can be prudently valued to roughly US$2 and $3 million/year, respectively.

Patients' Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India: The Part 3 (PPIH-3) Study.

PubMed

Manchanda, Rajkumar; Koley, Munmun; Saha, Subhranil; Sarkar, Debabrata; Mondal, Ramkumar; Thakur, Prosenjit; Biswas, Debjyoti; Rawat, Birendra Singh; Rajachandrasekar, Bhuvaneswari; Mittal, Renu

2016-05-23

Indian patients' preference for integrated homoeopathy services remains underresearched. Two earlier surveys revealed favorable attitude toward and satisfaction from integrated services. The objectives of this study were to examine knowledge, attitudes, and practice of homoeopathy and to evaluate preference toward its integration into secondary-level health care. A cross-sectional survey was conducted during May to October 2015 among 659 adult patients visiting randomly selected secondary-level conventional health care setups in Kolkata, Mumbai, Kottayam, and New Delhi (India) using a self-administered 24-item questionnaire in 4 local vernaculars (Bengali, Marathi, Malayalam, and Hindi). Knowledge and practice scores were compromised; attitude scores toward integration and legal regulation were high. Respondents were uncertain regarding side effects of homoeopathy and concurrent use and interactions with conventional medicines. A total of 82.40% (95% confidence interval = 79.23, 85.19) of the participants were in favor of integrating homoeopathy services. Preference was significantly higher in Delhi and lower in Kottayam. Probable strategic measures for further development of integrated models are discussed. © The Author(s) 2016.

Patients’ Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India

PubMed Central

Manchanda, Rajkumar; Koley, Munmun; Saha, Subhranil; Sarkar, Debabrata; Mondal, Ramkumar; Thakur, Prosenjit; Biswas, Debjyoti; Rawat, Birendra Singh; Rajachandrasekar, Bhuvaneswari; Mittal, Renu

2016-01-01

Indian patients’ preference for integrated homoeopathy services remains underresearched. Two earlier surveys revealed favorable attitude toward and satisfaction from integrated services. The objectives of this study were to examine knowledge, attitudes, and practice of homoeopathy and to evaluate preference toward its integration into secondary-level health care. A cross-sectional survey was conducted during May to October 2015 among 659 adult patients visiting randomly selected secondary-level conventional health care setups in Kolkata, Mumbai, Kottayam, and New Delhi (India) using a self-administered 24-item questionnaire in 4 local vernaculars (Bengali, Marathi, Malayalam, and Hindi). Knowledge and practice scores were compromised; attitude scores toward integration and legal regulation were high. Respondents were uncertain regarding side effects of homoeopathy and concurrent use and interactions with conventional medicines. A total of 82.40% (95% confidence interval = 79.23, 85.19) of the participants were in favor of integrating homoeopathy services. Preference was significantly higher in Delhi and lower in Kottayam. Probable strategic measures for further development of integrated models are discussed. PMID:27215693

Mental Health Services for Children and Youth in the Child Welfare System: A Focus on Caregivers as Gatekeepers.

PubMed

Villagrana, Margarita

2010-05-01

Caregivers serve as gatekeepers for children while in the child welfare system, but few studies have focused on the caregiver and the factors that influence the use of mental health services for the children under their care. The purpose of this study was to examine the child's mental health need, the caregiver's level of stress, depression, and social support, and the utilization of mental health services by children using the three most common types of caregivers in the child welfare system (i.e., birth parent, relative caregiver, and foster parent). Data comes from the Patterns of Care (POC) study of five public sectors of care. The present study examined parents/caregivers and youth from the child welfare sector. Findings suggest that while birth parents were more likely to endorse more risk factors for themselves, and the children under their care had a higher level of mental health need, they were the least likely to utilize mental health services for the children under their care. Implications for the child welfare and mental health systems are discussed.

Explaining Racial/Ethnic Disparities in Use of High-Volume Hospitals

PubMed Central

Gray, Bradford H.; Schlesinger, Mark

2014-01-01

Racial/ethnic minorities are less likely to use higher-quality hospitals than whites. We propose that a higher level of information-related complexity in their local hospital environments compounds the effects of discrimination and more limited access to services, contributing to racial/ethnic disparities in hospital use. While minorities live closer than whites to high-volume hospitals, minorities also face greater choice complexity and live in neighborhoods with lower levels of medical experience. Our empirical results reveal that it is generally the overall context associated with proximity, choice complexity, and local experience, rather than differential sensitivity to these factors, that provides a partial explanation of the disparity gap in high-volume hospital use. PMID:25316717

Profiling bone and joint problems and health service use in an Australian regional population: the Port Lincoln Health Study.

PubMed

Pham, Clarabelle; Gill, Tiffany K; Hoon, Elizabeth; Rahman, Muhammad Aziz; Whitford, Deirdre; Lynch, John; Beilby, Justin

2013-09-01

To describe the burden of bone and joint problems (BJP) in a defined regional population, and to identify characteristics and service-usage patterns. In 2010, a health census of adults aged ≥15 years was conducted in Port Lincoln, South Australia. A follow-up computer-assisted telephone interview provided more specific information about those with BJP. Overall, 3350 people (42%) reported current BJP. General practitioners (GP) were the most commonly used provider (85%). People with BJP were also 85% more likely to visit chiropractors, twice as likely to visit physiotherapists and 34% more likely to visit Accident and Emergency or GP out of hours (compared with the rest of the population). Among the phenotypes, those with BJP with co-morbidities were more likely to visit GP, had a significantly higher mean pain score and higher levels of depression or anxiety compared with those with BJP only. Those with BJP only were more likely to visit physiotherapists. GP were significant providers for those with co-morbidities, the group who also reported higher levels of pain and mental distress. GP have a central role in effectively managing this phenotype within the BJP population including linking allied health professionals with general practice to manage BJP more efficiently.

Mental health and professional help-seeking among college students with disabilities.

PubMed

Coduti, Wendy A; Hayes, Jeffrey A; Locke, Benjamin D; Youn, Soo Jeong

2016-08-01

Research has demonstrated that providing appropriate supports and services on campus can improve both mental health and academic outcomes for students with disabilities (Emerson, Honey, Madden, & Llewellyn, 2009; Stumbo, Martin, & Hedrick, 2009), but little is known about the specific mental health needs of this population. The purpose of this exploratory study, therefore, was to identify the mental health needs of college students with various types of disabilities. Researchers analyzed data, collected by the Center for Collegiate Mental Health, of 5,696 students with, and without, disabilities who utilized counseling services on campuses in the 2013-14 academic year. A nonclinical (students not in counseling) sample of 1,620 students with, and without, disabilities was also explored. Compared to students without disabilities, students with disabilities report more anxiety and academic-related distress, as well as higher rates of suicide ideation, suicide attempts, and nonsuicidal self-injury among both students in counseling and not in counseling. Although in certain areas students with disabilities show similar levels of distress as students without disabilities, students with disabilities have higher levels of distress in areas which could impact their academic success. Self-harming tendencies are higher for students with disabilities overall, but more so for specific disability types. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature.

PubMed

Plourde, Natasha; Brown, Hilary K; Vigod, Simone; Cobigo, Virginie

2016-01-01

Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers' training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients' receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.

Predator- and Scavenger-Mediated Ecosystem Services Determined by Distance to Field-Forest Interface in the Maine Lowbush Blueberry Agroecosystem.

PubMed

Jones, Matthew S; Halteman, William A; Drummond, Francis A

2016-10-01

Predators and scavengers play a vital role in regulating insect pests, weeds, and vertebrate scat in perennial agroecosystems. Understanding how farm management practices and surrounding habitat influence these beneficial ecosystem services contributes to our understanding of these complex ecological systems and guides future management decisions. In a mensurative 2-yr study, we determined how different pest management strategies and surrounding forest composition influenced levels of sentinel insect pupae, weed seeds, and deer scat (feces) removal. Removal of these bioresources was measured within 12 commercial lowbush blueberry fields during 2011 and 2012; farms differed in surrounding landscape composition and farm management strategies. Both the removal of sentinel pupae and scat, was significantly higher within field interiors than at field edges and within adjacent forests. Additionally, farm management strategy interacted with field position to result in significantly higher scat removal in conventional field interiors than organic field interiors. Surrounding forest composition had variable effects on removal of materials. Our results indicate higher levels of activity within field centers as opposed to field edges; this is contrary to what has been observed in other perennial cropping agroecosystems. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Service Quality in the U.S. Airline Industry: Variations in Performance Within Airlines and Between Airlines and the Industry

NASA Technical Reports Server (NTRS)

Rhoades, Dawna L.; Waguespack, Blaise, Jr.

2000-01-01

This study examined the service quality of 25 U.S. airlines (1987-1996) using data from the Department of Transportation's Air Travel Consumer Report. After a total quality and total complaint rate was calculated for these airlines, a 95 percent confidence interval was placed around the yearly and company means calculated to examine those cases that were significantly different from the mean. Results indicate that while the major carriers are converging toward a higher level of quality, there continues to be significant yearly variation. The service quality of regional carriers was much lower than major carriers and showed much greater variation.

Identifying factors associated with the uptake of prevention of mother to child HIV transmission programme in Tigray region, Ethiopia: a multilevel modeling approach.

PubMed

Lerebo, Wondwossen; Callens, Steven; Jackson, Debra; Zarowsky, Christina; Temmerman, Marleen

2014-04-23

Prevention of mother to child HIV transmission (PMTCT) remains a challenge in low and middle-income countries. Determinants of utilization occur--and often interact--at both individual and community levels, but most studies do not address how determinants interact across levels. Multilevel models allow for the importance of both groups and individuals in understanding health outcomes and provide one way to link the traditionally distinct ecological- and individual-level studies. This study examined individual and community level determinants of mother and child receiving PMTCT services in Tigray region, Ethiopia. A multistage probability sampling method was used for this 2011 cross-sectional study of 220 HIV positive post-partum women attending child immunization services at 50 health facilities in 46 districts. In view of the nested nature of the data, we used multilevel modeling methods and assessed macro level random effects. Seventy nine percent of mothers and 55.7% of their children had received PMTCT services. Multivariate multilevel modeling found that mothers who delivered at a health facility were 18 times (AOR = 18.21; 95% CI 4.37,75.91) and children born at a health facility were 5 times (AOR = 4.77; 95% CI 1.21,18.83) more likely to receive PMTCT services, compared to mothers delivering at home. For every addition of one nurse per 1500 people, the likelihood of getting PMTCT services for a mother increases by 7.22 fold (AOR = 7.22; 95% CI 1.02,51.26), when other individual and community level factors were controlled simultaneously. In addition, district-level variation was low for mothers receiving PMTCT services (0.6% between districts) but higher for children (27.2% variation between districts). This study, using a multilevel modeling approach, was able to identify factors operating at both individual and community levels that affect mothers and children getting PMTCT services. This may allow differentiating and accentuating approaches for different settings in Ethiopia. Increasing health facility delivery and HCT coverage could increase mother-child pairs who are getting PMTCT. Reducing the distance to health facility and increasing the number of nurses and laboratory technicians are also important variables to be considered by the government.

Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria.

PubMed

Adedokun, Sulaimon T; Adekanmbi, Victor T; Uthman, Olalekan A; Lilford, Richard J

2017-01-01

To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria. The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1), nested within 896 communities (level 2) from 37 states (level 3). About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%). While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31-2.03), from rich households (aOR = 1.76; 95% CrI = 1.35-2.25), with access to media (radio, television or magazine) (aOR = 1.18; 95% CrI = 1.08-1.29), and engaging in employment (aOR = 1.18; 95% CrI = 1.02-1.37) were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75-0.99) were less likely to have used health service for their children. Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of mobile clinics and establishment of more primary health care centres.

Job satisfaction, burnout and turnover intention in occupational therapists working in mental health.

PubMed

Scanlan, Justin Newton; Still, Megan

2013-10-01

Employee wellbeing is an important issue for mental health services. Poor employee wellbeing (i.e., high levels of burnout or low job satisfaction) is associated with poorer consumer outcomes and higher staff turnover. This study set out to examine factors related to job satisfaction, turnover intention and burnout in a group of occupational therapists in mental health. Thirty-four occupational therapists (response rate approximately 60%) in a metropolitan public mental health service participated in a whole-of-service workforce survey. The survey included measures of job satisfaction, turnover intention, burnout, job hindrances, job challenges and job resources and questions about positive and negative aspects of positions and factors that attracted employees to their current position. Burnout was associated with lower job satisfaction and higher turnover intention. Higher job satisfaction was associated with rewards (remuneration and recognition) as well as cognitively challenging work. The variables most significantly associated with poorer wellbeing (higher turnover intention and burnout) were recipient contact demands (perception that contact with service users or families was demanding), and feelings of stress or fatigue. This study provides a detailed analysis of factors associated with job satisfaction, turnover intention and burnout in a group of occupational therapists working in mental health. To promote workforce wellbeing and enhanced retention, interventions to minimise burnout should be implemented and evaluated. These strategies should focus on enhancing job resources such as supervisor support, feedback and participation in decision making as well as building the personal resilience of occupational therapists working in mental health. © 2013 Occupational Therapy Australia.

Towards Smart Homes Using Low Level Sensory Data

PubMed Central

Khattak, Asad Masood; Truc, Phan Tran Ho; Hung, Le Xuan; Vinh, La The; Dang, Viet-Hung; Guan, Donghai; Pervez, Zeeshan; Han, Manhyung; Lee, Sungyoung; Lee, Young-Koo

2011-01-01

Ubiquitous Life Care (u-Life care) is receiving attention because it provides high quality and low cost care services. To provide spontaneous and robust healthcare services, knowledge of a patient’s real-time daily life activities is required. Context information with real-time daily life activities can help to provide better services and to improve healthcare delivery. The performance and accuracy of existing life care systems is not reliable, even with a limited number of services. This paper presents a Human Activity Recognition Engine (HARE) that monitors human health as well as activities using heterogeneous sensor technology and processes these activities intelligently on a Cloud platform for providing improved care at low cost. We focus on activity recognition using video-based, wearable sensor-based, and location-based activity recognition engines and then use intelligent processing to analyze the context of the activities performed. The experimental results of all the components showed good accuracy against existing techniques. The system is deployed on Cloud for Alzheimer’s disease patients (as a case study) with four activity recognition engines to identify low level activity from the raw data captured by sensors. These are then manipulated using ontology to infer higher level activities and make decisions about a patient’s activity using patient profile information and customized rules. PMID:22247682

Association between social health insurance and choice of hospitals among internal migrants in China: a national cross-sectional study

PubMed Central

Wang, Haiqin; Zhang, Donglan; Hou, Zhiying; Yan, Fei; Hou, Zhiyuan

2018-01-01

Objectives There is a tendency to pursue higher-level hospitalisation services in China, especially for internal migrants. This study aims to investigate the choices of hospitalisation services among internal migrants, and evaluate the association between social health insurance and hospitalisation choices. Methods Data were from a 2014 nationally representative cross-sectional sample of internal migrants aged 15–59 years in China. Descriptive analyses were used to perform the distribution of healthcare facility levels for hospitalisation services, and multinomial logistic regression was applied to examine the association between social health insurance and hospitalisation choices. Results Of the 6121 inpatient care users, only 11.50% chose the primary healthcare facilities for hospitalisation services, 44.91% chose the secondary hospitals and 43.59% preferred the tertiary hospitals. The choices presented large regional variations across the country. Compared with the uninsured, social health insurance had no statistically significant effect on patient choices of healthcare facility levels among internal migrants in China, whereas socioeconomic status was positively associated with the choices. Conclusions Social health insurance had little influence on the hospital choice among the internal migrants. Thus, social health insurance should be consolidated and portable to enhance the proper incentive of health insurance on healthcare seeking behaviours. PMID:29440156

The importance of family factors and generation status: mental health service use among Latino and Asian Americans.

PubMed

Chang, Janet; Natsuaki, Misaki N; Chen, Chih-Nan

2013-07-01

The present study utilized data from the National Latino and Asian American Study to examine ethnic and generational differences in family cultural conflict and family cohesion and how the effects of such family conflict and cohesion on lifetime service use vary by generation status for Latino Americans (n = 2,554) and Asian Americans (n = 2,095). Findings revealed that first-generation Asian Americans reported greater family cultural conflict than their Latino counterparts, but third-generation Latino Americans had higher family conflict than their Asian American counterparts. First-generation Latino and Asian Americans had the highest levels of family cohesion. Results from logistic regression analyses indicated that Latino Americans who reported higher family cultural conflict and lower family cohesion were more likely to use mental health services. For Asian Americans, family cultural conflict, but not family cohesion, was associated with service use. Relative to third-generation Asian Americans, second-generation Asian Americans with higher family cultural conflict were more likely to use mental health services. Given that cohesive familial bonds appear to discourage service use on the part of Latino Americans irrespective of generation status, further research is needed to ascertain the extent to which this tendency stems from greater reliance on family support as opposed to the stigma associated with mental health treatment. Mental health providers and treatment programs need to address the role of family cultural conflict in the lives of Asian Americans, particularly second generation, and Latino Americans across generations, because conflictual family ties may motivate help-seeking behaviors and reveal substantial underlying distress. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Utilization of Antenatal HealthCare Services among Fishermen Population in Kanchipuram District, Tamil Nadu: A Cross-sectional Study.

PubMed

Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy

2017-01-01

Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.

Predisposing, enabling, and need factors associated with utilization of institutional delivery services: A community-based cross-sectional study in far-western Nepal.

PubMed

Freidoony, Leila; Ranabhat, Chhabi Lal; Kim, Chun-Bae; Kim, Chang-Soo; Ahn, Dong-Won; Doh, Young Ah

2018-01-01

Use of institutional delivery services can be effective in reducing maternal and infant mortality. In Nepal, however, the majority of women deliver at home. Using Andersen's behavioral model of use of health care services, this cross-sectional study aimed to identify factors associated with use of institutional delivery services in four villages and one municipality in Kailali district, Nepal. Mothers (N = 500) who had given birth in the 5 years preceding the survey (conducted between January and February 2015) were randomly selected by cluster sampling and interviewed using a semi-structured questionnaire. Bivariate analyses and multivariate hierarchical logistic regression analyses were performed. Among the women surveyed, 65.6% had used institutional delivery services for their last delivery, a higher proportion than the national average. Primiparity, having a secondary or higher education level, living in the Durgauli village, having husbands with occupations other than agriculture or professional/technical jobs, and having attended four or more antenatal care (ANC) visits had significantly increased use of institutional deliveries. Also, belonging to the richest 20% of the community and having experienced pregnancy complications were marginally significantly associated. These findings demonstrate the need for improving mother's education, encouraging them to attend ANC visits and addressing disparities between different regions.

"Preserve at All Costs": AIHEC Program Prepares New Generation of Leaders

ERIC Educational Resources Information Center

Selden, Ron

2004-01-01

The article presents information on American Indian Higher Education Consortium's (AIHEC) Leadership Program. The program is designed to prepare a new generation of senior-level leaders for AIHEC's 35-member tribal colleges and universities, where an increasing number of long-term administrators are leaving after decades of service. The W. K.…

Image and Academic Expectations of Different Levels of University Students: A South African Case

ERIC Educational Resources Information Center

Tait, M.; de Jager, J. W.

2009-01-01

Over the past decade the educational environment has not only become more competitive but also more commercialised. These trends have contributed to the introduction of service quality measurement at higher education institutions. Traditionally institutions assume that students have relatively homogeneous needs and expectations and the result is…

Language Centres as Translation-Service Providers: Joining Forces at European Level

ERIC Educational Resources Information Center

Harvey, Julia; Owen, David; Palumbo, Giuseppe

2017-01-01

The Translation Focus Group (TFG) within CercleS has paid particular attention to issues concerning the production of multilingual institutional texts within the context of European higher education, specifically in order to enhance the quality and effectiveness of terminology and style in ways that ensure the availability of the best possible…

76 FR 68668 - Airworthiness Directives; Fokker Services B.V. Model F.28 Mark 0100 Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-07

... compressive stress during braking at higher deceleration levels outside the regular fatigue load spectrum. [T]he high compressive stress locally exceeds the elasticity limit of the material, leaving a residual tensile stress at release of the heavy braking load. Subsequently, this local residual tensile stress...

The Influence of Higher Education on Law Enforcement Entry Level Examination Outcomes

ERIC Educational Resources Information Center

Paprota, David A.

2012-01-01

Entry into a career in law enforcement is most often dependent upon the aspiring candidate's relative success on a competitive, written, multiple-choice examination. In the state of New Jersey, as in many states, civil service laws preclude consideration of formal educational attainment when establishing the ordinal, eligibles lists for law…

Public Opinion toward User Fees in Public Libraries.

ERIC Educational Resources Information Center

Kinnucan, Mark T.; Estabrook, Leigh; Ferguson, Mark R.

1998-01-01

A reanalysis of data from a national telephone poll (n1181) conducted in 1991 determined that if local libraries faced a fiscal crisis, 47% favored raising taxes, 44% preferred instituting user fees, and 9% advocated reducing services. Frequent library use, urban residence, higher level of education, and greater income were associated with a…

Assessing Pre-Service Teacher Attitudes and Skills with the Technology Integration Confidence Scale

ERIC Educational Resources Information Center

Browne, Jeremy

2009-01-01

As technology integration continues to gain importance, preservice teachers must develop higher levels of confidence and proficiency in using technology in their classrooms (Kay, 2006). The acceptance of the National Educational Technology Standards for Teachers (NETS-T) by National Council for Accreditation of Teacher Education (NCATE) has…

Workplace Learning among General Practitioners and Specialists: The Use of Videoconferencing as a Tool

ERIC Educational Resources Information Center

Nilsen, Line Lundvoll

2011-01-01

Purpose: Videoconferencing between general practitioners and hospitals has been developed to provide higher quality health care services in Norway by promoting interaction between levels of care. This article aims to explore the use of videoconferencing for information exchange and consultation throughout the patient trajectory and to investigate…

From Discrepancy Evaluation to Response to Intervention (RTI): Are We Ready in Higher Education?

ERIC Educational Resources Information Center

Wheeler, Starr L.

2012-01-01

At the postsecondary and secondary levels of education, students with learning disabilities are by law entitled to reasonable accommodation in support of their education. Secondary and postsecondary institutions as disability service providers are required to follow guidelines and direction to make this accommodation possible. Yet as these…

Current Status of College Students in Academic Collective Bargaining. Special Report No. 22.

ERIC Educational Resources Information Center

Shark, Alan

College students are expanding their role in academic collective bargaining. They represent a fresh source of energy for reform that must be recognized by faculty unions and university administrators who seek higher levels of cooperation and new directions for service. This document reviews student involvement in collective bargaining. Some…

Journalism Education in India: Quest for Professionalism or Incremental Responses

ERIC Educational Resources Information Center

Bharthur, Sanjay Parthasarathy

2017-01-01

Journalism education in India is framed in the higher education system, comprising of programs in the universities, both government-supported and media-backed private institutions, as well as in-service and short-term courses offered by press associations and other organizations. They are offered at different levels from certificate to diploma to…

Size Matters — Determinants of Modern, Community-Oriented Mental Health Services

PubMed Central

Ala-Nikkola, Taina; Pirkola, Sami; Kontio, Raija; Joffe, Grigori; Pankakoski, Maiju; Malin, Maili; Sadeniemi, Minna; Kaila, Minna; Wahlbeck, Kristian

2014-01-01

Governances, structures and contents of mental health services are being reformed across countries. There is a need for data to support those changes. The aim of this study was to explore the quality, i.e., diversity and community orientation, and quantity, i.e., personnel resources, of mental health and substance abuse services (MHS) and evaluate correlation between population needs and quality and quantity of MHS. The European Service Mapping Schedule—Revised (ESMS-R) was used to classify mental health and substance abuse services in southern Finland. Municipal-level aggregate data, local data on unemployment rate, length of education, age of retirement, proportion of single households, alcohol sales and a composite mental health index were used as indicators of population mental health needs. Population size correlated strongly with service diversity, explaining 84% of the variance. Personnel resources did not associate with diversity or community orientation. The indicators of mental health services need did not have the expected association with quality and quantity of services. In terms of service organization, the results may support larger population bases, at least 150,000 adult inhabitants, when aiming for higher diversity. PMID:25153471

Infant mortality in India: use of maternal and child health services in relation to literacy status.

PubMed

Gokhale, Medha K; Rao, Shobha S; Garole, Varsha R

2002-06-01

Slow reduction in infant mortality rate in the last couple of decades is a major concern in India. State-level aggregate data from the National Family Health Survey 1992 and micro-level data on rural mothers (n=317) were used for examining the influence of female literacy on reduction of infant mortality through increased use of maternal and child health (MCH) services. Illiteracy of females was strongly associated with all variables relating to maternal care and also with infant mortality rate. States were grouped into best, medium, and worst on the basis of female illiteracy (about 11%, 48.5%, and 75% respectively). Infant mortality rate (per 1,000 livebirths) was significantly (p<0.01) higher among the worst group (90.99) than that among the medium (64.2) and the best (24.0) groups. Use of maternal health services increased in the worst to become the best groups for tetanus toxoid (from 48.0% to 84.4%), iron and folic acid tablets (36.6% to 76.2%), hospitalized deliveries (14.2% to 69.7%), and childcare services, such as vaccination (23.8% to 64.9%). Illiteracy of females had a more detrimental impact on rural than on urban areas. In the event of high female illiteracy, male literacy was beneficial for improving the use of services for reducing infant mortality rate. The micro-level study supported all major findings obtained for the national-level aggregate data. Programmes, like providing free education to girls, will yield long-term health benefits.

Quality of life of persons with severe mental illness living in an intermediate care facility.

PubMed

Anderson, R L; Lewis, D A

2000-04-01

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.

Promoting physical activity and quality of life in Vitoria, Brazil: evaluation of the Exercise Orientation Service (EOS) program.

PubMed

Reis, Rodrigo S; Hino, Adriano Akira F; Cruz, Danielle K; da Silva Filho, Lourival Espiridião; Malta, Deborah C; Domingues, Marlos R; Hallal, Pedro C

2014-01-01

The purpose of this study was to evaluate associations between exposure to the Exercise Orientation Service (EOS) program and physical activity (PA) and quality of life (QoL) in adults from Vitoria, Brazil. A phone survey was conducted with 2023 randomly selected participants (≥ 18 years) to measure awareness about the program, participation in the program, PA levels, and QoL. The associations were tested using Poisson and Linear regression models. 31.5% reported awareness about the program, 1.5% reported current participation, and 5.8% reported previous participation. Participation was higher among women (2.1%), older subjects (2.8%), and those reporting morbidities (2.4%). Awareness was higher among middle-aged persons (36.0%) and highly educated participants (37.1%). Current participation (PR = 2.22; 95% CI = 1.65-2.99) and awareness (PR = 1.15; 95% CI = 1.02-1.30) were associated with leisure-time PA (LTPA). Exposure to the program was not associated with QoL but was consistently associated with sufficient levels of LTPA among adults from Vitoria, Brazil.

Exploring Diversification as A Management Strategy in Substance Use Disorder Treatment Organizations.

PubMed

Fields, Dail; Riesenmy, Kelly; Roman, Paul M

2015-10-01

Implementation of the Affordable Care Act (ACA) creates both environmental uncertainties and opportunities for substance use disorder (SUD) treatment providers. One managerial response to uncertainties and emergent opportunities is strategic diversification of various dimensions of organizational activity. This paper explored organizational outcomes related to diversification of funding sources, services offered, and referral sources in a national sample of 590 SUD treatment organizations. Funding diversification was related to higher average levels of census, organization size, and recent expansion of operations. Service diversification was related to higher average levels of use of medication-assisted treatment (MAT), organization size, and expansion. Referral source diversification was related only to greater average use of MAT. Overall, strategic diversification in the three areas explored was related to positive organizational outcomes. Considering alternative strategies of diversification may help position SUD treatment centers to deliver more innovative treatments such as MAT as well as enhance capacity to satisfy current unmet treatment needs of individuals with behavioral health coverage provided under the ACA. Copyright © 2015 Elsevier Inc. All rights reserved.

Proximate Context of HIV-Related Stigma and Women's Use of Skilled Childbirth Services in Uganda.

PubMed

Ng, Courtney K; Tsai, Alexander C

2017-01-01

HIV-related stigma compromises both HIV prevention and treatment and has recently been described as a barrier to utilization of skilled childbirth services in sub-Saharan Africa. This study uses the 2011 Uganda Demographic Health Survey to estimate the associations between HIV-related stigma, measured both at the individual and community level, and use of facility delivery among women. Consistent with theoretical predictions, higher levels of stigma are associated with reduced likelihood of facility delivery. The negative relationship between stigma and facility delivery is especially pronounced when stigma is measured at the community level, highlighting the importance of understanding the proximate context of HIV-related stigma and its potential effects on behavior. Reducing the stigma of HIV will be critical to achieving the twin goals of reducing overall maternal mortality and preventing mother-to-child HIV transmission.

Retrospective Observational Study of Atypical Winter Respiratory Illness Season Using Real-Time Syndromic Surveillance, England, 2014–15

PubMed Central

Morbey, Roger; Pebody, Richard G.; Hughes, Thomas C.; de Lusignan, Simon; Yeates, F. Alex; Thomas, Helen; O’Brien, Sarah J.; Smith, Gillian E.; Elliot, Alex J.

2017-01-01

During winter 2014–15, England experienced severe strains on acute health services. We investigated whether syndromic surveillance could contribute to understanding of the unusually high level of healthcare needs. We compared trends for several respiratory syndromic indicators from that winter to historical baselines. Cumulative and mean incidence rates were compared by winter and age group. All-age influenza-like illness was at expected levels; however, severe asthma and pneumonia levels were above those expected. Across several respiratory indicators, cumulative incidence rates during 2014–15 were similar to those of previous years, but higher for older persons; we saw increased rates of acute respiratory disease, including influenza like illness, severe asthma, and pneumonia, in the 65–74- and >75-year age groups. Age group–specific statistical algorithms may provide insights into the burden on health services and improve early warning in future winters. PMID:29048277

Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices.

PubMed

Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D

2015-08-01

There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. © The Author(s) 2015.

Basing care reforms on evidence: The Kenya health sector costing model

PubMed Central

2011-01-01

Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies. PMID:21619567

Basing care reforms on evidence: the Kenya health sector costing model.

PubMed

Flessa, Steffen; Moeller, Michael; Ensor, Tim; Hornetz, Klaus

2011-05-27

The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies.

Adolescents' financial literacy: the role of financial socialization agents, financial experiences, and money attitudes in shaping financial literacy among South Korean youth.

PubMed

Sohn, Sang-Hee; Joo, So-Hyun; Grable, John E; Lee, Seonglim; Kim, Minjeung

2012-08-01

The purpose of this study was to test the relationships between financial socialization agents, financial experiences, money attitudes, demographic characteristics, and the financial literacy of Korean adolescents. Using the 2006 Korean National Financial Literacy Test Survey for Adolescents (N = 1185), a series of regression analyses were performed to determine the factors related to financial literacy. It was found that those who chose media as their primary financial socialization agent, and those who had a bank account, exhibited higher levels of financial literacy. Among the sample, those who saw money as good or as a reward for efforts tended to report higher levels of financial literacy, while those perceiving money in terms of avoidance or achievement had lower levels of financial literacy. Students with mid-range monthly allowances showed higher levels of financial literacy compared to the highest allowance group. Implications for financial educators, policy makers, and researchers are provided. Copyright © 2012 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Trajectories of dating violence: Differences by sexual minority status and gender.

PubMed

Martin-Storey, Alexa; Fromme, Kim

2016-06-01

The purpose of this study was to examine how sexual minority status (as assessed using both identity and behavior) was associated with trajectories of dating violence. University students from a large Southwestern university completed questions on their sexual minority identity, the gender of their sexual partners, and about experiences of dating violence for six consecutive semesters (N = 1942). Latent growth curve modeling indicated that generally, trajectories of dating violence were stable across study participation. Sexual minority identity was associated with higher initial levels of dating violence at baseline, but also with greater decreases in dating violence across time. These differences were mediated by number of sexual partners. Having same and other-sex sexual partners was associated with higher levels of dating violence at baseline, and persisted in being associated with higher levels over time. No significant gender difference was observed regarding trajectories of dating violence. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men.

PubMed

Hammond, Wizdom Powell; Matthews, Derrick; Mohottige, Dinushika; Agyemang, Amma; Corbie-Smith, Giselle

2010-12-01

The contribution of masculinity to men's healthcare use has gained increased public health interest; however, few studies have examined this association among African-American men, who delay healthcare more often, define masculinity differently, and report higher levels of medical mistrust than non-Hispanic White men. To examine associations between traditional masculinity norms, medical mistrust, and preventive health services delays. A cross-sectional analysis using data from 610 African-American men age 20 and older recruited primarily from barbershops in the North, South, Midwest, and West regions of the U.S. (2003-2009). Independent variables were endorsement of traditional masculinity norms around self-reliance, salience of traditional masculinity norms, and medical mistrust. Dependent variables were self-reported delays in three preventive health services: routine check-ups, blood pressure screenings, and cholesterol screenings. We controlled for socio-demography, healthcare access, and health status. After final adjustment, men with a greater endorsement of traditional masculinity norms around self-reliance (OR: 0.77; 95% CI: 0.60-0.98) were significantly less likely to delay blood pressure screening. This relationship became non-significant when a longer BP screening delay interval was used. Higher levels of traditional masculinity identity salience were associated with a decreased likelihood of delaying cholesterol screening (OR: 0.62; 95% CI: 0.45-0.86). African-American men with higher medical mistrust were significantly more likely to delay routine check-ups (OR: 2.64; 95% CI: 1.34-5.20), blood pressure (OR: 3.03; 95% CI: 1.45-6.32), and cholesterol screenings (OR: 2.09; 95% CI: 1.03-4.23). Contrary to previous research, higher traditional masculinity is associated with decreased delays in African-American men's blood pressure and cholesterol screening. Routine check-up delays are more attributable to medical mistrust. Building on African-American men's potential to frame preventive services utilization as a demonstration, as opposed to, denial of masculinity and implementing policies to reduce biases in healthcare delivery that increase mistrust, may be viable strategies to eliminate disparities in African-American male healthcare utilization.

Masculinity, Medical Mistrust, and Preventive Health Services Delays Among Community-Dwelling African-American Men

PubMed Central

Matthews, Derrick; Mohottige, Dinushika; Agyemang, Amma; Corbie-Smith, Giselle

2010-01-01

BACKGROUND The contribution of masculinity to men’s healthcare use has gained increased public health interest; however, few studies have examined this association among African-American men, who delay healthcare more often, define masculinity differently, and report higher levels of medical mistrust than non-Hispanic White men. OBJECTIVE To examine associations between traditional masculinity norms, medical mistrust, and preventive health services delays. DESIGN AND PARTICIPANTS A cross-sectional analysis using data from 610 African-American men age 20 and older recruited primarily from barbershops in the North, South, Midwest, and West regions of the U.S. (2003-2009). MEASUREMENTS Independent variables were endorsement of traditional masculinity norms around self-reliance, salience of traditional masculinity norms, and medical mistrust. Dependent variables were self-reported delays in three preventive health services: routine check-ups, blood pressure screenings, and cholesterol screenings. We controlled for socio-demography, healthcare access, and health status. RESULTS After final adjustment, men with a greater endorsement of traditional masculinity norms around self-reliance (OR: 0.77; 95% CI: 0.60–0.98) were significantly less likely to delay blood pressure screening. This relationship became non-significant when a longer BP screening delay interval was used. Higher levels of traditional masculinity identity salience were associated with a decreased likelihood of delaying cholesterol screening (OR: 0.62; 95% CI: 0.45–0.86). African-American men with higher medical mistrust were significantly more likely to delay routine check-ups (OR: 2.64; 95% CI: 1.34–5.20), blood pressure (OR: 3.03; 95% CI: 1.45–6.32), and cholesterol screenings (OR: 2.09; 95% CI: 1.03–4.23). CONCLUSIONS Contrary to previous research, higher traditional masculinity is associated with decreased delays in African-American men’s blood pressure and cholesterol screening. Routine check-up delays are more attributable to medical mistrust. Building on African-American men’s potential to frame preventive services utilization as a demonstration, as opposed to, denial of masculinity and implementing policies to reduce biases in healthcare delivery that increase mistrust, may be viable strategies to eliminate disparities in African-American male healthcare utilization. PMID:20714819

Perceived Challenges in Dementia Care by Vietnamese Family Caregivers and Care Workers in South Australia.

PubMed

Xiao, Lily Dongxia; Habel, Lesley; De Bellis, Anita

2015-09-01

The majority of Vietnamese Australians migrated to Australia as refugees to escape a war and this unique migration background may affect their ability to access and utilize healthcare services in Australia. Inability to utilize dementia services is associated with higher levels of caregiver burden, higher rates of morbidities and mortality and hospitalization. The aim of the study was to explore the perceived challenges of dementia care from Vietnamese family caregivers and Vietnamese care workers. Gadamer's philosophical hermeneutics was used to interpret and describe the experiences of the participants. Data were collected from in-depth interviews with six Vietnamese family caregivers and a focus group with Vietnamese care workers using purposive sampling. Participants were recruited from a Vietnamese community care organization in South Australia. Five themes were identified from the data analysis namely: (1) a need for culturally and linguistically appropriate dementia education programs; (2) a willingness and unwillingness to seek help; (3) poor knowledge of health care service availability related to dementia; (4) the effect of language barrier in accessing services; and (5) the main sources of services utilized. The study revealed that Vietnamese family caregivers and Vietnamese care workers held different views on the association of stigma with dementia. Findings also revealed factors that impacted accessing and utilizing dementia services. These findings facilitate a more comprehensive understanding of Vietnamese family caregivers' needs and have implications for developing individualized support for family caregivers and for consumer-directed dementia services in Australia.

Evaluating the Magnitude and Duration of Cold Load Pick-up on Residential Distribution Feeders Using Multi-State Load Models

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

Schneider, Kevin P.; Sortomme, Eric; Venkata, S. S.

The increased level of demand that is associated with the restoration of service after an outage, Cold Load Pick-Up (CLPU), can be significantly higher than pre-outage levels, even exceeding the normal distribution feeder peak demand. These high levels of demand can delay restoration efforts and in extreme cases damage equipment. The negative impacts of CLPU can be mitigated with strategies that restore the feeder in sections, minimizing the load current. The challenge for utilities is to manage the current level on critical equipment while minimizing the time to restore service to all customers. Accurately modeling CLPU events is the firstmore » step in developing improved restoration strategies that minimize restoration times. This paper presents a new method for evaluating the magnitude of the CLPU peak, and its duration, using multi-state load models. The use of multi-state load models allows for a more accurate representation of the end-use loads that are present on residential distribution feeders.« less

Hemoglobin levels and prevalence of anemia in pregnant women assisted in primary health care services, before and after fortification of flour.

PubMed

Araújo, Claudia Regina Marchiori Antunes; Uchimura, Taqueco Teruya; Fujimori, Elizabeth; Nishida, Fernanda Shizue; Veloso, Giovanna Batista Leite; Szarfarc, Sophia Cornblutz

2013-06-01

We evaluated hemoglobin-Hb levels and prevalence of anemia in pregnant women before and after fortification of flour. It was developed a study to evaluate intervention, of the type before and after, with independent population samples. Study was conducted in primary health care services in Maringá, PR. We assessed 366 and 419 medical records, Before and After implementation of fortification. Pregnant women with Hb < 11g/dL were considered anemic. Data were submitted to multiple linear regression analysis. There was low prevalence of anemia affecting 12.3% and 9.4% pregnant women Before and After fortification (p > 0.05), but the Group After the fortification had higher Hb levels (p < 0.05). Hb levels associated with Group, gestational age, previous pregnancy number, employment and marital status (p < 0.05). Although the fortification of flour may have had role in increasing the mean hemoglobin, we need consider the contribution of other variables not investigated.

Psychosis, Socioeconomic Disadvantage, and Health Service Use in South Australia: Findings from the Second Australian National Survey of Psychosis

PubMed Central

Sweeney, Shaun; Air, Tracy; Zannettino, Lana; Galletly, Cherrie

2015-01-01

The association between mental illness and poor physical health and socioeconomic outcomes has been well established. In the twenty-first century, the challenge of how mental illnesses, such as psychosis, are managed in the provision of public health services remains complex. Developing effective clinical mental health support and interventions for individuals requires a coordinated and robust mental health system supported by social as well as health policy that places a priority on addressing socioeconomic disadvantage in mental health cohorts. This paper, thus, examines the complex relationship between socioeconomic disadvantage, family/social supports, physical health, and health service utilization in a community sample of 402 participants diagnosed with psychosis. The paper utilizes quantitative data collected from the 2010 Survey of High Impact Psychosis research project conducted in a socioeconomically disadvantaged region of Adelaide, SA, Australia. Participants (42% female) provided information about socioeconomic status, education, employment, physical health, contact with family and friends, and health service utilization. The paper highlights that socioeconomic disadvantage is related to increased self-reported use of emergency departments, decreased use of general practitioners for mental health reasons, higher body mass index, less family contact, and less social support. In particular, the paper explores the multifaceted relationship between socioeconomic disadvantage and poor health confronting individuals with psychosis, highlighting the complex link between socioeconomic disadvantage and poor health. It emphasizes that mental health service usage for those with higher levels of socioeconomic disadvantage differs from those experiencing lower levels of socioeconomic disadvantage. The paper also stresses that the development of health policy and practice that seeks to redress the socioeconomic and health inequalities created by this disadvantage be an important focus for mental health services. Such health policy would provide accessible treatment programs and linked pathways to illness recovery and diminish the pressure on the delivery of health services. Consequently, the development of policy and practice that seeks to redress the socioeconomic and health inequalities created by disadvantage should be an important focus for the improvement of mental health services. PMID:26636059

The behaviour and sexual health of young international travellers (backpackers) in Australia.

PubMed

McNulty, A M; Egan, C; Wand, H; Donovan, B

2010-06-01

To study the demographics, risk behaviours and morbidity of young long-term international travellers (backpackers) attending a sexual health service in Sydney, Australia. Data on new patients were extracted from the Sydney Sexual Health Centre database for the period 1998 to 2006. The sexual risk behaviours and morbidity of the backpackers were compared with other patients of a similar age. The 5698 backpackers who attended the centre reported higher numbers of sexual partners (three or more partners in the past 3 months, 18% vs 12%, p<0.001) and a greater proportion drank alcohol at hazardous levels (22%) than the comparison group (9%, p<0.001). Rates of consistent (100%) condom use in the past 3 months were low in both backpackers (22%) and the comparison population (19%). Backpackers had higher rates of genital chlamydia infection (7% vs 5%, p<0.001) and reported higher rates of previous sexually transmitted infections (15% vs 10%, p<0.001). Backpackers should be a priority population for sexual health promotion and access to services.

Nurse-led HIV services and quality of care at health facilities in Kenya, 2014-2016.

PubMed

Rabkin, Miriam; Lamb, Matthew; Osakwe, Zainab T; Mwangi, Peter R; El-Sadr, Wafaa M; Michaels-Strasser, Susan

2017-05-01

To develop a novel measure to characterize human immunodeficiency virus (HIV) programme quality at health facilities in Kenya and explore its associations with patient- and facility-level characteristics. We developed a composite indicator to measure quality of HIV care, comprising: assessment of eligibility for antiretroviral therapy (ART); initiation of ART; and retention on ART or in care, if ineligible for ART, for 12 months. We applied the comprehensive retention indicator to routinely collected clinical data from 13 331 patients enrolled in HIV care and treatment at 63 health facilities in the Eastern and Nyanza regions of Kenya from 1 January 2014 to 31 March 2016. We explored the association between facility- and patient-level characteristics and the primary outcome: appropriate staging and management of HIV, and retention in care over 12 months. Of the enrolled patients, 8404 (63%) achieved comprehensive retention 12 months after enrolment in care. In univariate analyses, patients at facilities where nurses delivered HIV treatment services (including eligibility assessment, initiation and follow up of ART) had significantly higher comprehensive retention rates at 12 months. In multivariate analyses, after adjusting for both facility- and patient-level characteristics, patients at facilities where nurses initiated ART had significantly higher comprehensive retention in care at 12 months (relative risk, RR: 1.22; 95% confidence interval, CI: 1.00-1.48). Nurse-led HIV services were significantly associated with quality of care, confirming the central role of nurses in the achievement of global health goals, and the need for further investment in nursing education, training and mentoring.

The reaction of private physicians to price deregulation in France.

PubMed

Carrere, M O

1991-01-01

French private physicians are paid on a fee-for-service basis and nearly all of them are under contract to the Social Security, which refunds part of the medical fee to the whole population. Previously the prices of medical services were fixed, but since 1980, a new option has been possible: a doctor can choose to fix the price of his services freely, provided he pays a higher social insurance contribution. But the amount refunded by Social Security does not vary, so that the consumer has to bear the extra charge. Our purpose here is to identify the factors that influence the physician's option. In Section 2, we define a model of the private physician's economic behaviour, of the classic income-leisure type. In Section 3, empirical tests are performed on a sample of observations in 95 'départements', gathering information about private GPs on the one hand, and the whole population on the other. According to our results, GPs' decisions depend on characteristics of both supply of and demand for GPs' services. One of our conclusions is that GPs seem to make up for low activity levels with higher prices, on condition the income of their practice allows it.

Impact of social service and public health spending on teenage birth rates across the USA: an ecological study

PubMed Central

Sipsma, Heather L; Canavan, Maureen; Gilliam, Melissa; Bradley, Elizabeth

2017-01-01

Objective To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA. Design Ecological study. Setting USA. Participants 50 states. Primary outcome measure Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders. Results The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=−0.20; 95% CI −0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001). Conclusion Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical. PMID:28611088

Quality of antenatal care services and completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey.

PubMed

Muchie, Kindie Fentahun

2017-09-11

Antenatal care (ANC) is one of the core interventions for improving maternal outcomes. The average annual decline of maternal mortality rate from 1990 to 2013 was 5% in Ethiopia. This figure was below the least expected 5.5% to achieve the targeted 75% by 1990-2015. Moreover, completion of the recommended four or more ANC visits was only 32%. This study was aimed to examine individual, household and community level potential determinants of completing the recommended visits in the country. The 2014 Ethiopian Mini Demographic and Health Survey data were used. Among women aged 15-49 years 3694 who had given birth in the 5 years preceding the survey were included in the analysis. The robust standard error method of generalized estimation equations were used for binary outcome variable from the clustered data. Only 33.0% (95% CI 31. 5% 34.5%) of women completed the recommended visits. Out of the total women, 56.5% had at least one ANC visit. Out of those who had at least one ANC visit, 37.4% visited in their first trimester. Completing the recommended visits was negatively associated with women in the lower educational level, lower economic conditions, higher birth order, and rural residence. But, it was positively associated with the community level high quality ANC services received. Difference in age and region also affected the completion of the recommended visits. The finding revealed the need for improving the uptake of ANC services, early arrival in the first trimester for services, and motivating mothers that begin ANC to confirm continuity. Strategies to foster completing the recommended visits should focus on upgrading quality of care services at the community level. Women in low economic level, high birth order, rural residence, and low educational status should be given special attention. Early and late age groups should be given special attention regarding the services.

U.S. military service and the prevalence of metabolic syndrome: Findings from a cross-sectional analysis of the Cooper Center Longitudinal Study, 1979-2013.

PubMed

Janak, Jud C; Pérez, Adriana; Alamgir, Hasanat; Orman, Jean A; Cooper, Sharon P; Shuval, Kerem; DeFina, Laura; Barlow, Carolyn E; Gabriel, Kelley Pettee

2017-02-01

U.S. military service confers both health benefits and risks potentially associated with a clustering of cardiovascular risk factors called metabolic syndrome. However, the association between prior military service and metabolic syndrome has not sufficiently been examined. The purpose of the study was to compare the prevalence of metabolic syndrome by prior military service status. Among 42,370 men (887 with prior military service) examined from 1979 to 2013 at the Cooper Clinic (Dallas, TX), we used a cross-sectional study design to examine the association between military service and metabolic syndrome. First, an unadjusted log binomial regression model was performed by regressing the prevalence of metabolic syndrome on prior service. This was followed by performing Kleinbaum's modeling strategy for assessing confounding. The same methodology was used to explore the association between individual metabolic syndrome risk factors and prior service. Prior military service was not significantly associated with the prevalence of metabolic syndrome (PR=0.98, 0.89-1.07). None of the variables explored were identified as confounders. Participants with prior military service had lower prevalence of both elevated levels of triglycerides (PR=0.89, 0.80-0.99) and low levels of high-density lipoprotein-cholesterol (PR=0.78, 0.70-0.88). They had a higher prevalence of elevated resting systolic blood pressure (PR=1.23, 1.12-1.35). However, none of these associations were significant after adjusting for identified confounders: age; cardiorespiratory fitness; and exam year. Study findings indicate that military service was not independently associated with the prevalence of metabolic syndrome or its components. Future research is warranted longitudinally assessing the impact of military service on long-term outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Interventions to increase use of services; Mental Health Awareness in Nigeria.

PubMed

Eaton, Julian; Nwefoh, Emeka; Okafor, Godwin; Onyeonoro, Ugochukwu; Nwaubani, Kenneth; Henderson, Claire

2017-01-01

Mental health services in Nigeria consist mainly of large government psychiatric hospitals and there are very few mental health professionals to serve the large population of the country. However, more recently, community mental health services, which have been shown to improve access to care and clinical outcomes are beginning to develop in some locations. Despite efforts to promote more accessible services, low levels of knowledge about effective treatment of mental disorders means that even where these services are available, a very small proportion of people utilise these services. Therefore interventions to increase service use are an essential component of health system. This intervention was designed to increase use of a mental health services through the work of community-based Village Health Workers. Fifteen Village Health Workers in each Local Government Area (district) were selected and trained to create mental health awareness in communities. Their function also include identification and referral of persons with mental illness to trained mental health nurses in the clinics. Attendance data prior to and after intervention were collected and compared. The incident rate for initial period of intervention is five times higher than the baseline rate (95% CI; 3.42-7.56; p < 0.001) though this diminished in the long term, levelling off above initial baseline. This study demonstrated that addition of awareness raising using volunteers in communities as part of health programme implementation can increase services use by a population. Mechanisms such as informing populations of the existence of a service which they were previously lacking; explanation of causation of mental illness and achieving community leaders' support for a new service can make investment in services more efficient by increasing attendance.

Professional training in the workplace: the role of achievement motivation and locus of control.

PubMed

Suárez-Álvarez, Javier; Campillo-Álvarez, Angela; Fonseca-Pedrero, Eduardo; García-Cueto, Eduardo; Muñiz, José

2013-01-01

The core objective of the present work is to explore the reasons why workers from different employment sectors join training courses to improve their job. To this end we assessed achievement motivation, locus of control and professional qualifications according to the participants' employment sector. The final sample consisted of 1460 active Spanish workers from four different employment sectors: services, catering, metal construction, and others. Of the sample, 40.1% were male and 59.9% female, with a mean age of 33.3 years (SD = 9.7). The results show that the new scale developed to assess achievement motivation, locus of control and workers' qualifications presents adequate psychometric characteristics. Statistically significant differences were found in relation to employment sector. The areas studied showed satisfactory levels of workers' effort and achievement motivation to perform their jobs, though their attitudes toward the training courses as a basis for improving their employability are varied. Workers in the catering sector had higher levels of external attribution and the lowest interest in training. Those in the service sector had higher levels of achievement motivation and effort at work. Future research should develop a joint program covering the public and private sectors for the modification of these beliefs, attitudes and attributions.

Burnout, compassion fatigue, and compassion satisfaction among staff in community-based mental health services.

PubMed

Rossi, Alberto; Cetrano, Gaia; Pertile, Riccardo; Rabbi, Laura; Donisi, Valeria; Grigoletti, Laura; Curtolo, Cristina; Tansella, Michele; Thornicroft, Graham; Amaddeo, Francesco

2012-12-30

Providing care to individuals with complex mental health needs can be stressful. However, little research has focused on the emotional, cognitive, and physical consequences of providing mental health care. The aim of this study is to assess burnout (BO), compassion fatigue (CF) and compassion satisfaction (CS) among staff at the four community-based mental health services (CMHS) of Verona, Italy. All staff were asked to complete anonymously the Professional Quality of Life Scale, the General Health Questionnaire, and a socio-demographic questionnaire. In total 260 staff participated (a response rate of 84%). Psychiatrists and social workers were the professionals with the highest levels of BO and CF. Workers with psychological distress reported both higher BO and CF scores, and lower levels of CS. A significant increase in the BO and CF scores was also detected for each extra year spent working in a CMHS. A higher level of CF was associated with female and having been experienced one negative life event in the previous year. These findings are useful for health managers and team leaders to identify factors affecting the professional quality of life of mental healthcare staff, and can provide a rationale for detecting staff at risk for developing negative work-related outcomes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Quantification of burnout in emergency nurses: A systematic review and meta-analysis.

PubMed

Li, Hong; Cheng, Bin; Zhu, Xiao Ping

2018-01-17

Previous studies showed increased levels of absenteeism, drug abuse, depression, and symptoms allied with burnout in emergency nurses. This meta-analysis aimed to quantify the three dimensions of burnout in emergency nurses and estimate the proportion of nurses who experience higher than tolerable levels of burnout. A systematic search was conducted on PubMed, Scielo, Xueshu Baidu and Informa databases with a cut-off time between 1997 and 2017 to retrieve published papers in any language that had estimated the burnout levels in emergency nurses by using MBI scale. We identified a total of 11 eligible studies. The total mean estimate was moderate for emotional exhaustion (25.552), but clearly trending towards higher level, whereas depersonalization (10.383) and lack of personal accomplishment (30.652) showed higher burnouts levels. The proportion of emergency nurses suffering from high emotional exhaustion, high depersonalization, and low personal accomplishment was 40.5%, 44.3%, and 42.7%, respectively. Burnout is detrimental to achieving high-quality healthcare services and causes a loss of productivity. It is high time for nursing leader and management personnel to identify appropriate measures to counteract burnout. Copyright © 2017 Elsevier Ltd. All rights reserved.

Rehabilitation technology services and employment outcomes among consumers using division of rehabilitation services.

PubMed

Sprong, Matthew Evan; Dallas, Bryan; Paul, Erina; Xia, Michelle

2018-05-03

The primary goal of the study was to evaluate how the use of rehabilitation technology impacted closure status for consumers receiving services in fiscal year (FY) 2014. Rehabilitation Service Administration (RSA-911) Case Service Report FY 2014 archival dataset was obtained from the U.S. Department of Education (2014) and secondary analyses was performed for this study. RSA-911 archival data is updated on an annual basis and consists of all state-federal rehabilitation consumers who were served in the specific fiscal year. The dataset contains information related to each consumer's demographic information (e.g. age, gender, race) and other supplemental information (e.g. weekly earnings at closure, cause of disability, services provided). A multiple logistic regression analysis was utilized and revealed that white consumers receiving rehabilitation technology (RT) services have significantly higher closure rate than consumers of other races, RT services differ by the employment status at application, RT services differ by the type of disability, educational level at application for people receiving RT services did predict closure status (i.e. exiting with an employment outcome), IEP status did not predict closure status, weekly earnings at application did predict closure status and the interaction effect between IEP and RT services is statistically significant. The odds ratio (ORs) were presented at the 95% confidence interval (CI). Vocational rehabilitation counselors needs training to correctly identify appropriate RT services for consumers, so that the likelihood of exiting with an employment outcome is obtained. Implications for Rehabilitation RT services significantly improved their chances of successful employment compared to those who did not receive RT services. Education at closure would also have some significant impact on employment outcomes. Training in Assistive Technology (AT) for Vocational Rehabilitation counselors will assist in the proper identification of AT requirements, which may lead to a higher likelihood of consumers exiting with an employment outcome.

Use of ecological momentary assessment to determine which structural factors impact perceived teaching quality of attending rounds.

PubMed

Willett, Lisa; Houston, Thomas K; Heudebert, Gustavo R; Estrada, Carlos

2012-09-01

Providing high-quality teaching to residents during attending rounds is challenging. Reasons include structural factors that affect rounds, which are beyond the attending's teaching style and control. To develop a new evaluation tool to identify the structural components of ward rounds that most affect teaching quality in an internal medicine (IM) residency program. The authors developed a 10-item Ecological Momentary Assessment (EMA) tool and collected daily evaluations for 18 months from IM residents rotating on inpatient services. Residents ranked the quality of teaching on rounds that day, and questions related to their service (general medicine, medical intensive care unit, and subspecialty services), patient census, absenteeism of team members, call status, and number of teaching methods used by the attending. Residents completed 488 evaluation cards over 18 months. This found no association between perceived teaching quality and training level, team absenteeism, and call status. We observed differences by service (P < .001) and patient census (P  =  .009). After adjusting for type of service, census was no longer significant. Use of a larger variety of teaching methods was associated with higher perceived teaching quality, regardless of service or census (P for trend < .001). The EMA tool successfully identified that higher patient census was associated with lower perceived teaching quality, but the results were also influenced by the type of teaching service. We found that, regardless of census or teaching service, attendings can improve their teaching by diversifying the number of methods used in daily rounds.

Can state early intervention programs meet the increased demand of children suspected of having autism spectrum disorders?

PubMed

Wise, Marissa D; Little, Alison A; Holliman, Jaime Bruce; Wise, Paul H; Wang, C Jason

2010-01-01

To determine whether Early Intervention programs have the capacity to accommodate the expected increase in referrals following the American Academy of Pediatrics' 2007 recommendation for universal screening of 18- and 24-month-old children for Autism Spectrum Disorders (ASD). We conducted a telephone survey of all state and territory early. Intervention coordinators about the demand for ASD evaluations, services, and program capacity. We used multivariate models to examine state-level factors associated with the capacity to serve children with ASD. Fifty-two of the 57 coordinators (91%) responded to the survey. Most states reported an increase in demand for ASD-related evaluations (65%) and services (58%) since 2007. In addition, 46% reported that their current capacity poses a challenge to meeting the 45-day time limit for creating the Individualized Family Service Plan. Many states reported that they have shortages of ASD-related personnel, including behavioral therapists (89%), speech-language pathologists (82%), and occupational therapists (79%). Among states that reported the number of service hours (n = 34) 44% indicated that children with ASD receive 5 or fewer weekly service hours. Multivariate models showed that states with a higher percentage of African-American and Latino children were more likely to have provider shortages whereas states with higher population densities were more likely to offer a greater number of service hours. Many Early Intervention programs may not have the capability to address the expected increase in demand for ASD services. Early Intervention programs will likely need enhanced resources to provide all children with suspected ASD with appropriate evaluations and services.

An Australian study to evaluate worker exposure to chrysotile in the automotive service industry.

PubMed

Yeung, P; Patience, K; Apthorpe, L; Willcocks, D

1999-07-01

A study was conducted in Sydney, Australia, in 1996 to investigate the current exposure levels, control technologies, and work practices in five service garages (four car and one bus), three brake bonding workshops, and one gasket processing workshop. This study formed part of the assessment of chrysotile as a priority existing chemical under the Australian National Industrial Chemicals Notification and Assessment Scheme. A total of 68 (11 personal and 57 area) air samples were collected, in accordance with the Australian standard membrane filter method. Fiber concentrations were determined by the traditional phase contrast microscopy (PCM) method and 16 selected samples were analyzed by the more powerful transmission electron microscopy (TEM). Chrysotile exposure of car mechanics measured by PCM was typically below the reportable detection limit of 0.05 f/mL, irrespective of whether disc brake, drum brake, or clutch was being serviced. These low levels can be attributed to the wet cleaning or aerosol spray methods used in recent years to replace the traditional compressed air jet cleaning. In the three brake shoe relining workshops, task-specific exposure reached up to 0.16 f/mL in the processes of cutting and radius grinding. TEM results were generally higher, due to its higher resolution power. The median diameter on samples taken from the service garages (passenger cars), as determined by TEM, was 0.5-1.0 micron; and was between 0.2-0.5 micron for the brake bonding and gasket processing workshops, while that for the bus service depot was 0.1-0.2 micron. Most of the respirable fibers (84%, mainly forsterite) from the bus service depot were below 0.2 micron in diameter which is the resolution limit of PCM. In the brake bonding and gasket cutting workshops, 34 percent and 44 percent of the chrysotile fibers were below 0.2 micron in diameter.

Value for the money spent? Exploring the relationship between expenditures, insurance adequacy, and access to care for publicly insured children.

PubMed

Colby, Margaret S; Lipson, Debra J; Turchin, Sarah R

2012-04-01

This study examines the relationship between total state Medicaid spending per child and measures of insurance adequacy and access to care for publicly insured children. Using the 2007 National Survey of Children's Health, seven measures of insurance adequacy and health care access were examined for publicly insured children (n = 19,715). Aggregate state-level measures were constructed, adjusting for differences in demographic, health status, and household characteristics. Per member per month (PMPM) state Medicaid spending on children ages 0-17 was calculated from capitated, fee-for-service, and administrative expenses. Adjusted measures were compared with PMPM state Medicaid spending in scatter plots, and multilevel logistic regression models tested how well state-level expenditures predicted individual adequacy and access measures. Medicaid spending PMPM was a significant predictor of both insurance adequacy and receipt of mental health services. An increase of $50 PMPM was associated with a 6-7 % increase in the likelihood that insurance would always cover needed services and allow access to providers (p = 0.04) and a 19 % increase in the likelihood of receiving mental health services (p < 0.01). For the remaining four measures, PMPM was a consistent (though not statistically significant) positive predictor. States with higher total spending per child appear to assure better access to care for Medicaid children. The policies or incentives used by the few states that get the greatest value--lower-than-median spending and higher-than-median adequacy and access--should be examined for potential best practices that other states could adapt to improve value for their Medicaid spending.

[Immigrants' access to health care in Spain: a review].

PubMed

Llop-Gironés, Alba; Vargas Lorenzo, Ingrid; Garcia-Subirats, Irene; Aller, Marta-Beatriz; Vázquez Navarrete, María Luisa

2014-01-01

An important proportion of the population in Spain is immigrant and the international literature indicates their inadequate access to health services. The objective is to contribute to improving the knowledge on access to health care of the immigrant population in Spain. Review of original papers published (1998-2012) on access to health services of the immigrant population in Spain published in Medline and MEDES. Out of 319 studies, 20 were selected, applying predefined criteria. The results were analyzed using the Aday and Andersen framework. Among the publications, 13 quantitative studies analysed differences in health care use between the immigrant and the native population, and 7 studied determinants of access of immigrants. Studies showed less use of specialized care by immigrants, higher use of emergency care and no differences in the use of primary care between groups. Five quantitative articles on determinants of access focused on factors related to the immigrant population (sex, age, educational level and holding private health insurance), but without observing clear patterns. The two qualitative studies analyzed factors related to health services, describing access to healthcare barriers such as the limited provision of information or the requirements for personal health card. Access to health care in immigrants has been scarcely studied, using different approaches and the barely analysed factors related to the services. No clear patterns were observed, as differences depend on the classification of migrants according to country of origin and the level of care. However, studies showed less use of specialized care by immigrants, higher use of emergency care and the existence of determinants of access different to their needs.

An eye for inequality: how trachoma relates to poverty in Tanzania and Vietnam.

PubMed

Jansen, Evertjan; Baltussen, Rob M P M; van Doorslaer, Eddy; Ngirwamungu, Edith; Nguyen, Mai P; Kilima, Peter M

2007-01-01

An important challenge for trachoma control strategies is to break the circle of poverty, poor hygiene and poor health by bringing its benefits to the poor. This article aims to assess to what extent trachoma is a disease of the poor, and trachoma services reach the poor in Tanzania and Vietnam. Individual level data on trachoma prevalence (active trachoma and trichiasis) and utilization of trachoma-related services were collected in both countries in 2004. Prevalence data were also available for Vietnam in 2001. We used household level data to construct an asset index as our living standards measure. Next, we related trachoma prevalence and service use to living standards, and used concentration indices to summarize and test the degree of inequality. Trachoma prevalence was higher among the poorest groups in Tanzania. No such relation could be established in Vietnam where prevalence declined over the period 2001-2004 and particularly so among the least poor. Antibiotics were used more by the poorest in Tanzania and by the less poor in Vietnam. In both countries, there was no unequivocal pattern for the relation between living standards and the use of trachoma services. Trachoma is found to be a disease of the poorest in Tanzania, but not in Vietnam. In the latter country there are indications that district characteristics have an important impact on trachoma prevalence. The higher use of antibiotics among the better-off in Vietnam may have contributed to their larger decline in active trachoma prevalence between 2001 and 2004 compared to the poorer segments.

Urban caregiver empowerment: Caregiver nativity, child-asthma symptoms, and emergency-department use.

PubMed

Coutinho, Maria Teresa; Kopel, Sheryl J; Williams, Brittney; Dansereau, Katie; Koinis-Mitchell, Daphne

2016-09-01

In this study, we examined the associations between caregiver empowerment, child-asthma symptoms, and emergency-department (ED) use in a sample of school-age urban children with asthma. We examined differences in caregiver empowerment, and in the associations among caregiver empowerment, proportion of days with child-asthma symptoms, and ED use as a function of caregiver nativity. Participants for this study were part of a larger longitudinal study and included Latino, African American and non-Latino White urban caregivers and their children with asthma (ages 7-9; N = 130). Caregiver empowerment was assessed within family, asthma services, and community domains. Children whose caregivers reported greater empowerment within the family (i.e., possessing sufficient knowledge and ability to care for their families) presented with fewer asthma symptoms. Children whose caregivers reported greater empowerment within asthma services (i.e., the ability to collaborate with asthma providers and the health-care system), presented with more asthma symptoms. Foreign-born caregivers endorsed greater empowerment within the family, whereas U.S.-born caregivers reported greater empowerment within asthma services. For foreign-born caregivers, higher levels of empowerment in the family were associated with fewer child-asthma symptoms. For U.S.-born caregivers, higher levels of empowerment in asthma services were associated with more child-asthma symptoms. Results suggest that caregivers who feel more confident and better able to manage problems within their families may better manage their children's asthma symptoms. Foreign-born caregivers may benefit from increased support to more effectively navigate the asthma health-care system and manage their children's asthma. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Digital Technology and Teacher Preparation: The Instructional Role of Social Media Among Pre-Service Teachers

NASA Astrophysics Data System (ADS)

Trytten, Bria Klotz

As social media use becomes more prevalent among teachers, it becomes vital to understand how teachers are using social media and what effects it has, if any, on teaching practices in the classroom. This study sought to explore the relationship between pre-service teachers' use of social media and their perceptions of inquiry-based science education, an important teaching best practice. This study is unique in that it explores pre-service teachers' use of three social media platforms--Twitter, Facebook, and Pinterest--and how pre-service teachers plan to apply them to classroom education. Previous studies focused on only one social media platform, usually Twitter or Facebook. This study surveyed 113 pre-service teachers in their 3rd or 4th year of school at one of two teacher colleges. The survey employed multiple choice, open-ended, and Likert-type questions to assess pre-service teachers' use of social media as well as their attitudes surrounding inquiry-based instruction. In order to better explain and analyze survey results, fourteen survey participants were interviewed with follow-up questions to elaborate on both social media use and inquiry attitudes. Findings indicated that the pre-service teachers used social media, and overwhelmingly Pinterest, to find lesson plans and classroom organizational ideas. Cited reasons for this practice included convenience, variety of lesson planning, and easily searchable databases. The study found statistical significance in that teachers who aspire to teach lower grade levels will turn to social media to find lesson plans more frequently than those who aspire to teach higher grade levels. The study found social media use had no statistically significant effect on the level of inquiry-based teaching that the participants aimed to achieve in their future classrooms.

Factors associated with implementation of a multicomponent responsible beverage service program – results from two surveys in 290 Swedish municipalities

PubMed Central

2013-01-01

Background The purpose of this study was to investigate which factors affected the implementation of a multicomponent Responsible Beverage Service (RBS) program in 290 Swedish municipalities and whether the amount of such factors influenced the level of implementation of the program. Methods This study used variation in the presence of implementation-promoting factors to predict the level of implementation of the RBS program in municipalities throughout Sweden. The presence of such factors and the level of implementation of the program were studied by means of two surveys in all Swedish municipalities (N=290). Logistic regression and Spearman’s correlation analyses were used to analyze the relationship between implementation-promoting factors and the level of implementation of the RBS program. Results The response rates of the two surveys were 96% and 98%, respectively. One main finding was that program fidelity was low. Only 13% of the municipalities surveyed had implemented the RBS program as a whole, as stated in the specification of requirements. In municipalities reporting a higher amount of implementation-promoting factors, a significantly higher level of implementation of the program was shown. Evaluation and feedback was the only factor that correlated significantly with the level of implementation of the RBS program as a whole. Conclusion Evaluation and feedback constitutes an important implementation-promoting factor also in complex programs like the RBS program. Program fidelity is significant for the outcome of an intervention and must be a major focus of the implementation processes. PMID:23497692

Managers' experience of success criteria and barriers to implementing mobile radiography services in nursing homes in Norway: a qualitative study.

PubMed

Kjelle, Elin; Lysdahl, Kristin Bakke; Olerud, Hilde Merete; Myklebust, Aud Mette

2018-04-25

In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. Earlier research has shown mobile radiography services to be highly beneficial for nursing home residents in addition to being cost-effective. Despite the benefits, mobile radiography services are uncommon in Europe and Norway. The purpose of this study was to explore success criteria and barriers in the process of implementing mobile radiography services, from the point of view of the hospital and municipal managers. Eleven semi-structured interviews were conducted with managers from five hospitals and six municipalities in Norway where mobile radiography services had been implemented. Core issues in the interview guide were barriers and facilitators in the different phases of implementation. The framework method for thematic analysis was used for analysing the data inductively in a research team. Five main categories were developed through the success criteria and barriers experienced by the participants: national health policy, regional and municipal policy and conditions, inter-organizational implementation projects, experienced outcome, and professional skills and personal characteristics. The categories were allocated into three higher-order classifications: macro, meso and micro levels. The main barriers experienced by the managers were financial, procedural and structural. In particular, the reimbursement system, lack of management across healthcare levels and the lack of compatible information systems acted as barriers. The main facilitators were external funding, enthusiastic individuals in the organizations and good collaboration between hospitals and municipalities. The managers experienced financial, structural and procedural barriers. The main success criteria in the process were external funding, and the support and engagement from the individuals in the organizations. This commitment was mainly facilitated by the intuitive appeal of mobile radiography. Changes in healthcare management and in the financial system might facilitate services across healthcare levels. In addition, compatible information systems across healthcare levels are needed in order to facilitate the use of new technology and mobile services.

Extension and Higher Education Service-Learning: Toward a Community Development Service-Learning Model

ERIC Educational Resources Information Center

Stoecker, Randy

2014-01-01

This article explores how on-the-ground Extension educators interface with higher education service-learning. Most service-learning in Extension has focused on precollege youth and 4-H. When we look at higher education service-learning and Extension in Wisconsin, we see that there is not as much connection as might be expected. County-based…

Factors associated with the utilization of institutional delivery services in Bangladesh.

PubMed

Yaya, Sanni; Bishwajit, Ghose; Ekholuenetale, Michael

2017-01-01

Bangladesh has made remarkable progress towards reducing its maternal mortality rate (MMR) over the last two decades and is one of the few countries on track to achieving the MMR-related Millennium Development Goals (MDG-5A). However, the provision of universal access to reproductive healthcare (MDG-5B) and the utilization of maternal healthcare services (MHS) such as institutional delivery, which are crucial to the reduction of maternal mortality, are far behind the internationally agreed-upon target. Effective policymaking to promote the utilization of MHS can be greatly facilitated by the identification of the factors that hinder service uptake. In this study, we therefore aim to measure the prevalence of institutional delivery services and explore the factors associated with their utilization in Bangladesh. Data for this study were extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS, 2011); participants were 7,313 women between the ages of 15 and 49 years, selected from both urban and rural households. Data were analyzed using Chi-square analysis, and conditional logistic regression. According to the findings, fewer than one in three women reported delivering at a health facility. The multivariable regression analysis showed that participants from rural areas were 46.9% less likely to have institutional deliveries compared to urban dwellers (OR = 0.531; p<0.001; 95%CI: 0.467-0.604), and participants aged between 30 and 49 years had a 23.6% higher prevalence of institutional delivery service utilization compared to those aged 15 to 29 years (OR = 1.236; p = 0.006; 95%CI: 1.062-1.437). Moreover, participants with higher educational attainment were about twice as likely to deliver at a standard health facility when compared to those without formal education (OR = 2.081; p<0.001; 95%CI: 1.650-2.624), and similarly, husbands with higher educational attainment exhibited an approximately 71% higher service utilization of institutional delivery facilities compared to those without formal education (OR = 1.709; p<0.001; 95%CI: 1.412-2.069). Wealth status was also a significant predictor of institutional delivery service use, with participants belonging to the highest economic stratum being more likely to receive skilled care compared to the lowest economic stratum (OR = 2.507; p<0.001; 95%CI: 2.118-2.968). In addition, results indicated that households of average economic class had a 27% higher level of institutional delivery service utilization compared to those of lower economic status (OR = 1.272; p = 0.011; 95%CI: 1.057-1.531). Furthermore, institutional health service use was 18% higher among participants who were aware of community clinical services compared to those who were hardly aware of these services (OR = 0.816; p = 0.012; 95%CI: 0.696-0.957). Lastly, the odds of utilizing delivery services was 1.553 times more likely for participants who use family planning compared to those who do not (p<0.001; 95%CI: 1.374-1.754), and 3.639 times more likely for those who receive antenatal care compared to those who do not (p<0.001; 95%CI: 3.074-4.308). These were found to be significant predictors of the choice of delivery services. Our results suggest that efforts towards reducing national maternal mortality in Bangladesh could be aided by investments into education, poverty reduction and the strengthening of reproductive healthcare services through community clinics, with particular focus on rural areas.

30-Day Episode Payments and Heart Failure Outcomes Among Medicare Beneficiaries.

PubMed

Wadhera, Rishi K; Joynt Maddox, Karen E; Wang, Yun; Shen, Changyu; Yeh, Robert W

2018-05-01

The purpose of this study was to examine the association of 30-day payments for an episode of heart failure (HF) care at the hospital level with patient outcomes. There is increased focus among policymakers on improving value for HF care, given its rising prevalence and associated financial burden in the United States; however, little is known about the relationship between payments and mortality for a 30-day episode of HF care. Using Medicare claims data for all fee-for-service beneficiaries hospitalized for HF between July 1, 2011, and June 30, 2014, we examined the association between 30-day Medicare payments at the hospital level (beginning with a hospital admission for HF and across multiple settings following discharge) and patient 30-day mortality using mixed-effect logistic regression models. We included 1,343,792 patients hospitalized for HF across 2,948 hospitals. Mean hospital-level 30-day Medicare payments per beneficiary were $15,423 ± $1,523. Overall observed mortality in the cohort was 11.3%. Higher hospital-level 30-day payments were associated with lower patient mortality after adjustment for patient characteristics (odds ratio per $1,000 increase in payments: 0.961; 95% confidence interval [CI]: 0.954 to 0.967). This relationship was slightly attenuated after accounting for hospital characteristics and HF volume, but remained significant (odds ratio per $1,000 increase: 0.968; 95% CI: 0.962 to 0.975). Additional adjustment for potential mediating factors, including cardiac service capability and post-acute service use, did not significantly affect the relationship. Higher hospital-level 30-day episode payments were associated with lower patient mortality following a hospitalization for HF. This has implications for policies that incentivize reduction in payments without considering value. Further investigation is needed to understand the mechanisms that underlie this relationship. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Changes in Low-Value Services in Year 1 of the Medicare Pioneer Accountable Care Organization Program.

PubMed

Schwartz, Aaron L; Chernew, Michael E; Landon, Bruce E; McWilliams, J Michael

2015-11-01

Wasteful practices are widespread in the US health care system. It is unclear if payment models intended to improve health care efficiency, such as the Medicare accountable care organization (ACO) programs, discourage the provision of low-value services. To assess whether the first year of the Medicare Pioneer ACO program was associated with a reduction in use of low-value services. In a difference-in-differences analysis, we compared use of low-value services between Medicare fee-for-service beneficiaries attributed to health care provider groups that entered the Pioneer program (ACO group) and beneficiaries attributed to other health care providers (control group) before (2009-2011) vs after (2012) Pioneer ACO contracts began. Data analysis was conducted from December 1, 2014, to June 27, 2015. Comparisons were adjusted for beneficiaries' sociodemographic and clinical characteristics as well as for geography. We decomposed estimates according to service characteristics (clinical category, price, and sensitivity to patient preferences) and compared estimates between subgroups of ACOs with higher vs lower baseline use of low-value services. Use of, and spending on, 31 services in instances that provide minimal clinical benefit, measured as annual service counts per 100 beneficiaries and price-standardized annual service spending per 100 beneficiaries. During the precontract period, trends in the use of low-value services were similar for the ACO and control groups. The first year of ACO contracts was associated with a differential reduction (95% CI) of 0.8 low-value services per 100 beneficiaries for the ACO group (-1.2 to -0.4; P < .001), corresponding to a 1.9% differential reduction in service quantity (-2.9% to -0.9%) and a 4.5% differential reduction in spending on low-value services (-7.5% to -1.4%; P = .004). Differential reductions were similar for services less sensitive vs more sensitive to patient preferences and for higher- vs lower-priced services. The ACOs with higher than their markets' mean baseline levels of low-value service use experienced greater service reductions (-1.2 services per 100 beneficiaries; -1.7 to -0.7; P < .001) than did ACOs with use below the mean (-0.2 services per 100 beneficiaries, -0.6 to -0.2; P = .41; P = .003 for test of difference between subgroups). During its first year, the Pioneer ACO program was associated with modest reductions in low-value services, with greater reductions for organizations providing more low-value care. Accountable care organization-like risk contracts may be able to discourage use of low-value services even without specifying services to target.

Flood of January 1997 in the Carson River Basin, California and Nevada

USGS Publications Warehouse

Thomas, Karen A.; Williams, Rhea P.

1997-01-01

In late December 1996, storms built up a large snowpack (more than 180 percent of normal) in the higher altitudes of the Sierra Nevada (Daniel Greenlee, Natural Resource Conservation Service, oral commun., 1997) and also covered the valleys along the eastern Sierra Nevada. Then, a subtropical storm system originating in the central Pacific Ocean near the Hawaiian Islands brought heavy, unseasonably warm rain to the Sierra Nevada from December 30, 1996, through January 2, 1997. During this period, the Natural Resource Conservation Service recorded 16.4 inches (provisional data; Daniel Greenlee, oral commun., 1997) of precipitation at Ebbetts Pass, Calif. (8,700 feet above sea level), and the National Weather Service recorded 3.5 inches (National Oceanic and Atmospheric Administration, National Climate Data Center, written commun., 1997) at Minden (4,710 feet above sea level). Rain falling below about 10,000 feet depleted about 20 percent of the high-altitude snowpack and melted about 80 percent of the snowpack below about 7,000 feet.

Perceived importance of employees' traits in the service industry.

PubMed

Lange, Rense; Houran, James

2009-04-01

Selection assessments are common practice to help reduce employee turnover in the service industry, but as too little is known about employees' characteristics, which are valued most highly by human resources professionals, a sample of 108 managers and human resources professionals rated the perceived importance of 31 performance traits for Line, Middle, and Senior employees. Rasch scaling analyses indicated strong consensus among the respondents. Nonsocial skills, abilities, and traits such as Ethical Awareness, Self-motivation, Writing Skills, Verbal Ability, Creativity, and Problem Solving were rated as more important for higher level employees. By contrast, traits which directly affect the interaction with customers and coworkers (Service Orientation, Communication Style, Agreeableness, Sense of Humor, Sensitivity to Diversity, Group Process, and Team Building) were rated as more important for lower level employees. Respondents' age and sex did not substantially alter these findings. Results are discussed in terms of improving industry professionals' perceived ecological and external validities of generic and customized assessments of employee.

Associations of coping processes with posttraumatic stress disorder symptoms in national guard/reserve service members deployed during the OEF-OIF era.

PubMed

Rodrigues, Camila S; Renshaw, Keith D

2010-10-01

Studies have identified coping processes as one potential factor influencing PTSD in veterans. This study examined the associations between coping, combat exposure, and PTSD among 218 National Guard veterans deployed overseas since 2001. Problem-focused coping was unrelated to combat exposure and PTSD symptoms. In contrast, increased levels of emotion focused coping (EFC) were found in veterans who reported higher levels of combat exposure. Moreover, the severity of combat was a curvilinear moderator of the relation between coping process and PTSD, such that EFC was unrelated to PTSD symptom severity at low levels of combat, associated with higher symptom severity at moderate levels of combat, and associated with lower symptom severity at high levels of combat. These findings indicate that the type and severity of trauma may moderate the association of coping and psychological outcomes, and that these associations might not be linear. Published by Elsevier Ltd.

Association between addiction treatment staff professional and educational levels and perceptions of organizational climate and resources.

PubMed

Krull, Ivy; Lundgren, Lena; Beltrame, Clelia

2014-01-01

Research studies have identified addiction treatment staff who have higher levels of education as having more positive attitudes about evidence-based treatment practices, science-based training, and the usefulness of evidence-based practices. This study examined associations between addiction treatment staff level of education and their perceptions of 3 measures of organizational change: organizational stress, training resources and staffing resources in their treatment unit. The sample included 588 clinical staff from community-based substance abuse treatment organizations who received Substance Abuse and Mental Health Services Administration (SAMHSA) funding (2003-2008) to implement evidence-based practices (EBPs). Bivariate analysis and regression modeling methods examined the relationship between staff education level (no high school education, high school education, some college, associate's degree, bachelor's degree, master's degree, doctoral degree, and other type of degree such as medical assistant, registered nurse [RN], or postdoctoral) and attitudes about organizational climate (stress), training resources, and staffing resources while controlling for staff and treatment unit characteristics. Multivariable models identified staff with lower levels of education as having significantly more positive attitudes about their unit's organizational capacity. These results contradict findings that addiction treatment staff with higher levels of education work in units with greater levels of organizational readiness for change. It cannot be inferred that higher levels of education among treatment staff is necessarily associated with high levels of organizational readiness for change.

[Ophthalmologic healthcare utilization of people in need of long-term care : Analyses of health insurance data of the AOK Baden-Württemberg].

PubMed

Schuster, Alexander K; Pick, Julia; Saalmann, Frauke; Pfeiffer, Norbert

2018-04-10

Eye diseases causing visual impairment increase with age. Thus, seeking eye care has a higher probability in older people. In this study, the rate of utilization of outpatient eye care services in Germany was analyzed. The analyses focused on older persons and persons in need of either home-based or facility-based long-term care. A descriptive secondary data analysis of health insurance data of the AOK Baden-Württemberg from 2016 was conducted. The study population comprised all insured persons on 1 January 2016. The cohort of older persons (60 years+) was further stratified by the type of care (home-based/facility-based) and the level of care (0-3). The utilization of outpatient eye care services was defined by the reimbursement for an ophthalmologist's provision of service. While 39.3% of the study population 60+ years old sought eye care, the utilization rate was lower among people in need of home-based (33.0%) and facility-based care (19.3%). The utilization rates showed comparable age-dependent patterns, except for persons in need of facility-based care where rates were similar for all age groups. Utilization rates were negatively associated with increasing care levels. Only people with care level 0 showed lower utilization rates than people with care level 1. Utilization rates of eye healthcare services among older persons are considerably influenced by the need of long-term care, by the form of care as well as by the level of care.

Higher levels of multiple ecosystem services are found in forests with more tree species

PubMed Central

Gamfeldt, Lars; Snäll, Tord; Bagchi, Robert; Jonsson, Micael; Gustafsson, Lena; Kjellander, Petter; Ruiz-Jaen, María C.; Fröberg, Mats; Stendahl, Johan; Philipson, Christopher D.; Mikusiński, Grzegorz; Andersson, Erik; Westerlund, Bertil; Andrén, Henrik; Moberg, Fredrik; Moen, Jon; Bengtsson, Jan

2013-01-01

Forests are of major importance to human society, contributing several crucial ecosystem services. Biodiversity is suggested to positively influence multiple services but evidence from natural systems at scales relevant to management is scarce. Here, across a scale of 400,000 km2, we report that tree species richness in production forests shows positive to positively hump-shaped relationships with multiple ecosystem services. These include production of tree biomass, soil carbon storage, berry production and game production potential. For example, biomass production was approximately 50% greater with five than with one tree species. In addition, we show positive relationships between tree species richness and proxies for other biodiversity components. Importantly, no single tree species was able to promote all services, and some services were negatively correlated to each other. Management of production forests will therefore benefit from considering multiple tree species to sustain the full range of benefits that the society obtains from forests. PMID:23299890

Prenatal nutrition services: a cost analysis.

PubMed

Splett, P L; Caldwell, H M; Holey, E S; Alton, I R

1987-02-01

The scarcity of information about program costs in relation to quality care prompted a cost analysis of prenatal nutrition services in two urban settings. This study examined prenatal nutrition services in terms of total costs, per client costs, per visit costs, and cost per successful outcome. Standard cost-accounting principles were used. Outcome measures, based on written quality assurance criteria, were audited using standard procedures. In the studied programs, nutrition services were delivered for a per client cost of $72 in a health department setting and $121 in a hospital-based prenatal care program. Further analysis illustrates that total and per client costs can be misleading and that costs related to successful outcomes are much higher. The three levels of cost analysis reported provide baseline data for quantifying the costs of providing prenatal nutrition services to healthy pregnant women. Cost information from these cost analysis procedures can be used to guide adjustments in service delivery to assure successful outcomes of nutrition care. Accurate cost and outcome data are necessary prerequisites to cost-effectiveness and cost-benefit studies.

Public funding of health at the district level in Indonesia after decentralization – sources, flows and contradictions

PubMed Central

Heywood, Peter; Harahap, Nida P

2009-01-01

Background During the Suharto era public funding of health in Indonesia was low and the health services were tightly controlled by the central government; district health staff had practically no discretion over expenditure. Following the downfall of President Suharto there was a radical political, administrative and fiscal decentralization with delivery of services becoming the responsibility of district governments. In addition, public funding for health services more than doubled between 2001 and 2006. It was widely expected that services would improve as district governments now had both more adequate funds and the responsibility for services. To date there has been little improvement in services. Understanding why services have not improved requires careful study of what is happening at the district level. Methods We collected information on public expenditure on health services for the fiscal year 2006 in 15 districts in Java, Indonesia from the district health offices and district hospitals. Data obtained in the districts were collected by three teams, one for each province. Information on district government revenues were obtained from district public expenditure databases maintained by the World Bank using data from the Ministry of Finance. Results The public expenditure information collected in 15 districts as part of this study indicates district governments are reliant on the central government for as much as 90% of their revenue; that approximately half public expenditure on health is at the district level; that at least 40% of district level public expenditure on health is for personnel, almost all of them permanent civil servants; and that districts may have discretion over less than one-third of district public expenditure on health; the extent of discretion over spending is much higher in district hospitals than in the district health office and health centers. There is considerable variation between districts. Conclusion In contrast to the promise of decentralization there has been little increase in the potential for discretion at the district level in managing public funds for health – this is likely to be an important reason for the lack of improvement in publicly funded health services. Key decisions about money are still made by the central government, and no one is held accountable for the performance of the sector – the district blames the center and the central ministries (and their ministers) are not accountable to district populations. PMID:19371410

Public funding of health at the district level in Indonesia after decentralization-sources, flows and contradictions.

PubMed

Heywood, Peter; Harahap, Nida P

2009-04-16

During the Suharto era public funding of health in Indonesia was low and the health services were tightly controlled by the central government; district health staff had practically no discretion over expenditure. Following the downfall of President Suharto there was a radical political, administrative and fiscal decentralization with delivery of services becoming the responsibility of district governments. In addition, public funding for health services more than doubled between 2001 and 2006. It was widely expected that services would improve as district governments now had both more adequate funds and the responsibility for services. To date there has been little improvement in services. Understanding why services have not improved requires careful study of what is happening at the district level. We collected information on public expenditure on health services for the fiscal year 2006 in 15 districts in Java, Indonesia from the district health offices and district hospitals. Data obtained in the districts were collected by three teams, one for each province. Information on district government revenues were obtained from district public expenditure databases maintained by the World Bank using data from the Ministry of Finance. The public expenditure information collected in 15 districts as part of this study indicates district governments are reliant on the central government for as much as 90% of their revenue; that approximately half public expenditure on health is at the district level; that at least 40% of district level public expenditure on health is for personnel, almost all of them permanent civil servants; and that districts may have discretion over less than one-third of district public expenditure on health; the extent of discretion over spending is much higher in district hospitals than in the district health office and health centers. There is considerable variation between districts. In contrast to the promise of decentralization there has been little increase in the potential for discretion at the district level in managing public funds for health - this is likely to be an important reason for the lack of improvement in publicly funded health services. Key decisions about money are still made by the central government, and no one is held accountable for the performance of the sector - the district blames the center and the central ministries (and their ministers) are not accountable to district populations.

Exploring the relationship between population density and maternal health coverage

PubMed Central

2012-01-01

Background Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. Methods We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score’s calculation discounts a nation’s uninhabited territory under the assumption those areas are irrelevant to service delivery. Results We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Conclusions Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations’ Millennial Development Goals. PMID:23170895

Reexamining competitive priorities: Empirical study in service sector

NASA Astrophysics Data System (ADS)

Idris, Fazli; Mohammad, Jihad

2015-02-01

The general objective of this study is to validate the multi-level concept of competitive priorities using reflective-formative model at a higher order for service industries. An empirical study of 228 firms from 9 different service industries is conducted to answer the objective of this study. Partial least square analysis with SmartPLS 2.0 was used to perform the analysis. Finding revealed six priorities: cost, flexibility, delivery, quality talent management, quality tangibility, and innovativeness. It emerges that quality are expanded into two types; one is related to managing talent for process improvement and the second one is the physical appearance and tangibility of the service quality. This study has confirmed competitive priorities as formative second-order hierarchical latent construct by using rigorous empirical evidence. Implications, limitation and suggestion for future research are accordingly discussed in this paper.