... create refugee populations with immediate and long-term health problems. Some of the major diseases currently affecting ... also an international problem which can affect people's health. Many countries and health organizations are working together ...
Bauer, Axel W.; Bott, Oliver J.; Gietzelt, Matthias; Haarbrandt, Birger; Hackl, Werner O.; Hellrung, Nils; Hübner-Bloder, Gudrun; Jahn, Franziska; Jaspers, Monique W.; Kutscha, Ulrike; Machan, Christoph; Oppermann, Bianca; Pilz, Jochen; Schwartze, Jonas; Seidel, Christoph; Slot, Jan-Eric; Smers, Stefan; Spitalewsky, Katharina; Steckel, Nathalie; Strübing, Alexander; van der Haak, Minne
Summary Background Health information systems (HIS) are one of the most important areas for biomedical and health informatics. In order to professionally deal with HIS well-educated informaticians are needed. Because of these reasons, in 2001 an international course has been established: The Frank – van Swieten Lectures on Strategic Information Management of Health Information Systems. Objectives Reporting about the Frank – van Swieten Lectures and about our students‘ feedback on this course during the last 16 years. Summarizing our lessons learned and making recommendations for such international courses on HIS. Methods The basic concept of the Frank – van Swieten lectures is to teach the theoretical background in local lectures, to organize practical exercises on modelling sub-information systems of the respective local HIS and finally to conduct Joint Three Days as an international meeting were the resulting models are introduced and compared. Results During the last 16 years, the Universities of Amsterdam, Braunschweig, Heidelberg/Heilbronn, Leipzig as well as UMIT were involved in running this course. Overall, 517 students from these universities participated. Our students‘ feedback was clearly positive. The Joint Three Days of the Frank – van Swieten Lectures, where at the end of the course all students can meet, turned out to be an important component of this course. Based on the last 16 years, we recommend common teaching materials, agreement on equivalent clinical areas for the exercises, support of group building of international student groups, motivation of using a collaboration platform, ensuring quality management of the course, addressing different levels of knowledge of the students, and ensuring sufficient funding for joint activities. Conclusions Although associated with considerable additional efforts, we can clearly recommend establishing such international courses on HIS, such as the Frank – van Swieten Lectures.
Anell, A.; Willis, M.
The most frequently used bases for comparing international health care resources are health care expenditures, measured either as a fraction of gross domestic product (GDP) or per capita. There are several possible reasons for this, including the widespread availability of historic expenditure figures; the attractiveness of collapsing resource data into a common unit of measurement; and the present focus among OECD member countries and other governments on containing health care costs. Despite important criticisms of this method, relatively few alternatives have been used in practice. A simple framework for comparing data underlying health care systems is presented in this article. It distinguishes measures of real resources, for example human resources, medicines and medical equipment, from measures of financial resources such as expenditures. Measures of real resources are further subdivided according to whether their factor prices are determined primarily in national or global markets. The approach is illustrated using a simple analysis of health care resource profiles for Denmark, France, Germany, Sweden, the United Kingdom, and the USA. Comparisons based on measures of both real resources and expenditures can be more useful than conventional comparisons of expenditures alone and can lead to important insights for the future management of health care systems. PMID:10916914
Although mental disorders are a major public health problem, the development of mental health services has been a low priority everywhere, particularly in low- and middle-income countries. Recent years have seen a growing understanding of the importance of population mental health and increased attention to the need to developmental health systems for responding to population mental health service needs. In countries and regions where mental health services are all but nonexistent, and in postconflict and postdisaster settings, there are many impediments to establishing or scaling up mental health services. It is frequently necessary to act simultaneously on multiple fronts: generating local evidence that will inform decision makers; developing a policy framework; securing investment; determining the most appropriate service model for the context; training and supporting mental health workers; establishing or expanding existing services; putting in place systems for monitoring and evaluation; and strengthening leadership and governance capabilities. This article presents the approach of the Centre for International Mental Health in the Melbourne School of Population Health to mental health system development, and illustrates the way in which the elements of the program are integrated by giving a brief case example from Sri Lanka. (harv rev psychiatry 2012;20:37–46.) PMID:22335181
Background The Japan International Cooperation Agency (JICA) has focused its attention on appraising health development assistance projects and redirecting efforts towards health system strengthening. This study aimed to describe the type of project and targets of interest, and assess the contribution of JICA health-related projects to strengthening health systems worldwide. Methods We collected a web-based Project Design Matrix (PDM) of 105 JICA projects implemented between January 2005 and December 2009. We developed an analytical matrix based on the World Health Organization (WHO) health system framework to examine the PDM data and thereby assess the projects’ contributions to health system strengthening. Results The majority of JICA projects had prioritized workforce development, and improvements in governance and service delivery. Conversely, there was little assistance for finance or medical product development. The vast majority (87.6%) of JICA projects addressed public health issues, for example programs to improve maternal and child health, and the prevention and treatment of infectious diseases such as AIDS, tuberculosis and malaria. Nearly 90% of JICA technical healthcare assistance directly focused on improving governance as the most critical means of accomplishing its goals. Conclusions Our study confirmed that JICA projects met the goals of bilateral cooperation by developing workforce capacity and governance. Nevertheless, our findings suggest that JICA assistance could be used to support financial aspects of healthcare systems, which is an area of increasing concern. We also showed that the analytical matrix methodology is an effective means of examining the component of health system strengthening to which the activity and output of a project contributes. This may help policy makers and practitioners focus future projects on priority areas. PMID:24053583
McPake, B.; Mills, A.
Most commonly, lessons derived from comparisons of international health sector reform can only be generalized in a limited way to similar countries. However, there is little guidance as to what constitutes "similarity" in this respect. We propose that a framework for assessing similarity could be derived from the performance of individual policies in different contexts, and from the cause and effect processes related to the policies. We demonstrate this process by considering research evidence in the "public-private mix", and propose variables for an initial framework that we believe determine private involvement in the public health sector. The most influential model of public leadership places the private role in a contracting framework. Research in countries that have adopted this model suggests an additional list of variables to add to the framework. The variables can be grouped under the headings "demand factors", "supply factors", and "strength of the public sector". These illustrate the nature of a framework that could emerge, and which would help countries aiming to learn from international experience. PMID:10916918
Lee, Cheens; Robinson, Kerin M; Wendt, Kate; Williamson, Dianne
The unimpeded functioning of hospital Health Information Services (HIS) is essential for patient care, clinical governance, organisational performance measurement, funding and research. In an investigation of hospital Health Information Services' preparedness for internal disasters, all hospitals in the state of Victoria with the following characteristics were surveyed: they have a Health Information Service/ Department; there is a Manager of the Health Information Service/Department; and their inpatient capacity is greater than 80 beds. Fifty percent of the respondents have experienced an internal disaster within the past decade, the majority affecting the Health Information Service. The most commonly occurring internal disasters were computer system failure and floods. Two-thirds of the hospitals have internal disaster plans; the most frequently occurring scenarios provided for are computer system failure, power failure and fire. More large hospitals have established back-up systems than medium- and small-size hospitals. Fifty-three percent of hospitals have a recovery plan for internal disasters. Hospitals typically self-rate as having a 'medium' level of internal disaster preparedness. Overall, large hospitals are better prepared for internal disasters than medium and small hospitals, and preparation for disruption of computer systems and medical record services is relatively high on their agendas.
Jones, Abigail; Legido-Quigley, Helena
Objective To explore the feasibility of health systems strengthening from the perspective of international healthcare implementers and donors in South Sudan. Design A qualitative interview study, with thematic analysis using the WHO health system building blocks framework. Setting South Sudan. Participants 17 health system practitioners, working for international agencies in South Sudan, were purposively sampled for their knowledge and experiences of health systems strengthening, services delivery, health policy and politics in South Sudan. Results Participants universally reported the health workforce as insufficient and of low capacity and service delivery as poor, while access to medicines was restricted by governmental lack of commitment in undertaking procurement and supply. However, progress was clear in improved county health department governance, health management information system functionality, increased health worker salary harmonisation and strengthened financial management. Conclusions Resurgent conflict and political tensions have negatively impacted all health system components and maintaining or continuing health system strengthening has become extremely challenging. A coordinated approach to balancing humanitarian need particularly in conflict-affected areas, with longer term development is required so as not to lose improvements gained. PMID:26700280
Santos, Maria Angelica Borges dos; Passos, Sonia Regina Lambert
Health services have increasingly proven to be an innovative sector, gaining prominence in the medical industrial complex through expansion to public and international markets. International trade can foster economic development and redirect the resources and infrastructure available for healthcare in different countries in favorable or unfavorable directions. Wherever private providers play a significant role in government-funded healthcare, GATS commitments may restrict health policy options in subscribing countries. Systematic information on the impacts of electronic health services, medical tourism, health workers' migration, and foreign direct investment is needed on a case-by-case basis to build evidence for informed decision-making, so as to maximize opportunities and minimize risks of GATS commitments.
Pottie, Kevin; Hui, Charles; Rahman, Prinon; Ingleby, David; Akl, Elie A.; Russell, Grant; Ling, Li; Wickramage, Kolitha; Mosca, Davide; Brindis, Claire D.
Persons affected by migration require health systems that are responsive and adaptable to the needs of both disadvantaged migrants and non-migrant populations. The objective of this study is to support health systems for populations affected by migration. Materials and Methods: An international Delphi consensus process was used to identify policy approaches to improve health systems for populations affected by migration. Participants were leading migrant health experts from Americas, Europe, Middle East, Asia, and Australasia. We calculated average ranking scores and qualitatively analyzed open-ended questions. Results: Participants identified the following key areas as priorities for policy development: health inequities, system discrimination, migrant related health data, disadvantaged migrant sub-groups, and considerations for disadvantaged non-migrant populations. Highly ranked items to improve health systems were: Health Equity Impact Assessment, evidence based guidelines, and the International Organization for Migration annual reports. Discussion: Policy makers need tools, data and resources to address health systems challenges. Policies need to avoid preventable deaths of migrants and barriers to basic health services. PMID:28165380
Risso-Gill, Isabelle; McKee, Martin; Coker, Richard; Piot, Peter; Legido-Quigley, Helena
Myanmar has undergone a remarkable political transformation in the last 2 years, with its leadership voluntarily transitioning from an isolated military regime to a quasi-civilian government intent on re-engaging with the international community. Decades of underinvestment have left the country underdeveloped with a fragile health system and poor health outcomes. International aid agencies have found engagement with the Myanmar government difficult but this is changing rapidly and it is opportune to consider how Myanmar can engage with the global health system strengthening (HSS) agenda. Nineteen semi-structured, face-to-face interviews were conducted with representatives from international agencies working in Myanmar to capture their perspectives on HSS following political reform. They explored their perceptions of HSS and the opportunities for implementation. Participants reported challenges in engaging with government, reflecting the disharmony between actors, economic sanctions and barriers to service delivery due to health system weaknesses and bureaucracy. Weaknesses included human resources, data and medical products/infrastructure and logistical challenges. Agencies had mixed views of health system finance and governance, identifying problems and also some positive aspects. There is little consensus on how HSS should be approached in Myanmar, but much interest in collaborating to achieve it. Despite myriad challenges and concerns, participants were generally positive about the recent political changes, and remain optimistic as they engage in HSS activities with the government.
Prieto-Welch, Susan L.
This chapter describes the mental health status of international students in institutions of higher education, unique challenges these students face and their impact on mental health, and suggestions for ways to address these challenges.
The National Health Service (NHS) has been the body of the health care system in the United Kingdom (UK) for over 60 years and has sought to provide the population with a high quality service free of user charges for most services. The information age has seen the NHS rapidly transformed from a socialist, centrally planned and publicly provided system to a more market based system orientated towards patients as consumers. The forces of globalization have provided patients in the UK with greater choice in their health care provision, with NHS treatment now offered from any public or approved private provider and the possibility of treatment anywhere in the European Economic Area (EEA) or possibly further. The financial crisis, a large government deficit and austerity public spending policies have imposed a tight budget constraint on the NHS at a time of increasing demand for health care and population pressure. Hence, further rationing of care could imply that patients are incentivised to seek private treatment outside the constraints of the NHS, where the possibility of much greater choice exists in an increasingly globally competitive health care market. This chapter examines the evidence on the response of patients to the possibilities of increased choice and mobility within the internal NHS and external overseas health care markets. It also considers the relationships between patient mobility, health care provision and health policy. Patients are more mobile and willing to travel further to obtain better care outcomes and value for money, but are exposed to greater risk.
Braithwaite, Jeffrey; Hibbert, Peter; Blakely, Brette; Plumb, Jennifer; Hannaford, Natalie; Long, Janet Cameron; Marks, Danielle
Objectives: Performance indicators are a popular mechanism for measuring the quality of healthcare to facilitate both quality improvement and systems management. Few studies make comparative assessments of different countries’ performance indicator frameworks. This study identifies and compares frameworks and performance indicators used in selected Organisation for Economic Co-operation and Development health systems to measure and report on the performance of healthcare organisations and local health systems. Countries involved are Australia, Canada, Denmark, England, the Netherlands, New Zealand, Scotland and the United States. Methods: Identification of comparable international indicators and analyses of their characteristics and of their broader national frameworks and contexts were undertaken. Two dimensions of indicators – that they are nationally consistent (used across the country rather than just regionally) and locally relevant (measured and reported publicly at a local level, for example, a health service) – were deemed important. Results: The most commonly used domains in performance frameworks were safety, effectiveness and access. The search found 401 indicators that fulfilled the ‘nationally consistent and locally relevant’ criteria. Of these, 45 indicators are reported in more than one country. Cardiovascular, surgery and mental health were the most frequently reported disease groups. Conclusion: These comparative data inform researchers and policymakers internationally when designing health performance frameworks and indicator sets. PMID:28228948
Mercer, Mary Anne; Thompson, Susan M; de Araujo, Rui Maria
Achieving the United Nations Millennium Development Goals for health will require that programs supporting health in developing countries focus on strengthening national health care systems. However, the dominant neoliberal model of development mandates reduced public spending on health and other social services, often resulting in increased funding for nongovernmental organizations (NGOs) at the expense of support for government systems. East Timor, later Timor-Leste, is an example of a post-crisis country where international NGO efforts were initially critical to providing relief efforts to a traumatized population. Those groups were not prepared to help develop and support a standardized Timorese national health plan, however, and the cost of their support was unsustainable in the long term. In response, local authorities designed and implemented a post-crisis NGO phase-over plan that addressed risks to service disruption and monitored the process. Since then, some NGOs have worked collaboratively with the Ministry of Health to support specific efforts and initiatives under a framework provided by the ministry. Timor-Leste has shown that ministries of health can facilitate an effective transition of NGO support from crisis to development if they are allowed to plan and manage the process.
Saba, Farhad, Ed.
Completes a discussion of a systems model of distance education (in articles since May 1999) focusing on the most complex level, international. Discussion includes transfer of technology from United States universities to developing nations, the free market, and the age of the global economy. Presents a list of "early indicators" of changes in…
Block, Miguel A González
Aim International collaboration for health system development has been identified as a critical input to meet pressing global health needs. North-South collaboration has the potential to benefit both parties, while South-South collaboration offers promise to strengthen capacity rapidly and efficiently across developing countries. There is an emerging trend to analyze the fruits of such collaboration. This paper builds on this trend by applying an innovative concept-based bibliometric method to identify the international scope of collaboration within the field of health policy and systems research. Two key questions are addressed: to what extent are papers comparing developing countries as against reporting on single country studies? To what extent are papers in either case being produced by researchers within their respective countries or through North-South or South-South collaboration? Methods A total of 8,751 papers published in Medline between 1999 and 2003 with data on health systems and policies in developing countries were identified and content-analyzed using an innovative concept-based search technology. A sample of 13% of papers was used to identify the corresponding institution and countries covered. The sampled data was then analyzed by income group. Results Papers with an international, cross-country focus account for only 10% of the total. Just over a third of all papers are led by upper middle income country authors, closely followed by authors from high income countries. Just under half of all papers target low income countries. Cross-country papers are led mostly by institutions in high income countries, with 74% of the total. Only seven countries concentrate 60% of the papers led by developing country institutions. Institutions in the United States and the United Kingdom concentrate between them as many as 68% of the papers led by high income countries. Only 11% of all single-country papers and 21% of multi-country studies are the product of South
Mattila, Lea-Riitta; Pitkäjärvi, Marianne; Eriksson, Elina
The purpose of this qualitative study was to describe international student nurses' experiences of their clinical practice in the Finnish health care system. The data were collected by semi-structured interviews. Fourteen international student nurses of African and Asian origin were interviewed, and the data were then analysed by qualitative content analysis. The results indicated that appreciative orientation, sense of belonging to the team, enhancing independent working, growing towards professionalism and working as a member of the team were descriptions of positive experiences. Descriptions of negative experiences were related to restricted learning and compromised human dignity, which lead to negative feelings of being an outsider, decreased self-esteem, sense of giving up and anticipation of difficulties. Despite the small sample size, the results indicate a need to develop clinical practice arrangements when the language of the learning environment is other than that of the student nurse. As the number of international students has increased in the Finnish health care sector and in nursing education, it is important to recognise the factors related to positive and negative experiences in clinical practice.
Lima, Yara Oyram Ramos; Costa, Ediná Alves
The scope of this study was to analyze how the International Sanitary Regulation (ISR 2005)has been incorporated into the Brazilian legal-administrative system, in relation to sanitary control measures involving freight, means of transportation and travelers and possible alterations to health surveillance activities, competencies and procedures. This case study has been undertaken using a qualitative approach, of a descriptive and exploratory nature, using institutional data sources and interviews with key-informants involved in implementing ISR (2005). Alterations to the Brazilian legal-administrative system resulting from ISR (2005) were identified, in relation to standards, special competencies and procedures relating to sanitary controls for freight, modes of transportation and travelers. In its present form, the International Sanitary Regulation is an instrument that, in addition to introducing new international and national sanitary control concepts and elements, also helps to clarify questions that are helpful on a national level, relating to the specific competencies and procedures which will, to a certain extent, put pressure on administrative structures in the areas of sanitary control and surveillance.
Schieber, G J; Puollier, J P
Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, health care prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10
Frenk, J; Sepúlveda, J; Gómez-Dantés, O; McGuinness, M J; Knaul, F
New global and national health challenges require a new response. National health situations are increasingly influenced by the international transfer of health risks posed by environmental threats, overuse of resources, international migration, trade in harmful legal products (tobacco), traffic of illicit drugs, and diffusion of potentially inappropriate and costly medical technologies and treatment policies. This situation calls for reform of national health systems, and a natural extension of such reform is reform of the world health system. The first step toward this goal should be to achieve consensus about the essential core functions of international health organizations their division of labor. Currently international health agencies have overlapping mandates and duplicate efforts, and they have neglected the following essential functions: monitoring emerging diseases, setting consumer health standards, providing international coordination to control the transfer of health risks, coordinating research efforts and technological development, designing information systems to facilitate development of national and global health policies, accumulating knowledge about cost-effectiveness of medical technologies and interventions, and creating a process for sharing information about national health system reform. Reform "essentialists" identify the following core functions for international health organizations: surveillance and control of globally-threatening diseases, promotion of research and technological development, development of standards and norms for international certification, protection of international refugees, and assisting vulnerable populations. Others give international health organizations a more expansive role including redistributing resources from rich to poor countries, political advocacy, direct regulation of transnational corporations, and intervention in national health projects. Consensus must be reached to effect reform.
Pottie, Kevin; Hui, Charles; Rahman, Prinon; Ingleby, David; Akl, Elie A; Russell, Grant; Ling, Li; Wickramage, Kolitha; Mosca, Davide; Brindis, Claire D
Persons affected by migration require health systems that are responsive and adaptable to the needs of both disadvantaged migrants and non-migrant populations. The objective of this study is to support health systems for populations affected by migration.
A special Committee on Internal Medicine and Public Health was established by Sociedad Médica de Santiago (Chilean Society of Internal Medicine) in April 2007 with the duty to write a Consensus Paper on the interaction between both branches of medical profession. The main objective was to find the common grounds on which to construct a positive approach to regain space for Internal Medicine, based on prevalent epidemiológical features related to adult health issues. The authors describe the reasons to explain the gap between clinical medicine and population health and identify the nature and evolution of chronic diseases as the point of encounter between both. With Chilean health surveys data, they state that chronic diseases explain the high proportion of burden of disease, mortality and disability, and stress that by the year 2025 one in every five inhabitants will be over 65 years of age, with ageing as another main problem for the health care sector. Population with multiple risks and multimorbidity is the most important challenge for the Chilean Health Care System. A new model of care is needed to tackle this scenario with new skills regarding psychosocial determinants of health. The leading role of internists and ideally geriatricians, will be crucial in this process and will help the implementation of sound population based interventions. Both individual and community level interventions will help to improve quality of life of Chilean families.
Carmack, Heather J.; Bedi, Shireen; Heiss, Sarah N.
International students entering US universities often experience a variety of important socialization messages. One important message is learning about and using the US health system. International students often first encounter the US health system through their experiences with university health centers. The authors explore the memorable…
Jia, Peng; Sankoh, Osman; Tatem, Andrew J
The International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) has produced reliable longitudinal data about the lives of people in low- and middle-income countries (LMICs) through a global network of health and demographic surveillance system (HDSS) sites. Since reliable demographic data are scarce across many LMICs, we examine the environmental and socioeconomic (ES) similarities between existing HDSS sites and the rest of the LMICs. The HDSS sites were hierarchically grouped by the similarity of their ES conditions to quantify the ES variability between sites. The entire Africa and Asia region was classified to identify which regions were most similar to existing sites, based on available ES data. Results show that the current INDEPTH network architecture does a good job in representing ES conditions, but that great heterogeneities exist, even within individual countries. The results provide valuable information in determining the confidence with which relationships derived from present HDSS sites can be broadly extended to other areas, and to highlight areas where the new HDSS sites would improve significantly the ES coverage of the network.
Moran, Valerie; Jacobs, Rowena
There is a fundamental gap in the evidence base on quantitative cross-country comparison of mental healthcare systems due to the challenges of comparative analysis in mental health including a paucity of good quality data. We explore whether existing limited data sources can potentially be exploited to examine technical efficiency of inpatient mental healthcare systems in 32 OECD countries in 2010. We use two analytical approaches: Data Envelopment Analysis (DEA) with bootstrapping to produce confidence intervals of efficiency scores and country rankings, and Cluster Analysis to group countries according to two broad efficiency groupings. We incorporate environmental variables using a two-stage truncated regression. We find slightly tighter confidence intervals for the less efficient countries which loosely corresponds with the 'inefficient' cluster grouping in the Cluster Analysis. However there is little stability in country rankings making it difficult with current data to draw any policy inferences. Environmental factors do not appear to significantly impact on efficiency scores. The most pressing pursuit remains the search for better national data in mental healthcare to underpin future analyses. Otherwise the use of any sophisticated analytic techniques will prove futile for establishing robust conclusions regarding international comparisons of the performance of mental healthcare systems.
Burgess, K.; McKenzie, W.; Fehr, F.
This pilot study explored the international female (IF) students' (n = 17) lived experiences of health care accessibility while studying in a small town in Canada. Analysis guided by a phenomenological method resulted in three major themes--(1) after arriving to attend university, IF students experienced challenges in staying healthy, such as…
Schaumann, Leif; And Others
Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this seventh of ten manuals in the Interational Health Planning Methods Series deals with pharmaceutical supply systems planning in developing countries. Following an…
... a malaria-endemic area (See Chapter 3, Malaria ). Tuberculosis All internationally adopted children should be screened for tuberculosis (TB) after arriving in the United States. Internationally ...
An understanding of patient mobility, international patients and medical tourism includes supply and demand side considerations. As well as micro-level reports of motivation and satisfaction we must acknowledge broader system-level dynamics. Exploring these may unearth more complex geographies of patient travel. PMID:25905486
Hero, Joachim O; Blendon, Robert J; Zaslavsky, Alan M; Campbell, Andrea L
For decades, public satisfaction with the health care system has been lower in the United States than in other high-income countries. To better understand the distinctive nature of US health system satisfaction, we compared the determinants of satisfaction with the health system in the United States to those in seventeen other high-income countries by applying regression decomposition methods to survey data collected in the period 2011-13. We found that concerns related to "accessing most-preferred care" (the extent to which people feel that they can access their top preferences at a time of need) were more important to satisfaction in the United States than in other high-income countries, while the reverse was true for satisfaction with recent interactions with the health system. Differences among US socioeconomic groups in survey responses regarding access to most-preferred care suggest that wide variation in insurance coverage and generosity may play a role in these differences. While reductions in the uninsured population and the movement toward minimum health plan standards could help address some concerns about access to preferred care, our results raise the possibility of public backlash as market forces push plans toward more restricted access and higher cost sharing.
Haté, Vibhuti; Kornblet, Sarah; Fischer, Julie E.
The revised International Health Regulations (IHR ) conferred new responsibilities on member states of the World Health Organization, requiring them to develop core capacities to detect, assess, report, and respond to public health emergencies. Many countries have not yet developed these capacities, and poor understanding of the associated costs have created a barrier to effectively marshaling assistance. To help national and international decision makers understand the inputs and associated costs of implementing the IHR (2005), we developed an IHR implementation strategy to serve as a framework for making preliminary estimates of fixed and operating costs associated with developing and sustaining IHR core capacities across an entire public health system. This tool lays the groundwork for modeling the costs of strengthening public health systems from the central to the peripheral level of an integrated health system, a key step in helping national health authorities define necessary actions and investments required for IHR compliance. PMID:22710255
Katz, Rebecca; Haté, Vibhuti; Kornblet, Sarah; Fischer, Julie E
The revised International Health Regulations (IHR ) conferred new responsibilities on member states of the World Health Organization, requiring them to develop core capacities to detect, assess, report, and respond to public health emergencies. Many countries have not yet developed these capacities, and poor understanding of the associated costs have created a barrier to effectively marshaling assistance. To help national and international decision makers understand the inputs and associated costs of implementing the IHR (2005), we developed an IHR implementation strategy to serve as a framework for making preliminary estimates of fixed and operating costs associated with developing and sustaining IHR core capacities across an entire public health system. This tool lays the groundwork for modeling the costs of strengthening public health systems from the central to the peripheral level of an integrated health system, a key step in helping national health authorities define necessary actions and investments required for IHR compliance.
Stoney, Rhett J.; Kozarsky, Phyllis; Bostick, Roberd M.; Sotir, Mark J.
Background In 2011, the Centers for Disease Control and Prevention and the New Jersey Department of Health used the New Jersey Behavioral Risk Factor Survey (NJBRFS), a state component of the national Behavioral Risk Factor Surveillance System (BRFSS) to pilot a travel health module designed to collect population-based data on New Jersey residents travelling internationally. Our objective was to use this population-based travel health information to serve as a baseline to evaluate trends in US international travellers. Methods A representative sample of New Jersey residents was identified through a random-digit-dialing method and administered the travel health module, which asked five questions: travel outside of USA during the previous year; destination; purpose; if a healthcare provider was visited before travel and any travel-related illness. Additional health variables from the larger NJBRFS were considered and included in bivariate analyses and multiple logistic regression; weights were assigned to variables to account for survey design complexity. Results Of 4029 participants, 841 (21%) travelled internationally. Top destinations included Mexico (10%), Canada (9%), Dominican Republic (6%), Bahamas (5%) and Italy (5%). Variables positively associated with travel included foreign birth, ≥$75 000 annual household income, college education and no children living in the household. One hundred fifty (18%) of 821 travellers with known destinations went to high-risk countries; 40% were visiting friends and relatives and only 30% sought pre-travel healthcare. Forty-eight (6%) of 837 responding travellers reported travel-related illness; 44% visited high-risk countries. Conclusions Approximately one in five NJBRFS respondents travelled internationally during the previous year, a sizeable proportion to high-risk destinations. Few reported becoming ill as a result of travel but almost one-half of those ill had travelled to high-risk destinations. Population
Gordon, C; Gray, J A; Toth, B; Veloso, M
In Europe, North America and elsewhere, growing interest has focussed on evidence-based healthcare systems, incorporating the deployment of practice guidelines, as a field of application for health telematics. The clinical benefit and technical feasibility of common European approaches to this task has recently been demonstrated. In Europe it is likely that, building on recent progress in electronic health record architecture (EHRA) standards, a sufficient state of maturity can be reached to justify initiation within CEN TC251 of a prestandards process on guideline content formats during the current 5th Framework of EC RT&D activity. There is now a similar impetus to agree standards for this field in North America. Thanks to fruitful EC-USA contacts during the 4th Framework programme, there is now a chance, given well-planned coordination, to establish a global consensus optimally suited to serve the world-wide delivery and application of evidence-based medicine. This review notes three factors which may accelerate progress to convergence: (1) revolutionary changes in the knowledge basis of professional/patient/public healthcare partnerships, involving the key role of the Web as a health knowledge resource for citizens, and a rapidly growing market for personalised health information and advice; (2) the emergence at national levels of digital warehouses of clinical guidelines and EBM knowledge resources, agencies which are capable of brokering common mark-up and interchange media definitions between knowledge providers, industry and healthcare organizations; (3) the closing gap in knowledge management technology, with the advent of XML and RDF, between approaches and services based respectively on text mark-up and knowledge-base paradigms. A current project in the UK National Health Service (the National electronic Library of Health) is cited as an example of a national initiative designed to harness these trends.
Brown, Bertram S., Ed.; Torrey, E. Fuller, Ed.
Presented in five parts on research, services, training, drug abuse, and alcohol abuse are 31 reports of mental health studies and programs supported by the U.S. and other countries. Explained in the introduction are reasons the National Institute of Mental Health (NIMH) has supported international collaboration. The following are among subjects…
Forbes-Mewett, Helen; Sawyer, Anne-Maree
Since the early 2000s, reports of increased rates of mental ill health among young people worldwide have received much attention. Several studies indicate a greater incidence of mental health problems among tertiary students, compared with the general population, and higher levels of anxiety, in particular, among international students compared…
Background The study aimed at developing a set of attributes for a ‘good’ health system performance assessment (HSPA) framework from literature and experiences in different contexts and using the attributes for a structured approach to lesson learning for low-income countries (LICs). Methods Literature review to identify relevant attributes for a HSPA framework; attribute validation for LICs in general, and for Uganda in particular, via a high-level Ugandan expert group; and, finally, review of a selection of existing HSPA frameworks using these attributes. Results Literature review yielded six key attributes for a HSPA framework: an inclusive development process; its embedding in the health system’s conceptual model; its relation to the prevailing policy and organizational set-up and societal context; the presence of a concrete purpose, constitutive dimensions and indicators; an adequate institutional set-up; and, its capacity to provide mechanisms for eliciting change in the health system. The expert group contextualized these attributes and added one on the adaptability of the framework. Lessons learnt from the review of a selection of HSPA frameworks using the attributes include: it is possible and beneficial to involve a range of stakeholders during the process of development of a framework; it is important to make HSPA frameworks explicit; policy context can be effectively reflected in the framework; there are marked differences between the structure and content of frameworks in high-income countries, and low- and middle-income countries; champions can contribute to put HSPA high on the agenda; and mechanisms for eliciting change in the health system should be developed alongside the framework. Conclusion It is possible for LICs to learn from literature and the experience of HSPA in other contexts, including HICs. In this study a structured approach to lesson learning included the development of a list of attributes for a ‘good’ HSPA framework. The
Roesch, R; Ogloff, J R; Eaves, D
There is a need for researchers and policy makers in the area of mental health and law to collaborate and develop common methods of approach to research. Although we have learned a great deal about the prevalence and needs of mentally ill offenders in jails and prisons, there are a number of research questions that remain. If the "second generation" of research is to be fruitful--and useful to policy makers--we need to be sure that the methods we employ are valid and that the findings we obtain are reliable. By collaborating with colleagues in other jurisdictions, we can begin to learn whether some of the existing findings are of a general nature, or dependent upon the system in which they were found. Similarly, while the first-generation research has alerted us to the needs of mentally ill offenders in jails and prisons, second-generation research is needed to help identify factors that may help prevent the "revolving door phenomenon," which results in mentally ill people being volleyed among mental health, criminal justice, and community settings. One area that has received embarrassingly little attention has been the need for considering the relationship between substance abuse and mental disorders. In our own work, we have found an alarmingly high degree of substance abuse among offenders, including mentally ill offenders. We have come to realize the importance of considering the role that substance abuse coupled with other mental disorders may play in the criminal justice system. As a result of this concern, the Surrey Mental Health Project recently hired a full-time drug and alcohol counselor whose job it is to work with inmates with substance abuse disorders while in the jail, and to help arrange continuing treatment resources upon their release. As Wilson et al. (1995) discuss, intensive case management projects may be particularly useful at targeting the unique needs of mentally ill offenders with multiple problems. Much of the research conducted with
Wisniewski, Janna M; Yeager, Valerie A; Diana, Mark L; Hotchkiss, David R
The number of health systems strengthening (HSS) programs has increased in the last decade. However, a limited number of studies providing robust evidence for the value and impact of these programs are available. This study aims to identify knowledge gaps and challenges that impede rigorous monitoring and evaluation (M&E) of HSS, and to ascertain the extent to which these efforts are informed by existing technical guidance. Interviews were conducted with HSS advisors at United States Agency for International Development-funded missions as well as senior M&E advisors at implementing partner and multilateral organizations. Findings showed that mission staff do not use existing technical resources, either because they do not know about them or do not find them useful. Barriers to rigorous M&E included a lack suitable of indicators, data limitations, difficulty in demonstrating an impact on health, and insufficient funding and resources. Consensus and collaboration between international health partners and local governments may mitigate these challenges. Copyright © 2016 John Wiley & Sons, Ltd.
Integrated Disease Investigations and Surveillance planning: a systems approach to strengthening national surveillance and detection of events of public health importance in support of the International Health Regulations.
Taboy, Celine H; Chapman, Will; Albetkova, Adilya; Kennedy, Sarah; Rayfield, Mark A
The international community continues to define common strategic themes of actions to improve global partnership and international collaborations in order to protect our populations. The International Health Regulations (IHR) offer one of these strategic themes whereby World Health Organization (WHO) Member States and global partners engaged in biosecurity, biosurveillance and public health can define commonalities and leverage their respective missions and resources to optimize interventions. The U.S. Defense Threat Reduction Agency's Cooperative Biological Engagement Program (CBEP) works with partner countries across clinical, veterinary, epidemiological, and laboratory communities to enhance national disease surveillance, detection, diagnostic, and reporting capabilities. CBEP, like many other capacity building programs, has wrestled with ways to improve partner country buy-in and ownership and to develop sustainable solutions that impact integrated disease surveillance outcomes. Designing successful implementation strategies represents a complex and challenging exercise and requires robust and transparent collaboration at the country level. To address this challenge, the Laboratory Systems Development Branch of the U.S. Centers for Disease Control and Prevention (CDC) and CBEP have partnered to create a set of tools that brings together key leadership of the surveillance system into a deliberate system design process. This process takes into account strengths and limitations of the existing system, how the components inter-connect and relate to one another, and how they can be systematically refined within the local context. The planning tools encourage cross-disciplinary thinking, critical evaluation and analysis of existing capabilities, and discussions across organizational and departmental lines toward a shared course of action and purpose. The underlying concepts and methodology of these tools are presented here.
De Vos, Pol; Van der Stuyft, Patrick
For decades, two opposing logics have dominated the health policy debate: a comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and a private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations in the second half of the last century. The neoliberal approach is illustrated with Chile's health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive "public logic" is shown through the social insurance models in Costa Rica and in Brazil and through the national public health systems in Cuba since 1959 and in Nicaragua during the 1980s. These experiences emphasize that health care systems do not naturally gravitate toward greater fairness and efficiency, but require deliberate policy decisions.
Study of Global Health Strategy Based on International Trends: -Promoting Universal Health Coverage Globally and Ensuring the Sustainability of Japan's Universal Coverage of Health Insurance System: Problems and Proposals.
Hatanaka, Takashi; Eguchi, Narumi; Deguchi, Mayumi; Yazawa, Manami; Ishii, Masami
The Japanese government at present is implementing international health and medical growth strategies mainly from the viewpoint of business. However, the United Nations is set to resolve the Post-2015 Development Agenda in the fall of 2015; the agenda will likely include the achievement of universal health coverage (UHC) as a specific development goal. Japan's healthcare system, the foundation of which is its public, nationwide universal health insurance program, has been evaluated highly by the Lancet. The World Bank also praised it as a global model. This paper presents suggestions and problems for Japan regarding global health strategies, including in regard to several prerequisite domestic preparations that must be made. They are summarized as follows. (1) The UHC development should be promoted in coordination with the United Nations, World Bank, and Asian Development Bank. (2) The universal health insurance system of Japan can be a global model for UHC and ensuring its sustainability should be considered a national policy. (3) Trade agreements such as the Trans-Pacific Partnership (TPP) should not disrupt or interfere with UHC, the form of which is unique to each nation, including Japan. (4) Japan should disseminate information overseas, including to national governments, people, and physicians, regarding the course of events that led to the establishment of the Japan's universal health insurance system and should make efforts to develop international human resources to participate in UHC policymaking. (5) The development of separate healthcare programs and UHC preparation should be promoted by streamlining and centralizing maternity care, school health, infectious disease management such as for tuberculosis, and emergency medicine such as for traffic accidents. (6) Japan should disseminate information overseas about its primary care physicians (kakaritsuke physicians) and develop international human resources. (7) Global health should be developed in
Shaffer, Ellen R; Brenner, Joseph E
Since the 1980s, neoliberal policies have prescribed reducing the role of governments, relying on market forces to organize and provide health care and other vital human services. In this context, international trade agreements increasingly serve as mechanisms to enforce the privatization, deregulation, and decentralization of health care and other services, with important implications for democracy as well as for health. Critics contend that social austerity and "free" trade agreements contribute to the rise in global poverty and economic inequality and instability, and therefore to increased preventable illness and death. Under new agreements through the World Trade Organization that cover vital human services such as health care, water, education, and energy, unaccountable, secret trade tribunals could overrule decisions by democratically elected officials on public financing for national health care systems, licensing and training standards for health professionals, patient safety and quality regulations, occupational safety and health, control of hazardous substances such as tobacco and alcohol, the environment, and affordable access to safe water and sanitation. International negotiations in 2003 in Cancun and in Miami suggested that countervailing views are developing momentum. A concerned health care community has begun to call for a moratorium on trade negotiations on health care and water, and to reinvigorate an alternative vision of universal access to vital services.
Naughton, June C., Ed.; And Others
This handbook consists of 24 papers addressing various aspects on health care and health care systems and services for foreign students from the Asia Pacific Region. The papers are: "Providing Health Care for International Students" (Donald F. B. Char); "Major Health Care Systems in Asia and the Pacific: Mainland China, Taiwan, Hong…
Brugha, Ruairí; Crowe, Sophie
The relevance and effectiveness of the World Health Organization's (WHO's) Global Code of Practice on the International Recruitment of Health Personnel is being reviewed in 2015. The Code, which is a set of ethical norms and principles adopted by the World Health Assembly (WHA) in 2010, urges members states to train and retain the health personnel they need, thereby limiting demand for international migration, especially from the under-staffed health systems in low- and middle-income countries. Most countries failed to submit a first report in 2012 on implementation of the Code, including those source countries whose health systems are most under threat from the recruitment of their doctors and nurses, often to work in 4 major destination countries: the United States, United Kingdom, Canada and Australia. Political commitment by source country Ministers of Health needs to have been achieved at the May 2015 WHA to ensure better reporting by these countries on Code implementation for it to be effective. This paper uses ethics and health systems perspectives to analyse some of the drivers of international recruitment. The balance of competing ethics principles, which are contained in the Code's articles, reflects a tension that was evident during the drafting of the Code between 2007 and 2010. In 2007-2008, the right of health personnel to migrate was seen as a preeminent principle by US representatives on the Global Council which co-drafted the Code. Consensus on how to balance competing ethical principles--giving due recognition on the one hand to the obligations of health workers to the countries that trained them and the need for distributive justice given the global inequities of health workforce distribution in relation to need, and the right to migrate on the other hand--was only possible after President Obama took office in January 2009. It is in the interests of all countries to implement the Global Code and not just those that are losing their health
Brugha, Ruairí; Crowe, Sophie
The relevance and effectiveness of the World Health Organization’s (WHO’s) Global Code of Practice on the International Recruitment of Health Personnel is being reviewed in 2015. The Code, which is a set of ethical norms and principles adopted by the World Health Assembly (WHA) in 2010, urges members states to train and retain the health personnel they need, thereby limiting demand for international migration, especially from the under-staffed health systems in low- and middle-income countries. Most countries failed to submit a first report in 2012 on implementation of the Code, including those source countries whose health systems are most under threat from the recruitment of their doctors and nurses, often to work in 4 major destination countries: the United States, United Kingdom, Canada and Australia. Political commitment by source country Ministers of Health needs to have been achieved at the May 2015 WHA to ensure better reporting by these countries on Code implementation for it to be effective. This paper uses ethics and health systems perspectives to analyse some of the drivers of international recruitment. The balance of competing ethics principles, which are contained in the Code’s articles, reflects a tension that was evident during the drafting of the Code between 2007 and 2010. In 2007-2008, the right of health personnel to migrate was seen as a preeminent principle by US representatives on the Global Council which co-drafted the Code. Consensus on how to balance competing ethical principles – giving due recognition on the one hand to the obligations of health workers to the countries that trained them and the need for distributive justice given the global inequities of health workforce distribution in relation to need, and the right to migrate on the other hand – was only possible after President Obama took office in January 2009. It is in the interests of all countries to implement the Global Code and not just those that are losing their
International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks. PMID:25905481
Meier, Benjamin Mason; Fox, Ashley M
This article analyzes the growing chasm between international power and state responsibility in health rights, proposing an international legal framework for collective rights - rights that can reform international institutions and empower developing states to realize the determinants of health structured by global forces. With longstanding recognition that many developing state governments cannot realize the health of their peoples without international cooperation, scholars have increasingly sought to codify international obligations under the purview of an evolving human right to health, applying this rights-based approach as a foundational framework for reducing global health inequalities through foreign assistance. Yet the inherent limitations of the individual human rights framework stymie the right to health in impacting the global institutions that are most crucial for realizing underlying determinants of health through the strengthening of primary health care systems. Whereas the right to health has been advanced as an individual right to be realized by a state duty-bearer, the authors find that this limited, atomized right has proven insufficient to create accountability for international obligations in global health policy, enabling the deterioration of primary health care systems that lack the ability to address an expanding set of public health claims. For rights scholars to advance disease protection and health promotion through national primary health care systems - creating the international legal obligations necessary to spur development supportive of the public's health - the authors conclude that scholars must look beyond the individual right to health to create collective international legal obligations commensurate with a public health-centered approach to primary health care. Through the development and implementation of these collective health rights, states can address interconnected determinants of health within and across countries
Schirnding, Yasmin von; Onzivu, William; Adede, Andronico O.
The environment continues to be a source of ill-health for many people, particularly in developing countries. International environmental law offers a viable strategy for enhancing public health through the promotion of increased awareness of the linkages between health and environment, mobilization of technical and financial resources, strengthening of research and monitoring, enforcement of health-related standards, and promotion of global cooperation. An enhanced capacity to utilize international environmental law could lead to significant worldwide gains in public health. PMID:12571726
Mateos Jiménez, Juan Bta
The Industrial Revolution having been well under way by the mid-19th century, epidemics of pestilential diseases, severe and affecting many people (bubonic plague, yellow fever and Asian cholera) were still spreading freely given that many countries either had no preventive laws at all or enforced them chaotically, whilst even the simplest information concerning the health situation was not made known to other neighboring States, thus favoring the epidemic's spread. Therefore, there was an almost anxious desire among most Nations to come up with an acceptable way of putting an end to the confusion and ignorance of all the many different laws governing each country, even each individual port, with regard to the preventive health treatment to be imposed upon ships, passengers and goods, which mean a truly depressing confusion for both commerce and travellers. Following several different failed attempts, the French Government managed to get a plan under way which was generally well-accepted and which served as the basis for the First International Sanitary Conference, which opened on July 23, 1851 in Paris, in which all of the Nations having maritime interests in the Mediterranean had previously been invited to take part.
Lapão, Luís Velez; Silva, Andreia; Pereira, Natália; Vasconcelos, Paula; Conceição, Cláudia
Introduction Ebola epidemics have shown to have significant impacts on many aspects of healthcare systems. African countries have been facing many difficulties while addressing Ebola epidemics, moreover due to both lack of resources and fragmented involvement of national and international entities. The participation of multiple organizations has created serious problems of coordination of aid and the operation of that aid on the ground. This paper aims at addressing the impact of Ebola epidemics on African health systems, with a special focus on the definition of impact mitigation guidelines and the role of resilience. The example of Portuguese speaking countries is presented. Methods A combination of literature review and case study methods are used. A literature review on Ebola outbreak impact on health systems will provide information to define a set of guidelines for healthcare services response to Ebola. The role of cooperation in providing additional resilience is described. Finally a case study focusing on the Portuguese collaboration and intervention in African Portuguese Speaking Countries (PALOP) is presented, as an example how the international community can provide additional resilience. Results The existing knowledge is very helpful to guide both the preparation and the coordination of Ebola preparedness interventions. Additional resilience can be provided by international cooperation. Conclusion In addition to international concrete support in times of crisis, to have a regional strategy of creating (multi-national) teams to rapidly implement an intervention while establishing better regional capacity to have sufficient resources to support the “resilience” required of the health system. PMID:26740843
East, Maurice A.
Designed as a unit for an international relations course, this systems approach paper outlines a learning method which contributes to the student's awareness that the United States is only one of many actors in the world. It also makes the student aware that there are limitations on the U. S. individual actions because of this interdependence and…
Gille, J. P.
The development of an internal insulation system for cryogenic liquids is described. The insulation system is based on a gas layer concept in which capillary or surface tension effects are used to maintain a stable gas layer within a cellular core structure between the tank wall and the contained cryogen. In this work, a 1.8 meter diameter tank was insulated and tested with liquid hydrogen. Ability to withstand cycling of the aluminum tank wall to 450 K was a design and test condition.
Gostin, Lawrence O
The International Health Regulations (IHR), the only global regulations for infectious disease control, have not been significantly changed since they were first issued in 1951. The World Health Organization (WHO) is currently engaged in a process to modernize the IHR. This article reviews WHO's draft revised IHR and recommends new reforms to improve global health, which include (1) a robust mission, emphasizing the WHO's core public health purposes, functions, and essential services; (2) broad scope, flexibly covering diverse health threats; (3) global surveillance, developing informational networks of official and unofficial data sources; (4) national public health systems, setting performance criteria, measuring outcomes, and holding states accountable; (5) human rights protection, setting science-based standards and fair procedures; and (6) good governance, adopting the principles of fairness, objectivity, and transparency. The WHO should ensure state compliance with health norms and generous economic and technical assistance to poorer countries. An important issue for the international community is how sovereign countries can join together to make global health work for everyone, the poor and the wealthy alike.
The purpose of this catalog is to provide a detailed description of each piece of hardware in the Crew Health Care System (CHeCS), including subpacks associated with the hardware, and to briefly describe the interfaces between the hardware and the ISS. The primary user of this document is the Space Medicine/Medical Operations ISS Biomedical Flight Controllers (ISS BMEs).
Pelletier, Kenneth R
For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.
Brandt, J.; Silver, J. D.; Christensen, J. H.; Andersen, M. S.; Bønløkke, J. H.; Sigsgaard, T.; Geels, C.; Gross, A.; Hansen, A. B.; Hansen, K. M.; Hedegaard, G. B.; Kaas, E.; Frohn, L. M.
An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North seas, since special regulatory actions on sulfur emissions, called SECA (sulfur emission control area), have been introduced in these areas. We conclude that, despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem for human health. Hence the related external costs are considerable. The total health-related external costs for the whole of Europe are estimated at 803 bn euros yr-1 for the year 2000, decreasing to 537 bn euros yr-1 in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680 000 yr-1, decreasing to approximately 450 000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulfur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern
Zurn, Pascal; Dumont, Jean-Christophe
This paper examines health workforce and migration policies in New Zealand, with a special focus on the international recruitment of doctors and nurses. The health workforce in New Zealand, as in all OECD countries, plays a central role in the health system. Nonetheless, maybe more than for any other OECD country, the health workforce in New…
The International Monetary Fund's response to evidence on the impact of its programs on public health fails to address the fundamental criticisms about its policies. The IMF's demand for borrowers to achieve extremely low inflation targets is founded on very little empirical evidence in the peer-reviewed literature. The low-inflation policies privilege international creditors over domestic debtors and short-term priorities over long-term development goals, and contain high social costs, referred to by economists as a "sacrifice ratio." For example, governments' raising of interest rates to bring down inflation undermines the ability of domestic firms to expand production and employment and thus "sacrifices" higher economic growth and higher tax revenues and unnecessarily constrains domestic health spending. During financial crisis, most countries seek to lower interest rates to stimulate the economy, the opposite of the IMF's general advice. Perversely, compliance with IMF policies has become a prerequisite for receiving donor aid. Critiques of the IMF express significant concerns that IMF fiscal and monetary policies are unduly restrictive. Health advocates must weigh in on such matters and pressure their finance ministries, particularly in the G7, to take steps at the level of the IMF Executive Board to revisit and modify its policy framework on deficits and inflation. Such reforms are crucial to enable countries to generate more domestic resources while the global health community searches for ways to support strengthening health system capacity.
This article examines the role of international institutional actors in China's health policy process. Particular attention is paid to three major international institutional actors: the World Bank, the World Health Organization, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Through process tracing and comparative case studies, the article looks at how international institutions contribute to policy change in China and seeks to explain different outcomes in the relationship between international institutions and China's health policies. It finds that despite the opaque and exclusive authoritarian structure in China, international institutions play a significant role in the country's domestic health governance. By investing their resources and capabilities selectively and strategically, international institutions can change the preferences of government policy makers, move latent public health issues to the government's agenda, and affect the timing of government action and the content of policy design. Furthermore, the study suggests that different outcomes in the relationship between China's health policies and global health governance can be explained through the seriousness of the externalities China faces.
Propp, Timothy William
This viewgraph presentation gives a general overview of the International Space Station Power Systems. The topics include: 1) The Basics of Power; 2) Space Power Systems Design Constraints; 3) Solar Photovoltaic Power Systems; 4) Energy Storage for Space Power Systems; 5) Challenges of Operating Power Systems in Earth Orbit; 6) and International Space Station Electrical Power System.
Evans, John R
It is not easy to fit an introductory address to the topics of AIDS, transplantation, women's health, reproductive health, national health insurance and epidemiology and public health. I have been asked to speak on international challenges and opportunities in health care in the hope that the global context might frame your specific discussions in the broadest possible perspective. I will speak primarily about the widening gap in health status between rich and poor people and rich and poor nations -- a gap which poses great risks for the poor but increasing risks for all of us as well.
Background Beyond well-documented credentialing issues, internationally-educated nurses (IENs) may need considerable support in transitioning into new social and health care environments. This study was undertaken to gain an understanding of transitioning experiences of IENs upon relocation to Canada, while creating policy and practice recommendations applicable globally for improving the quality of transitioning and the retention of IENs. Methods A focused ethnography of newly-recruited IENs was conducted, using individual semi-structured interviews at both one-to-three months (Phase 1) and nine-to-twelve months post-relocation (Phase 2). A purposive sample of IENs was recruited during their orientation at a local college, to a health authority within western Canada which had recruited them for employment throughout the region. The interviews were recorded and transcribed, and data was managed using qualitative analytical software. Data analysis was informed by Roper and Shapira's framework for focused ethnography. Results Twenty three IENs consented to participate in 31 interviews. All IENs which indicated interest during their orientation sessions consented to the interviews, yet 14 did not complete the Phase 2 interview due to reorganization of health services and relocation. The ethno-culturally diverse group had an average age of 36.4 years, were primarily educated to first degree level or higher, and were largely (under) employed as "Graduate Nurses". Many IENs reported negative experiences related to their work contract and overall support upon arrival. There were striking differences in nursing practice and some experiences of perceived discrimination. The primary area of discontentment was the apparent communication breakdown at the recruitment stage with subsequent discrepancy in expected professional role and financial reimbursement. Conclusions Explicit and clear communication is needed between employers and recruitment agencies to avoid employment
Martín Martín, J; de Manuel Keenoy, E; Carmona López, G; Martínez Olmos, J
The article desired organizational and managerial changes in Primary Health Care, so as to develop a sound and feasible social marketing strategy. Key elements that should be changed are: 1. Rigid and centralized administrative structures and procedures. 2. Incentives system centralized and dissociated from the managerial structure. 3. Primary Health Care management units immersed in political conflict. 4. Absence of alternative in the margin. Users cannot choose. 5. Lack of an internal marketing strategy. Several ways of internal markets simulation are assessed as potential means for internal change. The need for an administration reform leading to a less inflexible system in the Spanish national and regional health services in reviewed too. Three changes are considered essential: a) Payment systems in Primary Health Care. b) Modifications in the personnel contracts. c) Reform of the budgeting processes. Specific strategies in each of these issues are suggested, making emphasizing the need of their interrelationship and coherence.
Globalization and international trade are having an increasingly evident impact on the day-to-day duties of the health sector, and the phenomenon has aroused a great deal of interest among governments, nongovernmental organizations, international organizations, and the mass media. Up to this point the heated and polemical debate on the subject has seriously hindered objective discourse on the health implications of globalization and international trade. This piece examines the possible impact of the two processes on health in the Region of the Americas, in order to foster policies for equity that are adopted within the framework of public health in the Americas. The piece considers the relationships among globalization, trade, and health in general and then focuses on the special case of trade in health goods and services. The piece looks at the possible impact on health equity of the agreements for integration and free trade that are being negotiated in the Americas. The piece concludes with a summary of the activities that the Pan American Health Organization has been carrying out in this area.
Shimanuki, H; Knox, D A
The international trade in bee products is a complex issue as a result of the diverse uses of these products. This is especially true with regard to honey. In most cases, honey is imported for human consumption: the high purchase and shipping costs preclude the use of honey as feed for bees. For these reasons, the risk of transmitting disease through honey is minimal. However, this risk should not be ignored, especially in those countries where American foulbrood is not known to occur. The importation of pollen for bee feed poses a definite risk, especially since there are no acceptable procedures for determining whether pollen is free from pathogens, insects and mites. Routine drying of pollen would reduce the survival of mites and insects, but would not have any impact on bacterial spores. Phytosanitary certificates should be required for the importation of honey and pollen when destined for bee feed. The declaration on the phytosanitary certificate should include country of origin, and should state whether the following bee diseases and parasitic mites are present: American foulbrood disease, European foulbrood disease, chalkbrood disease, Varroa jacobsoni and Tropilaelaps clareae.
Threats posed by new, emerging or re-emerging communicable diseases are taking a global dimension, to which the World Health Organization (WHO) Secretariat has been responding with determination since 1995. Key to the global strategy for tackling epidemics across borders is the concept of global public health surveillance, which has been expanded and formalized by WHO and its technical partners through a number of recently developed instruments and initiatives. The adoption by the 58th World Health Assembly of the revised (2005) International Health Regulations provides the legal framework for mandating countries to link and coordinate their action through a universal network of surveillance networks. While novel environmental threats and outbreak-prone diseases have been increasingly identified during the past three decades, new processes of influence have appeared more recently, driven by the real or perceived threats of bio-terrorism and disruption of the global economy. Accordingly, the global surveillance agenda is being endorsed, and to some extent seized upon by new actors representing security and economic interests. This paper explores external factors influencing political commitment to comply with international health regulations and it illustrates adverse effects generated by: perceived threats to sovereignty, blurred international health agendas, lack of internationally recognized codes of conduct for outbreak investigations, and erosion of the impartiality and independence of international agencies. A companion paper (published in this issue) addresses the intrinsic difficulties that health systems of low-income countries are facing when submitted to the ever-increasing pressure to upgrade their public health surveillance capacity.
Creese, Brian; Gonzalez, Alvaro; Isaacs, Tina
This paper sets out the main findings of the International Instructional Systems Study (IISS), conducted by the UCL Institute of Education and funded by the Center on International Education Benchmarking (CIEB). The study examined the instructional systems and intended curricula of six "high performing" countries and two US states. The…
Nuttall, I; Miyagishima, K; Roth, C; de La Rocque, S
The One Health approach encompasses multiple themes and can be understood from many different perspectives. This paper expresses the viewpoint of those in charge of responding to public health events of international concern and, in particular, to outbreaks of zoonotic disease. Several international organisations are involved in responding to such outbreaks, including the United Nations (UN) and its technical agencies; principally, the Food and Agriculture Organization of the UN (FAO) and the World Health Organization (WHO); UN funds and programmes, such as the United Nations Development Programme, the World Food Programme, the United Nations Environment Programme, the United Nations Children's Fund; the UN-linked multilateral banking system (the World Bank and regional development banks); and partner organisations, such as the World Organisation for Animal Health (OIE). All of these organisations have benefited from the experiences gained during zoonotic disease outbreaks over the last decade, developing common approaches and mechanisms to foster good governance, promote policies that cut across different sectors, target investment more effectively and strengthen global and national capacities for dealing with emerging crises. Coordination among the various UN agencies and creating partnerships with related organisations have helped to improve disease surveillance in all countries, enabling more efficient detection of disease outbreaks and a faster response, greater transparency and stakeholder engagement and improved public health. The need to build more robust national public human and animal health systems, which are based on good governance and comply with the International Health Regulations (2005) and the international standards set by the OIE, prompted FAO, WHO and the OIE to join forces with the World Bank, to provide practical tools to help countries manage their zoonotic disease risks and develop adequate resources to prevent and control disease
Hammond, David; Reid, Jessica L
Health warnings on tobacco products have emerged as a prominent area of tobacco control policy. Regulatory practice has rapidly evolved over the past decade to the point where health warnings on tobacco products continue to set international precedents for their size and comprehensiveness. The current paper provides a general review of current regulatory practices, including physical design features (such as size and location), message content (pictorial vs. text and content themes), and regulatory considerations such as rotation period and other novel practices.
Cook, R J
Neglect of women's reproductive health, perpetuated by law, is part of a larger, systematic discrimination against women. Laws obstruct women's access to reproductive health services. Laws protective of women's reproductive health are rarely or inadequately implemented. Moreover, few laws or policies facilitate women's reproductive health services. Epidemiological evidence and feminist legal methods provide insight into the law's neglect of women's reproductive health and expose long-held beliefs in the law's neutrality that harm women fundamentally. Empirical evidence can be used to evaluate how effectively laws are implemented and whether alternative legal approaches exist that would provide greater protection of individual rights. International human rights treaties, including those discussed in this article, are being applied increasingly to expose how laws that obstruct women's access to reproductive health services violate their basic rights.
Youth incarceration is an international public health concern among developed and developing countries. Worldwide, youth are held in incarceration, detention, and other secure settings that are inappropriate for their age and developmental stages, jeopardizing their prosocial development, and reintegration into society. Youth incarceration lacks evidence and cost-effectiveness. The well-being of youth is a key indicator of the welfare of families, communities, and society at large; therefore, the Society for Adolescent Health and Medicine (SAHM) supports a paradigm shift in the role of the justice system as it relates to treatment of youth. SAHM recommends justice systems focus greater attention and resources on identifying and reducing the antecedents of high-risk and criminal behaviors, recognizing the rights and freedom of young persons, and prioritizing the well-being of youth over punitive measures that may harm and disrupt healthy adolescent development. SAHM supports the following positions: (1) incarceration is a last option for selected offenders who have committed the most serious violent crimes and are unable to remain safely in the community; (2) youth justice policies, programs, and practices affecting youth be evidence based and trauma informed; (3) youth justice policies, programs, and practices must incorporate research and ongoing program evaluation; (4) youth justice policies shall protect the privacy and dignity of children younger than 18 years; and (5) health care professionals and media will promote positive portrayals of youth in healthy relationships within their communities and reduce representations and images of youth that are negative, violent, deviant, and threatening.
Tucker, Carole A; Escorpizo, Reuben; Cieza, Alarcos; Lai, Jin Shei; Stucki, Gerold; Ustun, T. Bedirhan; Kostanjsek, Nenad; Cella, David; Forrest, Christopher B.
Background The Patient Reported Outcomes Measurement Information System (PROMIS®) is a U.S. National Institutes of Health initiative that has produced self-reported item banks for physical, mental, and social health. Objective To describe the content of PROMIS at the item level using the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). Methods All PROMIS adult items (publicly available as of 2012) were assigned to relevant ICF concepts. The content of the PROMIS adult item banks were then described using the mapped ICF code descriptors. Results The 1006 items in the PROMIS instruments could all be mapped to ICF concepts at the second level of classification, with the exception of 3 items of global or general health that mapped across the first-level classification of ICF activity and participation component (d categories). Individual PROMIS item banks mapped from 1 to 5 separate ICF codes indicating one-to-one, one-to-many and many-to-one mappings between PROMIS item banks and ICF second level classification codes. PROMIS supports measurement of the majority of major concepts in the ICF Body Functions (b) and Activity & Participation (d) components using PROMIS item banks or subsets of PROMIS items that could, with care, be used to develop customized instruments. Given the focus of PROMIS is on measurement of person health outcomes, concepts in body structures (s) and some body functions (b), as well as many ICF environmental factor have minimal coverage in PROMIS. Discussion The PROMIS-ICF mapped items provide a basis for users to evaluate the ICF related content of specific PROMIS instruments, and to select PROMIS instruments in ICF based measurement applications. PMID:24760532
The World Federation for Mental Health was founded as an international apolitical organization concerned with quality of life rather than merely the absence or prevention of mental illness. An examination of the manner and extent to which mental problems arise in different cultural settings can provide data needed to understand the relationship…
Msengi, Clementine Mukeshimana
The number of international students attending higher education in the United States continues to grow (McLachlan & Justice, 2009). International students face several challenges while studying in the United States, some of which are health challenges (Zysberg, 2005). The purpose of this study was to examine the influence of various…
Ginsburg, Carren; Bocquier, Philippe; Béguy, Donatien; Afolabi, Sulaimon; Augusto, Orvalho; Derra, Karim; Herbst, Kobus; Lankoande, Bruno; Odhiambo, Frank; Otiende, Mark; Soura, Abdramane; Wamukoya, Marylene; Zabré, Pascal; White, Michael J; Collinson, Mark A
Migration has been hypothesised to be selective on health but this healthy migrant hypothesis has generally been tested at destinations, and for only one type of flow, from deprived to better-off areas. The circulatory nature of migration is rarely accounted for. This study examines the relationship between different types of internal migration and adult mortality in Health and Demographic Surveillance System (HDSS) populations in West, East, and Southern Africa, and asks how the processes of selection, adaptation and propagation explain the migration-mortality relationship experienced in these contexts. The paper uses longitudinal data representing approximately 900 000 adults living in nine sub-Saharan African HDSS sites of the INDEPTH Network. Event History Analysis techniques are employed to examine the relationship between all-cause mortality and migration status, over periods ranging from 3 to 14 years for a total of nearly 4.5 million person-years. The study confirms the importance of migration in explaining variation in mortality, and the diversity of the migration-mortality relationship over a range of rural and urban local areas in the three African regions. The results confirm that the pattern of migration-mortality relationship is not exclusively explained by selection but also by propagation and adaptation. Consequences for public health policy are drawn.
Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.
This analysis of the Armenian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2006. Armenia inherited a Semashko style health system on independence from the Soviet Union in 1991. Initial severe economic and sociopolitical difficulties during the 1990s affected the population health, though strong economic growth from 2000 benefited the populations health. Nevertheless, the Armenian health system remains unduly tilted towards inpatient care concentrated in the capital city despite overall reductions in hospital beds and concerted efforts to reform primary care provision. Changes in health system financing since independence have been more profound, as out-of-pocket (OOP) payments now account for over half of total health expenditure. This reduces access to essential services for the poorest households - particularly for inpatient care and pharmaceuticals - and many households face catastrophic health expenditure. Improving health system performance and financial equity are therefore the key challenges for health system reform. The scaling up of some successful recent programmes for maternal and child health may offer solutions, but require sustained financial resources that will be challenging in the context of financial austerity and the low base of public financing.
Global nuclear proliferation, bioterrorism, and emerging infections have challenged national capacities to achieve and maintain global security. Over the last century, emerging infectious disease threats resulted in the development of the preliminary versions of the International Health Regulations (IHR) of the World Health Organization (WHO). The current HR(2005) contain major differences compared to earlier versions, including: substantial shifts from containment at the border to containment at the source of the event; shifts from a rather small disease list (smallpox, plague, cholera, and yellow fever) required to be reported, to all public health threats; and shifts from preset measures to tailored responses with more flexibility to deal with the local situations on the ground. The new IHR(2005) call for accountability. They also call for strengthened national capacity for surveillance and control; prevention, alert, and response to international public health emergencies beyond the traditional short list of required reporting; global partnership and collaboration; and human rights, obligations, accountability, and procedures of monitoring. Under these evolved regulations, as well as other measures, such as the Revolving Fund for vaccine procurement of the Pan American Health Organization (PAHO), global health security could be maintained in the response to urban yellow fever in Paraguay in 2008 and the influenza (H1N1) pandemic of 2009-2010. PMID:21143824
Sittig, Dean F; Ash, Joan S; Feblowitz, Joshua; Meltzer, Seth; McMullen, Carmit; Guappone, Ken; Carpenter, Jim; Richardson, Joshua; Simonaitis, Linas; Evans, R Scott; Nichol, W Paul; Middleton, Blackford
Background Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. Objective To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs. Study design and methods We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4). Results Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common. Conclusion We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content. PMID:21415065
HATANAKA, Takashi; EGUCHI, Narumi; DEGUCHI, Mayumi; YAZAWA, Manami; ISHII, Masami
The Japanese government at present is implementing international health and medical growth strategies mainly from the viewpoint of business. However, the United Nations is set to resolve the Post-2015 Development Agenda in the fall of 2015; the agenda will likely include the achievement of universal health coverage (UHC) as a specific development goal. Japan’s healthcare system, the foundation of which is its public, nationwide universal health insurance program, has been evaluated highly by the Lancet. The World Bank also praised it as a global model. This paper presents suggestions and problems for Japan regarding global health strategies, including in regard to several prerequisite domestic preparations that must be made. They are summarized as follows. (1) The UHC development should be promoted in coordination with the United Nations, World Bank, and Asian Development Bank. (2) The universal health insurance system of Japan can be a global model for UHC and ensuring its sustainability should be considered a national policy. (3) Trade agreements such as the Trans-Pacific Partnership (TPP) should not disrupt or interfere with UHC, the form of which is unique to each nation, including Japan. (4) Japan should disseminate information overseas, including to national governments, people, and physicians, regarding the course of events that led to the establishment of the Japan’s universal health insurance system and should make efforts to develop international human resources to participate in UHC policymaking. (5) The development of separate healthcare programs and UHC preparation should be promoted by streamlining and centralizing maternity care, school health, infectious disease management such as for tuberculosis, and emergency medicine such as for traffic accidents. (6) Japan should disseminate information overseas about its primary care physicians (kakaritsuke physicians) and develop international human resources. (7) Global health should be developed in
Alena, Richard; Duncavage, Dan
Traditional mission and vehicle management involves teams of highly trained specialists monitoring vehicle status and crew activities, responding rapidly to any anomalies encountered during operations. These teams work from the Mission Control Center and have access to engineering support teams with specialized expertise in International Space Station (ISS) subsystems. Integrated System Health Management (ISHM) applications can significantly augment these capabilities by providing enhanced monitoring, prognostic and diagnostic tools for critical decision support and mission management. The Intelligent Systems Division of NASA Ames Research Center is developing many prototype applications using model-based reasoning, data mining and simulation, working with Mission Control through the ISHM Testbed and Prototypes Project. This paper will briefly describe information technology that supports current mission management practice, and will extend this to a vision for future mission control workflow incorporating new ISHM applications. It will describe ISHM applications currently under development at NASA and will define technical approaches for implementing our vision of future human exploration mission management incorporating artificial intelligence and distributed web service architectures using specific examples. Several prototypes are under development, each highlighting a different computational approach. The ISStrider application allows in-depth analysis of Caution and Warning (C&W) events by correlating real-time telemetry with the logical fault trees used to define off-nominal events. The application uses live telemetry data and the Livingstone diagnostic inference engine to display the specific parameters and fault trees that generated the C&W event, allowing a flight controller to identify the root cause of the event from thousands of possibilities by simply navigating animated fault tree models on their workstation. SimStation models the functional power flow
The September 8, 1988, Internal Regulations of the Secretariat of Health of Mexico govern an administrative unit which includes the General Directorate of Family Planning (FP) and the Internal Commission of the National Program of Women and Health. The General Directorate of FP formulates and proposes FP policies and strategies; designs, organizes, and supervises the FP programs of the Secretariat; regulates, directs, and evaluates FP programs of sectoral departments; promotes, coordinates, and performs FP research; formulates rules and controls the dispensing of FP services in private institutions; supports the participation of the Secretariat in the National Population Council; and coordinates, supervises, and evaluates the activities of departments of the Secretariat and the sector that provides FP services. The Internal Commission of the National Program of Women and Health promotes a quantitative and qualitative increase in activities directed at improving the specific health conditions of women, particularly those in the most disadvantaged circumstances; raises the awareness of women about the importance of their health and that of their families; promotes information and training for women as educators and helpers in the field of health; promotes the organized participation of women in community programs; encourages the personal development of women and their access to decision-making positions in health institutions; formulates a work program, defining priorities and determining activities, means, strategies, and a system of evaluation; proposes the implementation of programs and evaluates their execution; collects, analyses, and distributes information; coordinates activities with other internal commissions; promotes and proposes the coordination of activities of the National Program of Women and Health at the sectoral level; participates in the National Women's Commission and promotes the implementation of health activities within the National Program for
Phillips, S.L.; Lawrence, J.D.; Lepman, S.R.
The computerized international geothermal energy information system is reviewed. The review covers establishment of the Italy - United States linked data centers by the NATO Committee on Challenges of Modern Society, through a bilateral agreement, and up to the present time. The result of the information exchange project is given as the bibliographic and numerical data available from the data centers. Recommendations for the exchange of computerized geothermal information at the international level are discussed.
Chokshi, M; Patil, B; Khanna, R; Neogi, S B; Sharma, J; Paul, V K; Zodpey, S
Health systems and polices have a critical role in determining the manner in which health services are delivered, utilized and affect health outcomes. ‘Health' being a state subject, despite the issuance of the guidelines by the central government, the final prerogative on implementation of the initiatives on newborn care lies with the states. This article briefly describes the public health structure in the country and traces the evolution of the major health programs and initiatives with a particular focus on newborn health. PMID:27924110
Khodjamurodov, Ghafur; Rechel, Bernd
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Tajikistan is undergoing a complex transition from a health system inherited from the Soviet period to new forms of management, financing and health care provision. Following independence and the consequences of the civil war, health funding collapsed and informal out-of-pocket payments became the main source of revenue, with particularly severe consequences for the poor. With the aim of ensuring equitable access to health care and formalizing out-of-pocket payments, the Ministry of Health developed a programme that encompassed a basic benefit package (also known as the guaranteed benefit package) for people in need and formal co-payments for other groups of the population. One of the main challenges for the future will be to reorient the health system towards primary care and public health rather than hospital-based secondary and tertiary care. Pilots of primary care reform, introducing per capita financing, are under way in three of the country's oblasts. There are marked geographical imbalances in health care resources and financing, favouring the capital and regional centres over rural areas. There are also significant inequities in health care expenditures across regions. The quality of care is another major concern, owing to the lack of investment in health facilities and technologies, an insufficient supply of pharmaceuticals, poorly trained health care workers, and a lack of medical protocols and systems for quality improvement.
Moorthy, L N; Baldino, M E; Kurra, V; Puwar, D; Llanos, A; Peterson, M G E; Hassett, A L; Lehman, T J A
Previously, we described associations between health-related quality of life (HRQOL) and disease-related factors among childhood onset systemic lupus erythematosus (cSLE) patients. Here we determined the relationship between HRQOL, disease activity and damage in a large prospective international cohort of cSLE. We compared HRQOL, disease activity and disease damage across different continents and examined the relationship between children's and parents' assessments of HRQOL. Patients with cSLE and their parents completed HRQOL measures at enrollment and ≥4 follow-up visits. Physicians assessed disease activity and damage. The multinational cohort ( n = 467) had relatively low disease activity and damage. Patient and parent HRQOL scores were significantly correlated. Asian and European patients had the highest HRQOL, while South and North American patients had lower HRQOL scores. Renal, CNS, skin and musculoskeletal systems exhibited the highest levels of damage. North and South American and Asian patients were more likely to have disease damage and activity scores above median values, compared with Europeans. Asians were more likely to use cyclophosphamide/rituximab. Female gender, high disease activity and damage, non-White ethnicity, and use of cyclophosphamide and/rituximab were related to lower HRQOL. HRQOL domain scores continue to emphasize that SLE has widespread impact on all aspects of children's and parents' lives.
Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica
This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system.
Firestone, Michael P; Amler, Robert W
Parents in all countries want and deserve safe and healthy environments for their children. Children in all countries need, as part of normal growth and development, regular and frequent opportunities to interact with their environments as they learn to crawl, run, climb, swim, and explore. Environmental scientists and regulators recognize that environmental hazards are not contained by international borders. This is of special concern for children, because they are intrinsically at greater risk, compared to adults. They have different opportunities for exposure, greater response to certain toxicants, and less empowerment to alter their environments. There is a growing awareness that adverse health effects in children can adversely affect a country's future productivity and well-being. Multiple government agencies, NGOs, and advocates are mobilizing to address these concerns. A sustained concerted effort will be needed to afford equitable and effective environmental health protection to the world's children, present and future.
Background There are increasing evidence highlighting the importance of incorporating issues of global health into pre- and post-graduate medical curricula. Medical international cooperation is a fundamental component of strategies to include global health issues in post-graduate medical curricula. Methods Here we describe a seven-year cooperation between the Non Governmental Organization (NGO) “Doctors for Africa CUAMM” and the Pediatric Residency Program (PRP) of the University of Padua (Italy) that offers residents a well-articulated personalized international child’s health (ICH) elective in Africa, called “Junior Project Officer”. The elective includes: a careful candidate selection process; pre-departure educational course; preceptorship in Padua and Africa, personalized learning objectives, a personalized job description, a six-month hands-on learning experience in Africa, evaluation of the experience, and formal private and open feed-backs/reports. Results Between 2006 and 2012, 14 residents aged from 27 to 31 years, six attending the III, nine the IV and two the V year of residency completed the six-month stage in Africa. All worked in pediatric in-patient units; seven also worked in out-patient clinics, six in emergency rooms and seven in community health centers. Eleven were involved in teaching activities and four in clinical research projects. All residents claimed to have achieved their learning objectives. Conclusions A strong partnership between the NGO and the PRP, and well-articulated personalized learning objectives and job description contributed to a successful ICH elective. PMID:24499625
Accelerate Implementation of the WHO Global Code of Practice on International Recruitment of Health Personnel: Experiences From the South East Asia Region: Comment on "Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel - Ethical and Systems Perspectives".
Tangcharoensathien, Viroj; Travis, Phyllida
Strengthening the health workforce and universal health coverage (UHC) are among key targets in the heath-related Sustainable Development Goals (SDGs) to be committed by the United Nations (UN) Member States in September 2015. The health workforce, the backbone of health systems, contributes to functioning delivery systems. Equitable distribution of functioning services is indispensable to achieve one of the UHC goals of equitable access. This commentary argues the World Health Organization (WHO) Global Code of Practice on International Recruitment of Health Personnel is relevant to the countries in the South East Asia Region (SEAR) as there is a significant outflow of health workers from several countries and a significant inflow in a few, increased demand for health workforce in high- and middle-income countries, and slow progress in addressing the "push factors." Awareness and implementation of the Code in the first report in 2012 was low but significantly improved in the second report in 2015. An inter-country workshop in 2015 convened by WHO SEAR to review progress in implementation of the Code was an opportunity for countries to share lessons on policy implementation, on retention of health workers, scaling up health professional education and managing in and out migration. The meeting noted that capturing outmigration of health personnel, which is notoriously difficult for source countries, is possible where there is an active recruitment management through government to government (G to G) contracts or licensing the recruiters and mandatory reporting requirement by them. According to the 2015 second report on the Code, the size and profile of outflow health workers from SEAR source countries is being captured and now also increasingly being shared by destination country professional councils. This is critical information to foster policy action and implementation of the Code in the Region.
Gerkens, Sophie; Merkur, Sherry
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care.
The socioeconomic and sanitary conditions in many countries make it necessary to weigh as precisely as possible the uncertainties which might affect the health of internationally adopted children, which is one of the key drivers to adoption decision. Indeed, health troubles are more and more frequent among children proposed by countries, at a time when there are fewer children to be adopted. Hence the institutions and the actors in the field of international adoption are compelled to frequently update their professional practices, so as to cope both with the declining offer for adoptable children and with the increasing pressure from the birth countries of children to make host countries adopt children with high age or with special needs. It also requires from the administrations the will to provide better initial information and to implement the demand for an agreement. Meanwhile, in spite of those growing constraints, adopting families have been more and more risk adverse during the latest decades, this being a common trend in our developed countries.
Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina
This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending.
Heiba, Farouk I.
Every society has a system of values and seeks to achieve goals which it defines as desirable. To gain insight and a measure of understanding of another culture, international marketers can approach a country as a whole, seek out behavioral premises, obtain a theoretical knowledge of the culture, and learn the country's social heritage.…
Brant, Jacek; Chapman, Arthur; Isaacs, Tina
This paper reports on research conducted as part of the International Instructional System Study that explored five subject areas across nine jurisdictions in six high-performing countries. The Study's overall aim was to understand what, if anything, there is in common in the curricula and assessment arrangements among the high-performing…
Reinhardt, Jan D.; Li, Jianan; Gosney, James; Rathore, Farooq A.; Haig, Andrew J.; Marx, Michael; Delisa, Joel A.
Background Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design Qualitative literature review and secondary data analysis. Results Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health
Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard
Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures
Azzopardi Muscat, Natasha; Calleja, Neville; Calleja, Antoinette; Cylus, Jonathan
This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community.
Kanchanachitra, Churnrurtai; Lindelow, Magnus; Johnston, Timothy; Hanvoravongchai, Piya; Lorenzo, Fely Marilyn; Huong, Nguyen Lan; Wilopo, Siswanto Agus; dela Rosa, Jennifer Frances
In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues.
Ellsworth, Leanna; O'Keeffe, Annmaree
Background The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic – Canada, Greenland, USA (Alaska) and Russia (Chukotka). In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. Objective To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska) and Russia (Chukotka) and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Study design Literature review. Results It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems’ effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of comparison in terms of
Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout
In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health
De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm
This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to
Abstract In general, there is agreement that robust integrated information systems are the foundation for building successful regional health care delivery systems. Integrated Advanced Information Management System (IAIMS) institutions that, over the years, have developed strategies for creating cohesive institutional information systems and services are finding that IAIMS strategies work well in the even more complex regional environment. The key elements of IAIMS planning are described and lessons learned are discussed in the context of regional health information systems developed. The challenges of aligning the various information agencies and agendas in support of a regional health information system are complex ; however, the potential rewards for health care in quality, efficacy, and cost savings are enormous. PMID:9067887
Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout
This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system.
Thinking shift on health systems: from blueprint health programmes towards resilience of health systems Comment on "Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries".
International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks.
Vladescu, Cristian; Scintee, Silvia Gabriela; Olsavszky, Victor; Hernandez-Quevedo, Cristina; Sagan, Anna
This analysis of the Romanian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Romanian health care system is a social health insurance system that has remained highly centralized despite recent efforts to decentralize some regulatory functions. It provides a comprehensive benefits package to the 85% of the population that is covered, with the remaining population having access to a minimum package of benefits. While every insured person has access to the same health care benefits regardless of their socioeconomic situation, there are inequities in access to health care across many dimensions, such as rural versus urban, and health outcomes also differ across these dimensions. The Romanian population has seen increasing life expectancy and declining mortality rates but both remain among the worst in the European Union. Some unfavourable trends have been observed, including increasing numbers of new HIV/AIDS diagnoses and falling immunization rates. Public sources account for over 80% of total health financing. However, that leaves considerable out-of-pocket payments covering almost a fifth of total expenditure. The share of informal payments also seems to be substantial, but precise figures are unknown. In 2014, Romania had the lowest health expenditure as a share of gross domestic product (GDP) among the EU Member States. In line with the government's objective of strengthening the role of primary care, the total number of hospital beds has been decreasing. However, health care provision remains characterized by underprovision of primary and community care and inappropriate use of inpatient and specialized outpatient care, including care in hospital emergency departments. The numbers of physicians and nurses are relatively low in Romania compared to EU averages. This has mainly been attributed to the high rates of workers emigrating abroad over the
Gaal, Peter; Szigeti, Szabolcs; Csere, Marton; Gaskins, Matthew; Panteli, Dimitra
Hungary has achieved a successful transition from an overly centralized, integrated Semashko-style health care system to a purchaser provider split model with output-based payment methods. Although there have been substantial increases in life expectancy in recent years among both men and women, many health outcomes remain poor, placing Hungary among the countries with the worst health status and highest rate of avoidable mortality in the EU (life expectancy at birth trailed the EU27 average by 5.1 years in 2009). Lifestyle factors especially the traditionally unhealthy Hungarian diet, alcohol consumption and smoking play a very important role in shaping the overall health of the population.In the single-payer system, the recurrent expenditure on health services is funded primarily through compulsory, non-risk-related contributions made by eligible individuals or from the state budget. The central government has almost exclusive power to formulate strategic direction and to issue and enforce regulations regarding health care. In 2009 Hungary spent 7.4% of its gross domestic product (GDP) on health, with public expenditure accounting for 69.7% of total health spending, and with health expenditure per capita ranking slightly above the average for the new EU Member States, but considerably below the average for the EU27 in 2008. Health spending has been unstable over the years, with several waves of increases followed by longer periods of cost-containment and budget cuts. The share of total health expenditure attributable to private sources has been increasing, most of it accounted for by out-of-pocket (OOP) expenses. A substantial share of the latter can be attributed to informal payments, which are a deeply rooted characteristic of the Hungarian health system and a source of inefficiency and inequity. Voluntary health insurance, on the other hand, amounted to only 7.4% of private and 2.7% of total health expenditure in 2009. Revenue sources for health have been
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Olowokure, B.; Pooransingh, S.; Tempowski, J.; Palmer, S.; Meredith, T.
OBJECTIVE: In December 2001, an expert consultation convened by WHO identified strengthening national and global chemical incident preparedness and response as a priority. WHO is working towards this objective by developing a surveillance and response system for chemical incidents. This report describes the frequency, nature and geographical location of acute chemical incidents of potential international concern from August 2002 to December 2003. METHODS: Acute chemical incidents were actively identified through several informal (e.g. Internet-based resources) and formal (e.g. various networks of organizations) sources and assessed against criteria for public health emergencies of international concern using the then proposed revised International Health Regulations (IHR). WHO regional and country offices were contacted to obtain additional information regarding identified incidents. FINDINGS: Altogether, 35 chemical incidents from 26 countries met one or more of the IHR criteria. The WHO European Region accounted for 43% (15/35) of reports. The WHO Regions for Africa, Eastern Mediterranean and Western Pacific each accounted for 14% (5/35); South-East Asia and the Americas accounted for 9% (3/35) and 6% (2/35), respectively. Twenty-three (66%) events were identified within 24 hours of their occurrence. CONCLUSION: To our knowledge this is the first global surveillance system for chemical incidents of potential international concern. Limitations such as geographical and language bias associated with the current system are being addressed. Nevertheless, the system has shown that it can provide early detection of important events, as well as information on the magnitude and geographical distribution of such incidents. It can therefore contribute to improving global public health preparedness. PMID:16462985
Barry, Tom; Cunningham, Harry
Viewgraphs and discussion of onboard system health assessment are presented. Success of the space station program will be measured by how well it addresses the basic requirements for (1) maintaining the orbiting Space Station Freedom fully operational for its projected life of thirty years, and (2) the cost-effective execution of the overall space station program. Onboard system health assessment must provide complete and thorough testing capabilities along with effective associated redundancy/fault management.
Chevreul, Karine; Durand-Zaleski, Isabelle; Bahrami, Stéphane Bahrami; Hernández-Quevedo, Cristina; Mladovsky, Philipa
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The French health care system is a mix of public and private providers and insurers. Public insurance, financed by both employees and employer contributions and earmarked taxes, is compulsory and covers almost the whole population, while private insurance is of a complementary type and voluntary. Providers of outpatient care are largely private. Hospital beds are predominantly public or private non-profit-making. The French population enjoys good health and a high level of choice of providers. It is relatively satisfied with the health care system. However, as in many other countries, the rising cost of health care is of concern with regards to the objectives of the health care system. Many measures were or are being implemented in order to contain costs and increase efficiency. These include, for example, developing pay-for-performance for both hospitals and self-employed providers and increasing quality of professional practice; refining patient pathways; raising additional revenue for statutory health insurance (SHI); and increasing the role of voluntary health insurance (VHI). Meanwhile, socioeconomic disparities and geographic inequality in the density of health care professionals remain considerable challenges to providing a good level of equity in access to health care. Organizational changes at the regional level are important in attempting to tackle both equity and efficiency-related challenges. While the organizational structure of the system
Masri, Maysoun Dimachkie; Oetjen, Dawn; Rotarius, Timothy
To cope with the recent challenges within the health care industry, health care managers need to engage in the internal marketing of their various services. Internal marketing has been used as an effective management tool to increase employees' motivation, satisfaction, and productivity (J Mark Commun. 2010;16(5):325-344). Health care managers should understand that an intense focus on internal marketing factors will lead to a quality experience for employees that will ultimately have a positive effect on the patient experiences.
Smit, Eileen M
The purpose of this study was to identify and describe the health care experiences of families with an internationally adopted child. Content analysis of data from 107 adoptive parents was used to identify themes that characterized health care experiences of the families. Four themes were identified: a) Coming home: Like a lobster thrown into a boiling pot; b) Vigilance: Is my child healthy today? Will my child be healthy tomorrow?; c) Unique health care needs of international adoption families: We are different; and d) Importance of support by health care providers: Do they know or care? Health care providers need to be aware of the unique experiences of the increasing number of international adoption families. The themes identified provide insight into the health care experiences of international adoption families and the crucial role of health care providers in helping international adoption families feel supported on their journey.
Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech
Background The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. Methods A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Findings Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging ‘street level’ policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. Conclusions The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems. PMID:24560261
Csete, Joanne; Kamarulzaman, Adeeba; Kazatchkine, Michel; Altice, Frederick; Balicki, Marek; Buxton, Julia; Cepeda, Javier; Comfort, Megan; Goosby, Eric; Goulão, João; Hart, Carl; Horton, Richard; Kerr, Thomas; Lajous, Alejandro Madrazo; Lewis, Stephen; Martin, Natasha; Mejía, Daniel; Mathiesson, David; Obot, Isidore; Ogunrombi, Adeolu; Sherman, Susan; Stone, Jack; Vallath, Nandini; Vickerman, Peter; Zábranský, Tomáš; Beyrer, Chris
Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of
Globalization is a key challenge facing health policy-makers. A significant dimension of this is trade in health services. Traditionally, the flow of health services exports went from North to South, with patients travelling in the opposite direction. This situation is changing and a number of papers have discussed the growth of health services exports from Southern countries in its different dimensions. Less attention has been paid to assess the real scope of this trade at the global level and its potential impact at the local level. Given the rapid development of this area, there are little empirical data. This paper therefore first built an estimate of the global size and of the growth trend of international trade in health services since 1997, which is compared with several country-based studies. The second purpose of the paper is to demonstrate the significant economic impact of this trade at the local level for the exporting country. We consider the case of health providers in the South-Mediterranean region for which the demand potential, the economic effects and the consequence for the health system are presented. These issues lead to the overall conclusion that different policy options would be appropriate, in relation to the nature of the demand.
Practice, science and governance in interaction: European effort for the system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine.
Stucki, Gerold; Zampolini, Mauro; Juocevicius, Alvydas; Negrini, Stefano; Christodoulou, Nicolas
Since its launch in 2001, relevant international, regional and national PRM bodies have aimed to implement the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine (PRM), whereby contributing to the development of suitable practical tools. These tools are available for implementing the ICF in day-to-day clinical practice, standardized reporting of functioning outcomes in quality management and research, and guiding evidence-informed policy. Educational efforts have reinforced PRM physicians' and other rehabilitation professionals' ICF knowledge, and numerous implementation projects have explored how the ICF is applied in clinical practice, research and policy. Largely lacking though is the system-wide implementation of ICF in day-to-day practice across all rehabilitation services of national health systems. In Europe, system-wide implementation of ICF requires the interaction between practice, science and governance. Considering its mandate, the UEMS PRM Section and Board have decided to lead a European effort towards system-wide ICF implementation in PRM, rehabilitation and health care at large, in interaction with governments, non-governmental actors and the private sector, and aligned with ISPRM's collaboration plan with WHO. In this paper we present the current PRM internal and external policy agenda towards system-wide ICF implementation and the corresponding implementation action plan, while highlighting priority action steps - promotion of ICF-based standardized reporting in national quality management and assurance programs, development of unambiguous rehabilitation service descriptions using the International Classification System for Service Organization in Health-related Rehabilitation, development of Clinical Assessment Schedules, qualitative linkage and quantitative mapping of data to the ICF, and the cultural adaptation of the ICF Clinical Data Collection Tool in European languages.
Richardson, Erica; Malakhova, Irina; Novik, Irina; Famenka, Andrei
This analysis of the Belarusian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2008. Despite considerable change since independence, Belarus retains a commitment to the principle of universal access to health care, provided free at the point of use through predominantly state-owned facilities, organized hierarchically on a territorial basis. Incremental change, rather than radical reform, has also been the hallmark of health-care policy, although capitation funding has been introduced in some areas and there have been consistent efforts to strengthen the role of primary care. Issues of high costs in the hospital sector and of weaknesses in public health demonstrate the necessity of moving forward with the reform programme. The focus for future reform is on strengthening preventive services and improving the quality and efficiency of specialist services. The key challenges in achieving this involve reducing excess hospital capacity, strengthening health-care management, use of evidence-based treatment and diagnostic procedures, and the development of more efficient financing mechanisms. Involving all stakeholders in the development of further reform planning and achieving consensus among them will be key to its success.
Landry, Michel D; Gupta, Neeru; Tepper, Joshua
Internationally educated health professionals (IEHPs) have always been an important part of the Canadian health workforce. A particularly important aspect related to the role of IEHPs is their distribution across different sectors of the healthcare system and various geographical regions. Several provinces and territories have implemented strategies that restrict the initial practice of IEHPs to areas that have long-standing workforce shortages. While the outcomes of these approaches are mixed, some evidence suggests that IEHPs remain in place only as long as their contractual requirements stipulate. However, studies also indicate that IEHPs are increasingly practising in care settings that are perceived to be less attractive by their Canadian-trained counterparts. Whether the contribution of IEHPs is framed in terms of short- or long-term sustainable solutions, their role will continue to be an important component of health service across Canada.
Watson, J.D.; Cook-Deegan, R.M. )
The human genome project is designed to provide common resources for the study of human genetics, and to assist biomedical researchers in their assault on disease. The main benefit will be to provide several kinds of maps of the human genome, and those of other organisms, to permit rapid isolation of genes for further study about DNA structure and function. This article describes genome research programs in developed and developing countries, and the international efforts that have contributed to genome research programs. For example, the large-scale collaborations to study Duchenne's muscular dystrophy, Huntington's disease, Alzheimer's disease, cystic fibrosis involve collaborators from many nations and families spread throughout the world. In the USA, the US Department of Energy was first to start a dedicated genome research program in 1987. Since then, another major government program has begun at the National Center for Human Genome Research of the National Institutes of Health. Italy, China, Australia, France, Canada, and Japan have genome research programs also.
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupational status.The system is financed by the state budget, social insurance contributions and private payments.The largest share of health expenditure constitutes private expenditure, mainly in the form of out of pocket payments which is also the element contributing most to the overall increase in health expenditure. The delivery of health care services is based on both public and private providers. The presence of private providers is more obvious in primary care,especially in diagnostic technologies, private physicians' practices and pharmaceuticals. Despite success in improving the health of the population, the Greek health care system faces serious structural problems concerning the organization, financing and delivery of services. It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits. The high percentage of private expenditure goes against the principle of fair
Abstract International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public–private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries. PMID:22271965
Kusel, J; Oxner, T H
The internal auditor is an important management resource for maintaining control over operations. As the importance of healthcare cost management grows, so does the potential contribution of the internal auditor. A recent study examines what internal auditors do, what backgrounds they have, what salaries they receive, and what their career attitudes are.
Berry, Elliot M; Fatunmbi, Bayo S; Kaluski, Dorit Nitzan
The health of populations is related to the norms and characteristics of society and its socio-economic organization. The causes of food-related ill health are located at the national and international levels and the cure must be sought in good governance. Thus, it is obvious that a Master's Degree in International Public Health must include a thorough overview of the "food chain" from "plough to plate" within the political, economical, socio-economic changes, environmental, industrial, scientific, and health contexts. Nutritional deficiencies are addressed by a variety of measures, including food supply and utilization programs, specific supplementation for high-risk groups, and food fortification to reach a general population. All are part of a wide-based public health nutrition approach, applicable in developed, redeveloping, and newly developing countries. This article is based on experience in teaching Public Health Nutrition to a mixed group of foreign students from different countries. Our goal is to prepare students for a variety of public health careers related to nutrition and health. The aim of this course is to introduce current roles and aspects of food and nutrition policy, focusing on food and nutrition security, human rights for food and nutrition, and the complex interactions among local and global systems. Students are introduced to nutrition screening, assessment, and research skills, and nutrition in emergency situations and in disaster relief. During the course the students learn about the design and the evaluation of nutrition interventions at the individual, community, and national level. The course gives a broad-based examination of major themes related to development and underdevelopment, poverty and wealth, equality and inequality. It also introduces program planning from the perspective of international organisations such as the World Food Program and the Food and Agriculture Organisation and the World Health Organisation of the United
Ringard, Ånen; Sagan, Anna; Sperre Saunes, Ingrid; Lindahl, Anne Karin
Norways five million inhabitants are spread over nearly four hundred thousand square kilometres, making it one of the most sparsely populated countries in Europe. It has enjoyed several decades of high growth, following the start of oil production in early 1970s, and is now one of the richest countries per head in the world. Overall, Norways population enjoys good health status; life expectancy of 81.53 years is above the EU average of 80.14, and the gap between overall life expectancy and healthy life years is around half the of EU average. The health care system is semi decentralized. The responsibility for specialist care lies with the state (administered by four Regional Health Authorities) and the municipalities are responsible for primary care. Although health care expenditure is only 9.4% of Norways GDP (placing it on the 16th place in the WHO European region), given Norways very high value of GDP per capita, its health expenditure per head is higher than in most countries. Public sources account for over 85% of total health expenditure; the majority of private health financing comes from households out-of-pocket payments.The number of practitioners in most health personnel groups, including physicians and nurses, has been increasing in the last few decades and the number of health care personnel per 100 000 inhabitants is high compared to other EU countries. However, long waiting times for elective care continue to be a problem and are cause of dissatisfaction among the patients. The focus of health care reforms has seen shifts over the past four decades. During the 1970s the focus was on equality and increasing geographical access to health care services; during the 1980s reforms aimed at achieving cost containment and decentralizing health care services; during the 1990s the focus was on efficiency. Since the beginning of the millennium the emphasis has been given to structural changes in the delivery and organization of health care and to policies
Staats, Susan; Robertson, Douglas
The Millennium Project is an international effort to improve the health, economic status, and environmental resources of the world's most vulnerable people. Using data associated with the Millennium Project, students use algebra to explore international development issues including poverty reduction and the relationship between health and economy.…
Istepanian, Robert; Laxminarayan, Swamy; Pattichis, Constantinos S.
M-health can be defined as the "emerging mobile communications and network technologies for healthcare systems.' This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. M-Health: Emerging Mobile Health Systems presents a new and forward-looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare scenaria.
Brandt, Jørgen; Silver, Jeremy D.; Christensen, Jesper H.; Andersen, Mikael S.; Bønløkke, Jakob H.; Sigsgaard, Torben; Geels, Camilla; Gross, Allan; Hansen, Ayoe B.; Hansen, Kaj M.; Hedegaard, Gitte B.; Kaas, Eigil; Frohn, Lise M.
An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed, to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North Seas, since special regulatory actions on sulphur emissions, called SECA (sulphur emission control area), have been intro-duced in these areas,. We conclude that despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem to human health, hence the related external costs are considerable. The total health-related external costs for the whole of Europe is estimated at 803 bn Euro/year for the year 2000, decreasing to 537 bn Euro/year in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680,000/year, decreasing to approximately 450,000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulphur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern
García-Armesto, Sandra; Begoña Abadía-Taira, María; Durán, Antonio; Hernández-Quevedo, Cristina; Bernal-Delgado, Enrique
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. This edition of the Spanish HiT focuses on the consequences of the totally devolved status, consolidated in 2002, and the implementation of the road map established by the 2003 SNS Cohesion and Quality Act. Many of the steps already taken underline the improvement path chosen: the SNS Inter-territorial Council (CISNS) comprising the national and regional health ministries was upgraded to the highest SNS authority, paving the way for a brand new consensus-based policy-making process grounded in knowledge management; its effects are progressively starting to be evident. It led the way to the SNS common benefits basket or the SNS human resources policy framework, laying the cornerstones for coordination and the enactment of the SNS Quality Plan. The Plan includes the work in progress to implement the national health information system, the development of a single electronic clinical record (eCR) containing relevant clinical information guaranteeing to patients continuity of care outside their Autonomous Community (AC) of residence or a single patient ID to be used across the country, thus creating the basis for the SNS functional single insurer. It has also become one of the main drivers for the design, implementation and monitoring of quality standards across the SNS, developing national health strategies to tackle both most prevalent chronic diseases (e.g. cancer, cardiovascular diseases, diabetes) and rare diseases, as well as the National Strategy on
Pinzon-Perez, Helda; Kotkin-Jaszi, Suzanne; Perez, Miguel A.
Health policy has a direct impact on health education initiatives, health care delivery, resource allocation, and quality of life. Increasing rates in the epidemics of obesity and obesity-dependent diabetes mellitus (aka diabesity) suggest that health policy changes should be included in health education and disease prevention strategies. Health…
The shrinking size and weight of electronic circuitry has given rise to a new generation of smart clothing that enables biological data to be measured and transmitted. As the variation in the number and type of deployable devices and sensors increases, technology must allow their seamless integration so they can be electrically powered, operated, and recharged over a digital pathway. Nyx Illuminated Clothing Company has developed a lightweight health monitoring system that integrates medical sensors, electrodes, electrical connections, circuits, and a power supply into a single wearable assembly. The system is comfortable, bendable in three dimensions, durable, waterproof, and washable. The innovation will allow astronaut health monitoring in a variety of real-time scenarios, with data stored in digital memory for later use in a medical database. Potential commercial uses are numerous, as the technology enables medical personnel to noninvasively monitor patient vital signs in a multitude of health care settings and applications.
The development of health law as a sovereign subject of law could be seen as a correlative result of the development of international human rights law. From the perspectives of human rights law, health law gives us a unique possibility to change the traditional point of reference - from the regulation of medical procedures, to the protection of human rights as the main objective of law. At the end of the twentieth and the beginning of this century, human rights law and the most influential international instrument--the European Convention on Human Rights (and the jurisprudence of the ECHR) has influenced health care so much that it has became difficult to draw a line between these subjects. Health law sometimes directly influences and even aspires to change the content of Convention rights that are considered to be traditional. However, certain problems of law linked to health law are decided without influencing the essence of rights protected by the Convention, but just by construing the particularities of application of a certain right. In some cases by further developing the requirements of protection of individual rights that are also regulated by the health law, the ECHR even "codifies" some fields of health law (e.g., the rights of persons with mental disorders). The recognition of worthiness and diversity of human rights and the development of their content raise new objectives for national legislators when they regulate the national legal system. Here the national legislator is often put into a quandary whether to implement the standards of human rights that are recognized by the international community, or to refuse to do so, taking account of the interests of a certain group of the electorate.
Banta, David; Jonsson, Egon; Childs, Paul
The International Society for Technology Assessment in Health Care (ISTAHC) was formed in 1985. It grew out of the increasing awareness of the international dimensions of health technology assessment (HTA) and the need for new communication methods at the international level. The main function of ISTAHC was to present an annual conference, which gradually grew in size, and also to generally improve in quality from to year. ISTAHC overextended itself financially early in the first decade of the 2000s and had to cease its existence. A new society, Health Technology Assessment international (HTAi), based on many of the same ideas and people, grew up beginning in the year 2003. The two societies have played a large role in making the field of HTA visible to people around the world and providing a forum for discussion on the methods and role of HTA.
Room, Robin; Reuter, Peter
The Single Convention on Narcotic Drugs in 1961 aimed to eliminate the illicit production and non-medical use of cannabis, cocaine, and opioids, an aim later extended to many pharmaceutical drugs. Over the past 50 years international drug treaties have neither prevented the globalisation of the illicit production and non-medical use of these drugs, nor, outside of developed countries, made these drugs adequately available for medical use. The system has also arguably worsened the human health and wellbeing of drug users by increasing the number of drug users imprisoned, discouraging effective countermeasures to the spread of HIV by injecting drug users, and creating an environment conducive to the violation of drug users' human rights. The international system has belatedly accepted measures to reduce the harm from injecting drug use, but national attempts to reduce penalties for drug use while complying with the treaties have often increased the number of drug users involved with the criminal justice system. The international treaties have also constrained national policy experimentation because they require nation states to criminalise drug use. The adoption of national policies that are more aligned with the risks of different drugs and the effectiveness of controls will require the amendment of existing treaties, the formulation of new treaties, or withdrawal of states from existing treaties and re-accession with reservations.
The article deals with the issues of impact of globalization on population health and public health. The positive and negative aspects of this process are analyzed. The role of international organizations (UN, WHO, UNESCO, ILO, UNISEF) is demonstrated in the area of management of globalization impact on public health of different countries, Russia included.
Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina
Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope
Bellg, Albert J
Long-term health behavior maintenance remains a challenge for patients and health behavior interventionists. Resource-intensive systems of external reinforcement and behavioral cues can support behavior maintenance; an alternative approach is to promote patient internalization and self-regulation of health behaviors. Based in part on organismic internalization theory, self-determination theory, and the experience of patients successful at maintaining health behaviors, the health behavior internalization model (HBIM) is proposed to describe motivational factors associated with internalization processes and hypothesizes that integrated internalization may be associated with long-term health behavior maintenance. The HBIM identifies four self-needs (ownership, self-determination, security, and support) and four behavior-related needs (preference, context, competence, and coping) as motivating health behavior internalization. Behavior change strategies promoting integrated internalization are identified from self-determination theory, motivational interviewing, and transtheoretical model interventions. Other health behavior change constructs are reviewed in relation to internalization processes, and potential limits to the model are discussed.
Saulsberry, Regor; Nichols, Charles; Waller, Jess
Currently there are no integrated NDE methods for baselining and monitoring defect levels in fleet for Composite Overwrapped Pressure Vessels (COPVs) or related fracture critical composites, or for performing life-cycle maintenance inspections either in a traditional remove-and-inspect mode or in a more modern in situ inspection structural health monitoring (SHM) mode. Implicit in SHM and autonomous inspection is the existence of quantitative accept-reject criteria. To be effective, these criteria must correlate with levels of damage known to cause composite failure. Furthermore, implicit in SHM is the existence of effective remote sensing hardware and automated techniques and algorithms for interpretation of SHM data. SHM of facture critical composite structures, especially high pressure COPVs, is critical to the success of nearly every future NASA space exploration program as well as life extension of the International Space Station. It has been clearly stated that future NASA missions may not be successful without SHM . Otherwise, crews will be busy addressing subsystem health issues and not focusing on the real NASA mission
AbouZahr, Carla; Boerma, Ties
Public health decision-making is critically dependent on the timely availability of sound data. The role of health information systems is to generate, analyse and disseminate such data. In practice, health information systems rarely function systematically. The products of historical, social and economic forces, they are complex, fragmented and unresponsive to needs. International donors in health are largely responsible for the problem, having prioritized urgent needs for data over longer-term country capacity-building. The result is painfully apparent in the inability of most countries to generate the data needed to monitor progress towards the Millennium Development Goals. Solutions to the problem must be comprehensive; money alone is likely to be insufficient unless accompanied by sustained support to country systems development coupled with greater donor accountability and allocation of responsibilities. The Health Metrics Network, a global collaboration in the making, is intended to help bring such solutions to the countries most in need. PMID:16184276
Iverson, David L.
The Inductive Monitoring System (IMS) software was developed to provide a technique to automatically produce health monitoring knowledge bases for systems that are either difficult to model (simulate) with a computer or which require computer models that are too complex to use for real time monitoring. IMS uses nominal data sets collected either directly from the system or from simulations to build a knowledge base that can be used to detect anomalous behavior in the system. Machine learning and data mining techniques are used to characterize typical system behavior by extracting general classes of nominal data from archived data sets. IMS is able to monitor the system by comparing real time operational data with these classes. We present a description of learning and monitoring method used by IMS and summarize some recent IMS results.
Aran, Daniel; Laca, Hernán
This paper describes the Uruguayan health system, including its structure and coverage, its financial sources, the level and distribution of its health expenditure, the physical, material and human resources available, its stewardship functions, the institutions in charge of information and research, and the level and type of citizen's participation in the operation and evaluation of the system. The most recent policy innovations are also discussed, including the creation of the National Comprehensive Health System, the National Health Insurance, the National Health Fund and the Comprehensive Health Care Program. Finally, the impact of these innovations in health expenditure, fairness of health financing, coverage levels and main health indicators is analyzed.
Torjesen, Kristine; Olness, Karen
Many published articles and policies describe what should be state of the art in global child health, and there are dozens of large initiatives aimed at implementing these policies. We have knowledge of what should work, yet struggle to effectively implement that knowledge and improve child health outcomes in resource-poor settings, even at the most basic level of ensuring sufficient food and clean water for the world's children. This article highlights many smaller programs that are operational in the field, demonstrating excellence in global child health efforts, and may approach state of the art in actual implementation. The examples include a grass roots primary health care program, a home-based neonatal care program, kangaroo mother care, ready-to-use therapeutic food (RUTF), a vitamin A program, point-of-use water purification, disasters and children, a pain management program, and a developmental disabilities program. This article also discusses the importance of strengthening human resources for health by, for example, training child health professionals in low resource countries. These programs show what can be done and could be replicated in other communities to improve child health, given a few committed individuals and modest resources. Ultimately, truly state of the art health care for children must be defined locally and championed by each state or nation. Nevertheless, there are overarching components and supports that are the responsibility of the global community, particularly those needed to assure that the basic human rights of children, including health, are met throughout the world.
Fidler, D. P.
Global threats to public health in the 19th century sparked the development of international health diplomacy. Many international regimes on public health issues were created between the mid-19th and mid-20th centuries. The present article analyses the global risks in this field and the international legal responses to them between 1851 and 1951, and explores the lessons from the first century of international health diplomacy of relevance to contemporary efforts to deal with the globalization of public health. PMID:11584732
Fraser, Renee White; Shani, Hadasa
Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this second of ten manuals in the International Health Planning Methods Series deals with assessment, planning, and evaluation in the field of environmental health.…
Staff, Robert J.; Porter, Dennis R.
Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this third of ten manuals in the International Health Planning Methods Series deals with health manpower planning and assessment. It provides a conceptual and…
Women's International and Communication Service, Carouge (Switzerland).
Information on women and health from around the world is provided in this guide. So far, no country has formal mechanisms through which women themselves can create the policies and practices so critical to their own health and that of their families. A major purpose of the guide is to assist the many women's initiatives attempting to change this…
Bahia, Ligia; Scheffer, Mario; Tavares, Leandro Reis; Braga, Iale Falleiros
The concentration and internationalization of health plan companies in Brazil gave them a clearly financial face. Based on the need to understand the health care industry's capital accumulation patterns, the current study examines health plan companies' expansion strategies through the classification of their supply and demand characteristics by recent historical periods and an analysis of recent shareholding trends in one of the leading corporations in the Brazilian health care industry. The 1960s to 2000s witnessed changes in the scale of demands for health plans and adherence by companies to long-term accumulation strategies. Beginning in the early 21st century, changes in the shareholding structures of the largest Brazilian company, consistent with the financialization of its accumulation regime, resulted in the rapid multiplication of its capital. Deepening segmentation of the health care system in a context marked by the downturn in the national economy challenges the preservation of public subsidies for private health plans. Resumo: A concentração e internacionalização de empresas de planos de saúde no Brasil conferiram-lhes feição financeira. Considerando a necessidade de compreender os padrões de acumulação desse setor, o trabalho examina estratégias de expansão das empresas de planos de saúde por meio da periodização de atributos da oferta e demanda e exame da trajetória patrimonial recente de um dos grandes grupos do setor. Entre os anos 1960 e 2000, ocorreram alterações na escala das demandas por planos de saúde e adesão das empresas a estratégias de acumulação de longo prazo. A partir do século XXI, as alterações nas estruturas societárias da maior empresa brasileira, compatíveis com o regime de acumulação financeirizada, resultaram na multiplicação de seu capital em um curto intervalo de tempo. O aprofundamento da segmentação do sistema de saúde, em um contexto marcado pela desaceleração da economia, questiona a
Sirintrapun, S Joseph; Artz, David R
This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care.
Sirintrapun, S Joseph; Artz, David R
This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care.
Aldighieri, Sylvain; John, Ronald St.; Becerra-Posada, Francisco; Etienne, Carissa
The World Health Organization’s determination of the Ebola virus disease outbreak as a public health event of international concern prompted nonaffected countries to implement measures to prevent, detect, and manage the introduction of the virus in their territories. The outbreak provided an opportunity to assess the operational implementation of the International Health Regulations’ core capacities and health systems’ preparedness to handle a potential or confirmed case of Ebola virus disease. A public health framework implemented in Latin America and Caribbean countries encompassing preparatory self-assessments, in-country visits, and follow-up suggests that the region should increase efforts to consolidate and sustain progress on core capacities and health system preparedness to face public health events with national or international repercussions. PMID:26691130
McLean, R A
Fundamental changes in domestic healthcare delivery in the '90s have prompted many U.S. healthcare organizations to consider entering international markets. Opportunities available to U.S. organizations include investing in foreign organizations, controlling foreign facilities, and obtaining referrals from extraterritorial or cooperating foreign providers. Before entering into these arrangements, however, organizations must consider the benefits, risks, and constraints they may face, specifically with regard to reimbursement and cash flow, currency risk, regulation, and political risk. To succeed in international service delivery ventures, organizations also may need to make adjustments in the training of healthcare financial managers who will face the international marketplace. Being sensitive to the culture of the countries with which they will be dealing is just as important as knowing the currency and financial regulations.
Bean, N. H.; Martin, S. M.
Electronic data reporting from public health laboratories to a central site provides a mechanism for public health officials to rapidly identify problems and take action to prevent further spread of disease. However, implementation of reference laboratory systems is much more complex than simply adopting new technology, especially in international settings. We describe three major areas to be considered by international organizations for successful implementation of electronic reporting systems from public health reference laboratories: benefits of electronic reporting, planning for system implementation (e.g., support, resources, data analysis, country sovereignty), and components of system initiation (e.g., authority, disease definition, feedback, site selection, assessing readiness, problem resolution). Our experience with implementation of electronic public health laboratory data management and reporting systems in the United States and working with international organizations to initiate similar efforts demonstrates that successful reference laboratory reporting can be implemented if surveillance issues and components are planned. PMID:11747687
Pratt, Bridget; Loff, Bebe
Health research has been identified as a vehicle for advancing global justice in health. However, in bioethics, issues of global justice are mainly discussed within an ongoing debate on the conditions under which international clinical research is permissible. As a result, current ethical guidance predominantly links one type of international research (biomedical) to advancing one aspect of health equity (access to new treatments). International guidelines largely fail to connect international research to promoting broader aspects of health equity - namely, healthier social environments and stronger health systems. Bioethical frameworks such as the human development approach do consider how international clinical research is connected to the social determinants of health but, again, do so to address the question of when international clinical research is permissible. It is suggested that the narrow focus of this debate is shaped by high-income countries' economic strategies. The article further argues that the debate's focus obscures a stronger imperative to consider how other types of international research might advance justice in global health. Bioethics should consider the need for non-clinical health research and its contribution to advancing global justice.
Sykes, Catherine R
This commentary provides some reactions to the rehabilitation treatment taxonomy project in relation to work already underway to develop an International Classification of Health Interventions. This commentary also includes some comments in response to questions posed by the authors.
Montgomery, Judy K.
This article presents an interview with Dr. Dolores E. Battle, a professor of speech-language pathology and senior advisor to the president for equity and campus diversity at Buffalo State College. She is a former president of the American Speech-Language-Hearing Association (in 2005) and a very active member of international organizations of both…
Fischer, Peter; Ai, Amy L.
International terrorism has become a major global concern. Several studies conducted in North America and Europe in the aftermath of terrorist attacks reveal that international terrorism represents a significant short-term and long-term threat to mental health. In the present article, the authors clarify the concept and categories of terrorism and…
Hansson, Annika; Clausson, Eva; Janlov, Ann-Christin
Rapid globalization and the integration of national economies have contributed to the sharp rise in enrollment in international schools. How does this global nomadism affect international school children and their individual health needs? This study attempts to find an answer by interviewing 10 school nurses, with varying degrees of experience in…
Scaroni, E; Riccardo, F; De Rosa, A G; Russo, G; Pacini, A; Nardi, L; Pacifici, L E
Both medical doctors and humanitarian operators engaged in health relief or development missions abroad, are called to respect the general principles of international law, that is to say, customary law that is legally compulsory for the International Community and rules deriving from Treaties and International Conventions. Humanitarian operators have to observe also the rules and regulations of the hosting country. They have to respect all rules applying to their humanitarian action and they have to take responsibility towards beneficiaries and donors alike.
Aluttis, Christoph; Bishaw, Tewabech; Frank, Martina W.
The ‘crisis in human resources’ in the health sector has been described as one of the most pressing global health issues of our time. The World Health Organization (WHO) estimates that the world faces a global shortage of almost 4.3 million doctors, midwives, nurses, and other healthcare professionals. A global undersupply of these threatens the quality and sustainability of health systems worldwide. This undersupply is concurrent with globalization and the resulting liberalization of markets, which allow health workers to offer their services in countries other than those of their origin. The opportunities of health workers to seek employment abroad has led to a complex migration pattern, characterized by a flow of health professionals from low- to high-income countries. This global migration pattern has sparked a broad international debate about the consequences for health systems worldwide, including questions about sustainability, justice, and global social accountabilities. This article provides a review of this phenomenon and gives an overview of the current scope of health workforce migration patterns. It further focuses on the scientific discourse regarding health workforce migration and its effects on both high- and low-income countries in an interdependent world. The article also reviews the internal and external factors that fuel health worker migration and illustrates how health workforce migration is a classic global health issue of our time. Accordingly, it elaborates on the international community's approach to solving the workforce crisis, focusing in particular on the WHO Code of Practice, established in 2010. PMID:24560265
Aluttis, Christoph; Bishaw, Tewabech; Frank, Martina W
The 'crisis in human resources' in the health sector has been described as one of the most pressing global health issues of our time. The World Health Organization (WHO) estimates that the world faces a global shortage of almost 4.3 million doctors, midwives, nurses, and other healthcare professionals. A global undersupply of these threatens the quality and sustainability of health systems worldwide. This undersupply is concurrent with globalization and the resulting liberalization of markets, which allow health workers to offer their services in countries other than those of their origin. The opportunities of health workers to seek employment abroad has led to a complex migration pattern, characterized by a flow of health professionals from low- to high-income countries. This global migration pattern has sparked a broad international debate about the consequences for health systems worldwide, including questions about sustainability, justice, and global social accountabilities. This article provides a review of this phenomenon and gives an overview of the current scope of health workforce migration patterns. It further focuses on the scientific discourse regarding health workforce migration and its effects on both high- and low-income countries in an interdependent world. The article also reviews the internal and external factors that fuel health worker migration and illustrates how health workforce migration is a classic global health issue of our time. Accordingly, it elaborates on the international community's approach to solving the workforce crisis, focusing in particular on the WHO Code of Practice, established in 2010.
... 45 CFR Part 147 Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims... Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External... internal claims and appeals and external review processes for group health plans and health...
Stucki, Gerold; Bickenbach, Jerome; Melvin, John
A complete understanding of the experience of health requires information relevant not merely to the health indicators of mortality and morbidity but also to functioning-that is, information about what it means to live in a health state, "the lived experience of health." Not only is functioning information relevant to healthcare and the overall objectives of person-centered healthcare but to the successful operation of all components of health systems.In light of population aging and major epidemiological trends, the health strategy of rehabilitation, whose aim has always been to optimize functioning and minimize disability, will become a key health strategy. The increasing prominence of the rehabilitative strategy within the health system drives the argument for the integration of functioning information as an essential component in national health information systems.Rehabilitation professionals and researchers have long recognized in WHO's International Classification of Functioning, Disability and Health the best prospect for an internationally recognized, sufficiently complete and powerful information reference for the documentation of functioning information. This paper opens the discussion of the promise of integrating the ICF as an essential component in national health systems to secure access to functioning information for rehabilitation, across health systems and countries.
Auer, Annella; Guerrero Espinel, Juan Eduardo
A constantly changing and increasingly complex global environment requires leaders with special competencies to respond effectively to this scenario. Within this context, the Pan American Health Organization (PAHO) goes beyond traditional leadership training models both in terms of its design as well as its conceptual approach to international health. As an intergovernmental, centenary organization in health, PAHO allows participants a unique vantage point from which to conceptualize, share experiences and develop projects relevant to international health. Derived from over two decades of experience (1985-2006) training professionals through its predessor Training Program in International Health, the Leaders in International Health Program "Edmundo Granda Ugalde" (LIHP) utilizes an innovative design, virtual and practical learning activities, and a problem-based approach to analyze the main concepts, theories, actors, forces, and processes relevant to international health. In collaboration with PAHO/WHO Representative Offices and national institutions, participants develop country projects based on priority health issues, many of which are integrated into the Organization's technical cooperation and/or implemented by relevant ministries and other entities in their respective countries/subregions. A total of 185 participants representing 31 countries have participated in the LIHP since its inception in 2008, building upon the 187 trained through its predecessor. These initiatives have contributed to the development of health professionals in the Region of the Americas devoted to international health, as well as provided important input towards a conceptual understanding of international health by fostering debate on this issue.
Muiser, Jorine; Sáenz, María del Rocío; Bermúdez, Juan Luis
This paper describes the health conditions in Nicaragua and discusses the characteristics of its national health system including its structure and coverage, its financial sources its physical, material and human resources the stewardship functions developed by the Ministry of Health the participation of citizens in the operation and evaluation of the system and the level of satisfaction of health care users. It also discusses the most recent policy innovations, including the new General Health Law, the decentralization of the regulation of health facilities and the design and implementation of a new health care model known as Family and Community Health Model.
Ooms, Gorik; Hammonds, Rachel; Waris, Attiya; Criel, Bart; Van Damme, Wim; Whiteside, Alan
It has been argued that the international community is moving 'beyond aid'. International co-financing in the international collective interest is expected to replace altruistically motivated foreign aid. The World Health Organization promotes 'universal health coverage' as the overarching health goal for the next phase of the Millennium Development Goals. In order to provide a basic level of health care coverage, at least some countries will need foreign aid for decades to come. If international co-financing of global public goods is replacing foreign aid, is universal health coverage a hopeless endeavor? Or would universal health coverage somehow serve the international collective interest?Using the Sustainable Development Solutions Network proposal to finance universal health coverage as a test case, we examined the hypothesis that national social policies face the threat of a 'race to the bottom' due to global economic integration and that this threat could be mitigated through international social protection policies that include international cross-subsidies - a kind of 'equalization' at the international level.The evidence for the race to the bottom theory is inconclusive. We seem to be witnessing a 'convergence to the middle'. However, the 'middle' where 'convergence' of national social policies is likely to occur may not be high enough to keep income inequality in check.The implementation of the international equalization scheme proposed by the Sustainable Development Solutions Network would allow to ensure universal health coverage at a cost of US$55 in low income countries-the minimum cost estimated by the World Health Organization. The domestic efforts expected from low and middle countries are far more substantial than the international co-financing efforts expected from high income countries. This would contribute to 'convergence' of national social policies at a higher level. We therefore submit that the proposed international equalization scheme
It has been argued that the international community is moving ‘beyond aid’. International co-financing in the international collective interest is expected to replace altruistically motivated foreign aid. The World Health Organization promotes ‘universal health coverage’ as the overarching health goal for the next phase of the Millennium Development Goals. In order to provide a basic level of health care coverage, at least some countries will need foreign aid for decades to come. If international co-financing of global public goods is replacing foreign aid, is universal health coverage a hopeless endeavor? Or would universal health coverage somehow serve the international collective interest? Using the Sustainable Development Solutions Network proposal to finance universal health coverage as a test case, we examined the hypothesis that national social policies face the threat of a ‘race to the bottom’ due to global economic integration and that this threat could be mitigated through international social protection policies that include international cross-subsidies – a kind of ‘equalization’ at the international level. The evidence for the race to the bottom theory is inconclusive. We seem to be witnessing a ‘convergence to the middle’. However, the ‘middle’ where ‘convergence’ of national social policies is likely to occur may not be high enough to keep income inequality in check. The implementation of the international equalization scheme proposed by the Sustainable Development Solutions Network would allow to ensure universal health coverage at a cost of US$55 in low income countries-the minimum cost estimated by the World Health Organization. The domestic efforts expected from low and middle countries are far more substantial than the international co-financing efforts expected from high income countries. This would contribute to ‘convergence’ of national social policies at a higher level. We therefore submit that the proposed
Murphy, Jeannette; Jargin, Serge
This is the last in a series of articles exploring international trends in health science librarianship in the 21st century. The focus of the present issue is Russia. The next feature column will initiate a new series entitled New Directions in Health Science Librarianship. The first contribution will be from Australia. JM.
Peters, Michael A.; Drummond, John S.
This article introduces and explores the concept of political economy. In particular it focuses upon the political economy of health while also considering the implications for international nursing studies in the context of health care more generally. Political economy is not only about budgets, resources and policy. It is also about particular…
Perkowski, Patryk; Rodberg, Leonard
Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries.
Hutchinson, Paul; Morelli, Vincent
Health care globally has made great strides; for example, there are lower rates of infant and maternal mortality. Increased incomes have led to lower rates of diseases accompanying poverty and hunger. There has been a shift away from the infectious diseases so deadly in developing nations toward first-world conditions. This article presents health care statistics across age groups and geographic areas to help the primary care physician understand these changes. There is a special focus on underserved populations. New technologies in health and health care spending internationally are addressed, emphasizing universal health care. The article concludes with recommendations for the future.
Medical Education credit as follows: Physicians @ 15.5 hours, Category 1, Dentists and Dental Hygienists @ 15.5 hours, Nurses @ 16.5 hours. 5...Homeless� and �Telemedicine in the Desert.� Included were sessions on oral health, radiology/mammography, mobile medical/ dental vehicle design...records within the mobile medical environment. Evidenced based medicine sessions were offered by providers of both urban and rural medical and dental
Page, Chester H., Ed.; Vigoureux, Paul, Ed.
This document gives definitions and symbols for the basic units of measure, for derived units, and for supplementary units. Decimal multiples and sub-multiples of units and units outside the International System also are discussed. Appendix I reproduces the decisions made on units and on the International System by two committees (the General…
Background: Mobile phones and other technologies are widely used in health programming in developing countries, many introduced by international nongovernmental organizations (INGOs) to accelerate data collection. This research examined: How are INGOs adopting the innovation of mobile technology into M&E systems for health care programs in…
Sinclair, Lisa Bundara; Fox, Michael H; Betts, Donald R
This article describes use of the International Classification of Functioning, Disability and Health (ICF) as a tool for strategic planning. The ICF is the international classification system for factors that influence health, including Body Structures, Body Functions, Activities and Participation and Environmental Factors. An overview of strategic planning and the ICF are provided. Selected ICF concepts and nomenclature are used to demonstrate its utility in helping develop a classic planning framework, objectives, measures and actions. Some issues and resolutions for applying the ICF are described. Applying the ICF for strategic health planning is an innovative approach that fosters the inclusion of social ecological health determinants and broad populations. If employed from the onset of planning, the ICF can help public health organizations systematically conceptualize, organize and communicate a strategic health plan.
Parkinson, Clive; White, Mike
This paper considers how participatory arts informed by thinking in public health can play a significant part internationally in addressing inequalities in health. It looks beyond national overviews of arts and health to consider what would make for meaningful international practice, citing recent initiatives of national networks in English-speaking countries and examples of influential developments in South America and the European Union. In the context of public health thinking on inequalities and social justice, the paper posits what would make for good practice and appropriate research that impacts on policy. As the arts and health movement gathers momentum, the paper urges the arts to describe their potency in the policy-making arena in the most compelling ways to articulate their social, economic and cultural values. In the process, it identifies the reflexive consideration of participatory practice – involving people routinely marginalised from decision-making processes – as a possible avenue into this work. PMID:25729409
Wibulpolprasert, Suwit; Pachanee, Cha-aim; Pitayarangsarit, Siriwan; Hempisut, Pintusorn
This study aims at analysing the impact of international service trade on the health care system, particularly in terms of human resources for health (HRH), using Thailand as a case study. Information was gathered through a literature review and interviews of relevant experts, as well as a brainstorming session. It was found that international service trade has greatly affected the Thai health care system and its HRH. From 1965 to 1975 there was massive emigration of physicians from Thailand in response to increasing demand in the United States of America. The country lost about 1,500 physicians, 20% of its total number, during that period. External migration of health professionals occurred without relation to agreements on trade in services. It was also found that free trade in service sectors other than health could seriously affect the health care system and HRH. Free trade in financial services with free flow of low-interest foreign loans, which started in 1993 in Thailand, resulted in the mushrooming of urban private hospitals between 1994 and 1997. This was followed by intensive internal migration of health professionals from rural public to urban private hospitals. After the economic crisis in 1997, with the resulting downturn of the private health sector, reverse brain drain was evident. At the same time, foreign investors started to invest in the bankrupt private hospitals. Since 2001, the return of economic growth and the influx of foreign patients have started another round of internal brain drain. PMID:15225376
This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non-binding or so-called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law. In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.
Nikogosian, Haik; Kickbusch, Ilona
Public health instruments have been under constant development and renewal for decades. International legal instruments, with their binding character and strength, have a special place in this development. The start of the 21st century saw, in particular, the birth of the first World Health Organization (WHO)-era health treaties – the WHO Framework Convention on Tobacco Control (WHO FCTC) and its first Protocol. The authors analyze the potential impact of these instruments on global health governance and public health, beyond the traditional view of their impact on tobacco control. Overall, the very fact that globally binding treaties in modern-era health were feasible has accelerated the debate and expectations for an expanded role of international legal regimes in public health. The impact of treaties has also been notable in global health architecture as the novel instruments required novel institutions to govern their implementation. The legal power of the WHO FCTC has enabled rapid adoption of further instruments to promote its implementation, thus, enhancing the international instrumentarium for health, and it has also prompted stronger role for national legislation on health. Notably, the Convention has elevated several traditionally challenging public health features to the level of international legal obligations. It has also revealed how the legal power of the international health instrument can be utilized in safeguarding the interests of health in the face of competing agendas and legal disputes at both the domestic and international levels. Lastly, the legal power of health instruments is associated with their potential impact not only on health but also beyond; the recently adopted Protocol to Eliminate Illicit Trade in Tobacco Products may best exemplify this matter. The first treaty experiences of the 21st century may provide important lessons for the role of legal instruments in addressing the unfolding challenges in global health. PMID:28005547
Burkle, Frederick M
failed treaty management, the slow and incomplete process of reform, the magnitude and complexity of infectious disease outbreaks, and the rising severity of public health emergencies, a recommitment must be made to complete and restore the original mandates as a collaborative and coordinated global network responsibility, not one left to the actions of individual countries. The bottom line is that the global community can no longer tolerate an ineffectual and passive international response system. As such, this Treaty has the potential to become one of the most effective treaties for crisis response and risk reduction worldwide. Practitioners and health decision-makers worldwide must break their silence and advocate for a stronger Treaty and a return of WHO authority.
Paviot, Béatrice Trombert; Madden, Richard; Moskal, Lori; Zaiss, Albrecht; Bousquet, Cédric; Kumar, Anand; Lewalle, Pierre; Rodrigues, Jean Marie
: The WHO International Classification of Diseases is used in many national applications to plan, manage and fund through case mix health care systems and allows international comparisons of the performance of these systems. There is no such measuring tool for health interventions or procedures. To fulfil this requirement the WHO-FIC Network recommended in 2006 to develop an International Classification of Health Interventions (ICHI). This initiative is aimed to harmonise the existing national classifications and to provide a basic system for the countries which have not developed their own classification systems. It is based on the CEN/ISO ontology framework standard named Categorial Structure defined from a non formal bottom up ontology approach. The process of populating the framework is ongoing to start from a common model structure encompassing the ICD 9CM Volume 3 granularity.
Buss, Paulo Marchiori; Chamas, Claudia; Faid, Miriam; Morel, Carlos
This text main objective is to discuss development and health from the perspective of the influence of global health governance, using as the tracer the dimension of research, development, and innovation policies in health, which relate to both important inputs for the health system, like drugs and medicines, vaccines, diagnostic reagents, and equipment, and innovative concepts and practices for the improvement of health systems and public health. The authors examine the two main macro-processes that influence development and health: the post-2015 Development Agenda and the process under way in the World Health Organization concerning research and development, intellectual property, and access to health inputs. The article concludes, first, that much remains to be done for the Agenda to truly represent a coherent and viable international political pact, and that the two macro-processes related to innovation in health need to be streamlined. But this requires democratization of participation by the main stakeholders - patients and the general population of the poorest countries - since this is the only way to overcome a "zero sum" result in the clash in the current debates among member State representatives. Resumo: O objetivo central deste texto é discutir desenvolvimento e saúde sob a ótica da influência da governança da saúde global, utilizando como traçador a dimensão das políticas de pesquisa, desenvolvimento e inovação em saúde, que se referem, de um lado, a insumos importantes para o sistema de saúde - como fármacos e medicamentos, vacinas, reativos para diagnóstico e equipamentos e, de outro, a conceitos e práticas inovadoras para o aperfeiçoamento dos sistemas de saúde e da saúde pública. Examina os dois principais macroprocessos que influenciam o desenvolvimento e a saúde: a Agenda do Desenvolvimento para o pós-2015 e o processo sobre pesquisa e desenvolvimento, propriedade intelectual e acesso a insumos em saúde em curso na Organiza
Guerrero, Ramiro; Gallego, Ana Isabel; Becerril-Montekio, Victor; Vásquez, Johanna
This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes.
Lucio, Ruth; Villacrés, Nilhda; Henríquez, Rodrigo
This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.
Alcalde-Rabanal, Jacqueline Elizabeth; Lazo-González, Oswaldo; Nigenda, Gustavo
This paper describes the health conditions in Peru and, with greater detail, the Peruvian health system, including its structure and coverage, its financial sources, its physical, material and human resources, and its stewardship functions. It also discusses the activities developed in the information and research areas, as well as the participation of citizens in the operation and evaluation of the health system. The article concludes with a discussion of the most recent innovations, including the Comprehensive Health Insurance, the Health Care Enterprises system, the decentralization process and the Local Committees for Health Administration. The main challenge confronted by the Peruvian health system is the extension of coverage to more than I0% of the population presently lacking access to basic health care.
Stromberg, Bert E; Gasbarre, Louis C; Ballweber, Lora R; Dargatz, David A; Rodriguez, Judith M; Kopral, Christine A; Zarlenga, Dante S
During the United States Department of Agriculture (USDA) National Animal Health Monitoring System's (NAHMS) 2007-2008 beef study, 567 producers from 24 US States were offered the opportunity to collect fecal samples from weaned beef calves and have them evaluated for the presence of parasite eggs (Phase 1). Participating producers were provided with instructions and materials for sample collection. Up to 20 fresh fecal samples were collected from each of the 99 participating operations. Fresh fecal samples were submitted to one of 3 randomly assigned laboratories for evaluation. Upon arrival at the laboratories, all samples were processed for the enumeration of strongyle, Nematodirus, and Trichuris eggs using the modified Wisconsin technique. The presence or absence of coccidian oocysts and tapeworm eggs was also noted. In submissions where the strongyle eggs per gram exceeded 30, aliquots from 2 to 6 animals were pooled for DNA extraction. Extracted DNA was subjected to genus level polymerase chain reaction (PCR) identification for the presence of Ostertagia, Cooperia, Haemonchus, Oesophagostomum, and Trichostrongylus. In this study, 85.6% of the samples had strongyle type, Nematodirus, and Trichuris eggs. Among the samples evaluated, 91% had Cooperia, 79% Ostertagia, 53% Haemonchus, 38% Oesophagostomum, 18% Nematodirus, 7% Trichuris, and 3% Trichostrongylus. The prevalence of coccidia and tapeworm eggs was 59.9% and 13.7%, respectively.
In this article, the author talks about an internal content management system that they have created at Calvin College. It is a hybrid of CMS and intranet that organizes Web site content and a variety of internal tools to help librarians complete their daily tasks. Hobbes is a Web-based tool that uses Common Gateway Interface (CGI) scripts written…
Aims of the study This study wants to examine the availability of Belgian healthcare data in the three main international health databases: the World Health Organization European Health for All Database (WHO-HFA), the Organisation for Economic Co-operation and Development Health Data 2009 and EUROSTAT. Methods For the indicators present in the three databases, the availability of Belgian data and the source of these data were checked. Main findings The most important problem concerning the availability of Belgian health-related data in the three major international databases is the lack of recent data. Recent data are available for 27% of the indicators of the WHO-HFA database, 73% of the OECD Health Data, and for half of the Eurostat indicators. Especially recent data about health status (including mortality-based indicators) are lacking. Discussion Only the availability of the health-related data is studied in this article. The quality of the Belgian data is however also important to examine. The main problem concerning the availability of health data is the timeliness. One of the causes of this lack of (especially mortality) data is the reform of the Belgian State. Nowadays mortality data are provided by the communities. This results in a delay in the delivery of national mortality data. However several efforts are made to catch up. PMID:22958554
Birn, A E
Over the last decades women have become central to international health efforts, but most international health agencies continue to focus narrowly on the maternal and reproductive aspects of women's health. This article explores the origins of this paradigm as demonstrated in the emergence of women's health in the Rockefeller Foundation's public health programs in Mexico in the 1920s and 1930s. These efforts bore a significant reproductive imprint; women dispensed and received services oriented to maternal and childbearing roles. Women's health and social advocacy movements in Mexico and the United States partially shaped this interest. Even more important, the emphasis on women in the Rockefeller programs proved an expedient approach to the Foundation's underlying goals: promoting bacteriologically based public health to the government, medical personnel, business interests, and peasants; helping legitimize the Mexican state; and transforming Mexico into a good political and commercial neighbor. The article concludes by showing the limits to the maternal and reproductive health model currently advocated by most donor agencies, which continue to skirt--or sidestep--major concerns that are integral to the health of women. Images p400-a p401-a p402-a p403-a PMID:10076494
Sturtevant, Jessica L; Anema, Aranka; Brownstein, John S
Global public health surveillance is critical for the identification and prevention of emerging and reemerging infectious diseases. The World Health Organization recently released revised International Health Regulations (IHR) that serve as global legislation and provide guidelines for surveillance systems. The IHR aim to identify and prevent spread of these infectious diseases; however, there are some practical challenges that limit the usability of these regulations. IHR requires Member States to build necessary infrastructure for global surveillance, which may not be possible in underdeveloped countries. A large degree of freedom is given to each individual government and therefore different levels of reporting are common, with substantial emphasis on passive reporting. The IHR need to be enforceable and enforced without impinging on government autonomy or human rights. Unstable governments and developing countries require increased assistance in setting up and maintaining surveillance systems. This article addresses some challenges and potential solutions to the ability of national governments to adhere to the global health surveillance requirements detailed in the IHR. The authors review some practical challenges such as inadequate surveillance and reporting infrastructure, and legal enforcement and maintenance of individual human rights.
Gómez Dantés, Octavio; Sesma, Sergio; Becerril, Victor M; Knaul, Felicia M; Arreola, Héctor; Frenk, Julio
This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women: diabetes, ischaemic heart disease, cerebrovascular diseases and cancer. Part two is devoted to the description of the basic structure of the system: its main institutions, the population coverage, the health benefits of those affiliated to the different heath institutions, its financial sources, the levels of financial protection in health, the availability of physical, material and human resources for health, and the stewardship functions displayed by the Ministry of Health and other actors. This part also discusses the role of citizens in the monitorization and evaluation of the health system, as well as the levels of satisfaction with the rendered health services. In part three the most recent innovations and its impact on the performance of the health system are discussed. Salient among them are the System of Social Protection in Health and the Popular Health Insurance. The paper concludes with a brief analysis of the short- and middle-term challenges faced by the Mexican health system.
Sobrino Toro, M; Riaño Galan, I; Bassat, Q; Perez-Lescure Picarzo, J; de Aranzabal Agudo, M; Krauel Vidal, X; Rivera Cuello, M
The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters.
Wagstaff, A; van Doorslaer, E; van der Burg, H; Calonge, S; Christiansen, T; Citoni, G; Gerdtham, U G; Gerfin, M; Gross, L; Häkinnen, U; Johnson, P; John, J; Klavus, J; Lachaud, C; Lauritsen, J; Leu, R; Nolan, B; Perán, E; Pereira, J; Propper, C; Puffer, F; Rochaix, L; Rodríguez, M; Schellhorn, M; Winkelhake, O
This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.
Pincus, Harold Alan; Jun, Miraya; Franx, Gerdien; van der Feltz-Cornelis, Christina; Ito, Hiroto; Mossialos, Elias
A range of integration models for providing effective care to individuals with comorbid general medical and behavioral health conditions have been described and tested in varied settings internationally for several subsets of this population. This column examines models in three countries selected to showcase implementation in a variety of health systems: the national health system in England, nationally regulated individual insurance market in the Netherlands, and a mixture of employer-sponsored and government-funded health insurance plans in Japan. The authors describe a set of key practices for and challenges to the successful implementation of these models.
Cylus, Jonathan; Richardson, Erica; Findley, Lisa; Longley, Marcus; O'Neill, Ciaran; Steel, David
This analysis of the United Kingdom health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. It provides an overview of how the national health services operate in the four nations that make up the United Kingdom, as responsibility for organizing health financing and services was devolved from 1997. With devolution, the health systems in the United Kingdom have diverged in the details of how services are organized and paid for, but all have maintained national health services which provide universal access to a comprehensive package of services that are mostly free at the point of use. These health services are predominantly financed from general taxation and 83.5% of total health expenditure in the United Kingdom came from public sources in 2013. Life expectancy has increased steadily across the United Kingdom, but health inequalities have proved stubbornly resistant to improvement, and the gap between the most deprived and the most privileged continues to widen, rather than close. The United Kingdom faces challenges going forward, including how to cope with the needs of an ageing population, how to manage populations with poor health behaviours and associated chronic conditions, how to meet patient expectations of access to the latest available medicines and technologies, and how to adapt a system that has limited resources to expand its workforce and infrastructural capacity so it can rise to these challenges.
Giblin, Timothy W.
ISS Program Mission: Safely build, operate, and utilize a permanent human outpost in space through an international partnership of government, industry, and academia to advance exploration of the solar system, conduct scientific research, and enable commerce in space.
Ugalde, A; Jackson, J T
In 1993, the World Bank released the World Development Report: Investing in Health, its public statement of what it believes to be sound international health policy. This paper critically examines the report with regard to the applicability of its recommendations to the Third World. It looks at the World Bank and its critics, the Bank's view of development, the globalization of health policy making, and profits for multinationals. Report recommendations on privatization, decentralization, cost recovery fees, nutrition, and essential drug programs are analyzed, with the authors concluding that the World Bank's approach to health fits its ideologically-driven development model which favors Northern nations at the expense of the South. Moreover, the DALY index has major theoretical flaws and is of little value as a guide to health policy makers. The index could be used to deny essential health services to the poor in developing countries.
Ostry, A S
The World Trade Organization (WTO) creates new challenges for the Canadian health care system, arguably one of the most "socialized" systems in the world today. In particular, the WTO's enhanced trade dispute resolution powers, enforceable with sanctions, may make Canadian health care vulnerable to corporate penetration, particularly in the pharmaceutical and private health services delivery sectors. The Free Trade Agreement and its extension, the North American Free Trade Agreement, gave multinational pharmaceutical companies greater freedom in Canada at the expense of the Canadian generic drug industry. Recent challenges by the WTO have continued this process, which will limit the health care system's ability to control drug costs. And pressure is growing, through WTO's General Agreement on Trade in Services and moves by the Alberta provincial government to privatize health care delivery, to open up the Canadian system to corporate penetration. New WTO agreements will bring increasing pressure to privatize Canada's public health care system and limit government's ability to control pharmaceutical costs.
Bennett, Belinda; Carney, Terry
The declaration in 2009 that the H1N1 pandemic constituted a public health emergency of international concern (PHEIC) was the first such declaration under the revised International Health Regulations that were adopted in 2005. In the period since then PHEIC have been declared in relation to polio, Ebola, and Zika. This article evaluates initiatives that have been introduced globally, within the Asia-Pacific region, and within Australia, to strengthen preparedness for public health emergencies. Through analysis of evolving conceptualisations of risk, surveillance of zoonotic diseases, and development of public health capacities, the article argues that to date the global community has failed to make the necessary investments in health system strengthening, and that without these investments, global public health emergencies will continue to be an ongoing challenge.
The economic depression of the 1930s represented the most important economic and social crisis of its time. Surprisingly, its effect on health did not show in available morbidity and mortality rates. In 1932, the League of Nations Health Organisation embarked on a six-point program addressing statistical methods of measuring the effect and its influence on mental health and nutrition and establishing ways to safeguard public health through more efficient health systems. Some of these studies resulted in considerations of general relevance beyond crisis management. Unexpectedly, the crisis offered an opportunity to reconsider key concepts of individual and public health.
Hall, David R.; Sneddon, Cameron; Dahlgren, Scott Steven; Briscoe, Michael A.
The invention is a seal system for a coaxial cable and is placed within the coaxial cable and its constituent components. A series of seal stacks including load ring components and elastomeric rings are placed on load bearing members within the coaxial cable sealing the annular space between the coaxial cable and an electrical contact passing there through. The coaxial cable is disposed within drilling components to transmit electrical signals between drilling components within a drill string. The seal system can be used in a variety of downhole components, such as sections of pipe in a drill string, drill collars, heavy weight drill pipe, and jars.
Alvarez, Luz Stella; Salmon, J Warren; Swartzman, Dan
In 1993, the Colombian government sought to reform its health care system under the guidance of international financial institutions (the World Bank and International Monetary Fund). These institutions maintain that individual private health insurance systems are more appropriate than previously established national public health structures for overcoming inequities in health care in developing countries. The reforms carried out following international financial institution guidelines are known as "neoliberal reforms." This qualitative study explores consumer health choices and associated factors, based on interviews with citizens living in Medellin, Colombia, in 2005-2006. The results show that most study participants belonging to low-income and middle-income strata, even with medical expense subsidies, faced significant barriers to accessing health care. Only upper-income participants reported a selection of different options without barriers, such as complementary and alternative medicines, along with private Western biomedicine. This study is unique in that the informal health system is linked to overall neo-liberal policy change.
Jaspers, M W; Gardner, R M; Gatewood, L C; Haux, R; Leven, F J; Limburg, M; Ravesloot, J H; Schmidt, D; Wetter, T
Medical informatics contributes significantly to high quality and efficient health care and medical research. The need for well educated professionals in the field of medical informatics therefore is now worldwide recognized. Students of medicine, computer science/informatics are educated in the field of medical informatics and dedicated curricula on medical informatics have emerged. To advance and further develop the beneficial role of medical informatics in the medical field, an international orientation of health and medical informatics students seems an indispensable part of their training. An international orientation and education of medical informatics students may help to accelerate the dissemination of acquired knowledge and skills in the field and the promotion of medical informatics research results on a more global level. Some years ago, the departments of medical informatics of the university of Heidelberg/university of applied sciences Heilbronn and the university of Amsterdam decided to co-operate in the field of medical informatics. Now, this co-operation has grown out to an International Partnership of Health Informatics Education (IPHIE) of 5 universities, i.e. the university of Heidelberg, the university of Heilbronn, the university of Minnesota, the university of Utah and the university of Amsterdam. This paper presents the rationale behind this international partnership, the state of the art of the co-operation and our future plans for expanding this international co-operation.
The Pegasus Coating Removal System (PCRS) was demonstrated at Florida International University (FIU) where it was being evaluated for efficiency and cost. In conjunction with the FIU testing demonstration, a human factors assessment was conducted to assess the hazards and associated safety and health issues of concern for workers utilizing this technology. The PCRS is a chemical paste that is applied to the surface using a brush, roller, or airless sprayer. After the type of PCRS, thickness, and dwell time have been determined, a laminated backed material is placed on top of the chemical paste to slow down the drying process and to provide a mechanism to strip-off the chemical. After the dwell time is reached, the chemical substrate can be removed. Scrapers may be used to break-loose the layers as necessary or to break-loose the layers that are not removed when the laminated paper is picked up. Residue may also be cleaned off of the surface with a damp sponge with an agitating motion, absorbent sponges, or a vacuum, as needed. The paint and removal agent is then placed in drums for disposal at a later time. During the assessment sampling was conducted for organic vapors and general observational techniques were conducted for ergonomics. Recommendations for improved worker safety and health during application and removal of the PCRS include: (1) work practices that reflect avoidance of exposure or reducing the risk of exposure; (2) assuring all PPE and equipment are compatible with the chemicals being used; (3) work practices that reduce the worker`s need to walk on the slippery surface caused by the chemical or the use of special anti-slip soles; (4) careful control of overspray (if a spray application is used); and (5) the use of ergonomically designed long-handled tools to apply and remove the chemical (to alleviate some of the ergonomic concerns).
A number of European and International Standards on health and safety in welding have been published in recent years and work on several more is nearing completion. These standards have been prepared jointly by the International Standards Organization (ISO) and the European Committee for Standardization (CEN). The standards development work has mostly been led by CEN/TC 121/SC 9, with excellent technical input from experts within Europe; but work on the revision of published standards, which has recently gathered pace, is now being carried out by ISO/TC 44/SC 9, with greater international involvement. This paper gives an overview of the various standards that have been published, are being revised or are under development in this field of health and safety in welding, seeking to (i) increase international awareness of published standards, (ii) encourage wider participation in health and safety in welding standards work and (iii) obtain feedback and solicit comments on standards that are currently under development or revision. Such an initiative is particularly timely because work is currently in progress on the revision of one of the more important standards in this field, namely EN ISO 10882:2001 Health and safety in welding and allied processes— Sampling of airborne particles and gases in the operator's breathing zone — Part 1: Sampling of airborne particles.
Russell, Jean; Thomson, Garry; Rosenthal, Doreen
A large sample of international students attending an Australian metropolitan university provided data concerning use of university health and counselling services--their perceived need for help, resultant help-seeking, satisfaction with help given, explanations for not seeking help when in need, and variables that predicted help-seeking. Using as…
Feldman, Robert H. L.; Hollander, Roberta B.
Reasons for carrying out cross-cultural and international health education research are presented, along with suggestions for adapting research methods to different cultures. Selection of appropriate topics, research design, development of measurement instruments, and data collection methods are considered. (PP)
González Pier, Eduardo
Health conditions in Mexico have evolved along with socioeconomic conditions. As a result, today's health system faces several problems characterized by four overlapping transitions: demand, expectations, funding and health resources. These transitions engender significant pressures on the system itself. Additionally, fragmentation of the health system creates disparities in access to services and generates problems in terms of efficiency and use of available resources. To address these complications and to improve equity in access and efficiency, thorough analysis is required in how the right to access health care should be established at a constitutional level without differentiating across population groups. This should be followed by careful discussion about what rules of health care financing should exist, which set of interventions ought to be covered and how services must be organized to meet the health needs of the population.
In 1979, when the Frente Sandinista de Liberacion Nacional (FSLN), a popular revolutionary front, deposed Nicaragua's ruling Somoza family, the Nicaraguan population's health status ranked with that of Bolivia and Honduras as the worst in Latin America. The Sandinista government committed itself to improving health services and health status such that in 1982, the World Health Organization commended the major advances in health care made in the government's first few years. That progress, however, has not been maintained as Sandinista health, nutrition, literacy, and agrarian programs have been abandoned by the government under pressure from the International Monetary Fund (IMF) and the US government to privatize and cut public spending. The progress made over the past decade is now being undone by an imposed structural adjustment policy and the burden of international debt. The IMF has disregarded social equity as a criterion for its programs. Under current conditions, the health and well-being of the Nicaraguan people will continue to deteriorate. Until the Nicaraguan debt situation is resolved, there is no hope for sustainable growth and development.
Tchounwou, Paul B
During the past century, environmental hazards have become a major concern, not only to public health professionals, but also to the society at large because of their tremendous health, socio-cultural and economic impacts. Various anthropogenic or natural factors have been implicated in the alteration of ecosystem integrity, as well as in the development of a wide variety of acute and/or chronic diseases in humans. It has also been demonstrated that many environmental agents, acting either independently or in combination with other toxins, may induce a wide range of adverse health outcomes. Understanding the role played by the environment in the etiology of human diseases is critical to designing cost-effective control/prevention measures. This special issue of International Journal of Environmental Research and Public Health includes the proceedings of the Twelfth International Symposium on Recent Advances in Environmental Health Research. The Symposium provided an excellent opportunity to discuss the scientific advances in biomedical, environmental, and public health research that addresses global environmental health issues.
Tchounwou, Paul B.
During the past century, environmental hazards have become a major concern, not only to public health professionals, but also to the society at large because of their tremendous health, socio-cultural and economic impacts. Various anthropogenic or natural factors have been implicated in the alteration of ecosystem integrity, as well as in the development of a wide variety of acute and/or chronic diseases in humans. It has also been demonstrated that many environmental agents, acting either independently or in combination with other toxins, may induce a wide range of adverse health outcomes. Understanding the role played by the environment in the etiology of human diseases is critical to designing cost-effective control/prevention measures. This special issue of International Journal of Environmental Research and Public Health includes the proceedings of the Twelfth International Symposium on Recent Advances in Environmental Health Research. The Symposium provided an excellent opportunity to discuss the scientific advances in biomedical, environmental, and public health research that addresses global environmental health issues. PMID:27153079
Standley, Claire J; Sorrell, Erin M; Kornblet, Sarah; Fischer, Julie E; Katz, Rebecca
Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency's Cooperative Biological Engagement Program, the State Department's Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public health capacities. This article examines the extent to which cooperative bioengagement projects address public health capacity building under the revised International Health Regulations and alignment with the Global Health Security Agenda action packages.
This article offers a panoramic vision of the development of international health in Latin America during the late 1940s and the 1950s, when a series of bilateral and multilateral institutions, such as the World Health Organization and UNICEF, were founded and reshaped. The language, policies, and activities of these new institutional actors were heavily influenced by the context of the early Cold War between the era's superpowers: the United States and the Soviet Union. Vertical campaigns against yaws and malaria--implemented under the leadership of Fred L. Soper, director of the Pan American Sanitary Bureau--symbolized international health's technical orientation, as well as its contribution to the modernization of the countries of the region. The Cold War period has received little attention by historians of medicine, though it bears certain similarities to historiographical discussions of the relationship between tropical medicine and imperialism in the early 20th century.
The space environment is extreme. Hear how Stephanie Carrizales Flint,a biomedical engineer at NASAâs Johnson Space Center, and her teamdevelop and monitor systems making the International Spac...
The space environment is extreme. Hear how Stephanie Carrizales Flint, a biomedical engineer at NASAâs Johnson Space Center, and her team develop and monitor systems making the International Spac...
Alexa, Jan; Recka, Lukas; Votapkova, Jana; van Ginneken, Ewout; Spranger, Anne; Wittenbecher, Friedrich
This analysis of the Czech health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The Czech health-care system is based on compulsory statutory health insurance providing virtually universal coverage and a broad range of benefits, and doing so at 7.7 % of GDP in 2012 - well below the EU average - of which a comparatively high 85 % was publicly funded. Some important health indicators are better than the EU averages (such as mortality due to respiratory disease) or even among the best in the world (in terms of infant mortality, for example). On the other hand, mortality rates for diseases of the circulatory system and malignant neoplasms are well above the EU average, as are a range of health-care utilization rates, such as outpatient contacts and average length of stay in acute care hospitals. In short, there is substantial potential in the Czech Republic for efficiency gains and to improve health outcomes. Furthermore, the need for reform in order to financially sustain the system became evident again after the global financial crisis, but there is as yet no consensus about how to achieve this.
Thiermann, A B
This paper provides a description of the international standards contained in the TerrestrialAnimal Health Code of the World Organisation for Animal Health (OIE) that relate to the prevention and control of vector-borne diseases. It identifies the rights and obligations of OIE Member Countries regarding the notification of animal disease occurrences, as well as the recommendations to be followed for a safe and efficient international trade of animals and their products.
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Richard, Elizabeth E.; Russo, Dane
The proposed environmental health system (EHS) designed for the closed environment of the Space Station is examined. The internal contamination control and environmental health considerations for the Space Station are discussed. The microbiology, toxicology, water quality, radiological health, vibroacoustics, and barothermal physiology subsystems of the EHS are described. Proposed capabilities of the EHS are: the environmental sample collection, processing, and analysis of the breathing atmosphere, potable and hygiene water, and internal surfaces.
Davis, Jeffrey R.
Dr. Davis' presentation includes a brief overview of space flight and the lessons learned for health care in microgravity. He will describe the development of policy for health care for international crews. He will conclude his remarks with a discussion of an integrated health care system.
Bio-terrorism, the use of a microorganism with the deliberate intent of causing infection, before and since the anthrax attacks in the United States in October 2001, has emerged as a real medical and public health threat. The link between bio-terrorism, human security and public health raises complex questions on the normative trajectories of international law, the mandates of international organizations, and global health governance. In May 2001, the World Health Assembly of the World Health Organization (WHO) passed a resolution entitled "Global Health Security: Epidemic Alert and Response" which inter alia, urged WHO member states to participate actively in the verification and validation of surveillance data and information concerning health emergencies of international concern. This article explores the links between bio-terrorism, human security and public health, and investigates the effectiveness of international legal mechanisms that link them in an age of globalization of public health. The article explores the interaction of WHO's 'soft-law' approaches to global health security, and the 'moribund' negotiations of the verification and monitoring protocol to the Biological Weapons Convention 1972. Can international law link bio-terrorism, public health and human security? Does the WHO collaborate with other international organizations within and outside the United Nations system to develop effective legal and governance approaches to bio-terrorism and global health security? The article concludes that the globalization of public health threats like bio-terrorism requires globalized legal approaches.
Wagstaff, A; van Doorslaer, E; Calonge, S; Christiansen, T; Gerfin, M; Gottschalk, P; Janssen, R; Lachaud, C; Leu, R E; Nolan, B
This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.
Howard, L M
By direct consulation and review of published sources, a study of 16 selected official sources of international financial cooperation was conducted over the August 1979 to August 1980 period in order to assess the policies, programs, and prospects for support of established international health goals. This study demonstrated that approximately 90% of the external health sector funds are provided via development oriented agencies. The major agencies providing such assistance concur that no sector, including health, should be excluded "a priori," providing that the requesting nation conveys its proposals through the appropriate national development planning authority. The agencies in the study also were found to be supporting health related programs in all the geographic regions of the World Health Organization (WHO). An associated review of 30 external funding agencies revealed that only 5 reported providing health assistance in more than half of the countries where they provided assistance for general development purposes. Interviewed sources attributed this to the limited manner in which health proposals have been identified, prepared, and forwarded (with national development authority approval) to international agencies. In 1979 concessional development financing totaled approximately US$29.9 billion, US$24.2 billion being provided by 17 major industrial nations, US$4.7 billion by Organization of Petroleum Exporting (OPEC) countries, and less than US$1 billion by the countries of Eastern Europe. Approximately 2/3 of such concessional financing is administered bilaterally, only 1/3 passing through multilateral institutions. UN agencies receive only 12% of these total concessional development financing resources. In 1979, concessional funding for health totaled approximately US$3 billion, approximately 1/10 of which was administered by WHO and its regional offices. It is anticipated that future international funding for health in developing countries will continue
Yan, Zi; FitzPatrick, Kathleen
The process of acculturation often results in changes in the health behavior of international students. This study employed an open-ended, qualitative approach in an attempt to gain an in-depth understanding of the acculturation process for physical activity, diet, and drinking behavior among international students. Eighteen undergraduate international students (average age 19.20, standard deviation 1.21) were interviewed for 45-60 min. Most of the international students became more physically active after they arrived in the United States. Facilitators included accessibility, weight management, free time, and role modeling. Most international students were unsatisfied with the food on campus. Their strategies for adjusting to this included ordering food from restaurants, visiting supermarkets, and moving off campus. Most international students felt uncomfortable with the drinking culture in the United States, although some of them felt drinking was a good way to socialize with Americans and explore American culture. Colleges and universities should adopt strategies to better help their international students build lifelong healthy behaviors.
Cianciara, Dorota; Wysocki, Mirosław J
The aim of this article was: (1) the analysis of some concepts and definitions related with "set up of health", used in UN international arrangements; (2) an attempt to explain the evolution of organizational dimensions of health at worldwide agenda. The following organizational dimensions of health were discussed: (a) health for all, (b) health promotion, intersectoral and multisectoral actions, health in all policies, (c) health development, health as an element of human development, (d) investment for health, (e) health diplomacy and (f) mainstreaming of health. The analysis was based on World Health Assembly and UN General Assembly resolutions as well as supranational reports and statements available through conventional channels, not grey literature. It is apparent that some of notions are not in common use in Poland, some seems to be unknown. It was argued that some general and discreet thoughts and statements concerning organizational aspects of health were expressed in the preamble of WHO Constitution. Nevertheless they are not comparable with later propositions and proceedings. The first modern concepts and notions related as process were developed at late seventies. They originated from efforts to realize a vision of health for all and formulate national policies, strategies and plans of action for attaining this goal. The turning point was in 1981, when WHA adopted Global Strategy for Heath for All by the Year 2000. Since then one can observe considerable progress and new concepts came into existence, more and more precise and better reflecting the sense of health actions. The evolution of organizational dimensions of health was described in the context of brand positioning. It was assumed that first step of positioning was concentrated on structural dimensions of health. That served to awareness raise, attitudes change and motivation to action. That made a foundation to the next step--positioning based on process approach to health. Among others the
Creese, Brian; Isaacs, Tina
Although England was not included in the International Instructional Systems Study because it was not a high-performing jurisdiction by the Study's definition, contributors largely were England-based. Analysing the Study's nine overall aspects of instructional systems, this paper finds that England is out of step with many of the high-performing…
Cianciara, Dorota; Wysocki, Mirosław J
In the article, the health is perceived as complex, multidimensional concept and not as absence of disease. This is consistent with public health perspective, where public health is regarded as public as well as political activity. It aims to solve health and social problems, depends on analysis of phenomena, needs the negotiations and relies on making decision on feasible directions of changes--what, why, how, where, when and by whom should be done. Public health policy developed as a result of international relations, and UN family fora especially, is regarded as significant for creating of health position. The aim of this article was: (1) the analysis of selected concepts and definitions related to structural dimensions of health, used in UN international arrangements; (2) an attempt to explain the evolution of health structure notions at worldwide agenda. The UN main bodies, programmes and funds working on the health field are mentioned and voting rules in UN General Assembly and World Health Assembly are reminded. The following structural dimensions were considered: (a) well-being, (b) human rights, (c) everyday resource, health potential, (4) equity. All were explored in WHO Constitution, Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights, Ottawa Charter for Health Promotion and numerous WHA and UN GA resolutions, decisions as well as other documents. Some remarkable differences in English and Polish language versions and meanings were pointed out. It was argued that present perception of structural dimension of health is strongly derived from the preamble of the WHO Constitution adopted and signed on 22 July 1946 by the representatives of 61 States. It is an evidence of the strength of this document and wisdom of its authors. The greater progress is associated. with concepts and notion of organizational dimensions of health perceived as action and processes leading to health. Long-term efforts to strengthen
Gerstenmaier, William H.; Ticker, Ronald L.
Over the next few months, the International Space Station (ISS), and human spaceflight in general, will undergo momentous change. The European Columbus and Japanese Kibo Laboratories will be added to the station joining U.S. and Russian elements already on orbit. Columbus, Jules Vernes Automated Transfer Vehicle (ATV) and Kibo Control Centers will soon be joining control centers in the US and Russia in coordinating ISS operations and research. The Canadian Special Purpose Dexterous Manipulator (SPDM) will be performing extra vehicular activities that previously only astronauts on EVA could do, but remotely and with increased safety. This paper will address the integration of these international elements and operations into the ISS, both from hardware and human perspectives. Interoperability of on-orbit systems and ground control centers and their human operators from Europe, Japan, Canada, Russia and the U.S. pose significant and unique challenges. Coordination of logistical support and transportation of crews and cargo is also a major challenge. As we venture out into the cosmos and inhabit the Moon and other planets, it's the systems and operational experience and partnership development on ISS, humanity's orbiting outpost that is making these journeys possible.
Health and safety management systems have a background in theory and in various interests among employers and workplace health and safety professionals. These have resulted in a number of national systems emanating from national standard-writing centres and from employers' organizations. In some cases these systems have been recognized as national standards. The contenders for an international standard have been the International Organization of Standardization (ISO) and the International Labour Organization (ILO). The quality and environmental management systems of ISO indicate what an ISO health and safety management standard would look like. The ILO Guidelines on Safety and Health Management Systems, by contrast, are stringent, specific and potentially effective in improving health and safety performance in the workplace.
Di Giacomo, Paola; Maceratini, Riccardo
In this paper, we discuss international policy in relation to the use of health websites and we describe the results obtained from application of a search engine to the recognition and classification of health websites in Italy. We then compare the results with health websites in other countries. Effective use of technology has led to medical advances that have not only extended life expectancy, but also fuelled an increasingly well-informed public to expect more and more from today's healthcare providers. As a consequence of the Web's rapid, chaotic growth, the resulting network of information lacks organization and structure and the quest for a method of quickly finding relevant and reliable information is spawning the growth of Internet portal sites. The US and the European Union and now Italy, have established the importance of rules to check the quality of health sites both for the non-professional users (citizens), mainly for privacy and security (for example, of medical records); and for health operators (physicians and others), where the most important thing is to evaluate the quality of content. In June 2001, the search engine used here found 2627 Italian health sites, of which only 46 exhibited the HON Code, and they can be classified into: 1% personal medical sites, 17% health portals, 18%, metasites, 27% documental sites and 37% information sites for health operators and/or for citizens.
Deber, R; Swan, B
There are different ways to measure how much Canada spends on health care and the quality of these measurements may vary. This paper examines Organization for Economic Cooperation and Development data for 3 common standards of measure: health expenditures as a proportion of gross domestic product (GDP), nominal spending per capita (US dollars) and spending per capita in purchasing power parities (PPP) equivalents. In 1994, the most recent year for which there were firm data. Canada spent 9.9% of its GDP on health care (rank 3 of 29), and $1999 PPPs per capita (rank 3). However, actual spending was only US$1824 per capita (rank 14). In the same year Japan spent 7% of GDP on health care (rank 22), $1478 in PPPs per capita (rank 16), but actually spent US$2614 per capita (rank 3). Although each measure is suitable for some policy purposes, Canadian spending remains modest by international standards.
Curlander, John C.
A set of considerations that are pertinent to future international cooperation in the area of synthetic aperture radar (SAR) ground data systems are presented. The considerations are as follows: (1) success of future spaceborne SAR missions will require multi-agency and/or multi-national collaboration; (2) ground processing is typically performed by each agency for their user base; (3) international standards are required to achieve a uniform data product independent of the processing center; (4) to reduce the aggregate cost of the ground data systems, collaboration is required in design and development; (5) effective utilization of the data by an international user community; (6) commercialization of data products; and (7) security of data systems.
Househ, Mowafa; Alsughayar, Abdulrahman; Al-Mutairi, Maha
Little information is known about how Saudi health websites compare internationally. The purpose of this paper is to compare two leading Saudi health websites with leading international health websites. The study was conducted as a convenience sample at a graduate health college in Saudi Arabia. A total of 42 students participated in the study. The study found that, in general, English websites have higher levels of performance with regard to quality of information, authority and objectivity, coverage and currency, and design. However, the respondents considered Saudi health websites to be superior with regard to maintaining privacy and security. The results indicate that much more work is needed in designing Saudi Health to make them more trustworthy and credible. The limitations of this work and future research directions are also discussed.
Due to rising health care expenditures international comparisons of health care systems are recently gaining more importance. These benchmarks can provide interesting information for improving health care systems. Many of these comparisons implicitly assume that countries have a universal understanding of justice. But this assumption is rather questionable. With regard to the existing cultural differences in the understanding of justice the transferability of elements of health care systems is not always assured. A transfer usually requires a thorough examination of the judicial systems in each country. This article analyses the influence of different judicial systems applying to health care. In this context theories of justice by Rawls, Nozick and Confucius representing the possible understanding of justice in different cultures are described and analysed with regards to their influence on health care systems. The example of financing health care shows that the three theories of justice have very different consequences for designing health care systems especially concerning the role of governments.
Petersen, Poul Erik; Bourgeois, Denis; Bratthall, Douglas; Ogawa, Hiroshi
This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable, chronic disease, and data stored in the WHO Global InfoBase may allow advanced health systems research. Sound knowledge about progress made in prevention of oral and chronic disease and in health promotion may assist countries to implement effective public health programmes to the benefit of the poor and disadvantaged population groups worldwide. PMID:16211160
Daoud, Nihaya; Shankardass, Ketan; O'Campo, Patricia; Anderson, Kim; Agbaria, Ayman K
Long term health impacts of internal displacement (ID) resulting from political violence are not well documented or understood. One such case is the ID of 300,000-420,000 Palestinian citizens of Israel and their descendants during the Nakba of 1948 (Palestinian Catastrophe). We aim to document the long term health impacts of this ID. We draw on data collected in 2005 from a nationwide random sample of 902 individuals aged 30-70. Research participants were interviewed in person after being selected through a multistage sampling procedure. About 24% of participants reported that either they or their families had been internally displaced. Palestinian internally displaced persons (IDPs), that is, those who were forcibly displaced and dispossessed from their homes and lands during the Nakba and its aftermath, as well as their families and descendants, and who reside within the current borders of Israel, had an odds ratio of 1.45 (95% CI = 1.02-2.07) for poor self-rated health (SRH) compared to non-IDPs after controlling for demographic, socioeconomic and psychosocial factors. No difference was found between IDPs and non-IDPs in limiting longstanding illness following control for confounders. Low socioeconomic position and chronic stress were significantly related to ID and to SRH. Our findings suggest adverse long term health impacts of the Nakba on the IDPs when compared to non-IDPs. We propose that these disparities might stem from IDPs' unhealed post-traumatic scars from the Nakba, or from becoming a marginalized minority within their own society due to their displacement and loss of collective identity. Given these long term health consequences, we conclude that displacement should be addressed with health and social policies for IDPs.
The effect of population growth is not limited to national boundaries. Indeed the inability of people in developing countries to control their own fertility has repercussions on global security and on the balance between population and environment as well a on their health and welfare. All nations need to take steps to slow down rapid population growth now, otherwise we will suffer serious consequences. The different between 2 UN projections of world population equals current world population size. Almost 90% of the increase of the larger projection would occur in developing countries, yet they are the least capable of managing big populations. Further major inequalities in reproductive health between developed and developing countries, as well as between men and women exist. The infant mortality rate in developed regions is around 6 times lower than it is in developing regions, child mortality is 7 times lower, and maternal mortality is 15 times lower. International collaboration to rid the world of these inequalities is need to improve reproductive health. Specifically, political and health leaders should mobilize necessary international and national resources. Even though there is more than US $50,000 million in official development assistance funds available annually, the level of population related funding has decreased to less than 1.1% of these funds for 1993-1994. Developed countries could reduce the debt burden to free funds for population activities and to reverse the flow from the poor countries in the Southern Hemisphere to the rich countries in the Northern Hemisphere. Besides developing countries spend much of their money on the military (e.g. sub-Saharan Africa spends US$ 10,000 million). International cooperation leading to peace would make significantly more money available for the social and health sectors, especially reproductive health care.
In this report unified ideas are presented about what the Office of International Health Programs does, what the individual contributions are, and how the organization connects to the Department of Energy. The planning efforts have focused on the office`s three areas of responsibility: Europe, Japan, and the Marshall Islands. Common to each technical program area are issues related to the following: health of populations exposed to radiation incidents and the associated medical aspects of exposure; dose reconstruction; training; and public involvement. Each of the program areas, its customers, and primary customer interests are described.
Unger, Jean-Pierre; DePaepe, Pierre; Ghilbert, Patricia; Soors, Werner; Green, Andrew
Abstract Purpose To propose a social-and-democrat health policy alternative to the current neoliberal one. Context of case The general failure of neoliberal health policies in low and middle-income countries justifies the design of an alternative to bring disease control and health care back in step with ethical principles and desired outcomes. Data sources National policies, international programmes and pilot experiments—including those led by the authors—are examined in both scientific and grey literature. Case description We call for the promotion of a publicly-oriented health sector as a cornerstone of such alternative policy. We define ‘publicly-oriented’ as opposed to ‘private-for-profit’ in terms of objectives and commitment, not of ownership. We classify development strategies for such a sector according to an organisation-based typology of health systems defined by Mintzberg. As such, strategies are adapted to three types of health systems: machine bureaucracies, professional bureaucracies and divisionalized forms. We describe avenues for family and community health and for hospital care. We stress social control at the peripheral level to increase accountability and responsiveness. Community-based, national and international sources are required to provide viable financing. Conclusions and discussion Our proposed social-and-democrat health policy calls for networking, lobbying and training as a joint effort in which committed health professionals can lead the way. PMID:17006552
Domínguez-Alonso, Emma; Zacea, Eduardo
This paper describes the health conditions in Cuba and the general characteristics of the Cuban health system, including its structure and coverage, its financial sources, its health expenditure, its physical, material and human resources, and its stewardship functions. It also discusses the increasing importance of its research institutions and the role played by its users in the operation and evaluation of the system. Salient among the social actors involved in the health sector are the Cuban Women Federation and the Committees for the Defense of the Revolution. The paper concludes with the discussion of the most recent innovations implemented in the Cuban health system, including the cardiology networks, the Miracle Mission (Misión Milagro) and the Battle of Ideas (Batalla de Ideas).
Scott, O. L.
A cost effective thermal storage system for a solar central receiver power system using molten salt stored in internally insulated carbon steel tanks is described. Factors discussed include: testing of internal insulation materials in molten salt; preliminary design of storage tanks, including insulation and liner installation; optimization of the storage configuration; and definition of a subsystem research experiment to demonstrate the system. A thermal analytical model and analysis of a thermocline tank was performed. Data from a present thermocline test tank was compared to gain confidence in the analytical approach. A computer analysis of the various storage system parameters (insulation thickness, number of tanks, tank geometry, etc.,) showed that (1) the most cost-effective configuration was a small number of large cylindrical tanks, and (2) the optimum is set by the mechanical constraints of the system, such as soil bearing strength and tank hoop stress, not by the economics.
One year ago, the Office of International Health Programs provided you with our 1996 Operating Plan, which defined our ideas and ideals for conducting business in 1996. We have again this year undertaken an intensive planning effort, first reviewing our accomplishments and shortcomings during 1996, and then developing plans and priorities for the upcoming year, taking into account input from customers and outside review panels, and ensuring that the demands on the office have been balanced with anticipated human, financial, and material resources.
Gómez-Dantés, O; Khoshnood, B
The purpose of this paper is to discuss the historical evolution of the concept and activities that have come under the rubric of international health during its modern "formative" years in the 20th century. The analysis seeks to illuminate the changing objectives and key players, the achievements and failures, and the challenges that lie ahead. The emphasis is placed on its institutional component, particularly as it relates to the countries of the American continents.
Lieberman, Samuel; Gottret, Pablo; Yeh, Ethan; de Beyer, Joy; Oelrichs, Robert; Zewdie, Debrework
Efforts to finance HIV responses have generated large increases in funding, catalyzed activism and institutional innovation, and brought renewed attention to health issues and systems. The benefits go well beyond HIV programs. The substantial increases in HIV funding are a tiny percentage of overall increases in health financing, with other areas also seeing large absolute increases. Data on health funding suggest an improved "pro-poor" distribution, with Africa benefiting relatively more from increased external flows. A literature review found few evidence-based analyses of the impact of AIDS programs and funding on broader health financing. Conceptual frameworks that would facilitate such analysis are summarized.
Many calls have been made for a systems approach to public health. My response is to offer a methodology for systemic intervention that (1) emphasizes the need to explore stakeholder values and boundaries for analysis, (2) challenges marginalization, and (3) draws upon a wide range of methods (from the systems literature and beyond) to create a flexible and responsive systems practice. I present and discuss several well-tested methods with a view to identifying their potential for supporting systemic intervention for public health. PMID:16449577
Ozdenizci, Busra; Coskun, Vedat; Ok, Kerem
Indoor navigation systems have recently become a popular research field due to the lack of GPS signals indoors. Several indoors navigation systems have already been proposed in order to eliminate deficiencies; however each of them has several technical and usability limitations. In this study, we propose NFC Internal, a Near Field Communication (NFC)-based indoor navigation system, which enables users to navigate through a building or a complex by enabling a simple location update, simply by touching NFC tags those are spread around and orient users to the destination. In this paper, we initially present the system requirements, give the design details and study the viability of NFC Internal with a prototype application and a case study. Moreover, we evaluate the performance of the system and compare it with existing indoor navigation systems. It is seen that NFC Internal has considerable advantages and significant contributions to existing indoor navigation systems in terms of security and privacy, cost, performance, robustness, complexity, user preference and commercial availability.
Ozdenizci, Busra; Coskun, Vedat; Ok, Kerem
Indoor navigation systems have recently become a popular research field due to the lack of GPS signals indoors. Several indoors navigation systems have already been proposed in order to eliminate deficiencies; however each of them has several technical and usability limitations. In this study, we propose NFC Internal, a Near Field Communication (NFC)-based indoor navigation system, which enables users to navigate through a building or a complex by enabling a simple location update, simply by touching NFC tags those are spread around and orient users to the destination. In this paper, we initially present the system requirements, give the design details and study the viability of NFC Internal with a prototype application and a case study. Moreover, we evaluate the performance of the system and compare it with existing indoor navigation systems. It is seen that NFC Internal has considerable advantages and significant contributions to existing indoor navigation systems in terms of security and privacy, cost, performance, robustness, complexity, user preference and commercial availability. PMID:25825976
Bonvecchio, Anabelle; Becerril-Montekio, Victor; Carriedo-Lutzenkirchen, Angela; Landaeta-Jiménez, Maritza
This paper describes the Venezuelan health system, including its structure and coverage, financial sources, human and material resources and its stewardship functions. This system comprises a public and a private sector. The public sector includes the Ministry of Popular Power for Health (MS) and several social security institutions, salient among them the Venezuelan Institute for Social Security (IVSS). The MH is financed with federal, state and county contributions. The IVSS is financed with employer, employee and government contributions. These two agencies provide services in their own facilities. The private sector includes providers offering services on an out-of-pocket basis and private insurance companies. The Venezuelan health system is undergoing a process of reform since the adoption of the 1999 Constitution which calls for the establishment of a national public health system. The reform process is now headed by the Barrio Adentro program.
Barba, Pere; Burns, Linda J; Litzow, Mark R; Juckett, Mark B; Komanduri, Krishna V; Lee, Stephanie J; Devlin, Sean M; Costa, Luciano J; Khan, Shakila; King, Andrea; Klein, Andreas; Krishnan, Amrita; Malone, Adriana; Mir, Muhammad A; Moravec, Carina; Selby, George; Roy, Vivek; Cochran, Melissa; Stricherz, Melisa K; Westmoreland, Michael D; Perales, Miguel-Angel; Wood, William A
The American Society for Blood and Marrow Transplantation (ASBMT) Clinical Case Forum (CCF) was launched in 2014 as an online secure tool to enhance interaction and communication among hematopoietic cell transplantation (HCT) professionals worldwide through the discussion of challenging clinical care issues. After 14 months, we reviewed clinical and demographical data of cases posted in the CCF from January 29, 2014 to March 18, 2015. A total of 137 cases were posted during the study period. Ninety-two cases (67%) were allogeneic HCT, 29 (21%) were autologous HCT, and in 16 (12%), the type of transplantation (autologous versus allogeneic) was still under consideration. The diseases most frequently discussed included non-Hodgkin lymphoma (NHL; n = 30, 22%), acute myeloid leukemia (n = 23, 17%), and multiple myeloma (MM; n = 20, 15%). When compared with the US transplantation activity reported by the US Department of Health and Human Services, NHL and acute lymphoblastic leukemia cases were over-represented in the CCF, whereas MM was under-represented (P < .001). A total of 259 topics were addressed in the CCF with a median of 2 topics/case (range, 1 to 6). Particularly common topics included whether transplantation was indicated (n = 57, 41%), conditioning regimen choice (n = 44, 32%), and post-HCT complications after day 100 (n = 43, 31%). The ASBMT CCF is a successful tool for collaborative discussion of complex cases in the HCT community worldwide and may allow identification of areas of controversy or unmet need from clinical, educational and research perspectives.
Ledo, Carmen; Soria, René
This paper describes the Bolivian health system, including its structure and organization, its financing sources, its health expenditure, its physical, material and humans resources, its stewardship activities and the its health research institutions. It also discusses the most recent policy innovations developed in Bolivia: the Maternal and Child Universal Insurance, the Program for the Extension of Coverage to Rural Areas, the Family, Community and Inter-Cultural Health Model and the cash-transfer program Juana Azurduy intended to strengthen maternal and child care.
Marasović Šušnjara, Ivana
Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.
Cui, Helen H.; Erkkila, Tracy; Chain, Patrick S. G.; Vuyisich, Momchilo
Genome science and technologies are transforming life sciences globally in many ways and becoming a highly desirable area for international collaboration to strengthen global health. The Genome Science Program at the Los Alamos National Laboratory is leveraging a long history of expertise in genomics research to assist multiple partner nations in advancing their genomics and bioinformatics capabilities. The capability development objectives focus on providing a molecular genomics-based scientific approach for pathogen detection, characterization, and biosurveillance applications. The general approaches include introduction of basic principles in genomics technologies, training on laboratory methodologies and bioinformatic analysis of resulting data, procurement, and installation of next-generation sequencing instruments, establishing bioinformatics software capabilities, and exploring collaborative applications of the genomics capabilities in public health. Genome centers have been established with public health and research institutions in the Republic of Georgia, Kingdom of Jordan, Uganda, and Gabon; broader collaborations in genomics applications have also been developed with research institutions in many other countries. PMID:26697418
Cui, Helen H.; Erkkila, Tracy; Chain, Patrick S. G.; Vuyisich, Momchilo
Genome science and technologies are transforming life sciences globally in many ways and becoming a highly desirable area for international collaboration to strengthen global health. The Genome Science Program at the Los Alamos National Laboratory is leveraging a long history of expertise in genomics research to assist multiple partner nations in advancing their genomics and bioinformatics capabilities. The capability development objectives focus on providing a molecular genomics-based scientific approach for pathogen detection, characterization, and biosurveillance applications. The general approaches include introduction of basic principles in genomics technologies, training on laboratory methodologies and bioinformatic analysis of resulting data, procurement, and installation of next-generation sequencing instruments, establishing bioinformatics software capabilities, and exploring collaborative applications of the genomics capabilities in public health. Genome centers have been established with public health and research institutions in the Republic of Georgia, Kingdom of Jordan, Uganda, and Gabon; broader collaborations in genomics applications have also been developed with research institutions in many other countries.
Becerril-Montekio, Víctor; López-Dávila, Luis
This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.
A method is presented for computing sensitivity derivatives with respect to independent (input) variables for complex, internally coupled systems, while avoiding the cost and inaccuracy of finite differencing performed on the entire system analysis. The method entails two alternative algorithms: the first is based on the classical implicit function theorem formulated on residuals of governing equations, and the second develops the system sensitivity equations in a new form using the partial (local) sensitivity derivatives of the output with respect to the input of each part of the system. A few application examples are presented to illustrate the discussion.
Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems
Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
...-AQ66 Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and... amendment to the interim final rules (76 FR 37208) entitled, ``Group Health Plans and Health Insurance... rule with request for comments entitled, ``Group Health Plans and Health Insurance Issuers:...
Meads, Geoffrey; Russell, Grant; Lees, Amanda
Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non
Hannan, Terry J
The management of health care delivery requires the availability of effective 'information management' tools based on e-technologies [eHealth]. In developed economies many of these 'tools' are readily available whereas in Low and Middle Income Countries (LMIC) there is limited access to eHealth technologies and this has been defined as the "digital divide". This paper provides a short introduction to the fundamental understanding of what is meant by information management in health care and how it applies to all social economies. The core of the paper describes the successful implementation of appropriate information management tools in a resource poor environment to manage the HIV/AIDS epidemic and other disease states, in sub-Saharan Africa and how the system has evolved to become the largest open source eHealth project in the world and become the health information infrastructure for several national eHealth economies. The system is known as Open MRS [www.openmrs.org). The continuing successful evolution of the OpenMRS project has permitted its key implementers to define core factors that are the foundations for successful eHealth projects.
Schneider, Maria Cristina; Aguilera, Ximena P; Smith, Ryan M; Moynihan, Matthew J; Silva, Jarbas Barbosa da; Aldighieri, Sylvain; Almiron, Maria
This study analyzed the importance of zoonoses and communicable diseases common to man and animals as potential Public Health Emergencies of International Concern to build an evidence base for future efforts to reduce risk of infection at the animal/human health interface. The events recorded in the World Health Organization (WHO) Event Management System (EMS) database for the Americas during the 18 months since the implementation of the 2005 revised version of WHO's International Health Regulations (15 June 2007-31 December 2008) were the main source for this analysis. Of the 110 events recorded by the EMS for the Americas during the study period, 86 were classified as communicable diseases-77 (70.0%) "within the animal/human health interface," 9 (8.2%) "not common to man and animals," 16 (14.5%) "syndromes with unknown etiologies," and 8 (7.3%) "product-related/ other." Of the 77 events within the animal/human health interface, 48 were "substantiated" (the presence of hazard was confirmed and/or human cases occurred clearly in excess of normal expectancy). These results confirm previous research and underscore the importance of the animal/human health interface as well as inter-sectoral collaboration.
Bermúdez-Madriz, Juan Luis; Sáenz, María del Rocío; Muiser, Jorine; Acosta, Mónica
This paper describes the health system of Honduras, including its challenges, structure coverage, sources of financing, resources and stewardship activities. This system counts with a public and a private sector. The public sector includes the Ministry of Health (MH) and the Honduran Social Security Institute (HSSI). The private sector is dominated by a set of providers offering services payed mostly out-of-pocket. The National Health Plan 2010-2014 includes a set of reforms oriented towards the creation of an integrated and plural system headed by the MH in its stewardship role. It also anticipates the creation of a public health insurance for the poor population and the transformation of the HSSI into a public insurance agency which contracts services for its affiliates with public and private providers under a family medicine model.
Yeager, Valerie A; Bertrand, Jane
The current limited focus on management in global health activities is highly problematic given the amounts of financial and human resources that are pouring into health system strengthening interventions and the complexity of clinical operations across settings. By ensuring that public health and healthcare practitioners in domestic and international settings receive management training in their educational programs and that we build management capacity among individuals already in the health workforce, we can begin to prepare for more effective health systems strengthening efforts. Rigorous evaluation of health systems strengthening and the impact of management capacity building is crucial to building evidence for the field.
Sheahan, M D
Despite the political and economic reforms that have swept Eastern Europe in the past 5 years, there has been little change in Poland's health care system. The Ministry of Health and Social Welfare has targeted preventive care as a priority, yet the enactment of legislation to meet this goal has been slow. The process of reform has been hindered by political stagnation, economic crisis, and a lack of delineation of responsibility for implementing the reforms. Despite the delays in reform, recent developments indicate that a realistic, sustainable restructuring of the health care system is possible, with a focus on preventive services. Recent proposals for change have centered on applying national goals to limited geographic areas, with both local and international support. Regional pilot projects to restructure health care delivery at a community level, local health education and disease prevention initiatives, and a national training program for primary care and family physicians and nurses are being planned. Through regionalization, an increase in responsibility for both the physician and the patient, and redefinition of primary health care and the role of family physicians, isolated local movements and pilot projects have shown promise in achieving these goals, even under the current budgetary constraints. PMID:7610217
Shah, A.; Penswick, L.; Dodson, C.; Roberts, T.
High performance sensors are playing an increasingly important role in all aspects of all critical DoD missions. There is a family of sensors that operate with improved sensitivities if cooled to very low (cryogenic) temperatures. For these sensors, a healthy and reliable mechanical refrigeration system (cryocooler) is required. The ability to accurately predict the "health" or remaining useful life of the cryocooler has significant benefits from the viewpoint of ensuring that mission critical functions can be carried out with a high probability of success. The paper provides an overview and approaches used for the development of a Cryocooler Prognostic Health Management System (CPHMS) capable of assessing the cryocooler "health" from the viewpoint of the level of performance degradation and/or the potential for near term failure. Additionally, it quantifies the reliable remaining useful life of the cryocooler. While the proposed system is focused on the specific application to linear drive cryocoolers, especially for DoD, many of the attributes of the system can be applied to other specialized system hardware in both commercial and U.S. Government agency for situations where it is critical that all aspects of the hardware "health" and "remaining useful life" be fully understood. Several benefits of the health monitoring system are also described in the paper.
Kohl, Katrin S; Arthur, Ray R; O'Connor, Ralph; Fernandez, Jose
Under the current International Health Regulations, 194 states parties are obligated to report potential public health emergencies of international concern to the World Health Organization (WHO) within 72 hours of becoming aware of an event. During July 2007-December 2011, WHO assessed and posted on a secure web portal 222 events from 105 states parties, including 24 events from the United States. Twelve US events involved human influenza caused by a new virus subtype, including the first report of influenza A(H1N1)pdm09 virus, which constitutes the only public health emergency of international concern determined by the WHO director-general to date. Additional US events involved 5 Salmonella spp. outbreaks, botulism, Escherichia coli O157:H7 infections, Guillain-Barré syndrome, contaminated heparin, Lassa fever, an oil spill, and typhoid fever. Rapid information exchange among WHO and member states facilitated by the International Health Regulations leads to better situation awareness of emerging threats and enables a more coordinated and transparent global response.
This patent describes a valve control system for an internal combustion engine. The system comprising a primary control and a secondary control for modifying the operation of the primary control. The primary control comprising: a camshaft journaled for rotation in camshaft brackets, intake and exhaust cylindrical cams including cam channels; valve pin means; and timing belt means. The secondary system comprising: control plate means adjustably mounted between the cylindrical cams, rocker arm means; and at least one driver positioned between the driver leg and one of cylindrical cams.
Efendi, Ferry; Mackey, Timothy Ken; Huang, Mei-Chih; Chen, Ching-Min
Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country's adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country's own participation in a bilateral trade and investment agreement, known as the Indonesia-Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia-Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia-Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia-Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.
Faunce, Thomas; Watal, Aparna
Silver in nanoparticle form is used extensively worldwide in hospital and general practice settings, in dressings as a treatment for external wounds, burns and ulcers. Nanosilver is also an increasingly important coating over embedded medical devices, inhibiting the development of biofilm. Nanosilver disinfectant sprays and polymer coatings are being widely promoted as protective against viral infections. In addition, nanosilver is widely used for its antibacterial properties in food processing and packaging, as well as in consumer products used for domestic cleaning and clothing. This article argues that medical devices, therapeutic products, and domestic food and goods containing nanosilver, although offering therapeutic benefits, must be subject to precautionary regulation owing to associated public health and environmental risks, particularly from large volumes of nanosilver in waste water. The article first examines the use of nanosilver in a variety of contemporary medical and domestic products, the utilization of which may assist in resolving global public health problems, such as restricted access to safe food, water and medical care. It then discusses the mechanisms of toxicity for nanosilver, whether it should be classified as a new chemical entity for regulatory purposes and whether its increased usage poses significant environmental and public health risks. The article next critically analyses representative international regulatory regimes (the USA, EU, UK and Australia) for medical and domestic use of nanosilver. The conclusion includes a set of recommendations for improving international regulation of nanosilver.
Wilson, Kumanan; McDougall, Christopher; Fidler, David P; Lazar, Harvey
The International Health Regulations (IHR), the principal legal instrument guiding the international management of public health emergencies, have recently undergone an extensive revision process. The revised regulations, referred to as the IHR (2005), were unanimously approved in May 2005 by all Member States of the World Health Assembly (WHA) and came into effect on 15 June 2007. The IHR (2005) reflect a modernization of the international community's approach to public health and an acknowledgement of the importance of establishing an effective international strategy to manage emergencies that threaten global health security. The success of the IHR as a new approach to combating such threats will ultimately be determined by the ability of countries to live up to the obligations they assumed in approving the new international strategy. However, doing so may be particularly challenging for decentralized countries, specifically those with federal systems of government. Although the IHR (2005) are the product of an agreement among national governments, they cover a wide range of matters, some of which may not fall fully under the constitutional jurisdiction of the national government within many federations. This tension between the separation of powers within federal systems of government and the requirements of an evolving global public health governance regime may undermine national efforts towards compliance and could ultimately jeopardize the regime's success. We hosted a workshop to examine how federal countries could address some of the challenges they may face in implementing the IHR (2005). We present here a series of recommendations, synthesized from the workshop proceedings, on strategies that these countries might pursue to improve their ability to comply with the revised IHR.
Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L
People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.
This system is designed to assist diagnosis of the plant health globally. The system is formed by portable plant health measurement devices connected to a diagnosis and analysis center through a flexible information network. A flexible network is formed so that users from the remote areas as well as internet are able to use the system. The hardware and software is designed in an open technology for easier upgrades. Portable plant health measurement instrument is a networkable leaf flash spectrophotometer capable of measuring Qa, Electrochromy, P700, Fluorescence, S Fluorescence, reflectance spectra, temperature, humidity and image of the leaf with GPS information. The network and intelligent user interface options of the system can be used by any commercially or user designed instrument.
Loyola, Maria Andréa; Corrêa, Marilena Cordeiro Dias Villela; Guimarães, Eduardo Ribas De Biase
In the available literature, there is no study devoted to international cooperation in public health. This paper aims to partly fill this gap, raising and examining the state of art in this area as well as how it interferes in the evaluation of post-graduate programs. The study used secondary data available at CAPES "Indicators Journals", during the years of 1998 to 2006. It also analyzes foreign scholarships and special programs of cooperation of CAPES from 2005 to 2009 through a quantitative descriptive methodology. It shows that international cooperation in the area is relatively developed in a variety of themes and diverse partnerships, focusing in the United States. It is observed a positive correlation between the number of international cooperation and a high-concept program into the evaluation of CAPES, the last triennium of evaluation. The sub-areas where there is more cooperation are, in order: epidemiology; planning, and others. There is a variety of institutions, themes and subareas involved in international cooperation that could be a positive indicator in the evaluation, but as far as was possible to infer, no significant correlation in this direction was found.
Memish, Kate; Martin, Angela; Bartlett, Larissa; Dawkins, Sarah; Sanderson, Kristy
The aim of this systematic review was to determine the quality and comprehensiveness of guidelines developed for employers to detect, prevent, and manage mental health problems in the workplace. An integrated approach that combined expertise from medicine, psychology, public health, management, and occupational health and safety was identified as a best practice framework to assess guideline comprehensiveness. An iterative search strategy of the grey literature was used plus consultation with experts in psychology, public health, and mental health promotion. Inclusion criteria were documents published in English and developed specifically for employers to detect, prevent, and manage mental health problems in the workplace. A total of 20 guidelines met these criteria and were reviewed. Development documents were included to inform quality assessment. This was performed using the AGREE II rating system. Our results indicated that low scores were often due to a lack of focus on prevention and rather a focus on the detection and treatment of mental health problems in the workplace. When prevention recommendations were included they were often individually focused and did not include practical tools or advice to implement. An inconsistency in language, lack of consultation with relevant population groups in the development process and a failure to outline and differentiate between the legal/minimum requirements of a region were also observed. The findings from this systematic review will inform translation of scientific evidence into practical recommendations to prevent mental health problems within the workplace. It will also direct employers, clinicians, and policy-makers towards examples of best-practice guidelines.
Sanders, Jay H.
The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.
Becerril-Montekio, Víctor; Reyes, Juan de Dios; Manuel, Annick
This paper describes the Chilean health system, including its structure, financing, beneficiaries, and its physical, material and human resources. This system has two sectors, public and private. The public sector comprises all the organisms that constitute the National System of Health Services, which covers 70% of the population, including the rural and urban poor, the low middle-class, the retired, and the self-employed professionals and technicians.The private sector covers 17.5% of the population, mostly the upper middle-class and the high-income population. A small proportion of the population uses private health services and pays for them out-of-pocket. Around l0% of the population is covered by other public agencies, basically the Health Services for the Armed Forces. The system was recently reformed with the establishment of a Universal System of Explicit Entitlements, which operates through a Universal Plan of Explicit Entitlements (AUGE), which guarantees timely access to treatment for 56 health problems, including cancer in children, breast cancer, ischaemic heart disease, HIV/AIDS and diabetes.
This article addresses several issues pertinent to health systems governance for health equity. It argues the importance of health systems using measures of positive health (well-being), discriminating in favour of historically less advantaged groups and weighing the costs of health care against investments in the social determinants of health. It cautions that the concept of governance could weaken the role of government, with disequalizing effects, while emphasizing the importance of two elements of good governance (transparency and participation) in health systems decision-making. It distinguishes between participation as volunteer labour and participation as exercising political rights, and questions the assumption that decentralization in health systems is necessarily empowering. It then identifies five health system roles to address issues of equity (educator/watchdog, resource broker, community developer, partnership developer and advocate/catalyst) and the implications of these roles for practice. Drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers' roles, noting the importance of health workers claiming their identity as citizens. The article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other.
Panisello, Maria Luisa; Pastor, Inma
This paper presents an analysis of the incorporation of the gender perspective in health care-related policies. Based on the recommendations of international organizations, the importance of the incorporation of the gender concept in the health field is analyzed, in order to design health policies that seeking to redress existing inequalities by virtue of sex/gender. This paper presents an analysis of the published guidelines in order to facilitate the incorporation of the gender perspective in health care systems. The article concludes with a proposal of gender-sensitive health indicators that can ensure the gender perspective in health care policies.
Taylor, Allyn L.
The evolving domain of international health law encompasses increasingly diverse and complex concerns. Commentators agree that health development in the twenty-first century is likely to expand the use of conventional international law to create a framework for coordination and cooperation among states in an increasingly interdependent world. This article examines the forces and factors behind the emerging expansion of conventional international health law as an important tool for present and future multilateral cooperation. It considers challenges to effective international health cooperation posed for intergovernmental organizations and other actors involved in lawmaking. Although full consolidation of all aspects of future international health lawmaking under the auspices of a single international organization is unworkable and undesirable, the World Health Organization (WHO) should endeavour to serve as a coordinator, catalyst and, where appropriate, platform for future health law codification. Such leadership by WHO could enhance coordination, coherence and implementation of international health law policy. PMID:12571727
Critchley, Kim A; Richardson, Eileen; Aarts, Clara; Campbell, Barbara; Hemmingway, Ann; Koskinen, Liisa; Mitchell, Maureen P; Nordstrom, Pam
With growing interconnectivity of healthcare systems worldwide and increased immigration, inappropriate cultural and role assumptions are often seen when cultures clash within a country or when there is practice across country boundaries in times of disaster and during international travel. To increase students' multicultural awareness and work experiences abroad, the authors describe a 7-school, 5-country international student exchange project. The authors also share the students' evaluations of their experiences as they are challenged to erase boundaries and embrace nursing across countries. Participating faculty describe the process, challenges, and keys to success found in creating and living this international project. Students involved in the exchange process evaluate the learning opportunities and challenges and the joy of coming together as newfound colleagues and friends.
Toro-Palacio, Luis Fernando; Ochoa-Jaramillo, Francisco Luis
This article points out the enormous gap that exists between complex thinking of an intellectual nature currently present in our environment, and complex experimental thinking that has facilitated the scientific and technological advances that have radically changed the world. The article suggests that life, human beings, global society, and all that constitutes health be considered as adaptive complex systems. This idea, in turn, prioritizes the adoption of a different approach that seeks to expand understanding. When this rationale is recognized, the principal characteristics and emerging properties of health as an adaptive complex system are sustained, following a care and services delivery model. Finally, some pertinent questions from this perspective are put forward in terms of research, and a series of appraisals are expressed that will hopefully serve to help us understand all that we have become as individuals and as a species. The article proposes that the delivery of health care services be regarded as an adaptive complex system.
The International Program on the Health Effects of the Chernobyl Accident (IPHECA) was established by the World Health Organization (WHO) in 1991. Currently, the technical part of IPHECA consists of five projects addressing the following areas of priority health problems or needs: thyroid, hematology, brain damage in utero, epidemiological registry and oral health. Important findings are: 1) a significant increase of thyroid cancer in children in Belarus and Ukraine since 1989, and in Russia since 1992 though not so pronounced. A relationship between detected thyroid cancers and radiation exposure is yet to be established, 2) no increase yet in the incidence of hemoblastoses in the three States, 3) no relationship established between mental retardation and radiation exposure in utero in 4,500 children investigated. The importance of dosimetry and biological indicators of radiation damage has been recognized by IPHECA. Several methods of biological and physical dosimetry are being employed using instrumentation provided by IPHECA. Some preliminary results indicate: 1) unstable aberrations can indicate an integral exposure but it is heavily biased to recent exposures, 2) when comparing healthy persons and patients with hematological diseases in contaminated areas, there is a higher ratio of total aberrations compared to their background and that the level of stable is lower than unstable aberrations, and 3) by applying electron spin resonance (ESR) it has been shown that the individual distribution of doses approaches a log-normal one, especially for adults, and that a peak shift towards higher doses is noticeable for children.
The international Symposium on Clusters and Nanostructures was held in Richmond, Virginia during November 7-10, 2011. The symposium focused on the roles clusters and nanostructures play in solving outstanding problems in clean and sustainable energy, environment, and health; three of the most important issues facing science and society. Many of the materials issues in renewable energies, environmental impacts of energy technologies as well as beneficial and toxicity issues of nanoparticles in health are intertwined. Realizing that both fundamental and applied materials issues require a multidisciplinary approach the symposium provided a forum by bringing researchers from physics, chemistry, materials science, and engineering fields to share their ideas and results, identify outstanding problems, and develop new collaborations. Clean and sustainable energy sessions addressed challenges in production, storage, conversion, and efficiency of renewable energies such as solar, wind, bio, thermo-electric, and hydrogen. Environmental issues dealt with air- and water-pollution and conservation, environmental remediation and hydrocarbon processing. Topics in health included therapeutic and diagnostic methods as well as health hazards attributed to nanoparticles. Cross-cutting topics such as reactions, catalysis, electronic, optical, and magnetic properties were also covered.
de Campos, André Luiz Vieira
This paper analyzes the role of the Serviço Especial de Saúde Pública (Special Service of Public Health) in developing and expanding higher education in nursing and to train auxiliary health personnel in Brazil under bilateral agreements between the US and Brazil during the 1940s and 1950s. The Nursing Program of the Special Service is approached from the perspective of its participation in a broader international cooperation developed by the Pan American Health Organization, but also as part of the state and nation building effort of the first Vargas Regime.
This article examines the evolution of the current international system for responding to refugee problems and the climate within which the legal and institutional framework has developed. It reviews the background and handling of some of the key refugee movements since World War II and traces the legal and institutional adjustments that have been made to deal with new refugee movements that have occurred predominantly, but not exclusively, in the developing world. Finally, it assesses the adequacy of the present system to meet the challenges ahead.
Krewitt, W; Hurley, F; Trukenmüller, A; Friedrich, R
Health risks from fossil, renewable and nuclear reference energy systems are estimated following a detailed impact pathway approach. Using a set of appropriate air quality models and exposure-effect functions derived from the recent epidemiological literature, a methodological framework for risk assessment has been established and consistently applied across the different energy systems, including the analysis of consequences from a major nuclear accident. A wide range of health impacts resulting from increased air pollution and ionizing radiation is quantified, and the transferability of results derived from specific power plants to a more general context is discussed.
Higgins, C W; Philips, B U; Bruhn, J G; Aker, L T
Public Law 93-641 provides health systems agencies (HSAs) with a broad planning preview which has enabled a number of agencies to address environmental health issues in their health systems plans. Opponents of HSA involvement in environmental health planning charge that these activities overextend agency resources, duplicate efforts of other government agencies and involve HSAs in "issues of public policy." Closer examination of these charges finds them lacking in validity. The planning activities of health systems agencies are cooperative in nature, drawing upon the planning efforts of other institutions and agencies. It is illogical to exclude environmental concerns from general health planning in light of the impact of the environment upon health. Charges that issues of public policy are inappropriate topics for health planning are seen as attempts to avoid scrutiny of inconsistant legislative policies. Cooperative planning between health systems agencies and environmental health agencies is considered both desirable and essential for the development of effective health planning. PMID:7428743
Melcher, Kevin J.; Wong, Edmond; Fulton, Christopher E.; Sowers, Thomas S.; Maul, William A.
A document discusses the Portable Health Algorithms Test (PHALT) System, which has been designed as a means for evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT system allows systems health management algorithms to be developed in a graphical programming environment, to be tested and refined using system simulation or test data playback, and to be evaluated in a real-time hardware-in-the-loop mode with a live test article. The integrated hardware and software development environment provides a seamless transition from algorithm development to real-time implementation. The portability of the hardware makes it quick and easy to transport between test facilities. This hard ware/software architecture is flexible enough to support a variety of diagnostic applications and test hardware, and the GUI-based rapid prototyping capability is sufficient to support development execution, and testing of custom diagnostic algorithms. The PHALT operating system supports execution of diagnostic algorithms under real-time constraints. PHALT can perform real-time capture and playback of test rig data with the ability to augment/ modify the data stream (e.g. inject simulated faults). It performs algorithm testing using a variety of data input sources, including real-time data acquisition, test data playback, and system simulations, and also provides system feedback to evaluate closed-loop diagnostic response and mitigation control.
Simón Soria, Fernando; Guillén Enríquez, Francisco Javier
The world is changing more and faster than ever before. New diseases are coming to light each year, controlled diseases are reemerging as potential threats, and natural or man-made disasters are increasingly affecting human health. The "International Health Regulations (2005)" reflect the changes in the response of public health to this new situation. Surveillance of specific diseases and predefined control measures have been replaced by surveillance of public health events of international concern and control measures adapted to each situation. The public health events of international interest are characterized by their seriousness, predictability, the risk of international spread and potential for travel or trade restrictions. The development of the European Early Warning and Response System in 1998 and the creation of the European Center for Disease Prevention and Control in 2005 demonstrate political commitment in Europe, with early detection of and response to public health threats. However, timely risk evaluation and response at a national level requires improved data digitalization and accessibility, automatic notification processes, data analysis and dissemination of information, the combination of information from multiple sources and adaptation of public health services. The autonomous regions in Spain are initiating this adaptation process, but interoperability between systems and the development of guidelines for a coordinated response should be steered by the National Interregional Health Council and coordinated by the Ministry of Health. Efficient early warning systems of health threats that allow for a timely response and reduce uncertainty about information would help to minimize the risk of public health crises. The profile of public health threats is nonspecific. Early detection of threats requires access to information from multiple sources and efficient risk assessment. Key factors for improving the response to public health threats are the
Benzian, Habib; Monse, Bella; Belizario, Vicente; Schratz, Alexander; Sahin, Murat; Helderman, Wim van Palenstein
School health programmes as a platform to deliver high-impact health interventions are currently underrated by decision makers and do not get adequate attention from the international public health community. We describe the award-winning Fit for School Approach from the Philippines as an example of a large-scale, integrated, cost-effective and evidence-based programme that bridges the gap between sectors, and between evidence and practice. In view of the challenges to achieve the health and education related Millennium Development Goals (MDGs) in many countries, intensified efforts are required. We present the Fit for School Action Framework as a realistic and tested approach that helps to make schools places of public health for children and wider communities.
Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana
This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.
This study re-examines the healthy migrant phenomenon in China's internal migration process and investigates the different trajectories of place of origin on migrants' self-rated physical health and psychological distress. Data came from a household survey (N = 1474) conducted in Beijing between May and October in 2009. Multiple regression techniques were used to model the associations between self-rated physical health, psychological distress, and migration experience, controlling for sociodemographic characteristics. The healthy migrant phenomenon was observed among migrants on self-rated physical health but not on psychological distress. Different health status trajectories existed between physical health versus mental health and between rural-to-urban migrants versus urban-to-urban migrants. The study draws particular attention to the diminishing physical health advantage and the initial high level of psychological distress among urban-to-urban migrants. The initial physical health advantage indicates that it is necessary to reach out to the migrant population and provide equal access to health services in the urban area. The high level of psychological distress suggests that efforts targeting mental health promotion and mental disorder prevention among the migrant population are an urgent need. The findings of the study underline the necessity to make fundamental changes to the restrictive hukou system and the unequal distribution of resources and opportunities in urban and rural areas. These changes will lessen the pressure on big cities and improve the living conditions and opportunities of residents in townships/small cities and the countryside.
Gagnon, Anita J; Dougherty, Geoffrey; Wahoush, Olive; Saucier, Jean-François; Dennis, Cindy-Lee; Stanger, Elizabeth; Palmer, Becky; Merry, Lisa; Stewart, Donna E
There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women-infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.
Mogollón-Pérez, Amparo Susana; Vázquez, María Luisa
In Colombia, the on-going armed conflict causes displacement of thousands of persons that suffer its economic, social, and health consequences. Despite government regulatory efforts, displaced people still experience serious problems in securing access to health care. In order to analyze the institutional factors that affect access to health care by the internally displaced population, a qualitative, exploratory, and descriptive study was carried out by means of semi-structured individual interviews with a criterion sample of stakeholders (81). A narrative content analysis was performed, with mixed generation of categories and segmentation of data by themes and informants. Inadequate funding, providers' problems with reimbursement by insurers, and lack of clear definition as to coverage under the Social Security System in Health pose barriers to access to health care by the internally displaced population. Bureaucratic procedures, limited inter- and intra-sector coordination, and scarce available resources for public health service providers also affect access. Effective government action is required to ensure the right to health care for this population.
The current context of cost control relative to health expenditures forces hospitals to wonder about their management style. Therefore, the question of the efficiency of the health system is raised. Would the formalization by contract bring the beginnings of an answer? This is what its growing development within numerous public health establishments leads one to suppose, thus signing an evolution towards some new "medical and administrative" governance. Through this article, I therefore suggest to you a questioning on the essence of the contractual method, its stakes, its limits and especially a projective approach on the consequences of this management method considering the "health executive" function. As the stake in this reflection is to highlight the fact that if the health executive has a place acknowledged in the internal formalization by contract, its competence will constitute an increase in value in the contractual process. Indeed, this questioning seems important to me and this, all the more as the ordinance dated May 2, 2005 including "various arrangements relative to the functioning of public health establishments and modifying the public health code", stipulates that public hospitals should resort to the method of internal formalization by contract in setting up centres of activity and this, at the latest, before December 31, 2006.
Online peer support communities play an important part in many people’s experience of healthcare. They can be particularly significant in behavioral health/mental health due to the difficulties that people may experience in accessing face to face care for these conditions. There is considerable diversity of practice in service management, target group, and moderation practices of online peer support communities. People using the communities also appear to have diverse aims and experiences. This heterogeneity contributes to a relative lack of data about the value and effectiveness of online peer support in behavioral health, although there is significant research into some aspects of these communities. The digital behavioral health service Big White Wall was launched in the UK in 2007, and in the US in 2015, and is focused on delivering moderated peer support. There are considerable differences in health systems between the two countries, and this has been reflected in different experiences of implementation. The value of online peer support could be maximized if systemic challenges to implementation and adoption were addressed more effectively. PMID:28293613
Understanding the state of a polar station's power system can be critical to a successful long-term deployment. Knowing how the system is functioning, prior to service, is key to proper logistics, scheduling and the service performed during a visit. A full record of power system performance is key to proper analysis of the health of the power system. The design of a power system with monitoring is a balance of components to gather information while still trying to keep complexity low. To properly incorporate a system to analyze a stations power system a firm understanding of how the power components function in polar environments as well as communication to data acquisition and / or telemetry is needed. For example designers will need to know how a station's power storage system will change in colder environments then manufactures standard design criteria. This would include the reduced available capacity, change in the mean time between failure and possible new failure modes. This understanding coupled with a system that would collect key information on the state of health of the power system will provide crucial insight in to what service is needed to keep the station functioning.
Bigdeli, Maryam; Jacobs, Bart; Tomson, Goran; Laing, Richard; Ghaffar, Abdul; Dujardin, Bruno; Van Damme, Wim
Most health system strengthening interventions ignore interconnections between systems components. In particular, complex relationships between medicines and health financing, human resources, health information and service delivery are not given sufficient consideration. As a consequence, populations' access to medicines (ATM) is addressed mainly through fragmented, often vertical approaches usually focusing on supply, unrelated to the wider issue of access to health services and interventions. The objective of this article is to embed ATM in a health system perspective. For this purpose, we perform a structured literature review: we examine existing ATM frameworks, review determinants of ATM and define at which level of the health system they are likely to occur; we analyse to which extent existing ATM frameworks take into account access constraints at different levels of the health system. Our findings suggest that ATM barriers are complex and interconnected as they occur at multiple levels of the health system. Existing ATM frameworks only partially address the full range of ATM barriers. We propose three essential paradigm shifts that take into account complex and dynamic relationships between medicines and other components of the health system. A holistic view of demand-side constraints in tandem with consideration of multiple and dynamic relationships between medicines and other health system resources should be applied; it should be recognized that determinants of ATM are rooted in national, regional and international contexts. These are schematized in a new framework proposing a health system perspective on ATM. PMID:23174879
Ammar, Walid; Kdouh, Ola; Hammoud, Rawan; Hamadeh, Randa; Harb, Hilda; Ammar, Zeina; Atun, Rifat; Christiani, David; Zalloua, Pierre A
Background Between 2011 and 2013, the Lebanese population increased by 30% due to the influx of Syrian refugees. While a sudden increase of such magnitude represents a shock to the health system, threatening the continuity of service delivery and destabilizing governance, it also offers a unique opportunity to study resilience of a health system amidst ongoing crisis. Methods We conceptualized resilience as the capacity of a health system to absorb internal or external shocks (for example prevent or contain disease outbreaks and maintain functional health institutions) while sustaining achievements. We explored factors contributing to the resilience of the Lebanese health system, including networking with stakeholders, diversification of the health system, adequate infrastructure and health human resources, a comprehensive communicable disease response and the integration of the refugees within the health system. Results In studying the case of Lebanon we used input–process–output–outcome approach to assess the resilience of the Lebanese health system. This approach provided us with a holistic view of the health system, as it captured not only the sustained and improved outcomes, but also the inputs and processes leading to them. Conclusion Our study indicates that the Lebanese health system was resilient as its institutions sustained their performance during the crisis and even improved. PMID:28154758
Katz, Rebecca; Sorrell, Erin M; Kornblet, Sarah A; Fischer, Julie E
The launch of the Global Health Security Agenda (GHSA) in February 2014 capped over a decade of global efforts to develop new approaches to emerging and reemerging infectious diseases-part of the growing recognition that disease events, whether natural, accidental, or intentional, threaten not just public health, but national, regional, and global security interests. In 2005, the United States, along with other Member States of the World Health Organization (WHO), adopted the revised International Health Regulations [IHR (2005)]. The IHR (2005) conferred new responsibilities on WHO and the global health community to coordinate resources for capacity building and emergency response, and on the now-196 States Parties to develop the core capacities required to detect, assess, report, and respond to potential public health emergencies of international concern. Both GHSA and the IHR aim to elevate political attention and encourage participation, coordination, and collaboration by multiple stakeholders, while leveraging previously existing commitments and multilateral efforts. GHSA and the IHR (2005) are platforms for action; how efforts under each will complement each other remains unclear. Mechanisms that measure progress under these 2 overlapping frameworks will aid in focusing resources and in sustaining political momentum for IHR implementation after 2016.
Study objective To examine the Canadian origins of the Lalonde Report and its impact on British and American health promotion activities. Design: A brief history of the development of key Canadian documents and their use by politicians and public health activists in the United Kingdom and United States. Setting: This paper focuses on the impact of the Canadian model on Canada, the United Kingdom and United States. Main results: This paper argues that internal political and economic forces are as important as international trends in determining healthcare policy initiatives. Conclusions: In the 1970s all the English‐speaking developed nations were facing deficits as curative costs rose. Adopting health promotion policies permitted them to shift responsibility back to local governments and individuals while limiting their expenditures. Health and community activists, however, used this concept to broaden their focus to include the social, economic and political determinants of health and thus reinvented public health discourse and practice for the 21st century. PMID:17933952
Two international scientific societies dedicated to research in neurotoxicology and neurobehavioral toxicology are the International Neurotoxicology Association (INA) and the International Congress on Occupational Health International Symposium on Neurobehavioral Methods and Effe...
Cui, Helen H.; Erkkila, Tracy; Chain, Patrick S. G.; ...
Genome science and technologies are transforming life sciences globally in many ways and becoming a highly desirable area for international collaboration to strengthen global health. The Genome Science Program at the Los Alamos National Laboratory is leveraging a long history of expertise in genomics research to assist multiple partner nations in advancing their genomics and bioinformatics capabilities. The capability development objectives focus on providing a molecular genomics-based scientific approach for pathogen detection, characterization, and biosurveillance applications. The general approaches include introduction of basic principles in genomics technologies, training on laboratory methodologies and bioinformatic analysis of resulting data, procurement, and installationmore » of next-generation sequencing instruments, establishing bioinformatics software capabilities, and exploring collaborative applications of the genomics capabilities in public health. Genome centers have been established with public health and research institutions in the Republic of Georgia, Kingdom of Jordan, Uganda, and Gabon; broader collaborations in genomics applications have also been developed with research institutions in many other countries.« less
Summary Objectives To summarize excellent current research in the field of Health Information Systems. Method Creation of a synopsis of the articles selected for the 2014 edition of the IMIA Yearbook. Results Four papers from international peer reviewed journals were selected and are summarized. Conclusions Selected articles illustrate current research regarding the impact and the evaluation of health information technology and the latest developments in health information exchange. PMID:25123731
Background Strengthening health research is an important objective for international health organisations, but there has been less attention to support for health research in Europe. We describe the public-health (population and organisational level) research systems in the 27 European Union countries. Methods We developed a typology for describing health research structures based on funding streams and strategies. We drew data from internet sources and asked country informants to review these for consistency and completeness. The structures were described as organograms and narratives in country profiles for each of the 27 EU member states. National public-health research structures included public and independent funding organisations, 'mixed' institutions (which receive funds, and both use and allocate them) and provider institutions. Results Most health research is funded through ministries of science or science councils (and sometimes foundations), while parliaments and regions may also contribute. National institutes of public health are usually funded by ministries of health. Many national research organisations both determine research programmes and undertake health research, but there is a move towards public-health sciences within the universities, and a transition from internal grants to competitive funding. Of 27 national research strategies, 17 referred to health and 11 to public health themes. Although all countries had strategies for public health itself, we found little coherence in public-health research programmes. The European Commission has country contact points for both EU research and health programmes, but they do not coordinate with national health-research programmes. Conclusions Public-health research is broadly distributed across programmes in EU countries. Better understanding of research structures, programmes and results would improve recognition for public health in Europe, and contribute to practice. EU ministries of health should
Qureshi, Naseem Akhtar; Al-Habeeb, Abdulhameed Abdullah; Koenig, Harold G
Background There is evidence that mapping mental health systems (MHSs) helps in planning and developing mental health care services for users, families, and other caregivers. The General Administration of Mental Health and Social Services of the Ministry of Health over the past 4 years has sought to streamline the delivery of mental health care services to health consumers in Saudi Arabia. Objective We overview here the outcome of a survey that assessed the Saudi MHS and suggest strategic steps for its further improvement. Method The World Health Organization Assessment Instrument for Mental Health Systems was used systematically to collect information on the Saudi MHS in 2009–2010, 4 years after a baseline assessment. Results Several mental health care milestones, especially provision of inpatient mental health services supported by a ratified Mental Health Act, were achieved during this period. However, community mental health care services are needed to match international trends evident in developed countries. Similarly, a larger well-trained mental health workforce is needed at all levels to meet the ever-increasing demand of Saudi society. Conclusion This updated MHS information, discussed in light of international data, will help guide further development of the MHS in Saudi Arabia in the future, and other countries in the Eastern Mediterranean region may also benefit from Saudi experience. PMID:23966783
Hall, David R.; Hall, Jr., H. Tracy; Pixton, David; Dahlgren, Scott; Sneddon, Cameron; Briscoe, Michael; Fox, Joe
The invention is a seal system for a coaxial cable more specifically an internal seal system placed within the coaxial cable and its constituent components. A series of seal stacks including flexible rigid rings and elastomeric rings are placed on load bearing members within the coaxial cable. The current invention is adapted to seal the annular space between the coaxial cable and an electrical contact passing there through. The coaxial cable is disposed within drilling components to transmit electrical signals between drilling components within a drill string. During oil and gas exploration, a drill string can see a range of pressures and temperatures thus resulting in multiple combinations of temperature and pressure and increasing the difficulty of creating a robust seal for all combinations. The seal system can be used in a plurality of downhole components, such as sections of pipe in a drill string, drill collars, heavy weight drill pipe, and jars.
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Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. Management implies storage, distribution, sharing, maintenance, processing, reasoning, and presentation. ISHM is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this chapter, concepts, procedures, and approaches are presented as a foundation for implementing an ISHM capability relevant to intelligent systems. The capability stresses integration of DIaK from all elements of a system, emphasizing an advance toward an on-board, autonomous capability. Both ground-based and on-board ISHM capabilities are addressed. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
Homoeopathy is a therapy which involves many components and three main agents: the patient, with his or her condition and personal characteristics; the medication used, with its composition and manufacturing procedure; and the physician, with his or her approach to treatment and concepts of health. The development of research and evaluation structures, combined with a critical education in the discipline, would help to improve practices and define homoeopathy's potential role in relation to the other therapies, both conventional and unconventional, used in Western health systems. PMID:10083716
Stuckler, David; Basu, Sanjay
In April 2009, the G20 countries committed US $750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF provides loans to financially ailing countries, but with strict conditions, typically involving a mix of privatization, liberalization, and fiscal austerity programs. These loan conditions have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. As more countries are being exposed to IMF policies, there is a need to establish what we know and do not know about the IMF's effects on global health. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund's effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programs have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to prevent the current wave of IMF programs from further undermining public health in financially ailing countries and limiting progress toward the health Millennium Development Goals.
The literature indicates that the health of women in Afghanistan is poor. In 1997 maternal mortality in Afghanistan was one of the worst in the world. Difficulties in establishing health services revolve around fundamentalist Islamic ideas and ongoing violence within Afghanistan. The literature holds advice on key behaviours for health professionals who may chose to work in Afghanistan. The literature also identifies the local level action that is occurring as the issue of women's health is recognised. Humanitarian assistance has been provided, with international aid agencies having to weigh the ethical responsibilities they hold and one agency tragically facing the violent loss of its own staff. Easy answers are not in the literature, merely an opportunity to understand, consider, and take action about what is facing women in Afghanistan and those who try to help.
Cloatre, Emilie; Pickersgill, Martyn
Recent social science scholarship has employed the term “pharmaceuticalization” in analyses of the production, circulation and use of drugs. In this paper, we seek to open up further discussion of the scope, limits and potential of this as an analytical device through consideration of the role of law and legal processes in directing pharmaceutical flows. To do so, we synthesize a range of empirical and conceptual work concerned with the relationships between access to medicines and intellectual property law. This paper suggests that alongside documenting the expansion or reduction in demand for particular drugs, analysts of pharmaceuticalization attend to the ways in which socio-legal developments change (or not) the identities of drugs, and the means through which they circulate and come to be used by states and citizens. Such scholarship has the potential to more precisely locate the biopolitical processes that shape international agendas and targets, form markets, and produce health. PMID:25431535
Cloatre, Emilie; Pickersgill, Martyn
Recent social science scholarship has employed the term "pharmaceuticalization" in analyses of the production, circulation and use of drugs. In this paper, we seek to open up further discussion of the scope, limits and potential of this as an analytical device through consideration of the role of law and legal processes in directing pharmaceutical flows. To do so, we synthesize a range of empirical and conceptual work concerned with the relationships between access to medicines and intellectual property law. This paper suggests that alongside documenting the expansion or reduction in demand for particular drugs, analysts of pharmaceuticalization attend to the ways in which socio-legal developments change (or not) the identities of drugs, and the means through which they circulate and come to be used by states and citizens. Such scholarship has the potential to more precisely locate the biopolitical processes that shape international agendas and targets, form markets, and produce health.
Ibrahim, Jennifer K; Burris, Scott; Hays, Scott
The importance of law in the organization and operation of public health systems has long been a matter of interest to public health lawyers and practitioners, but empirical research on law as a factor in health system performance has been limited in quantity and sophistication. The emergence of Public Health Law Research and Public Health Systems and Services Research within a coordinated effort to strengthen public health research and practice has dramatically changed matters. This article introduces Public Health Law Research as an integral part of Public Health Systems and Services Research, discusses the challenges of integrating the 2 fields, and highlights 2 examples of current research that demonstrate the benefits of an integrated approach to improve the use of law in public health practice.
Meng, Qingyue; Fang, Hai; Liu, Xiaoyun; Yuan, Beibei; Xu, Jin
Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes.
Child Family Health International (CFHI) is a U.S.-based nonprofit, nongovernmental organization (NGO) that has more than 25 global health education programs in seven countries annually serving more than 600 interprofessional undergraduate, graduate, and postgraduate participants in programs geared toward individual students and university partners. Recognized by Special Consultative Status with the United Nations Economic and Social Council (ECOSOC), CFHI utilizes an asset-based community engagement model to ensure that CFHI's programs challenge, rather than reinforce, historical power imbalances between the "Global North" and "Global South." CFHI's programs are predicated on ethical principles including reciprocity, sustainability, humility, transparency, nonmaleficence, respect for persons, and social justice.
Le Loup, G; Fleury, S; Camargo, K; Larouzé, B
The sustainability of successful public health programmes remains a challenge in low and middle income settings. These programmes are often subjected to mobilization-demobilization cycle. Indeed, political and organizational factors are of major importance to ensure this sustainability. The cooperation between the World Bank and the Brazilian AIDS programme highlights the role of international institutions and global health initiatives (GHI), not only to scale up programmes but also to guarantee their stability and sustainability, at a time when advocacy is diminishing and vertical programmes are integrated within health systems. This role is critical at the local level, particularly when economic crisis may hamper the future of public health programmes. Political and organizational evolution should be monitored and warnings should trigger interventions of GHI before the decline of these programmes.
The Professional Health Card Public interest group (Groupement d'Intérêt Public-Carte de professionnel de Santé (GIP-CPS)) was founded in 1993 as a joint initiative by the different parties involved in health care in France: the state, the representatives of the health care professions and the compulsory and complementary health insurance organizations. The CPS system enables safe exchange and electronic sharing of medical data. Via Intranet connections and Extranet hosting of medical files, databases, the CPS system enables health care professionals who access servers to be identified with certainty. For email exhanges, the CPS systems guarantees the sender's identity and capacity. The electronic signature gives legal value to the email. The system also enables confidential email. The health card system (CPS) contributes to making the health service efficient. Shared medical files, health care networks, health warning systems or electronic requests for reimbursement of health insurance expenses all use the CPS system. More than 300,000 health care professionals use it regularly. The freedom of movement of patients throughout Europe has led to the growth of exchanges and information sharing between health professionals in the States of the Union. More and more health professionals will be leaving their own countries to work in foreign countries in the future. It is essential that their freedom of movement is accompanied by the ability to prove their rights to practice.
Belló, Mariana; Becerril-Montekio, Victor M
This paper describes the health system of Argentina.This system has three sectors: public, social security and private.The public sector includes the national and provincial ministries as well as the network of public hospitals and primary health care units which provide care to the poor and uninsured population. This sector is financed with taxes and payments made by social security beneficiaries that use public health care facilities. The social security sector or Obras Sociales (OS) covers all workers of the formal economy and their families. Most OS operate through contracts with private providers and are financed with payroll contributions of employers and employees. Finally, the private sector includes all those private providers offering services to individuals, OS beneficiaries and all those with private health insurance.This sector also includes private insurance agencies called Prepaid Medicine Enterprises, financed mostly through premiums paid by families and/or employers.This paper also discusses some of the recent innovations implemented in Argentina, including the program Remediar.
Ezzati, Majid; Bailis, Rob; Kammen, Daniel M.; Holloway, Tracey; Price, Lynn; Cifuentes, Luis A.; Barnes, Brendon; Chaurey, Akanksha; Dhanapala, Kiran N.
It is well-documented that energy and energy systems have a central role in social and economic development and human welfare at all scales, from household and community to regional and national (41). Among its various welfare effects, energy is closely linked with people s health. Some of the effects of energy on health and welfare are direct. With abundant energy, more food or more frequent meals can be prepared; food can be refrigerated, increasing the types of food items that are consumed and reducing food contamination; water pumps can provide more water and eliminate the need for water storage leading to contamination or increased exposure to disease vectors such as mosquitoes or snails; water can be disinfected by boiling or using other technologies such as radiation. Other effects of energy on public health are mediated through more proximal determinants of health and disease. Abundant energy can lead to increased irrigation, agricultural productivity, and access to food and nutrition; access to energy can also increase small-scale income generation such as processing of agricultural commodities (e.g., producing refined oil from oil seeds, roasting coffee, drying and preserving fruits and meats) and production of crafts; ability to control lighting and heating allows education or economic activities to be shielded from daily or seasonal environmental constraints such as light, temperature, rainfall, or wind; time and other economic resources spent on collecting and/or transporting fuels can be used for other household needs if access to energy is facilitated; energy availability for transportation increases access to health and education facilities and allow increased economic activity by facilitating the transportation of goods and services to and from markets; energy for telecommunication technology (radio, television, telephone, or internet) provides increased access to information useful for health, education, or economic purposes; provision of energy
Nalewajski, Roman F.
A thermodynamiclike theory of internal equilibrium and constrained equilibrium states of individual molecular systems is formulated, based on the Legendre transformed density functional theory (LT DFT). The molecular system (nonrelativistic, field free, Born-Oppenheimer or non-Born-Oppenheimer) is treated as the closed composite thermodynamic system, consisting of very small, rigid (open) subsystems (simple systems) containing a multi-(m)-component charged fluid in the presence of an external field. The generalized Levy constrained search construction of various ``thermodynamic'' potentials of LT DFT is given and the local Maxwell relations are derived. The reduction of various second-order partial functional derivatives (system sensitivities) in terms of few independent, basic kernels is described, using the Jacobian determinants technique. The qualitative implications for the basic kernels of the theory, from the Maxwell relations and stability criteria (generalized Le Châtelier and Le Châtelier-Braun principles) are systematically examined. Finally, possible applications of the general formalism in the thermodynamic analysis of the chemical bond, molecular stability, and chemical reactivity are identified.
Groenewegen, Peter P; Kerssens, Jan J; Sixma, Herman J; van der Eijk, Ingrid; Boerma, Wienke GW
Background Quality of care from the perspective of users is increasingly used in evaluating health care performance. Going beyond satisfaction studies, quality of care from the users' perspective is conceptualised in two dimensions: the importance users attach to aspects of care and their actual experience with these aspects. It is well established that health care systems differ in performance. The question in this article is whether there are also differences in what people in different health care systems view as important aspects of health care quality. The aim is to describe and explain international differences in the importance that health care users attach to different aspects of health care. Methods Data were used from different studies that all used a version of the QUOTE-questionnaire that measures user views of health care quality in two dimensions: the importance that users attach to aspects of care and their actual experience. Data from 12 European countries and 5133 individuals were used. They were analysed using multi-level analysis. Results Although most of the variations in importance people attach to aspects of health care is located at the individual level, there are also differences between countries. The ranking of aspects shows similarities. 'My GP should always take me seriously' was in nearly all countries ranked first, while an item about waiting time in the GP's office was always ranked lowest. Conclusion Differences between countries in how health care users value different aspects of care are difficult to explain. Further theorising should take into account that importance and performance ratings are positively related, that people compare their experiences with those of others, and that general and instrumental values might be related through the institutions of the health care system. PMID:15723701
Atlani-Duault, Laëtitia; Dozon, Jean-Pierre; Wilson, Andrew; Delfraissy, Jean-François; Moatti, Jean-Paul
The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. From decolonisation to the end of the Cold War (1960-99), French assistance to newly independent states was affected by sans frontièrisme, Health for All, and the AIDS pandemic. Since 2000, France has had an active role in development of global health initiatives and favoured multilateral action for health assistance. Today, with adoption of the 2030 Sustainable Development Goals and the challenges of non-communicable diseases, economic inequality, and climate change, French international health assistance needs new direction. In the context of current debate over global health as a universal goal, understanding and acknowledging France's history could help strengthen advocacy in favour of universal health coverage and contribute to advancing global equity through income redistribution, from healthy populations to people who are sick and from wealthy individuals to those who are poor.
Backman, Gunilla; Hunt, Paul; Khosla, Rajat; Jaramillo-Strouss, Camila; Fikre, Belachew Mekuria; Rumble, Caroline; Pevalin, David; Páez, David Acurio; Pineda, Mónica Armijos; Frisancho, Ariel; Tarco, Duniska; Motlagh, Mitra; Farcasanu, Dana; Vladescu, Cristian
60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the highest attainable standard of health. This right is central to the creation of equitable health systems. We identify some of the right-to health features of health systems, such as a comprehensive national health plan, and propose 72 indicators that reflect some of these features. We collect globally processed data on these indicators for 194 countries and national data for Ecuador, Mozambique, Peru, Romania, and Sweden. Globally processed data were not available for 18 indicators for any country, suggesting that organisations that obtain such data give insufficient attention to the right-to-health features of health systems. Where they are available, the indicators show where health systems need to be improved to better realise the right to health. We provide recommendations for governments, international bodies, civil-society organisations, and other institutions and suggest that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.
... 39 Postal Service 1 2013-07-01 2013-07-01 false Internal measurement systems. 3055.4 Section 3055... SATISFACTION REPORTING Annual Reporting of Service Performance Achievements § 3055.4 Internal measurement systems. Service performance measurements obtained from internal measurement systems or hybrid...
... 39 Postal Service 1 2011-07-01 2011-07-01 false Internal measurement systems. 3055.4 Section 3055... SATISFACTION REPORTING Annual Reporting of Service Performance Achievements § 3055.4 Internal measurement systems. Service performance measurements obtained from internal measurement systems or hybrid...
... 39 Postal Service 1 2012-07-01 2012-07-01 false Internal measurement systems. 3055.4 Section 3055... SATISFACTION REPORTING Annual Reporting of Service Performance Achievements § 3055.4 Internal measurement systems. Service performance measurements obtained from internal measurement systems or hybrid...
... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Internal control system. 917.6 Section 917.6... internal control system that addresses: (i) The efficiency and effectiveness of Bank activities; (ii) The... activities necessary to maintain the internal control system required under paragraph (a)(1) of this...
... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Internal control system. 917.6 Section 917.6... internal control system that addresses: (i) The efficiency and effectiveness of Bank activities; (ii) The... activities necessary to maintain the internal control system required under paragraph (a)(1) of this...
Specter, Steven; Schuermann, Lily; Hakiruwizera, Celestin; Sow, Mah-Séré Keita
The revised International Health Regulations [IHR(2005)], which requires the Member States of the World Health Organization (WHO) to develop core capacities to detect, assess, report, and respond to public health threats, is bringing new challenges for national and international surveillance systems. As more countries move toward implementation and/or strengthening of their infectious disease surveillance programs, the strengthening of clinical microbiology laboratories becomes increasingly important because they serve as the first line responders to detect new and emerging microbial threats, re-emerging infectious diseases, the spread of antibiotic resistance, and the possibility of bioterrorism. In fact, IHR(2005) Core Capacity #8, "Laboratory", requires that laboratory services be a part of every phase of alert and response.Public health laboratories in many resource-constrained countries require financial and technical assistance to build their capacity. In recognition of this, in 2006, the American Society for Microbiology (ASM) established an International Laboratory Capacity Building Program, LabCap, housed under the ASM International Board. ASM LabCap utilizes ASM's vast resources and its membership's expertise-40,000 microbiologists worldwide-to strengthen clinical and public health laboratory systems in low and low-middle income countries. ASM LabCap's program activities align with HR(2005) by building the capability of resource-constrained countries to develop quality-assured, laboratory-based information which is critical to disease surveillance and the rapid detection of disease outbreaks, whether they stem from natural, deliberate or accidental causes.ASM LabCap helps build laboratory capacity under a cooperative agreement with the U.S. Centers for Disease Control and Prevention (CDC) and under a sub-contract with the Program for Appropriate Technology in Health (PATH) funded by the United States Agency for International Development (USAID
Cohen, Nicole J; Brown, Clive M; Alvarado-Ramy, Francisco; Bair-Brake, Heather; Benenson, Gabrielle A; Chen, Tai-Ho; Demma, Andrew J; Holton, N Kelly; Kohl, Katrin S; Lee, Amanda W; McAdam, David; Pesik, Nicki; Roohi, Shahrokh; Smith, C Lee; Waterman, Stephen H; Cetron, Martin S
During the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC implemented travel and border health measures to prevent international spread of the disease, educate and protect travelers and communities, and minimize disruption of international travel and trade. CDC staff provided in-country technical assistance for exit screening in countries in West Africa with Ebola outbreaks, implemented an enhanced entry risk assessment and management program for travelers at U.S. ports of entry, and disseminated information and guidance for specific groups of travelers and relevant organizations. New and existing partnerships were crucial to the success of this response, including partnerships with international organizations, such as the World Health Organization, the International Organization for Migration, and nongovernment organizations, as well as domestic partnerships with the U.S. Department of Homeland Security and state and local health departments. Although difficult to assess, travel and border health measures might have helped control the epidemic's spread in West Africa by deterring or preventing travel by symptomatic or exposed persons and by educating travelers about protecting themselves. Enhanced entry risk assessment at U.S. airports facilitated management of travelers after arrival, including the recommended active monitoring. These measures also reassured airlines, shipping companies, port partners, and travelers that travel was safe and might have helped maintain continued flow of passenger traffic and resources needed for the response to the affected region. Travel and border health measures implemented in the countries with Ebola outbreaks laid the foundation for future reconstruction efforts related to borders and travel, including development of regional surveillance systems, cross-border coordination, and implementation of core capacities at designated official points of entry in accordance with the International Health Regulations
place to the base unit (consultation site). The transmission is performed through GSM, Satellite links or POTS . Using this device a specialist...standardized medical protocol. Keywords – Emergency Health Care Telemedicine, GSM, Satellite, POTS I. INTRODUCTION The availability of prompt and expert...of communication means (Satellite, GSM and Plain Old Telephony System - POTS ). The base unit is comprised of a set of user-friendly software
Jian, Wei-yan; Xiong, Xian-jun; Li, Jing-hu; Ding, Yang; Wang, Li-li; Guo, Yan
This study compares physicians' regulations set by the United Kingdom, the United States, Canada and Germany which have typical healthcare systems. Physicians' regulations are defined in this study as four aspects: physicians' training and qualifications, career pathways, payment methods and behavior regulations. Strict access rules, practicing with freedom, different training models between general and special practitioners, health services priced by negotiations and regulations by professional organizations are the common features of physicians' regulations in these four western countries. Three aspects--introducing contract mechanism, enhancing the roles of professional organizations and extending physicians' practice space should be taken into account in China's future reform of physicians' regulations.
McCall, Douglas S; Rootman, Irving; Bayley, Dale
In Canada, researchers, policy-makers and non-governmental organisations have re-conceptualized the school setting as being an ecological entity, linked to parallel ecologies of the homes and the community it serves. The school, public health and other systems that seek to deliver programs in that setting are open, loosely coupled and bureaucratic. This reconceived view of the school as a setting for health promotion leads to an emphasis on building organizational, system, professional and community capacity. One of the most effective ways of building such capacities when resources are scarce is to invest in a variety of formal and informal networks that can sustain themselves with little or no external resources. A number of recognised researchers from the health and education sectors have emphasized this systems-based approach and the need to build supportive, small-scale networks or learning communities. In recent health promotion research, networking at various levels, across sectors and within communities is viewed as a key strategy within new, more effective health promotion strategies. In education, the notion of networking for educational change has been described as "learning communities" for continuous school improvement. The authors suggest that this strategy of networking be used at the international level to address several global challenges: There is no single, convenient way to obtain basic information about the status and nature of national and state/provincial school health programs around the world. There is no global research agenda in school health promotion, despite the obvious value of sharing such research and knowledge. There is no global mechanism to facilitate the development of common or shared tools for surveillance of child/youth health and monitoring of school health policies and programs, despite the excellent work being done in individual countries and by the European Network of Health Promoting Schools. There is no international
The international non-conformist denomination, Seventh-day Adventists, have since their foundation in 1863, had a distinctive health care model for their members. The life-style has included vegetarian diet, abstinence from alcohol, tobacco and other drugs and the observance of a day of rest once a week. The health policy has striven to care for God's creation in the hope of resurrection at the Day of Judgment and to reform the conventional medical practice. The Adventists have pursued an extensive international health care system--from the start based on dietary and physical treatment methods, such as hydrotherapy, massage and physiotherapy--in line with the Christian mission. Health care establishments have been inaugurated around the world as a vehicle for enabling the Christian health care message to reach the upper classes. With Adventist and Doctor, John Harvey Kellogg's Battle Creek Sanatorium in Michigan as both inspirational source and educational institution, the health care mission--including a vegetarian health food industry, following in the footsteps of cornflakes--spread to the Nordic countries by the turn of the century, 1900. Skodsborgs Badesanatorium near Copenhagen became the model institution for several health care establishments in Sweden during the 1900's, such as Hultafors Sanatorium. The American-Nordic link has manifested itself through co-publication of papers, exchange of health care personnel and reporting to the central Adventist church. The American non-conformist domain as well as a private sphere of activity, aiming mainly from the outset at society's upper classes, has encountered certain difficulties in maintaining this distinction in Sweden's officially increasing secularised society, and in relation to a state health insurance and a publicly financed health care system. With the passing of time, the socioeconomic composition of patients at Hultafors became more heterogeneous, and conventional medical procedures were increasingly
Wilson, Mark E.; Cole, Harold; Rector, Tony; Steele, John; Varsik, Jerry
The Internal Active Thermal Control System (IATCS) aboard the International Space Station (ISS) is primarily responsible for the removal of heat loads from payload and system racks. The IATCS is a water based system which works in conjunction with the EATCS (External ATCS), an ammonia based system, which are interfaced through a heat exchanger to facilitate heat transfer. On-orbit issues associated with the aqueous coolant chemistry began to occur with unexpected increases in CO2 levels in the cabin. This caused an increase in total inorganic carbon (TIC), a reduction in coolant pH, increased corrosion, and precipitation of nickel phosphate. These chemical changes were also accompanied by the growth of heterotrophic bacteria that increased risk to the system and could potentially impact crew health and safety. Studies were conducted to select a biocide to control microbial growth in the system based on requirements for disinfection at low chemical concentration (effectiveness), solubility and stability, material compatibility, low toxicity to humans, compatibility with vehicle environmental control and life support systems (ECLSS), ease of application, rapid on-orbit measurement, and removal capability. Based on these requirements, ortho-phthalaldehyde (OPA), an aromatic dialdehyde compound, was selected for qualification testing. This paper presents the OPA qualification test results, development of hardware and methodology to safely apply OPA to the system, development of a means to remove OPA, development of a rapid colorimetric test for measurement of OPA, and the OPA on-orbit performance for controlling the growth of microorganisms in the ISS IATCS since November 3, 2007.
Wilson, Mark E.; Cole, Harold E.; Rector, Tony; Steele, John; Varsik, Jerry
The Internal Active Thermal Control System (IATCS) aboard the International Space Station (ISS) is primarily responsible for the removal of heat loads from payload and system racks. The IATCS is a water based system which works in conjunction with the EATCS (External ATCS), an ammonia based system, which are interfaced through a heat exchanger to facilitate heat transfer. On-orbit issues associated with the aqueous coolant chemistry began to occur with unexpected increases in CO2 levels in the cabin. This caused an increase in total inorganic carbon (TIC), a reduction in coolant pH, increased corrosion, and precipitation of nickel phosphate. These chemical changes were also accompanied by the growth of heterotrophic bacteria that increased risk to the system and could potentially impact crew health and safety. Studies were conducted to select a biocide to control microbial growth in the system based on requirements for disinfection at low chemical concentration (effectiveness), solubility and stability, material compatibility, low toxicity to humans, compatibility with vehicle environmental control and life support systems (ECLSS), ease of application, rapid on-orbit measurement, and removal capability. Based on these requirements, ortho-phthalaldehyde (OPA), an aromatic dialdehyde compound, was selected for qualification testing. This paper presents the OPA qualification test results, development of hardware and methodology to safely apply OPA to the system, development of a means to remove OPA, development of a rapid colorimetric test for measurement of OPA, and the OPA on-orbit performance for controlling the growth of microorganisms in the ISS IATCS since November 3, 2007.
Sekretaryova, Alina N; Eriksson, Mats; Turner, Anthony P F
We present a brief overview of bioelectrocatalytic devices for in vitro health applications, including food safety and environmental analysis, focusing on microelectrode- and microfluidic-based biosensors, paper-based point-of-care devices and wearable biosensors. The main hurdles and future perspectives are discussed. We then consider the role of electron transfer between a biocatalyst and an electrode in biosensor design. Brief descriptions of indirect, direct and mediated mechanisms are given. The principal strategies, as well as recent developments for modulation of electron transfer in biocatalytic systems are summarised. In conclusion, we highlight some of the challenges associated with improving these redox systems.
Rosenthal, Joshua; Jessup, Christine; Felknor, Sarah; Humble, Michael; Bader, Farah; Bridbord, Kenneth
For the past 16 years, the International Training and Research in Environmental and Occupational Health program (ITREOH) has supported projects that link U.S. academic scientists with scientists from low- and middle-income countries in diverse research and research training activities. Twenty-two projects of varied duration have conducted training to enhance the research capabilities of scientists at 75 institutions in 43 countries in Asia, Africa, Eastern Europe, and Latin America, and have built productive research relationships between these scientists and their U.S. partners. ITREOH investigators and their trainees have produced publications that have advanced basic sciences, developed methods, informed policy outcomes, and built institutional capacity. Today, the changing nature of the health sciences calls for a more strategic approach. Data-rich team science requires greater capacity for information technology and knowledge synthesis at the local institution. More robust systems for ethical review and administrative support are necessary to advance population-based research. Sustainability of institutional research capability depends on linkages to multiple national and international partners. In this context, the Fogarty International Center, the National Institute of Environmental Sciences and the National Institute for Occupational Safety and Health, have reengineered the ITREOH program to support and catalyze a multi-national network of regional hubs for Global Environmental and Occupational Health Sciences (GEOHealth). We anticipate that these networked science hubs will build upon previous investments by the ITREOH program and will serve to advance locally and internationally important health science, train and attract first-class scientists, and provide critical evidence to guide policy discussions. PMID:23109132
Rosenthal, Joshua; Jessup, Christine; Felknor, Sarah; Humble, Michael; Bader, Farah; Bridbord, Kenneth
For the past 16 years, the International Training and Research in Environmental and Occupational Health program (ITREOH) has supported projects that link U.S. academic scientists with scientists from low- and middle-income countries in diverse research and research training activities. Twenty-two projects of varied duration have conducted training to enhance the research capabilities of scientists at 75 institutions in 43 countries in Asia, Africa, Eastern Europe, and Latin America, and have built productive research relationships between these scientists and their U.S. partners. ITREOH investigators and their trainees have produced publications that have advanced basic sciences, developed methods, informed policy outcomes, and built institutional capacity. Today, the changing nature of the health sciences calls for a more strategic approach. Data-rich team science requires greater capacity for information technology and knowledge synthesis at the local institution. More robust systems for ethical review and administrative support are necessary to advance population-based research. Sustainability of institutional research capability depends on linkages to multiple national and international partners. In this context, the Fogarty International Center, the National Institute of Environmental Sciences and the National Institute for Occupational Safety and Health, have reengineered the ITREOH program to support and catalyze a multi-national network of regional hubs for Global Environmental and Occupational Health Sciences (GEOHealth). We anticipate that these networked science hubs will build upon previous investments by the ITREOH program and will serve to advance locally and internationally important health science, train and attract first-class scientists, and provide critical evidence to guide policy discussions.
This patent describes an internal combustion engine, a hydraulic system for varying the timing of an intake valve camshaft and an exhaust valve camshaft relative to a crankshaft. It comprises a drive flange adapted to be rotatably coupled to a crank shaft for rotation about one the camshaft axis; a driven flange coupled to the camshaft for rotation above the one camshaft axis; a hydraulic coupling including a housing means connected to one of the flanges and a piston means cooperating with the housing means and connected to the other of the flanges; valve means for regulating the flow of fluid in the conduit means in response to a control signal to cause the drive and driven flanges to rotate relative to one another in a direction selected without any external power utilizing the cyclically varying fluid pressure within the fluid chambers.
Peruski, Anne Harwood; Birmingham, Maureen; Tantinimitkul, Chawalit; Chungsamanukool, Ladawan; Chungsamanukool, Preecha; Guntapong, Ratigorn; Pulsrikarn, Chaiwat; Saengklai, Ladapan; Supawat, Krongkaew; Thattiyaphong, Aree; Wongsommart, Duangdao; Wootta, Wattanapong; Nikiema, Abdoulaye; Pierson, Antoine; Peruski, Leonard F; Liu, Xin; Rayfield, Mark A
Introduction Thailand conducted a national laboratory assessment of core capacities related to the International Health Regulations (IHR) (2005), and thereby established a baseline to measure future progress. The assessment was limited to public laboratories found within the Thai Bureau of Quality and Safety of Food, National Institute of Health and regional medical science centres. Methods The World Health Organization (WHO) laboratory assessment tool was adapted to Thailand through a participatory approach. This adapted version employed a specific scoring matrix and comprised 16 modules with a quantitative output. Two teams jointly performed the on-site assessments in December 2010 over a two-week period, in 17 public health laboratories in Thailand. The assessment focused on the capacity to identify and accurately detect pathogens mentioned in Annex 2 of the IHR (2005) in a timely manner, as well as other public health priority pathogens for Thailand. Results Performance of quality management, budget and finance, data management and communications was considered strong (>90%); premises quality, specimen collection, biosafety, public health functions, supplies management and equipment availability were judged as very good (>70% but ≤90%); while microbiological capacity, staffing, training and supervision, and information technology needed improvement (>60% but ≤70%). Conclusions This assessment is a major step in Thailand towards development of an optimized and standardized national laboratory network for the detection and reporting of infectious disease that would be compliant with IHR (2005). The participatory strategy employed to adapt an international tool to the Thai context can also serve as a model for use by other countries in the Region. The participatory approach probably ensured better quality and ownership of the results, while providing critical information to help decision-makers determine where best to invest finite resources. PMID:26693144
El Oakley, Reida M.; Ghrew, Murad H.; Aboutwerat, Ali A.; Alageli, Nabil A.; Neami, Khaldon A.; Kerwat, Rajab M.; Elfituri, Abdulbaset A.; Ziglam, Hisham M.; Saifenasser, Aymen M.; Bahron, Ali M.; Aburawi, Elhadi H.; Sagar, Samir A.; Tajoury, Adel E.; Benamer, Hani T.S.
The extra demand imposed upon the Libyan health services during and after the Libyan revolution in 2011 led the ailing health systems to collapse. To start the planning process to re-engineer the health sector, the Libyan Ministry of Health in collaboration with the World Health Organisation (WHO) and other international experts in the field sponsored the National Health Systems Conference in Tripoli, Libya, between the 26th and the 30th of August 2012. The aim of this conference was to study how health systems function at the international arena and to facilitate a consultative process between 500 Libyan health experts in order to identify the problems within the Libyan health system and propose potential solutions. The scientific programme adopted the WHO health care system framework and used its six system building blocks: i) Health Governance; ii) Health Care Finance; iii) Health Service Delivery; iv) Human Resources for Health; v) Pharmaceuticals and Health Technology; and vi) Health Information System. The experts used a structured approach starting with clarifying the concepts, evaluating the current status of that health system block in Libya, thereby identifying the strengths, weaknesses, and major deficiencies. This article summarises the 500 health expert recommendations that seized the opportunity to map a modern health systems to take the Libyan health sector into the 21st century. PMID:23359277
Nguyen, Binh N.
The Choctaw Tribe is the first and only tribe to develop a health delivery system to take over an existing Indian Health Service inpatient facility. The takeover was accomplished in January 1984 under the Indian Self-Determination Act through a contract with the Indian Health Service. The Choctaw Health Delivery System includes a 35-bed general…
Zhang, Jing; Luo, Rong; Chen, Shi; Petrovic, Djordje; Redfern, Julie; Xu, Dong Roman; Patel, Anushka
Background With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. Objective The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. Methods We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. Results A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth
Breman, Joel G.; Bridbord, Kenneth; Kupfer, Linda E.; Glass, Roger I.
Summary The Fogarty International Center (FIC) of the U.S. National Institutes of Health has supported long-term (>6 months) basic, clinical and applied research training and research for over 3,600 future leaders in science and public health from low- and middle-income countries (LMICs); tens of thousands more persons have received short-term training. FIC started these programs in 1988 with the flagship HIV/AIDS International Training and Research Program (AITRP) in response to the global pandemic. More than 23 extramural training and research programs plus an intramural program are now operating – all in collaboration with other Institutes and Centers at NIH, U.S. government agencies, foundations, and partner institutions in LMICs and the U.S. While infectious diseases still reign mightily in Sub-Saharan African and South East Asian countries, non-communicable diseases are emerging globally, including in LMICs. Newer FIC training programs are addressing chronic, non-communicable diseases and strengthening the quality of medical schools and health care provider training, in addition to expanding expertise in infectious diseases. The model for successful training is based on long-term commitments, institutional strengthening, “twinning” of research centers, focus on local problems, and active mentoring. Trainees from Africa, Asia, and Latin America have made notable scientific contributions to global health, attained leadership positions, and received special recognition nationally and internationally. As the FIC programs are institutional-strengthening partnerships and candidates are carefully selected and mentored, close to 90% of FIC trainees return to their countries of origin. After returning home the FIC-trained leaders have continued to mentor and train thousands of individuals in their home countries. PMID:21896356
Shaokang, Zhan; Zhenwei, Sun; Blas, Erik
Economic migration and growth in informal employment in many of the major cities of developing countries, combined with health sector reforms that are increasingly relying on insurance and out-of-pocket payment, are raising concerns about equity and sustainability of economic and social development. In China, the number of internal migrants has dramatically grown since economic transition started in 1980, and maternal health care for these is a pressing issue to be addressed. To provide information for policy-makers and health administrators, a medical records review, a questionnaire survey and qualitative interviews were carried out in Minhang District, Shanghai. This paper describes important inequities in main maternal health outcomes and utilization indicators relating to economic and social transformation of the Chinese society. Analysis of the data collected clarifies that insufficient antenatal care is one of the main determinants for poor maternal health outcomes and that migrants are using antenatal care services significantly less than permanent residents. The data suggest that there is no single explanatory factor, but that migrants are faced with a package of obstacles to accessing health care services, and that health systems may need to rethink and redesign their delivery approaches to specifically target those groups that are faced with such multi-faceted packages of obstacles to service-access. Although the study addresses a specific Chinese phenomenon related to internal migration and registration of residency, parallels can be drawn to other settings where a combination of economic and social transitions of the society and a reform of health care financing are potentially creating the same conditions of significant inequalities.
Abdulrauf, Saleem I; Ashour, Ahmed M; Marvin, Eric; Coppens, Jeroen; Kang, Brian; Hsieh, Tze Yu Yeh; Nery, Breno; Penanes, Juan R; Alsahlawi, Aysha K; Moore, Shawn; Al-Shaar, Hussam Abou; Kemp, Joanna; Chawla, Kanika; Sujijantarat, Nanthiya; Najeeb, Alaa; Parkar, Nadeem; Shetty, Vilaas; Vafaie, Tina; Antisdel, Jastin; Mikulec, Tony A; Edgell, Randall; Lebovitz, Jonathan; Pierson, Matt; Pires de Aguiar, Paulo Henrique; Buchanan, Paula; Di Cosola, Angela; Stevens, George
Introduction: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system. Materials and Methods: We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography. We identified specific anatomic landmarks to define the beginning and end of each ICA segment. Results: The ICA was classified into eight segments based on the cadaver and imaging findings: (1) Cervical segment; (2) cochlear segment (ascending segment of the ICA in the temporal bone) (relation of the start of this segment to the base of the styloid process: Above, 425 sides [80%]; below, 2 sides [0.4%]; at same level, 107 sides [20%]; P < 0.0001) (relation of cochlea to ICA: Posterior, 501 sides [85%]; posteromedial, 84 sides [14%]; P < 0.0001); (3) petrous segment (horizontal segment of ICA in the temporal bone) starting at the crossing of the eustachian tube superolateral to the ICA turn in all 10 samples; (4) Gasserian-Clival segment (ascending segment of ICA in the cavernous sinus) starting at the petrolingual ligament (PLL) (relation to vidian canal on imaging: At same level, 360 sides [63%]; below, 154 sides [27%]; above, 53 sides [9%]; P < 0.0001); in this segment, the ICA projected medially toward the clivus in 275 sides (52%) or parallel to the clivus with no deviation in 256 sides (48%; P < 0.0001); (5) sellar segment (medial loop of ICA in the cavernous sinus) starting at the takeoff of the meningeal hypophyseal trunk (ICA was medial into the sella in 271 cases [46%], lateral without touching the sella in 127 cases [23%], and abutting the sella in 182 cases [31%]; P < 0.0001); (6) sphenoid segment (lateral loop of ICA within the
Samb, Badara; Evans, Tim; Dybul, Mark; Atun, Rifat; Moatti, Jean-Paul; Nishtar, Sania; Wright, Anna; Celletti, Francesca; Hsu, Justine; Kim, Jim Yong; Brugha, Ruairi; Russell, Asia; Etienne, Carissa
Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money, and outcomes in global public health, then these opportunities should not be missed.
Davidson, Patricia M; McGrath, Sarah J; Meleis, Afaf I; Stern, Phyllis; Digiacomo, Michelle; Dharmendra, Tessa; Correa-de-Araujo, Rosaly; Campbell, Jacquelyn C; Hochleitner, Margarethe; Messias, Deanne K H; Brown, Hazel; Teitelman, Anne; Sindhu, Siriorn; Reesman, Karen; Richter, Solina; Sommers, Marilyn S; Schaeffer, Doris; Stringer, Marilyn; Sampselle, Carolyn; Anderson, Debra; Tuazon, Josefina A; Cao, Yingjuan; Krassen Covan, Eleanor
The International Council on Women's Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of women's health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl's health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.
Roman, Monsi C.; Wieland, Paul O.
Since January 1999, the chemical the International Space Station Thermal Control System (IATCS) and microbial state of (ISS) Internal Active fluid has been monitored by analysis of samples returned to Earth. Key chemical parameters have changed over time, including a drop in pH from the specified 9.5 +/- 0.5 ta = 58.4, an increase in the level of total inorganic carbon (TIC), total organic carbon (TOC) and dissolved nickel (Ni) in the fluid, and a decrease in the phosphate (PO,) level. In addition, silver (AS) ion levels in the fluid decreased rapidly as Ag deposited on internal metallic surfaces of the system. The lack of available Ag ions coupled with changes in the fluid chemistry has resulted in a favorable environment for microbial growth. Counts of heterotrophic bacteria have increased from less than 10 colony-forming units (CFUs)/l00 mL to l0(exp 6) to l0(exp 7) CFUs/100 mL. The increase of the microbial population is of concern because uncontrolled microbiological growth in the IATCS can contribute to deterioration in the performance of critical components within the system and potentially impact human health if opportunistic pathogens become established and escape into the cabin atmosphere. Micro-organisms can potentially degrade the coolant chemistry; attach to surfaces and form biofilms; lead to biofouling of filters, tubing, and pumps; decrease flow rates; reduce heat transfer; initiate and accelerate corrosion; and enhance mineral scale formation. The micro- biological data from the ISS IATCS fluid, and approaches to addressing the concerns, are summarized in this paper.
Baur, X; Budnik, L T; Preisser, A M
The increasing transport of goods worldwide is mainly carried in standard containers. These containers are frequently fumigated in order to protect freight from pests and to follow regulations of importing countries. Fumigants as well as toxic industrial chemicals can adsorb to goods and be emitted from them over various periods of time. This review is based on a literature search, analyses of air samples from a randomized selection of import containers at the port of Hamburg and clinical investigations of intoxicated subject. These data indicate that about 70% of imported containers exceed national or international threshold levels, about one sixth exceeding occupational exposure limits of fumigants and/or toxic industrial chemical, 0.5% had concentrations immediately dangerous to life or health. Intoxications by inhalation mainly occur in workers in the logistics area. No information exists on possible fumigation in small and medium-sized companies where the container units are unloaded. Neurological and respiratory ailments dominated in patients from our outpatient clinic and those reported in the literature: symptoms were often misdiagnosed. Our results confirm findings of other investigators that subjects who unload containers or have otherwise intensive contact with imported goods are frequently exposed to toxic or very toxic volatile chemicals. It can be assumed that there are many unrecognized cases and also health risks to the ultimate consumers of transported goods. History taking targeted on potential exposure is of great diagnostic importance in elucidating typical temporal relationship between exposure by inhalation and symptoms such as headache, skin irritation, cough, dyspnea, diarrhoea and neurological deficits. Detailed investigations by medical specialists is necessary to confirm suspected diagnoses. This should be combined with immediate special analyses of air samples and laboratory tests (biological monitoring).
Anderberg, Peter; Larsson, Tobias C; Fricker, Samuel A; Berglund, Johan
deployed across European Union countries. Results The relevance of the evaluation aspects created by the UVON method for the FI-STAR project was validated by the corresponding stakeholders of each case. These evaluation aspects were extracted from a UVON-generated ontology structure that reflects both the internally declared required quality attributes in the 7 eHealth applications of the FI-STAR project and the evaluation aspects recommended by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. The extracted evaluation aspects were used to create questionnaires (for the corresponding patients and health professionals) to evaluate each individual case and the whole of the FI-STAR project. Conclusions The UVON method can provide a relevant set of evaluation aspects for a heterogeneous set of health information systems by organizing, unifying, and aggregating the quality attributes through ontological structures. Those quality attributes can be either suggested by evaluation models or elicited from the stakeholders of those systems in the form of system requirements. The method continues to be systematic, context sensitive, and relevant across a heterogeneous set of health information systems. PMID:27311735
Williams, M. Lee
A study identified and categorized different types of internal communication systems and developed an applied model of internal communication in adaptive organizational systems. Twenty-one large organizations were selected for their varied missions and diverse approaches to managing internal communication. Individual face-to-face or telephone…
Spitzberg, Irving J., Jr.
The relationship between international knowledge exchange and the international exchange of persons, particularly through and to higher education systems, is examined. Higher education policy is discussed as one case of international knowledge exchange. Attention is directed to the following policy areas: immigration policy (particularly the…
Rathe, Magdalena; Moliné, Alejandro
This paper describes the health conditions in Dominican Republic and the characteristics of the Dominican health system, including its structure and coverage, its financial sources, the health expenditure, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health and the generation of health information. The participation of health care users in the operation and evaluation of the system and the most recent policy innovations, including the new General Health Law, the new Social Security Law and the Decennial Health Plan are also discussed.
Guimarães, Luisa; Giovanella, Lígia
This article explores the health policy repercussions of countries' regional integration into the European Union. The aim is to review the regulation of access in other countries, with the conclusion of the single European market and the free circulation of persons, services, goods, and capital. The article begins by reviewing the various forms of integration and describes the expansion and institutionalization of Community agencies. The repercussions of European integration on health policies and regulation of access are analyzed. Market impacts on health result from Treaty directives and internal policy adjustments to free circulation. Health services access is gradually regulated and granted by rulings. Projects along borders illustrate the dynamics where differences are used to achieve comprehensive care. In the oldest integration experience, the market regulation has generated intentional and non-intentional impacts on the health policies of member states, regardless of the organizational model. Knowledge and analysis of this experience signals challenges for the Southern Cone Common Market (Mercosur) and adds to future debates and decisions.
Jove-Colon, Carlos F.
The Used Fuel Disposition Campaign (UFDC) within the DOE Fuel Cycle Technologies (FCT) program has been engaging in international collaborations between repository R&D programs for high-level waste (HLW) disposal to leverage on gathered knowledge and laboratory/field data of near- and far-field processes from experiments at underground research laboratories (URL). Heater test experiments at URLs provide a unique opportunity to mimetically study the thermal effects of heat-generating nuclear waste in subsurface repository environments. Various configurations of these experiments have been carried out at various URLs according to the disposal design concepts of the hosting country repository program. The FEBEX (Full-scale Engineered Barrier Experiment in Crystalline Host Rock) project is a large-scale heater test experiment originated by the Spanish radioactive waste management agency (Empresa Nacional de Residuos Radiactivos S.A. – ENRESA) at the Grimsel Test Site (GTS) URL in Switzerland. The project was subsequently managed by CIEMAT. FEBEX-DP is a concerted effort of various international partners working on the evaluation of sensor data and characterization of samples obtained during the course of this field test and subsequent dismantling. The main purpose of these field-scale experiments is to evaluate feasibility for creation of an engineered barrier system (EBS) with a horizontal configuration according to the Spanish concept of deep geological disposal of high-level radioactive waste in crystalline rock. Another key aspect of this project is to improve the knowledge of coupled processes such as thermal-hydro-mechanical (THM) and thermal-hydro-chemical (THC) operating in the near-field environment. The focus of these is on model development and validation of predictions through model implementation in computational tools to simulate coupled THM and THC processes.
Acosta, Mónica; Sáenz, María del Rocío; Gutiérrez, Blanca; Bermúdez, Juan Luis
This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.
Background International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Discussion Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address
Pranjić, Nurka; Karamehić, Jasenko; Ljuca, Farid; Zigić, Zlata; Ascerić, Mensura
In this review we used the published data on depleted uranium (experimental and epidemiological) from the current literature. Depleted uranium is a toxic heavy metal that in high dose may cause poisoning and health effects as those caused by lead, mercury, and chromium. It is slightly radioactive. The aim of this review was to select, to arrange, to present references of scientific papers, and to summarise the data in order to give a comprehensive image of the results of toxicological studies on depleted uranium that have been done on animals (including carcinogenic activity). We have also used epidemiological posted study results related to occupational and environmental exposure to depleted uranium. The toxicity of uranium has been studied extensively. The results of the studies indicated primarily its chemical toxicity, particularly renal effects, but depleted uranium is not radiological hazard. Uranium is not metal determined to be carcinogenic (the International Agency of Research on Cancer). The military use of depleted uranium will give additional insight into the toxicology of depleted uranium. The present controversy over the radiological and chemical toxicity of depleted uranium used in the Gulf War requests further experimental and clinical investigations of its effects on the biosphere and human beings.
Beyeler, Walter E.; Finley, Patrick D.; Arndt, William; Walser, Alex Christian; Mitchell, Michael David
We applied modeling and simulation to examine the real-world tradeoffs between developingcountry public-health improvement and the need to improve the identification, tracking, and security of agents with bio-weapons potential. Traditionally, the international community has applied facility-focused strategies for improving biosecurity and biosafety. This work examines how system-level assessments and improvements can foster biosecurity and biosafety. We modeled medical laboratory resources and capabilities to identify scenarios where biosurveillance goals are transparently aligned with public health needs, and resource are distributed in a way that maximizes their ability to serve patients while minimizing security a nd safety risks. Our modeling platform simulates key processes involved in healthcare system operation, such as sample collection, transport, and analysis at medical laboratories. The research reported here extends the prior art by provided two key compone nts for comparative performance assessment: a model of patient interaction dynamics, and the capability to perform uncertainty quantification. In addition, we have outlined a process for incorporating quantitative biosecurity and biosafety risk measures. Two test problems were used to exercise these research products examine (a) Systemic effects of technological innovation and (b) Right -sizing of laboratory networks.
Zhou, Wei; Xiao, Shuiyuan
Mental health is a challenging public health issue worldwide and surveillance is crucial for it. However, mental health surveillance has not been developed until recently in certain developed countries; many other countries, especially developing countries, have poor or even no health information systems. This paper presents surveillance related to mental health in China, a developing country with a large population of patients with mental disorders. Detailed information of seven relevant surveillance systems is introduced respectively. From the perspective of utilization, problems including accessibility, comprehensiveness and data quality are discussed. Suggestions for future development are proposed.
... Control Internal Transmitter Control Systems § 90.475 Operation of internal transmitter control systems in specially equipped systems. (a) An internal transmitter control system need not be designed to meet the... premises controlled by the licensee. (2) An internal transmitter control system may......
... Control Internal Transmitter Control Systems § 90.475 Operation of internal transmitter control systems in specially equipped systems. (a) An internal transmitter control system need not be designed to meet the... premises controlled by the licensee. (2) An internal transmitter control system may......
Fryatt, Robert; Mills, Anne; Nordstrom, Anders
Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches.
Lawson, R. A.
Results are presented regarding the first commercially available, fully operational, tsunami detection system to have passed stringent U.S. government testing requirements and to have successfully demonstrated its ability to detect an actual tsunami at sea. Spurred by the devastation of the December 26, 2004, Indian Ocean tsunami that killed more than 230,000 people, the private sector actively supported the Intergovernmental Oceanographic Commission's (IOC"s) efforts to develop a tsunami warning system and mitigation plan for the Indian Ocean region. As each country in the region developed its requirements, SAIC recognized that many of these underdeveloped countries would need significant technical assistance to fully execute their plans. With the original focus on data fusion, consequence assessment tools, and warning center architecture, it was quickly realized that the cornerstone of any tsunami warning system would be reliable tsunami detection buoys that could meet very stringent operational standards. Our goal was to leverage extensive experience in underwater surveillance and oceanographic sensing to produce an enhanced and reliable deep water sensor that could meet emerging international requirements. Like the NOAA Deep-ocean Assessment and Recording of Tsunamis (DART TM ) buoy, the SAIC Tsunami Buoy (STB) system consists of three subsystems: a surfaccommunications buoy subsystem, a bottom pressure recorder subsystem, and a buoy mooring subsystem. With the operational success that DART has demonstrated, SAIC decided to build and test to the same high standards. The tsunami detection buoy system measures small changes in the depth of the deep ocean caused by tsunami waves as they propagate past the sensor. This is accomplished by using an extremely sensitive bottom pressure sensor/recorder to measure very small changes in pressure as the waves move past the buoy system. The bottom pressure recorder component includes a processor with algorithms that
Tichy, N M; Taylor, J I
This article presents the case of Dr. Martin Luther King Jr. Health Center's unique community management system in which neighborhood workers have been developed to assume managerial responsibilities and are directing the Center. The Martin Luther King Center experience is instructive because the Center was able to achieve significant community control by focusing primarily on the internal dimension of control, namely, management, without experiencing destructive conflicts and the deterioration of health services.
Bara, Debra; McPhillips-Tangum, Carol; Wild, Ellen L; Mann, Marie Y
Public health agencies at state and local levels are integrating information systems to improve health outcomes for children. An assessment was conducted to describe the extent to which public health agencies are currently integrating child health information systems (CHIS). Using online technology information was collected, to assess completed and planned activities related to integration of CHIS, maturity of these systems, and factors that influence decisions by public health agencies to pursue integration activities. Of the 39 public health agencies that participated, 18 (46%) reported already integrating some or all of their CHIS, and 13 (33%) reported to be planning to integrate during the next 3 years. Information systems most commonly integrated include Early Hearing Detection and Intervention (EHDI), immunization, vital records, and Newborn Dried Bloodspot Screening (NDBS). Given the high priority that has been placed on using technology to improve health status in the United States, the emphasis on expanding the capability for the electronic exchange of health information, and federal support for electronic health records by 2014, public health agencies should be encouraged and supported in their efforts to develop, implement, and maintain integrated CHIS to facilitate the electronic exchange of health information with the clinical healthcare sector.
Sen, Gita; Govender, Veloshnee
Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities). PMID:25536851
A fuel injection system is described for an internal combustion engine, comprising: (a) a fuel injection pump driven by the engine for fuel injection thereto and including a plunger reciprocably movable at a non-uniform speed and a control sleeve slidably fitted on the plunger; (b) first drive means operatively connected with the plunger for rotating the latter to thereby adjust the effective stroke of the plunger; (c) second drive means operatively connected with the control sleeve for displacing the latter in an axial direction to thereby adjust the pre-stroke of the control sleeve; (d) an operation sensor for detecting operating conditions of the engine; (e) a position sensor for detecting a position of the control sleeve; (f) first arithmetic means responsive to the engine operating conditions detected by the operation sensor, for computing an object injection quantity; (g) second arithmetic means responsive to the position of the control sleeve detected by the position sensor, for computing an object pre-stroke of the plunger; (h) third arithmetic means responsive to the engine operating conditions detected and the position of the control sleeve detected, for computing a correction amount; (i) first control means responsive to the correction amount computed by the third arithmetic means, for correcting the object injection quantity and for delivering a control signal to the first drive means; and (j) second control means responsive to the object injection quantity computed by the second arithmetic means, for delivering a control signal to the second drive means.
The economic and social crises affecting Latin America have had a profound social and political effect on its structures. This paper analyzes this impact from 2 perspectives: 1) the impact on the apparatus of the state, in particular on its health infra-structures; and 2) the direction of the democratic process in the continent and the participatory processes of civil societies. The institutionalization of the Local Health Systems (SILOS) is an effort to analyze the problem from within the health sector and propose solutions. This paper discusses the issues of human resource development in health systems; training in human resource development and human resource development in local health care systems. There are 3 strategies used to change health systems: 1) The judicial-political system: The state's apparatus 2) The political-administrative system: the national health care system; and 3) the political-operative system: local health care systems. To assure implementation of SILOS there are 4 steps to be followed: 1) create political conditions that allow the transformation and development of local health systems; 2) development of high-level institutional and political initiatives to develop health care networks; 3) offer key players institutional space and social action to develop the SILOS process; 4) rapidly develop SILOS in regions to assure its integration with other development efforts. The labor force in the health sector and organized communities play critical roles in proposing and institutionalizing health programs.
Spiegel, Jerry; Breilh, Jaime; Cabarcas, Fabio; Huish, Robert; Yassi, Annalee
Abstract This paper examines two innovative educational initiatives for the Ecuadorian public health workforce: a Canadian-funded Masters programme in ecosystem approaches to health that focuses on building capacity to manage environmental health risks sustainably; and the training of Ecuadorians at the Latin American School of Medicine in Cuba (known as Escuela Latinoamericana de Medicina in Spanish). We apply a typology for analysing how training programmes address the needs of marginalized populations and build capacity for addressing health determinants. We highlight some ways we can learn from such training programmes with particular regard to lessons, barriers and opportunities for their sustainability at the local, national and international levels and for pursuing similar initiatives in other countries and contexts. We conclude that educational efforts focused on the challenges of marginalization and the determinants of health require explicit attention not only to the knowledge, attitudes and skills of graduates but also on effectively engaging the health settings and systems that will reinforce the establishment and retention of capacity in low- and middle-income settings where this is most needed. PMID:19551240
Godoy-Ruiz, Paula; Cole, Donald C.; Lenters, Lindsey; McKenzie, Kwame
Within a global context of growing health inequities, the fostering of partnerships and collaborative research have been promoted as playing a critical role in tackling health inequities and health system problems worldwide. Since 2004, the Canadian Coalition for Global Health Research (CCGHR) has facilitated annual Summer Institutes for new global health researchers aimed at strengthening global health research competencies and partnerships among participants. We sought to explore CCGHR Summer Institute alumni perspectives on the Summer Institute experience, particularly on the individual research pairings of Canadian and low- and middle-income countries researchers that have characterised the program. The results reveal that the Summer Institute offered an enriching learning opportunity for participants and worked to further their collaborative projects through providing dedicated one-on-one time with their international research partner, feedback from colleagues from around the world and mentorship by more senior researchers. Positive individual relationships among researchers, as well as the existence of institutional collaborations, employer and funding support, and agendas of local and national politicians were factors that have influenced the ongoing collaboration of partners. There is a need to more fully examine the interplay between individual and institutional-level collaborations, as well as their social and political contexts. PMID:25642809
Basu, Sanjay; Stuckler, David; McKee, Martin
Several public health groups have called for the creation of a global fund for 'social protection'-a fund that produces the international equivalent of domestic tax collection and safety net systems to finance care for the ill and disabled and related health costs. All participating countries would pay into a global fund based on a metric of their ability to pay and withdraw from the common pool based on a metric of their need for funds. We assessed how alternative strategies and metrics by which to operate such a fund would affect its size and impact on health system financing. Using a mathematical model, we found that common targets for health funding in low-income countries require higher levels of aid expenditures than presently distributed. Some mechanisms exist that may incentivize reduction of domestic health inequalities, and direct most funds towards the poorest populations. Payments from high-income countries are also likely to decrease over time as middle-income countries' economies grow.
Nagase, H.; Hirayama, T.
This patent describes a supercharger control system for an internal combustion engine. The system has a throttle valve with a throttle operating lever, an engine air inlet passage, and a venturi-type carburetor. It consists of: a supercharger located in the engine air inlet passage upstream of the throttle valve, the supercharger being driven by the engine, a bypass within the engine inlet passage around the supercharger, a control valve with a control lever located within the bypass to control air flow, a diaphragm device, a first side of the diaphragm device being in communication with the engine inlet passage at the exit of the supercharger, a second side of the diaphragm being in communication with the venturi carburetor, a valve control linkage being constructed and arranged to open the control valve with increased vacuum in the first side of the diaphragm, spring means biasing the diaphragm to open the control valve, an activation lever with a stopper protrustion, the activation lever being pivotally mounted about the throttle valve, a first stop pin in the intake passage wall, a second stop pin on the throttle operating lever to selectively engage the activation lever, a regulation lever pivotally mounted about the control valve, a third stop pin on the control lever to selectively engage the regulating lever, an activation linkage connecting the activation lever and the regulating lever so as to create reciprocating motion, and spring means biasing both the regulating lever against the third stop pin when the control valve is in the fully open position and the stopper protrusion is against the first stop pin.
Richard, Elizabeth E.; Russo, Dane
The Environmental Health System (EHS), a subsystem of the Space Station Freedom (SSF) Crew Health Care System, was established to ensure that crewmembers will have a safe and healthy environment in which to live and work. EHS is comprised of six subsystems: Microbiology, Toxicology, Water Quality, Radiological Health, Vibroacoustics, and Barothermal Physiology. Each subsystem contributes to the overall functions of the EHS including environmental planning, environmental monitoring, environmental monitoring, environmental health assessments, and operations support. The EHS will provide hardware for monitoring the air, water, and internal surfaces of Freedom, including capabilities for inflight sample collection, processing, and analysis. The closed environment of SSF, and its dependence on recycled air and water, will necessitate a reliable monitoring system to alert crewmembers if contamination levels exceed the maximum allowable limits established to ensure crew health and safety. This paper describes the functions and hardware design status of the EHS.
Yan, Zi; Finn, Kevin; Cardinal, Bradley J.; Bent, Lauren
Background: Peer education has the potential to promote health behaviors and cultural competence for both international and domestic college students. Purpose: The present study examined a peer education program aimed at promoting cultural competence and health behaviors among international and American students in a university setting. Methods:…
Musto, Jennie; Gregory, Joy; Fullerton, Kathleen
Every year, Australia identifies 2–3 outbreaks associated with imported foods. To examine national authorities’ obligations under the International Health Regulations (2005), we reviewed outbreaks in 2001–2007 that implicated internationally distributed foods. Under these regulations, 6 (43%) of 14 outbreaks would have required notification to the World Health Organization. PMID:18760015
Nikolova, Svetlana; Araujo, Fernando; Aktas, Kadircan; Malakhova, Marina; Otsuka, Riyo; Han, Dongmei; Assef, Thierry; Nava, Elisabetta; Mickevicius, Sigitas; Agrebi, Abdelouaheb
The IMS is a globally distributed network of monitoring facilities using sensors from four technologies: seismic, hydroacoustic, infrasound and radionuclide. It is designed to detect the seismic and acoustic waves produced by nuclear test explosions and the subsequently released radioactive isotopes. Monitoring stations transmit their data to the IDC in Vienna, Austria, over a global private network known as the GCI. Since 2013, the data availability (DA) requirements for IMS stations account for quality of the data, meaning that in calculation of data availability data should be exclude if: - there is no input from sensor (SHI technology); - the signal consists of constant values (SHI technology); Even more strict are requirements for the DA of the radionuclide (particulate and noble gas) stations - received data have to be analyzed, reviewed and categorized by IDC analysts. In order to satisfy the strict data and network availability requirements of the IMS Network, the operation of the facilities and the GCI are managed by IDC Operations. Operations has following main functions: - to ensure proper operation and functioning of the stations; - to ensure proper operation and functioning of the GCI; - to ensure efficient management of the stations in IDC; - to provide network oversight and incident management. At the core of the IMS Network operations are a series of tools for: monitoring the stations' state of health and data quality, troubleshooting incidents, communicating with internal and external stakeholders, and reporting. The new requirements for data availability increased the importance of the raw data quality monitoring. This task is addressed by development of additional tools for easy and fast identifying problems in data acquisition, regular activities to check compliance of the station parameters with acquired data by scheduled calibration of the seismic network, review of the samples by certified radionuclide laboratories. The DA for the networks of
Lin, Yanwei; Zhang, Qi; Chen, Wen; Shi, Jingrong; Han, Siqi; Song, Xiaolei; Xu, Yong; Ling, Li
Internal migrants are the individuals who migrate between regions in one country. The number of internal migrants were estimated at 245 million in China in 2013. Results were inconsistent in the literature about the relationship between their health statuses and social integration. The main difference exists on how to measure the social integration and whether health statuses of internal migrants improve with years of residence. To complement the existing literature, this study measured social integration more comprehensively and estimated the internal migrants' health statuses with varying years of residence, and explored the associations between the migrants' social integration and health. We used the data from 2014 Internal Migrant Dynamic Monitoring Survey of Health and Family Planning in ZhongShan, China. Health status was measured from four aspects: self-reported health, subjective well-being, perception of stress, mental health. We measured social integration through four dimensions: economy, social communication, acculturation, and self-identity. The analyses used multiple linear regressions to examine the associations between self-reported health, subjective well-being, and perception of stress, mental health and social integration. The analytical sample included 1,999 households of the internal migrants and 1,997 local registered households, who were permanent residents in ZhongShan. Among the internal migrants, Adults in the labor force, who were aged 25 to 44 years old, accounted for 91.2% of the internal migrant population, while 74.6% of the registered population were in that age group. Median residential time among migrants was 2.8 (1.3-6.2) years, and 20.2% of them were migrating in the same Guangdong province. Except for mental health, other health statuses among migrants had significant differences compared with local registered population, e.g. self-reported health was better, but subjective well-being was worse. However, these health
Lin, Yanwei; Zhang, Qi; Chen, Wen; Shi, Jingrong; Han, Siqi; Song, Xiaolei; Xu, Yong; Ling, Li
Internal migrants are the individuals who migrate between regions in one country. The number of internal migrants were estimated at 245 million in China in 2013. Results were inconsistent in the literature about the relationship between their health statuses and social integration. The main difference exists on how to measure the social integration and whether health statuses of internal migrants improve with years of residence. To complement the existing literature, this study measured social integration more comprehensively and estimated the internal migrants’ health statuses with varying years of residence, and explored the associations between the migrants’ social integration and health. We used the data from 2014 Internal Migrant Dynamic Monitoring Survey of Health and Family Planning in ZhongShan, China. Health status was measured from four aspects: self-reported health, subjective well-being, perception of stress, mental health. We measured social integration through four dimensions: economy, social communication, acculturation, and self-identity. The analyses used multiple linear regressions to examine the associations between self-reported health, subjective well-being, and perception of stress, mental health and social integration. The analytical sample included 1,999 households of the internal migrants and 1,997 local registered households, who were permanent residents in ZhongShan. Among the internal migrants, Adults in the labor force, who were aged 25 to 44 years old, accounted for 91.2% of the internal migrant population, while 74.6% of the registered population were in that age group. Median residential time among migrants was 2.8 (1.3–6.2) years, and 20.2% of them were migrating in the same Guangdong province. Except for mental health, other health statuses among migrants had significant differences compared with local registered population, e.g. self-reported health was better, but subjective well-being was worse. However, these health
India's ruling class, in association with international agencies, bureaucrats, and business interests, has formed a powerful syndicate that has been imposing its will on the country to the detriment of public health. After gaining independence, India developed a body of knowledge suited to its social, cultural, economic, and epidemiological conditions. This led to an alternative approach to public health education, practice, and research that foreshadowed the Alma Ata Declaration on Primary Health Care of 1978. In the early 1980s, global power shifts undermined national and international commitment to the Declaration. Wealthy countries' response to the declaration of self-reliance by economically disadvantaged countries was swift: an effort to suppress the Declaration's ideals in favor of an unscientific, market-driven agenda. As a result, public health practice in India virtually disappeared. Responding to growing restiveness among a population in need, political leaders have launched the foredoomed National Rural Health Mission and pursued an American brand of public health through the Public Health Foundation of India. Reconstructing the damaged public health system will require pressure on the syndicate to ensure India's public health heritage will be used to effectively transfer "People's health in people's hands" according to the guidelines set down at Alma Ata.
Brinkerhoff, Derick W; Bossert, Thomas J
Governance is increasingly recognized as an important factor in health system performance, yet conceptually and practically it remains poorly understood and subject to often vague and competing notions of both what its role is and how to address its weaknesses. This overview article for the symposium on health governance presents a model of health governance that focuses on the multiplicity of societal actors in health systems, the distribution of roles and responsibilities among them and their ability and willingness to fulfil these roles and responsibilities. This focus highlights the principal-agent linkages among actors and the resulting incentives for good governance and health system performance. The discussion identifies three disconnects that constitute challenges for health system strengthening interventions that target improving governance: (1) the gap between the good governance agenda and existing capacities, (2) the discrepancy between formal and informal governance and (3) the inattention to sociopolitical power dynamics. The article summarizes the three country cases in the symposium and highlights their governance findings: health sector reform in China, financial management of health resources in Brazilian municipalities and budget reform in hospitals in Lesotho. The concluding sections clarify how the three cases apply the model's principal-agent linkages and highlight the importance of filling the gaps remaining between problem diagnosis and the development of practical guidance that supports 'best fit' solutions and accommodates political realities in health systems strengthening.
Dykes, Patricia C; Hurley, Ann C; Brown, Suzanne; Carr, Robyn; Cashen, Margaret; Collins, Rita; Cook, Robyn; Currie, Leanne; Docherty, Charles; Ensio, Anneli; Foster, Joanne; Hardiker, Nicholas R; Honey, Michelle L L; Killalea, Rosaleen; Murphy, Judy; Saranto, Kaija; Sensmeier, Joyce; Weaver, Charlotte
In 2005, the Healthcare Information Management Systems Society (HIMSS) Nursing Informatics Community developed a survey to measure the impact of health information technology (HIT), the I-HIT Scale, on the role of nurses and interdisciplinary communication in hospital settings. In 2007, nursing informatics colleagues from Australia, England, Finland, Ireland, New Zealand, Scotland and the United States formed a research collaborative to validate the I-HIT across countries. All teams have completed construct and face validation in their countries. Five out of six teams have initiated reliability testing by practicing nurses. This paper reports the international collaborative's validation of the I-HIT Scale completed to date.
Ooms, Gorik; Hammonds, Rachel
People living in low-income countries require protection from the economic and social impacts of global economic competition, yet, historically, the International Monetary Fund's (IMF) fiscal austerity programs have weakened the potential for redistribution both within poor countries and between rich and poor countries. The current development paradigm's focus on "sustainability" is an obstacle to developing systems of global social protection and an impediment to future progress. Reforming IMF policy conditionality and democratizing the IMF's decision-making processes will be necessary for offsetting growing inequalities in health financing among poor nations.
Lee, Eun-Jeong; Chan, Fong; Ditchman, Nicole; Feigon, Maia
Asian students comprise over half of all international students in the United States, yet little is known about their help-seeking behaviors and preferences for mental health professionals. The purpose of this study was to use conjoint analysis to examine characteristics of mental health professionals influencing Korean international students' preferences when choosing a mental health professional. Korean international students from three universities in the United States were recruited on a volunteer basis to participate in this study (N = 114). Results indicated that mental health professional characteristics, including ethnicity, age, professional identity, and training institution, were significant factors in students' preference formation; however, gender of the mental health professional was not found to be a significant factor in the present study. Ethnic similarity was the most powerful predictor of preference formation. Implications for promoting help-seeking and mental health service utilization among Asian international students are discussed.
Liu, Bin; Sun, Yan; Dong, Qian; Zhang, Zongjiu; Zhang, Liang
As an international legal instrument, the International Health Regulations (IHR) is internationally binding in 196 countries, especially in all the member states of the World Health Organization (WHO). The IHR aims to prevent, protect against, control, and respond to the international spread of disease and aims to cut out unnecessary interruptions to traffic and trade. To meet IHR requirements, countries need to improve capacity construction by developing, strengthening, and maintaining core response capacities for public health risk and Public Health Emergency of International Concern (PHEIC). In addition, all the related core capacity requirements should be met before June 15, 2012. If not, then the deadline can be extended until 2016 upon request by countries. China has promoted the implementation of the IHR comprehensively, continuingly strengthening the core public health capacity and advancing in core public health emergency capacity building, points of entry capacity building, as well as risk prevention and control of biological events (infectious diseases, zoonotic diseases, and food safety), radiological, nuclear, and chemical events, and other catastrophic events. With significant progress in core capacity building, China has dealt with many public health emergencies successfully, ensuring that its core public health capacity has met the IHR requirements, which was reported to WHO in June 2014. This article describes the steps, measures, and related experiences in the implementation of IHR in China.
Liu, Bin; Sun, Yan; Dong, Qian; Zhang, Zongjiu; Zhang, Liang
As an international legal instrument, the International Health Regulations (IHR) is internationally binding in 196 countries, especially in all the member states of the World Health Organization (WHO). The IHR aims to prevent, protect against, control, and respond to the international spread of disease and aims to cut out unnecessary interruptions to traffic and trade. To meet IHR requirements, countries need to improve capacity construction by developing, strengthening, and maintaining core response capacities for public health risk and Public Health Emergency of International Concern (PHEIC). In addition, all the related core capacity requirements should be met before June 15, 2012. If not, then the deadline can be extended until 2016 upon request by countries. China has promoted the implementation of the IHR comprehensively, continuingly strengthening the core public health capacity and advancing in core public health emergency capacity building, points of entry capacity building, as well as risk prevention and control of biological events (infectious diseases, zoonotic diseases, and food safety), radiological, nuclear, and chemical events, and other catastrophic events. With significant progress in core capacity building, China has dealt with many public health emergencies successfully, ensuring that its core public health capacity has met the IHR requirements, which was reported to WHO in June 2014. This article describes the steps, measures, and related experiences in the implementation of IHR in China. PMID:26029897
Beguy, Donatien; Elung'ata, Patricia; Mberu, Blessing; Oduor, Clement; Wamukoya, Marylene; Nganyi, Bonface; Ezeh, Alex
The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was the first urban-based longitudinal health and demographic surveillance platform in sub-Saharan Africa (SSA). The NUHDSS was established in 2002 to provide a platform to investigate the long-term social, economic and health consequences of urban residence, and to serve as a primary research tool for intervention and impact evaluation studies focusing on the needs of the urban poor in SSA. Since its inception, the NUHDSS has successfully followed every year a population of about 65,000 individuals in 24,000 households in two slum communities--Korogocho and Viwandani--in Nairobi, Kenya. Data collected include key demographic and health information (births, deaths including verbal autopsy, in- and out-migration, immunization) and other information that characterizes living conditions in the slums (livelihood opportunities, household amenities and possessions, type of housing etc.). In addition to the routine data, it has provided a robust platform for nesting several studies examining the challenges of rapid urbanization in SSA and associated health and poverty dynamics. NUHDSS data are shared through internal and external collaborations, in accordance with the Centre's guidelines for publications, data sharing.
Hemmings, Sarah; Limaye, Ashutosh; Irwin, Dan
Background: SERVIR -- the Regional Visualization and Monitoring System -- helps people use Earth observations and predictive models based on data from orbiting satellites to make timely decisions that benefit society. SERVIR operates through a network of regional hubs in Mesoamerica, East Africa, and the Hindu Kush-Himalayas. USAID and NASA support SERVIR, with the long-term goal of transferring SERVIR capabilities to the host countries. Objective/Purpose: The purpose of this presentation is to describe how the SERVIR system helps the SERVIR regions cope with eight areas of societal benefit identified by the Group on Earth Observations (GEO): health, disasters, ecosystems, biodiversity, weather, water, climate, and agriculture. This presentation will describe environmental health applications of data in the SERVIR system, as well as ongoing and future efforts to incorporate additional health applications into the SERVIR system. Methods: This presentation will discuss how the SERVIR Program makes environmental data available for use in environmental health applications. SERVIR accomplishes its mission by providing member nations with access to geospatial data and predictive models, information visualization, training and capacity building, and partnership development. SERVIR conducts needs assessments in partner regions, develops custom applications of Earth observation data, and makes NASA and partner data available through an online geospatial data portal at SERVIRglobal.net. Results: Decision makers use SERVIR to improve their ability to monitor air quality, extreme weather, biodiversity, and changes in land cover. In past several years, the system has been used over 50 times to respond to environmental threats such as wildfires, floods, landslides, and harmful algal blooms. Given that the SERVIR regions are experiencing increased stress under larger climate variability than historic observations, SERVIR provides information to support the development of
Mitano, Fernando; Ventura, Carla Aparecida Arena; de Lima, Mônica Cristina Ribeiro Alexandre d'Auria; Balegamire, Juvenal Bazilashe; Palha, Pedro Fredemir
Objective to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country. Results Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage. PMID:27027677
This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.
Gomes, Barbara; Harding, Richard; Foley, Kathleen M; Higginson, Irene J
More people will need palliative care in aging societies with stretched health budgets and less ability to provide informal care. The future will bring new and tougher challenges to sustain, optimize, and expand the 8000 dedicated palliative care services that currently exist in the world. The full breakdown of the costs of palliative care is yet to be unveiled, and this has left huge unresolved questions for funding, costing, evaluating, and modeling palliative care. At an international meeting in London in November 2007, a group of 40 researchers, health economists, policy makers, and advocates exchanged their experiences, concerns, and recommendations in five main areas: shared definitions, strengths and weaknesses of different payment systems, international and country-specific research challenges, appropriate economic evaluation methods, and the varied perspectives to the costs of palliative care. This article reports the discussions that took place and the views of this international group of experts on the best research approaches to capture, analyze, and interpret data on both costs and outcomes for families and patients toward the end of life.
Deatsch-Kratochvil, Amanda N; Pascual, Thomas Neil; Kesner, Adam; Rosenblatt, Eduardo; Chhem, Rethy K
Global health has been an issue of seemingly low political importance in comparison with issues that have direct bearing on countries' national security. Recently, health has experienced a "political revolution" or a rise in political importance. Today, we face substantial global health challenges, from the spread of infectious disease, gaps in basic maternal and child health care, to the globalization of cancer. A recent estimate states that the "overall lifetime risk of developing cancer (both sexes) is expected to rise from more than one in three to one in two by 2015." These issues pose significant threats to international health security. To successfully combat these grave challenges, the international community must embrace and engage in global health diplomacy, defined by scholars Thomas Novotny and Vicanne Adams as a political activity aimed at improving global health, while at the same time maintaining and strengthening international relations. The IAEA (International Atomic Energy Agency) is an international organization with a unique mandate to "accelerate and enlarge the contribution of atomic energy to peace, health, and prosperity throughout the world." This article discusses global health diplomacy, reviews the IAEA's program activities in human health by focusing on radiation medicine and cancer, and the peaceful applications of atomic energy within the context of global health diplomacy.
Monkman, Helen; Kushniruk, Andre W
Derived from overlapping concepts in consumer health, a consumer health information system refers to any of the broad range of applications, tools, and educational resources developed to empower consumers with knowledge, techniques, and strategies, to manage their own health. As consumer health information systems become increasingly popular, it is important to explore the factors that impact their adoption and success. Accumulating evidence indicates a relationship between usability and consumers' eHealth Literacy skills and the demands consumer HISs place on their skills. Here, we present a new model called the Consumer Health Information System Adoption Model, which depicts both consumer eHealth literacy skills and system demands on eHealth literacy as moderators with the potential to affect the strength of relationship between usefulness and usability (predictors of usage) and adoption, value, and successful use (actual usage outcomes). Strategies for aligning these two moderating factors are described.
Persson, Ulf; Jönsson, Bengt
All 28 EU member states except Sweden and the UK apply international reference pricing (IRP), international price comparison, external reference pricing or cross-reference pricing. The attractiveness of using prices of other countries as a benchmark for decisions within a national price control is obvious. Alternative models for price and reimbursement decision making such as value-based pricing (VBP), i.e. cost-effectiveness analyses, are more complicated. However, IRP provides incentives for stakeholders to take action not in line with optimal (welfare-maximizing) pricing. IRP is costly for two reasons. First, manufacturers are incentivised to limit or delay access to new innovative treatments in countries with small markets and/or a low income, which can be costly in terms of loss of health. Second, all countries also experience a loss of welfare (health) because IRP reduces the opportunities for differential pricing (Ramsey pricing), i.e. using the fact that the ability and willingness to pay differs between countries. Thus, IRP results in less sales revenue to finance research and development of new innovative drugs. We can now observe that payers and manufacturers are engaged in different types of risk-sharing schemes, price-volume negotiations, payback arrangements, confidential discounts, coverage with evidence developments, etc., all with the purpose of returning to the old model of price discrimination and Ramsey pricing. Shortly, real prices for use in IRP systems will cease to exist and, thus, we expect to soon see the end of IRP, a new system for price discrimination and an increasing demand for VBP.
Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public’s health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite
Diallo, Khassoum; Zurn, Pascal; Gupta, Neeru; Dal Poz, Mario
Background Despite the undoubted importance of human resources to the functions of health systems, there is little consistency between countries in how human resource strategies are monitored and evaluated. This paper presents an integrated approach for developing an evidence base on human resources for health (HRH) to support decision-making, drawing on a framework for health systems performance assessment. Methods Conceptual and methodological issues for selecting indicators for HRH monitoring and evaluation are discussed, and a range of primary and secondary data sources that might be used to generate indicators are reviewed. Descriptive analyses are conducted drawing primarily on one type of source, namely routinely reported data on the numbers of health personnel and medical schools as covered by national reporting systems and compiled by the World Health Organization. Regression techniques are used to triangulate a given HRH indicator calculated from different data sources across multiple countries. Results Major variations in the supply of health personnel and training opportunities are found to occur by region. However, certain discrepancies are also observed in measuring the same indicator from different sources, possibly related to the occupational classification or to the sources' representation. Conclusion Evidence-based information is needed to better understand trends in HRH. Although a range of sources exist that can potentially be used for HRH assessment, the information that can be derived from many of these individual sources precludes refined analysis. A variety of data sources and analytical approaches, each with its own strengths and limitations, is required to reflect the complexity of HRH issues. In order to enhance cross-national comparability, data collection efforts should be processed through the use of internationally standardized classifications (in particular, for occupation, industry and education) at the greatest level of detail
McKee, Martin; Gilmore, Anna B; Schwalbe, Nina
The world is increasingly shaped by powerful global forces, many of which have consequences for human health and the social, economic, and environmental factors that influence health are increasingly determined at a supranational level. As a result, local or national level efforts to influence health determinants can have only a limited impact and it is all too easy for the individual public health practitioner to feel powerless. Yet while public health practitioners, on their own, may indeed be comparatively powerless, together they can achieve a great deal. Part I of this glossary explores a range of issues that arise as they seek to make a difference.
Arlton, Donna; Miller, Marie
The faculty achievements and challenges in an international nursing education project between two colleges are presented. In the spring of 1985, the University of Northern Colorado (UNC) and the University Autonomous of Benito Juarez of Oaxaca (UABJO), Oaxaca, Mexico, entered into an international covenant to develop a baccalaureate nursing…
Schneider, H; Lehmann, U
One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalize the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS.
Hanney, Stephen R; González Block, Miguel A
Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS) provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics related to the above
Paim, Jairnilson; Travassos, Claudia; Almeida, Celia; Bahia, Ligia; Macinko, James
Brazil is a country of continental dimensions with widespread regional and social inequalities. In this report, we examine the historical development and components of the Brazilian health system, focusing on the reform process during the past 40 years, including the creation of the Unified Health System. A defining characteristic of the contemporary health sector reform in Brazil is that it was driven by civil society rather than by governments, political parties, or international organisations. The advent of the Unified Health System increased access to health care for a substantial proportion of the Brazilian population, at a time when the system was becoming increasingly privatised. Much is still to be done if universal health care is to be achieved. Over the past 20 years, there have been other advances, including investments in human resources, science and technology, and primary care, and a substantial decentralisation process, widespread social participation, and growing public awareness of a right to health care. If the Brazilian health system is to overcome the challenges with which it is presently faced, strengthened political support is needed so that financing can be restructured and the roles of both the public and private sector can be redefined.
Perspectives of development of the Tunisian health system are presented, in reference to the conceptual framework recommended by the World Health Organization, while a project of health insurance reform of the social security regimes is submitted to a dialogue with the different concerned parts. Recommended orientations articulate around five axes: 1. The promotion of care provision by improving the accessibility to services, notably in zones under served, by introducing new modes of dispensation, organization and management of care provision in the framework of a continuous quality assurance strategy. 2. The financing of health care, with the implementation of the health insurance reform, has to allow an improvement of the financial accessibility of the population to health care, while supervising the evolution of total health expenditures and by developing the system's management capacities. 3. Proposals relative to the mobilization of resources are advanced in areas of medicine, training of health professionals and research on the health system. 4. Adaptation of the health system governance to the new context is necessary and would have to be developed around evolving standards for the health system, on evaluation of its performances and on information and communication with its users. 5. The health system responsiveness, new motion whose contours are again blurred, would have to be analysed and adapted to the specific context of the country.
Health worker migration theories have tended to focus on labour market conditions as principal push or pull factors. The role of education systems in producing internationally oriented health workers has been less explored. In place of the traditional conceptual approaches to understanding health worker, especially nurse, migration, I advocate global political economy (GPE) as a perspective that can highlight how educational investment and global migration tendencies are increasing interlinked. The Indian case illustrates the globally oriented nature of health care training, and informs a broader understanding of both the process of health worker migration, and how it reflects wider marketization tendencies evident in India's education and health systems. The Indian case also demonstrates how the global orientation of education systems in source regions is increasingly central to comprehending the place of health workers in the global and Asian rise in migration. The paper concludes that Indian corporate health care training systems are increasingly aligned with the production of professionals orientated to globally integrated health human resource labour markets, and our conceptual analysis of such processes must effectively reflect these tendencies.
The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable.
Bogomolov, V. V.; Grigoriev, A. I.; Kozlovskaya, I. B.
The main purpose of the medical support system aboard International Space Station (ISS) is crew health maintenance and high level of work capability assurance prior to during and after in space flights. In the present communication the Russian point of view dealing with the problems and achievements in this branch is presented. An overview on medical operations during flight and after finalization of the space missions based on Russian data of crew health and environment state monitoring, as well as data on the inflight countermeasures (prophylaxis) jointly with data on operational problems that are specific to ISS is presented. The report summarizes results of the medical examination of Russian members of the ISS and taxi crews during and after visits to the ISS.
Neff, Roni A.; Palmer, Anne M.; Mckenzie, Shawn E.; Lawrence, Robert S.
The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments—and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture. PMID:23173027
This paper describes past and present European efforts to address the mental health needs of refugees. It begins with a brief historical survey of mental health services for refugees after the Second World War and delineates the policy recommendations from the 1948 International Congress on Mental Health. The next section describes current…
Rosenthal, Doreen Anne; Russell, Jean; Thomson, Garry
A representative sample of undergraduate and postgraduate international students at a large Australian university (n=979, 64% females) completed a mail-back survey of their health and wellbeing. Most students evaluated their current and previous physical and mental health positively. Health-related risk practices such as unprotected sexual…
Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan
At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients.
Nelson, Robert A.
Traces the events leading to the creation of the International Bureau of Weights and Measures (BIPM). Discusses how the units have been represented by their standards, and investigates how the original metric system evolved into the International System of Units (SI), focusing on the meter, second, kilogram, and electrical units. (SK)
Luke, Douglas A.; Stamatakis, Katherine A.
Complex systems abound in public health. Complex systems are made up of heterogeneous elements that interact with one another, have emergent properties that are not explained by understanding the individual elements of the system, persist over time and adapt to changing circumstances. Public health is starting to use results from systems science studies to shape practice and policy, for example in preparing for global pandemics. However, systems science study designs and analytic methods remain underutilized and are not widely featured in public health curricula or training. In this review we present an argument for the utility of systems science methods in public health, introduce three important systems science methods (system dynamics, network analysis, and agent-based modeling), and provide three case studies where these methods have been used to answer important public health science questions in the areas of infectious disease, tobacco control, and obesity. PMID:22224885
Argollo de Menezes, M; Barabási, A-L
The observable behavior of a complex system reflects the mechanisms governing the internal interactions between the system's components and the effect of external perturbations. Here we show that by capturing the simultaneous activity of several of the system's components we can separate the internal dynamics from the external fluctuations. The method allows us to systematically determine the origin of fluctuations in various real systems, finding that while the Internet and the computer chip have robust internal dynamics, highway and Web traffic are driven by external demand. As multichannel measurements are becoming the norm in most fields, the method could help uncover the collective dynamics of a wide array of complex systems.
Krieger, N; Northridge, M; Gruskin, S; Quinn, M; Kriebel, D; Davey, S; Bassett, M; Rehkopf, D; Miller, C
Health impact assessment (HIA) seeks to expand evaluation of policy and programmes in all sectors, both private and public, to include their impact on population health. While the idea that the public's health is affected by a broad array of social and economic policies is not new and dates back well over two centuries, what is new is the notion—increasingly adopted by major health institutions, such as the World Health Organisation (WHO) and the United Kingdom National Health Services (NHS)—that health should be an explicit consideration when evaluating all public policies. In this article, it is argued that while HIA has the potential to enhance recognition of societal determinants of health and of intersectoral responsibility for health, its pitfalls warrant critical attention. Greater clarity is required regarding criteria for initiating, conducting, and completing HIA, including rules pertaining to decision making, enforcement, compliance, plus paying for their conduct. Critical debate over the promise, process, and pitfalls of HIA needs to be informed by multiple disciplines and perspectives from diverse people and regions of the world. PMID:12933768
RD-RI54 682 EXCELLENCE WiTHIN THE NAVY HEALTH CARE SYSTEM (U) NAVAL I. POSTGRADUATE SCHOOL MONTEREY CA J A NORTON DEC 84 UNCLRSSIFIED F/G 6/12...STANDAROS-1963-A -J% * .NAVAL POSTGRADUATE SCHOOL Monterey, California DTIC THESIS EXCELLENCE WITHIN THE NAVY HEALTH CARE SYSTEM by JAMES ALFRED NORTON...Within the Navy Health Care December 1984 System S. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(s) I. CONTRACT OR GRANT NUMBER(@) James Alfred Norton S
The problems in obtaining international agreements on geostationary orbit availability, microwave frequency allocations and microwave frequency standards for satellites transmitting solar power are considered. The various U.S. policy options, strategies and time frames with respect to key issues are analyzed.
Schmitt, Harrison H.
Existing international space law as well as the best interest of all nations are consistent with the establishment of a user-based international organization, herein called INTERMARS. INTERMARS would provide access to facilities and services at a Martian base which would be of high functional potential, quality, safety, and reliability. These opportunities would be available on an open and nondiscriminatory basis to all peaceful users and investors. INTERMARS is a model organization concept tailored to provide cooperative international management of a Martian base for the benefit of its members, users, and investors. Most importantly, INTERMARS would provide such management through a sharing of both sovereignty and opportunity rather then unilateral control by any one nation or set of competing nations. Through an Assembly of Parties, a Board of Governors, a Board of Users and Investors, and a Director General, INTERMARS would meet its primary goal as it would be in the self-interest of all members, users, and investors to do so. The internal structure and philosophy of INTERMARS would provide not only for all participants to have representation in decisions affecting its activities, but also would insure effective and responsive management. Surely this is the precedent wished for, to establish for mankind at the now not-so-distant shores of the new ocean of space.
Popov, Alexandre; Fink, Wolfgang; Hess, Andrew
Long-duration missions bring numerous risks that must be understood and mitigated in order to keep astronauts healthy, rather than treat a diagnosed health disorder. Having a limited medical support from mission control center on space exploration missions, crew members need a personal health-tracking tool to predict and assess his/her health risks if no preventive measures are taken. This paper refines a concept employing technologies from Prognostics and Health Management (PHM) for systems, namely real-time health monitoring and condition-based health maintenance with predictive diagnostics capabilities. Mapping particular PHM-based solutions to some Human Health and Performance (HH&P) technology candidates, namely by NASA designation, the Autonomous Medical Decision technology and the Integrated Biomedical Informatics technology, this conceptual paper emphasize key points that make the concept different from that of both current conventional medicine and telemedicine including space medicine. The primary benefit of the technologies development for the HH&P domain is the ability to successfully achieve affordable human space missions to Low Earth Orbit (LEO) and beyond. Space missions on the International Space Station (ISS) program directly contribute to the knowledge base and advancements in the HH&P domain, thanks to continued operations on the ISS, a unique human-tended test platform and the only test bed within the space environment. The concept is to be validated on the ISS, the only "test bed" on which to prepare for future manned exploration missions. The paper authors believe that early self-diagnostic coupled with autonomous identification of proper preventive responses on negative trends are critical in order to keep astronauts healthy.
Andrade, Priscila Almeida; Carvalho, Denise Bomtempo Birche de
Since 1990, international organizations have been increasingly involved in building an international sub-regime for research, development and innovation in health. This article analyzes the priorities of developing countries in health since the 1990s. It is a descriptive and analytical study that investigates the literature and contributions of key informants. Calling for the end of global inequities in the support for science and technology in health, international organizations recommend that developing countries focus their efforts on neglected diseases and operational research, an insufficient agenda for science and technology cooperation to effectively overcome the vulnerabilities between countries.
Mazidi, Mohammad; Ostovar, Soghra
This study was designed to assess the effects of religion and two types of religious internalization on the mental health of Iranian adolescents. High school students (82 Moslem and 37 Christian) were selected randomly from four high schools in Shiraz and completed the Religious Self-regulation Questionnaire and the General Health Questionnaire. Analysis showed that main effects of types of religious internalization measured on four subscales of the General Health Questionnaire were significant. Religion was significantly associated only with somatic symptoms. For other scales no main effects of religion, types of religious internalization, or their interactions were significant.
Low, Sharon; Tun, Kyaw Thura; Mhote, Naw Pue Pue; Htoo, Saw Nay; Maung, Cynthia; Kyaw, Saw Win; Shwe Oo, Saw Eh Kalu; Pocock, Nicola Suyin
report provides evidence of the substantive system of health care provision and access in the Karen/Kayin State over the past 20 years. It underscores the climate of vulnerability of the EHOs and CBHOs due to lack of regional and international understanding of the political complexities in Burma/Myanmar. As Association of Southeast Asian Nations (ASEAN) integration gathers pace, this case study highlights potential issues relating to migration and health access. The case also documents the challenge of integrating indigenous and/or cross-border health systems, with the ongoing risk of deepening ethnic conflicts in Burma/Myanmar as the peace process is negotiated. PMID:25280737
Bagley, Christopher; And Others
The key dependent variable in adoption research is the child's mental health, in the short and the long term. Defining mental health as the development of basic ego strength and a feeling of self-worth, which enable an individual to cope with stresses later in life, this book focuses on how well adolescents and young adults have fared in adoption.…
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources. PMID:28356772
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources.
Geraghty, Adam W A; Torres, Leandro D; Leykin, Yan; Pérez-Stable, Eliseo J; Muñoz, Ricardo F
Worldwide automated Internet health interventions have the potential to greatly reduce health disparities. High attrition from automated Internet interventions is ubiquitous, and presents a challenge in the evaluation of their effectiveness. Our objective was to evaluate variables hypothesized to be related to attrition, by modeling predictors of attrition in a secondary data analysis of two cohorts of an international, dual language (English and Spanish) Internet smoking cessation intervention. The two cohorts were identical except for the approach to follow-up (FU): one cohort employed only fully automated FU (n = 16 430), while the other cohort also used 'live' contact conditional upon initial non-response (n = 1000). Attrition rates were 48.1 and 10.8% for the automated FU and live FU cohorts, respectively. Significant attrition predictors in the automated FU cohort included higher levels of nicotine dependency, lower education, lower quitting confidence and receiving more contact emails. Participants' younger age was the sole predictor of attrition in the live FU cohort. While research on large-scale deployment of Internet interventions is at an early stage, this study demonstrates that differences in attrition from trials on this scale are (i) systematic and predictable and (ii) can largely be eliminated by live FU efforts. In fully automated trials, targeting the predictors we identify may reduce attrition, a necessary precursor to effective behavioral Internet interventions that can be accessed globally.
Pyone, Thidar; Smith, Helen; van den Broek, Nynke
Governance of the health system is a relatively new concept and there are gaps in understanding what health system governance is and how it could be assessed. We conducted a systematic review of the literature to describe the concept of governance and the theories underpinning as applied to health systems; and to identify which frameworks are available and have been applied to assess health systems governance. Frameworks were reviewed to understand how the principles of governance might be operationalized at different levels of a health system. Electronic databases and web portals of international institutions concerned with governance were searched for publications in English for the period January 1994 to February 2016. Sixteen frameworks developed to assess governance in the health system were identified and are described. Of these, six frameworks were developed based on theories from new institutional economics; three are primarily informed by political science and public management disciplines; three arise from the development literature and four use multidisciplinary approaches. Only five of the identified frameworks have been applied. These used the principal-agent theory, theory of common pool resources, North's institutional analysis and the cybernetics theory. Governance is a practice, dependent on arrangements set at political or national level, but which needs to be operationalized by individuals at lower levels in the health system; multi-level frameworks acknowledge this. Three frameworks were used to assess governance at all levels of the health system. Health system governance is complex and difficult to assess; the concept of governance originates from different disciplines and is multidimensional. There is a need to validate and apply existing frameworks and share lessons learnt regarding which frameworks work well in which settings. A comprehensive assessment of governance could enable policy makers to prioritize solutions for problems identified
Petrochuk, M A; Javalgi, R G
Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.
Burgio, Alessandra; Crialesi, Roberta; Loghi, Marzia
The Health for All - Italia information system collects health data from several sources. It is intended to be a cornerstone for the achievement of an overview about health in Italy. Health is analyzed at different levels, ranging from health services, health needs, lifestyles, demographic, social, economic and environmental contexts. The database associated software allows to pin down statistical data into graphs and tables, and to carry out simple statistical analysis. It is therefore possible to view the indicators' time series, make simple projections and compare the various indicators over the years for each territorial unit. This is possible by means of tables, graphs (histograms, line graphs, frequencies, linear regression with calculation of correlation coefficients, etc) and maps. These charts can be exported to other programs (i.e. Word, Excel, Power Point), or they can be directly printed in color or black and white.
White (E.H.) Co., San Francisco, CA.
Intended as a companion piece to volume 3 in the Method Series, Health Manpower Planning (CE 024 231), this third of six volumes in the International Health Planning Reference Series is a combined literature review and annotated bibliography dealing with health manpower planning for developing countries. The review identifies literature relevant…
Fraser, Renee White; Shani, Hadasa
Intended as a companion piece to volume 2 in the Method Series, Environmental Health Planning (CE 024 230), this second of six volumes in the International Health Planning Reference Series is a combined literature review and annotated bibliography dealing with environmental factors in health planning for developing countries. The review identifies…
This paper challenges conventional narratives on the role of international non-governmental organisations (INGOs) in the delivery of health services in Tanzania. Adopting an historical gaze which focuses on the 1960s to mid-1980s the paper argues that the 'franchise state' in the Tanzanian health system was not created by collusion between international donors and INGOs, underpinned by a set of health sector reforms that advocated the use of non-state actors; but was rather the legacy of the colonial health system bequeathed to the post-independence state. It was a system in which voluntary non-state actors (but, importantly, not INGOs) were already entrenched as key providers; and in which many of the features of the franchise state - fragmentation, structural weaknesses, lack of accountability to users - were already long established. But if INGOs did not create these features, as their critics attest, they did contribute to the maintenance and extension of these features. The short-term perspectives of NGOs, their small-scale piecemeal engagement, and the extra demands they placed upon their voluntary actor partners, left little scope for the development of sustainable, national and accountable solutions to the health needs of the country. In exploring these ideas, the paper contributes to a more nuanced understanding of the path dependency that created Tanzania's health system. The analysis also contributes to a deepening of the understanding of the make-up of the voluntary sector beyond a narrow gaze on the institution of the INGO.
Toniolo, Franco; Mantoan, Domenico; Maresso, Anna
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. This HiT is one of the first to be written on a subnational level of government and focuses on the Veneto Region of northern Italy. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Veneto Region is one of Italy's richest regions and the health of its resident population compares favourably with other regions in Italy. Life expectancy for both men and women, now at 79.1 and 85.2 years, respectively, is slightly higher than the national average, while mortality rates are comparable to national ones. The major causes of death are tumours and cardiovascular diseases. Under Italy's National Health Service, the organization and provision of health care is a regional responsibility and regions must provide a nationally defined (with regional input) basic health benefit package to all of their citizens; extra services may be provided if budgets allow. Health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. Historically, health budget deficits have been a major problem in most Italian regions, but since the early 2000s the introduction of efficiency measures and tighter procedures on financial management have contributed to a significant decrease in the Veneto Regions health budget deficit.The health system is governed by the Veneto Region government (Giunta) via the Departments of Health and Social Services, which receive technical support from a single General Management Secretariat. Health care is
Németh, Károly; Challacombe, Matt; Van Veenendaal, Michel
This article presents several considerations for the appropriate choice of internal coordinates in various complex chemical systems. The appropriate and black box recognition of internal coordinates is of fundamental importance for the extension of internal coordinate algorithms to all fields where previously Cartesian coordinates were the preferred means of geometry manipulations. Such fields range from local and global geometry optimizations to molecular dynamics as applied to a wide variety of chemical systems. We present a robust algorithm that is capable to quickly determine the appropriate choice of internal coordinates in a wide range of atomic arrangements.
Vail, David J.
The guidebook is introduced by general observations on the Scandinavian countries concerning history, social policy, medicine, mental health, and psychiatric diagnosis. Discussed individually for Norway, Sweden, and Denmark are the following areas: mental health programs and statistics; mental illness programs, regional, hospital, aftercare,…
Pathology/Diagnosis 3107 Oral Maxillofacial Surgery 3108 Orthodontics 3109 Pedodontics 3110 Periodontics 3111 Public Health Dentistry 3112 Prosthodontics...Maxillofacial Surgery 3108 Orthodontics 3109 Pedodontics 3110 Periodontics 3111 Public Health Dentistry 3112 Prosthodontics 3113 Comprehensive...Executive Dentistry 3103 Endodontics 3102 Oral Pathology/Diagnosis 3107 Oral Maxillofacial Surgery 3108 Orthodontics 3109 Pedodontics 3110 Periodontics 3111
Health services are now advertised in a global marketplace. Hip and knee replacements, ophthalmologic procedures, cosmetic surgery, cardiac care, organ transplants, and stem cell injections are all available for purchase in the global health services marketplace. "Medical tourism" companies market "sun and surgery" packages and arrange care at international hospitals in Costa Rica, India, Mexico, Singapore, Thailand, and other destination nations. Just as automobile manufacturing and textile production moved outside the United States, American patients are "offshoring" themselves to facilities that use low labor costs to gain competitive advantage in the marketplace. Proponents of medical tourism argue that a global market in health services will promote consumer choice, foster competition among hospitals, and enable customers to purchase high-quality care at medical facilities around the world. Skeptics raise concerns about quality of care and patient safety, information disclosure to patients, legal redress when patients are harmed while receiving care at international hospitals, and harms to public health care systems in destination nations. The emergence of a global market in health services will have profound consequences for health insurance, delivery of health services, patient-physician relationships, publicly funded health care, and the spread of medical consumerism.
Nidzvetska, Svitlana; Rodriguez-Llanes, Jose M.; Aujoulat, Isabelle; Gil Cuesta, Julita; Tappis, Hannah; van Loenhout, Joris A. F.; Guha-Sapir, Debarati
Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine’s proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended. PMID:28075363
Nidzvetska, Svitlana; Rodriguez-Llanes, Jose M; Aujoulat, Isabelle; Gil Cuesta, Julita; Tappis, Hannah; van Loenhout, Joris A F; Guha-Sapir, Debarati
Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine's proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended.
Jay Carney, Timothy; Kong, Amanda Y
Informaticians are challenged to design health IT solutions for complex problems like health disparities but are only achieving mixed results in demonstrating a direct impact on health outcomes. This presentation of collective intelligence and the corresponding terms of smart health, knowledge ecosystem, enhanced health disparities informatics capacities, knowledge exchange, big-data, and situational awareness are means of demonstrating the complex challenges informatics professional face in trying to model, measure, and manage an intelligence and a smart systems response to health disparities. A critical piece in our understanding of collective intelligence for public and population health rests in our understanding of any public and population health as a living and evolving network of individuals, organizations, and resources. This discussion represents a step in advancing the conversation of what a smart response to health disparities should represent and how informatics can drive the design of intelligent systems to assist in eliminating health disparities and achieving health equity.
Unlike the managerially oriented reforms that have brought auditing and accounting into such prominence in the UK National Health Service (NHS), and which seem alien to the culture of the caring professions, consumerist reforms may seem to complement moves towards the acceptance of wide definitions of health, and towards increasing patient autonomy. The empowerment favoured by those who support patient autonomy sounds like the sort of empowerment that is sometimes associated with the patient's charter. For this reason moral criticism of recent NHS reforms may stop short of calling consumerism into question. This, however, would be a mistake: consumerism can be objectionable both within and beyond the health care market. PMID:9134485
... 47 Telecommunication 5 2014-10-01 2014-10-01 false Operation of internal transmitter control systems in specially equipped systems. 90.475 Section 90.475 Telecommunication FEDERAL COMMUNICATIONS... Control Internal Transmitter Control Systems § 90.475 Operation of internal transmitter control systems...
... 47 Telecommunication 5 2013-10-01 2013-10-01 false Operation of internal transmitter control systems in specially equipped systems. 90.475 Section 90.475 Telecommunication FEDERAL COMMUNICATIONS... Control Internal Transmitter Control Systems § 90.475 Operation of internal transmitter control systems...
... 47 Telecommunication 5 2012-10-01 2012-10-01 false Operation of internal transmitter control systems in specially equipped systems. 90.475 Section 90.475 Telecommunication FEDERAL COMMUNICATIONS... Control Internal Transmitter Control Systems § 90.475 Operation of internal transmitter control systems...
This paper explores the dynamics of health and health care in Cuba during a period of severe crisis by placing it within its economic, social, and political context using a comparative historical approach. It outlines Cuban achievements in health care as a consequence of the socialist transformations since 1959, noting the full commitment by the Cuban state, the planned economy, mass participation, and a self-critical, working class perspective as crucial factors. The roles of two external factors, the U.S. economic embargo and the Council of Mutual Economic Cooperation (CMEA), are explored in shaping the Cuban society and economy, including its health care system. It is argued that the former has hindered health efforts in Cuba. The role of the latter is more complex. While the CMEA was an important source for economic growth, Cuban relations with the Soviet bloc had a damaging effect on the development of socialism in Cuba. The adoption of the Soviet model of economic development fostered bureaucracy and demoralization of Cuban workers. As such, it contributed to two internal factors that have undermined further social progress including in health care: low productivity of labor and the growth of bureaucracy. While the health care system is still consistently supported by public policy and its structure is sound, economic crisis undermines its material and moral foundations and threatens its achievements. The future of the current Cuban health care system is intertwined with the potentials for its socialist development.
Liaropoulos, Lycourgos; Goranitis, Ilias
The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.
Qayumi, Karim; Pachev, George; Zheng, Bin; Ziv, Amitai; Koval, Valentyna; Badiei, Sadia; Cheng, Adam
Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current findings to support simulation in the next developmental stages. PMID:25489254
Qayumi, Karim; Pachev, George; Zheng, Bin; Ziv, Amitai; Koval, Valentyna; Badiei, Sadia; Cheng, Adam
Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current findings to support simulation in the next developmental stages.
Our objective is to discuss the implications internationally of the increased focus on nutrigenomics as the underlying basis for individualized health promotion and chronic disease prevention and the challenges presented to existing nutrient database and nutrient analysis systems by these trends. De...
Hunter-Jones, John; Hunter-Jones, Philippa
Organizing international school trips can be a demanding experience because of the age of the participants, the unfamiliar surroundings and the excitement associated with the foreign trip. As many organizers are full-time teachers, without a background in the travel sector, the pressures can be even greater. The need to anticipate potential risks…
Fulop, Tamas; Roemer, Milton I.
This guide is intended to assist countries contemplating a comprehensive, action-oriented review of health labor force development to improve their national health systems. Various aspects of the health system infrastructure are examined (major components, organizational structure, coordinating mechanisms, sources of information, and…
Cutts, Emily; Kavikondala, Sushma; Salcedo, Alejandra; D'Souza, Karan; Hernandez-Torre, Martin; Anderson, Claire; Tiwari, Agnes; Ho, Kendall; Last, Jason
Background Social media is an asset that higher education students can use for an array of purposes. Studies have shown the merits of social media use in educational settings; however, its adoption in health science education has been slow, and the contributing reasons remain unclear. Objective This multidisciplinary study aimed to examine health science students’ opinions on the use of social media in health science education and identify factors that may discourage its use. Methods Data were collected from the Universitas 21 “Use of social media in health education” survey, distributed electronically among the health science staff and students from 8 universities in 7 countries. The 1640 student respondents were grouped as users or nonusers based on their reported frequency of social media use in their education. Results Of the 1640 respondents, 1343 (81.89%) use social media in their education. Only 462 of the 1320 (35.00%) respondents have received specific social media training, and of those who have not, the majority (64.9%, 608/936) would like the opportunity. Users and nonusers reported the same 3 factors as the top barriers to their use of social media: uncertainty on policies, concerns about professionalism, and lack of support from the department. Nonusers reported all the barriers more frequently and almost half of nonusers reported not knowing how to incorporate social media into their learning. Among users, more than one fifth (20.5%, 50/243) of students who use social media “almost always” reported sharing clinical images without explicit permission. Conclusions Our global, interdisciplinary study demonstrates that a significant number of students across all health science disciplines self-reported sharing clinical images inappropriately, and thus request the need for policies and training specific to social media use in health science education. PMID:28052842
Clark, Phillip G; Weeks, Lori E; van Den Bergh, Graziella; Doucet, Shelley
The need for interprofessional teamwork and the global challenges for health care systems of dramatically increasing numbers of older adults have received increased recognition in gerontological and geriatrics education. The authors report on the pilot development of a hybrid course on aging and health for graduate-level health professions students from Norway, Canada, and the United States. International faculty from partnering universities developed, taught, and evaluated the course. Course assignments included online forum postings, reflections, and a problem-based learning group assignment and presentation. Directed readings and discussion included topics related to health care systems and services in the three participating countries, teamwork, and patient-centered care. To evaluate the course, quantitative and qualitative data were collected and analyzed. Results indicate a significant impact on student learning outcomes, including understanding of issues in international aging and health, attitudes and skills in teamwork, and application to clinical practice. This course clearly established the importance of developing innovative interprofessional educational experiences that respond to the increasingly universal impacts of aging populations on health and social care systems around the world.
This article addresses the increasing influence of economic rationalities in global health over the past 30 years by examining the genealogy of one economic strategy – taxation – that has become central to international anti-smoking initiatives in the global South. It argues that this genealogy sits uncomfortably with the usual story about economics and global health, which reduces the economisation of international health to neoliberal structural adjustment policies aimed at stabilisation, liberalisation and privatisation and laments their detrimental effect on health. While not disputing these policies' importance and damaging impact, the genealogy of tobacco taxes outlined in this article shows that the economisation of global health is not only about neoliberal structural adjustment policies but also about sin taxes, market failures and health economics. By stressing how changes in health like the global South's epidemiological transition can impact on economics and how beneficial taxation can be for health, it also shows that the relation between economics and health is not always unidirectional and detrimental to the latter. In doing so, the article contributes to the critique of the often mechanical use of neo-liberalism to explicate change and calls for other stories about the economisation of global health to be told. PMID:23750175
This article addresses the increasing influence of economic rationalities in global health over the past 30 years by examining the genealogy of one economic strategy - taxation - that has become central to international anti-smoking initiatives in the global South. It argues that this genealogy sits uncomfortably with the usual story about economics and global health, which reduces the economisation of international health to neoliberal structural adjustment policies aimed at stabilisation, liberalisation and privatisation and laments their detrimental effect on health. While not disputing these policies' importance and damaging impact, the genealogy of tobacco taxes outlined in this article shows that the economisation of global health is not only about neoliberal structural adjustment policies but also about sin taxes, market failures and health economics. By stressing how changes in health like the global South's epidemiological transition can impact on economics and how beneficial taxation can be for health, it also shows that the relation between economics and health is not always unidirectional and detrimental to the latter. In doing so, the article contributes to the critique of the often mechanical use of neo-liberalism to explicate change and calls for other stories about the economisation of global health to be told.
Hakamies, Nina; Geissler, Paul Wenzel; Borchert, Matthias
Reproductive health care for internally displaced persons (IDPs) is recognised by the Inter-Agency Working Group on Reproductive Health in Refugee Situations and the Reproductive Health Response in Conflict Consortium as a neglected area in humanitarian relief operations. To identify barriers to agencies providing reproductive health care to IDPs, and their strategies for overcoming these barriers, we interviewed representatives of 12 relief and development agencies providing health care to conflict-affected populations. Although material and human resources are significant constraints on agencies, the main challenge is to tackle ideological, managerial and policy barriers, and those related to donor influence. The absence of a legal instrument that recognises IDPs internationally has contributed to the difficulties agencies face in systematically reaching IDPs. Our findings suggest that considerable efforts are needed to close the gap between international commitments and the provision of services at field level. We recommend that agencies carry out awareness-raising activities internally and among partner organisations and donors, strengthen internal organisation and inter-agency collaboration and share expertise in order to maximise benefits and save resources at the local level. We also recommend exploring the possibility of an international convention to protect the rights of internally displaced persons.
Coutinho, Janine Giuberti; Recine, Elisabetta
With ever-increasing frequency, consumers are seeking information on the foods they eat. Food labels are an important source of this type of information, and the Codex Alimentarius, created by the World Health Organization and the Food and Agriculture Organization of the United Nations, provides a global reference for coordinated food quality and identification standards. The Codex Alimentarius agenda includes nutritional information and "health claims," which are defined as any representation that states, suggests, or implies that a relationship exists between a food or a constituent of that food and health. Although food labeling seems to effectively assist consumers in choosing among processed foods, consumers are not always capable of reading or interpreting nutritional information correctly, so health claims may allow for more precise decision-making for these products. The present paper examines the use of health claims in countries and regions that have already implemented this type of regulation (Brazil, Chile, Canada, United States of America, the European Union, and Japan).
Barna, Lauren; Meyers, Margaret; Sherman, Susan E.
In 2014, the United States in partnership with international organizations and nearly 30 partner countries launched the Global Health Security Agenda (GHSA) to accelerate progress to improve prevention, detection, and response capabilities for infectious disease outbreaks that can cause public health emergencies. Objective 9 of the GHSA calls for improved global access to medical countermeasures and establishes as a target the development of national policy frameworks for sending and receiving medical countermeasures from and to international partners during public health emergencies. The term medical countermeasures refers to vaccines, antimicrobials, therapeutics, and diagnostics that address the public health and medical consequences of chemical, biological, radiological, and nuclear events; pandemic influenza; and emerging infectious diseases. They are stockpiled by a few countries to protect their own populations and by international organizations, such as the World Health Organization (WHO), for the international community, typically for recipients with limited resources. However, as observed during the 2009 H1N1 influenza pandemic, legal, regulatory, logistical, and funding barriers slowed the ability of WHO and countries to quickly deploy or receive vaccine. Had the 2009 H1N1 influenza pandemic been more severe, the world would have been ill prepared to cope with the global demand for rapid access to medical countermeasures. This article summarizes the US government efforts to develop a national framework to deploy medical countermeasures internationally and a number of engagements to develop regional and international mechanisms, thus increasing global capacity to respond to public health emergencies. PMID:25254917
Background Given that many low income countries are heavily reliant on external assistance to fund their health sectors the acceptance of obligations of international assistance and cooperation with regard to the right to health (global health obligations) is insufficiently understood and studied by international health and human rights scholars. Over the past decade Global Health Initiatives, like the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) have adopted novel approaches to engaging with stakeholders in high and low income countries. This article explores how this experience impacted on acceptance of the international obligation to (help) fulfil the right to health beyond borders. Methods The authors conducted an extensive review of international human rights law literature, transnational legal process literature, global public health literature and grey literature pertaining to Global Health Initiatives. To complement this desk work and deepen their understanding of how and why different legal norms evolve the authors conducted 19 in-depth key informant interviews with actors engaged with three stakeholders; the European Union, the United States and Belgium. The authors then analysed the interviews through a transnational legal process lens. Results Through according value to the process of examining how and why different legal norms evolve transnational legal process offers us a tool for engaging with the dynamism of developments in global health suggesting that operationalising global health obligations could advance the right to health for all. Conclusions In many low-income countries the health sector is heavily dependent on external assistance to fulfil the right to health of people thus it is vital that policies and tools for delivering reliable, long-term assistance are developed so that the right to health for all becomes more than a dream. Our research suggests that the Global Fund experience offers lessons to build on. PMID
Labonté, Ronald; Sanders, David; Packer, Corinne; Schaay, Nikki
Background The 4-year (2007–2011) Revitalizing Health for All international research program (http://www.globalhealthequity.ca/projects/proj_revitalizing/index.shtml) supported 20 research teams located in 15 low- and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. Teams were organized in a triad comprised of a senior researcher, a new researcher, and a ‘research user’ from government, health services, or other organizations with the authority or capacity to apply the research findings. Multiple regional and global team capacity-enhancement meetings were organized to refine methods and to discuss and assess cross-case findings. Objective Most research projects used mixed methods, incorporating analyses of qualitative data (interviews and focus groups), secondary data, and key policy and program documents. Some incorporated historical case study analyses, and a few undertook new surveys. The synthesis of findings in this report was derived through qualitative analysis of final project reports undertaken by three different reviewers. Results Evidence of comprehensiveness (defined in this research program as efforts to improve equity in access, community empowerment and participation, social and environmental health determinants, and intersectoral action) was found in many of the cases. Conclusions Despite the important contextual differences amongst the different country studies, the similarity of many of their findings, often generated using mixed methods, attests to certain transferable health systems characteristics to create and sustain CPHC practices. These include: Well-trained and supported community health workers (CHWs) able to work effectively with marginalized communities Effective mechanisms for community participation, both informal (through participation in projects and programs, and meaningful consultation) and formal (though program
Waterston, T; Goldhagen, J
The UN Convention on the Rights of the Child provides a framework for improving children's lives around the world. It covers both individual child health practice and public health and provides a unique and child-centred approach to paediatric problems. The Convention applies to most child health problems and the articles are grouped into protection, provision and participation. Examples of the first are the right to protection from abuse, from economic exploitation and from illicit drugs. We examine one particular problem in each of these categories, specifically child labour, services for children with a disability and violence against children. The role of the paedialrician in applying a children's rights approach is discussed. Children's rights are increasingly being accepted around the world but still there is much more rhetoric paid to their value than genuine enforcement. Paediatricians can make a difference to the status of children worldwide by adopting a rights-based approach.
Waterston, T; Goldhagen, J
The UN Convention on the Rights of the Child provides a framework for improving children's lives around the world. It covers both individual child health practice and public health and provides a unique and child‐centred approach to paediatric problems. The Convention applies to most child health problems and the articles are grouped into protection, provision and participation. Examples of the first are the right to protection from abuse, from economic exploitation and from illicit drugs. We examine one particular problem in each of these categories, specifically child labour, services for children with a disability and violence against children. The role of the paedialrician in applying a children's rights approach is discussed. Children's rights are increasingly being accepted around the world but still there is much more rhetoric paid to their value than genuine enforcement. Paediatricians can make a difference to the status of children worldwide by adopting a rights‐based approach. PMID:17264288
Duggan, Ruth Ann
To effectively manage the security or control of its borders, a country must understand its border management activities as a system. Using its systems engineering and security foundations as a Department of Energy National Security Laboratory, Sandia National Laboratories has developed such an approach to modeling and analyzing border management systems. This paper describes the basic model and its elements developed under Laboratory Directed Research and Development project 08-684.
INTELSAT, the International Telecommunications Satellite Organization, is a not-for-profit commercial cooperate of 124 member nations, created on 20 August 1964. It owns and operates a global system of communications satellites that provides international telecommunications services to 180 countries, territories, and dependencies, and domestic telecommunications services to 40 nations. INTELSAT has actively encouraged the use of satellites for both telemedicine and disaster relief. Topics discussed include: INTELSAT domestic/regional services; use of transportable antennas; INTELNET; using the existing telecommunications infrastructure for remote health care applications: Project Access; INTELSAT's role in disaster telecommunications efforts; and how INTELSAT's existing infrastructure can be used for disaster telecommunications.
Olson, J.A.; Custer, D. Jr.
This patent describes an internal combustion engine. It comprises: means defining a combustion chamber, means defining a fuel/air chamber adapted to communicate with a source of air under pressure, means including a moveable wall defining a fuel chamber, selectively operable means for supplying fuel to the fuel chamber at a pressure sufficient to move the wall in the direction increasing the volume of the fuel chamber, means defining a fuel orifice which is spaced from the wall and which communicates between the fuel chamber and the fuel/air chamber, and means for opening the fuel/air chamber to the combustion chamber in response to movement of the wall in the direction increasing the volume of the fuel chamber.
Nolen, Lexi Bambas; Braveman, Paula; Dachs, J. Norberto W.; Delgado, Iris; Gakidou, Emmanuela; Moser, Kath; Rolfe, Liz; Vega, Jeanette; Zarowsky, Christina
Special studies and isolated initiatives over the past several decades in low-, middle- and high-income countries have consistently shown inequalities in health among socioeconomic groups and by gender, race or ethnicity, geographical area and other measures associated with social advantage. Significant health inequalities linked to social (dis)advantage rather than to inherent biological differences are generally considered unfair or inequitable. Such health inequities are the main object of health development efforts, including global targets such as the Millennium Development Goals, which require monitoring to evaluate progress. However, most national health information systems (HIS) lack key information needed to assess and address health inequities, namely, reliable, longitudinal and representative data linking measures of health with measures of social status or advantage at the individual or small-area level. Without empirical documentation and monitoring of such inequities, as well as country-level capacity to use this information for effective planning and monitoring of progress in response to interventions, movement towards equity is unlikely to occur. This paper reviews core information requirements and potential databases and proposes short-term and longer term strategies for strengthening the capabilities of HIS for the analysis of health equity and discusses HIS-related entry points for supporting a culture of equity-oriented decision-making and policy development. PMID:16184279
Begg, Robert T.
Examines system for safeguarding assets and guaranteeing reliability of library's financial records within context of management functions that comprise accounting controls: planning by budget or other standard of comparison; operation of effective accounting and record-keeping system; personnel management practices. Cash controls as example of…
Block, Robert C.; Duron, Vincent; Creigh, Peter; McIntosh, Scott
Objective: We aimed to improve the education of medical students involved in a longitudinal perinatal health improvement project in Gowa, Malawi. Design: We conducted qualitative interviews with students who participated in the project, reviewed their quantitative reports, and assessed the application of methodologies consonant with the learning…
Health Information Science and Systems is an exciting, new, multidisciplinary journal that aims to use technologies in computer science to assist in disease diagnoses, treatment, prediction and monitoring through the modeling, design, development, visualization, integration and management of health related information. These computer-science technologies include such as information systems, web technologies, data mining, image processing, user interaction and interface, sensors and wireless networking and are applicable to a wide range of health related information including medical data, biomedical data, bioinformatics data, public health data.
Cave, Ben; Birley, Martin
The lending and technical support provided by the International Monetary Fund affect the determinants of health and healthy equity. Most health determinants lie outside the control of the health sector, and thus non-health-sector policies have profound positive and negative effects on population health. Health Impact Assessment (HIA) is an instrument for identifying the effect of policies, plans, programs, and projects on population health and health equity. It is a feasible, cost-effective, and transparent process that has been adopted by several financial institutions, including members of the World Bank Group. Adopting HIA would assist the IMF in ensuring that the potential health consequences of its policies are identified and addressed.
Tang, S. S.; Riccardella, P. C.; Andrews, R. J.; Grady, J. E.; Mucciaradi, A. N.
An automated system was developed to monitor the health status of composites. It uses the vibration characteristics of composites to identify a component's damage condition. The vibration responses are characterized by a set of signal features defined in the time, frequency and spatial domains. The identification of these changes in the vibration characteristics corresponding to different health conditions was performed using pattern recognition principles. This allows efficient data reduction and interpretation of vast amounts of information. Test components were manufactured from isogrid panels to evaluate performance of the monitoring system. The components were damaged by impact to simulate different health conditions. Free vibration response was induced by a tap test on the test components. The monitoring system was trained using these free vibration responses to identify three different health conditions. They are undamaged vs. damaged, damage location and damage zone size. High reliability in identifying the correct component health condition was achieved by the monitoring system.
Chee, Grace; Pielemeier, Nancy; Lion, Ann; Connor, Catherine
There is increasing recognition that efforts to improve global health cannot be achieved without stronger health systems. Interpretation of health system strengthening (HSS) has varied widely however, with much of the focus to-date on alleviating input constraints, whereas less attention has been given to other performance drivers. It is important to distinguish activities that support the health system, from ones that strengthen the health system. Supporting the health system can include any activity that improves services, from distributing mosquito nets to procuring medicines. These activities improve outcomes primarily by increasing inputs. Strengthening the health system is accomplished by more comprehensive changes to performance drivers such as policies and regulations, organizational structures, and relationships across the health system to motivate changes in behavior and/or allow more effective use of resources to improve multiple health services. Even organizations that have made significant investments in health systems have not provided guidance on what HSS entails. While both supporting and strengthening are important and necessary, it is nonetheless important to make a distinction. If activities fail to produce improvements in system performance because they were incorrectly labeled as system strengthening, the value of HSS investments could quickly be discredited. Not distinguishing supportive activities from strengthening ones will lead to unmet expectations of stronger health systems, as well as neglect of critical system strengthening activities. Distinguishing between these two types of activities will improve programming impact. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22777839
Bahman, Azarbar; Langlois, Jacques R.; Frank, Christopher J.
International and domestic regulatory issues which affect the implementation of a mobile satellite system (