48 CFR 41.101 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... service supplier to cover utility service needs of Federal agencies within the franchise territory of the..., transports, controls, and sells electrical and water supply service to customers. Franchise territory means a geographical area that a utility supplier has a right to serve based upon a franchise, a certificate of public...

48 CFR 41.101 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... service supplier to cover utility service needs of Federal agencies within the franchise territory of the..., transports, controls, and sells electrical and water supply service to customers. Franchise territory means a geographical area that a utility supplier has a right to serve based upon a franchise, a certificate of public...

Dental Workforce Availability and Dental Services Utilization in Appalachia: A Geospatial Analysis

PubMed Central

Feng, Xue; Sambamoorthi, Usha; Wiener, R. Constance

2016-01-01

Objectives There is considerable variation in dental services utilization across Appalachian counties, and a plausible explanation is that individuals in some geographical areas do not utilize dental care due to dental workforce shortage. We conducted an ecological study on dental workforce availability and dental services utilization in Appalachia. Methods We derived county-level (n = 364) data on demographic, socio-economic characteristics and dental services utilization in Appalachia from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) using person-level data. We obtained county-level dental workforce availability and physician-to-population ratio estimates from Area Health Resource File, and linked them to the county-level BRFSS data. The dependent variable was the proportion using dental services within the last year in each county (ranging from 16.6% to 91.0%). We described the association between dental workforce availability and dental services utilization using ordinary least squares regression and spatial regression techniques. Spatial analyses consisted of bivariate Local Indicators of Spatial Association (LISA) and geographically weighted regression (GWR). Results Bivariate LISA showed that counties in the central and southern Appalachian regions had significant (p < .05) low-low spatial clusters (low dental workforce availability, low percent dental services utilization). GWR revealed considerable local variations in the association between dental utilization and dental workforce availability. In the multivariate GWR models, 8.5% (t-statistics >1.96) and 13.45% (t-statistics >1.96) of counties showed positive and statistically significant relationships between the dental services utilization and workforce availability of dentists and dental hygienists, respectively. Conclusions Dental workforce availability was associated with dental services utilization in the Appalachian region; however, this association was not statistically significant in all counties. The findings suggest that program and policy efforts to improve dental services utilization need to focus on factors other than increasing the dental workforce availability for many counties in Appalachia. PMID:27957773

A transaction assessment method for allocation of transmission services

NASA Astrophysics Data System (ADS)

Banunarayanan, Venkatasubramaniam

The purpose of this research is to develop transaction assessment methods for allocating transmission services that are provided by an area/utility to power transactions. Transmission services are the services needed to deliver, or provide the capacity to deliver, real and reactive power from one or more supply points to one or more delivery points. As the number of transactions increase rapidly in the emerging deregulated environment, accurate quantification of the transmission services an area/utility provides to accommodate a transaction is becoming important, because then appropriate pricing schemes can be developed to compensate for the parties that provide these services. The Allocation methods developed are based on the "Fair Resource Allocation Principle" and they determine for each transaction the following: the flowpath of the transaction (both real and reactive power components), generator reactive power support from each area/utility, real power loss support from each area/utility. Further, allocation methods for distributing the cost of relieving congestion on transmission lines caused by transactions are also developed. The main feature of the proposed methods is representation of actual usage of the transmission services by the transactions. The proposed method is tested extensively on a variety of systems. The allocation methods developed in this thesis for allocation of transmission services to transactions is not only useful in studying the impact of transactions on a transmission system in a multi-transaction case, but they are indeed necessary to meet the criteria set forth by FERC with regard to pricing based on actual usage. The "consistency" of the proposed allocation methods has also been investigated and tested.

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

PubMed

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

2013-10-30

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

Characteristics of HIV-infected adults in the Deep South and their utilization of mental health services: A rural vs. urban comparison.

PubMed

Reif, Susan; Whetten, Kathryn; Ostermann, Jan; Raper, James L

2006-01-01

Insufficient utilization of mental health services has been described among HIV-infected individuals in urban areas; however, little is known about utilization of mental health services among rural-living HIV-infected individuals. This article examines use of mental health services by HIV-infected adults in the Southern U.S., where approximately two-thirds of rural HIV cases reside, and compares mental health services use between those in rural and urban areas. Data were obtained from surveys of HIV-infected individuals receiving care at tertiary Infectious Diseases clinics in the Southern U.S. (n = 474). Study findings indicated that participants living in areas with a higher proportion of rural-living individuals were less likely to report seeing a mental health provider (p < .001) in the last year even though there were no differences in level of psychological distress by degree of rurality. Participants living in more rural areas also reported significantly fewer mental health visits in the previous month (p = .025). Furthermore, rural living was significantly associated with being African-American, heterosexual, less educated, and having minor children in the home. Due to differences in characteristics and mental health services use by degree of rurality, efforts are needed to assess and address the specific mental health and other needs of HIV-infected individuals in rural areas.

Service Networks and Patterns of Utilization: Mental Health Programs, Indian Health Service (IHS). Volume 8: Phoenix Area, 1966-1974.

ERIC Educational Resources Information Center

Attneave, Carolyn L.; Beiser, Morton

The eighth volume in a 10-volume report on the historical development (1966-1973) of the 8 administrative Area Offices of the Indian Health Service (IHS) Mental Health Programs, this report presents information on the Phoenix Area Office and the Tucson Sub-Area Office. Included in this document are: (1) The Context: Political and Geographic (the…

7 CFR 1735.11 - Area coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 11 2013-01-01 2013-01-01 false Area coverage. 1735.11 Section 1735.11 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... Policies § 1735.11 Area coverage. Borrowers must make adequate telephone service available to the widest...

Evaluation on equality and efficiency of health resources allocation and health services utilization in China.

PubMed

Sun, Jian; Luo, Hongye

2017-07-14

China is faced with a daunting challenge to equality and efficiency in health resources allocation and health services utilization in the context of rapid economic growth. This study sought to evaluate the equality and efficiency of health resources allocation and health services utilization in China. Demographic, economic, and geographic area data was sourced from China Statistical Yearbook 2012-2016. Data related to health resources and health services was obtained from China Health Statistics Yearbook 2012-2016. Furthermore, we evaluated the equality of health resources allocation based on Gini coefficient. Concentration index was used to measure the equality in utilization of health services. Data envelopment analysis (DEA) was employed to assess the efficiency of health resources allocation. From 2011 to 2015, the Gini coefficients for health resources by population ranged between 0.0644 and 0.1879, while the Gini coefficients for the resources by geographic area ranged from 0.6136 to 0.6568. Meanwhile, the concentration index values for health services utilization ranged from -0.0392 to 0.2110. Moreover, in 2015, 10 provinces (32.26%) were relatively efficient in terms of health resources allocation, while 7 provinces (22.58%) and 14 provinces (45.16%) were weakly efficient and inefficient, respectively. There exist distinct regional disparities in the distribution of health resources in China, which are mainly reflected in the geographic distribution of health resources. Furthermore, the people living in the eastern developed areas are more likely to use outpatient care, while the people living in western underdeveloped areas are more likely to use inpatient care. Moreover, the efficiency of health resources allocation in 21 provinces (67.74%) of China was low and needs to be improved. Thus, the government should pay more attention to the equality based on geographic area, guide patients to choose medical treatment rationally, and optimize the resource investments for different provinces.

The Rural-Urban Divide: Health Services Utilization among Older Mexicans in Mexico

ERIC Educational Resources Information Center

Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

2010-01-01

Context: Mexico. Purpose: Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods: The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health…

El Portal Latino Alzheimer's Project: Model Program for Latino Caregivers of Alzheimer's Disease-Affected People.

ERIC Educational Resources Information Center

Aranda, Maria P.; Villa, Valentine M.; Trejo, Laura; Ramirez, Rosa; Ranney, Martha

2003-01-01

Describes the El Portal Latino Alzheimer's Project--a dementia-specific outreach and services program targeting Latino caregivers in the Los Angeles area. Results of an evaluation of service utilization indicate a reduction in barriers to care and an increase in services utilization. Implications for social work practice are discussed. (Contains…

Service Networks and Patterns of Utilization: Mental Health Programs, Indian Health Service (IHS). Volume 5: Billings Area, 1963-1973.

ERIC Educational Resources Information Center

Attneave, Carolyn L.; Beiser, Morton

The fifth volume in a 10-volume report on the historical development (1966-1973) of the 8 administrative Area Offices of the Indian Health Service (IHS) Mental Health Programs, this report presents information on the Billings Area Office. Included in this document are: (1) General Description (geography, demography, and transportation facilities…

7 CFR 1703.126 - Criteria for scoring grant applications.

Code of Federal Regulations, 2011 CFR

2011-01-01

... benefits derived from services (up to 55 points); (2) The comparative rurality of the project service area... the United States Department of Agriculture. (2) The comparative rurality of the project service area... international levels. To the extent possible, educational and health care networks should be designed to utilize...

7 CFR 1703.126 - Criteria for scoring grant applications.

Code of Federal Regulations, 2013 CFR

2013-01-01

... benefits derived from services (up to 55 points); (2) The comparative rurality of the project service area... the United States Department of Agriculture. (2) The comparative rurality of the project service area... international levels. To the extent possible, educational and health care networks should be designed to utilize...

7 CFR 1703.126 - Criteria for scoring grant applications.

Code of Federal Regulations, 2014 CFR

2014-01-01

... benefits derived from services (up to 55 points); (2) The comparative rurality of the project service area... the United States Department of Agriculture. (2) The comparative rurality of the project service area... international levels. To the extent possible, educational and health care networks should be designed to utilize...

7 CFR 1703.126 - Criteria for scoring grant applications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... benefits derived from services (up to 55 points); (2) The comparative rurality of the project service area... the United States Department of Agriculture. (2) The comparative rurality of the project service area... international levels. To the extent possible, educational and health care networks should be designed to utilize...

7 CFR 1703.126 - Criteria for scoring grant applications.

Code of Federal Regulations, 2010 CFR

2010-01-01

... benefits derived from services (up to 55 points); (2) The comparative rurality of the project service area... the United States Department of Agriculture. (2) The comparative rurality of the project service area... international levels. To the extent possible, educational and health care networks should be designed to utilize...

Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

PubMed Central

Memon, Zahid; Zaidi, Shehla; Riaz, Atif

2016-01-01

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers. PMID:26925902

Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network.

PubMed

O'Gorman, Laurel D; Hogenbirk, John C; Warry, Wayne

2016-06-01

Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province. We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care. There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south. Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.

Service Networks and Patterns of Utilization: Mental Health Programs, Indian Health Service (IHS). Volume 9: Portland Area, 1966-1973.

ERIC Educational Resources Information Center

Attneave, Carolyn L.; Beiser, Morton

The ninth volume in a 10-volume report on the historical development (1966-1973) of the 8 administrative Area Offices of the Indian Health Service (IHS) Mental Health Programs, this report presents information on the Portland Area Office. Included in this document are: (1) The Context (early history of the Oregon Territory, geography and tribal…

Comparing post-deployment mental health services utilization in soldiers deployed to Balkan, Iraq and Afghanistan.

PubMed

Madsen, T; Sadowa Vedtofte, M; Nordentoft, M; Ravnborg Nissen, L; Bo Andersen, S

2017-06-01

Insight on how different missions have impacted rates of mental health service (MHS) utilization is unexplored. We compared postdeployment MHS utilization in a national cohort of first-time deployed to missions in Balkan, Iraq, and Afghanistan respectively. A prospective national cohort study of 13 246 first-time deployed in the period 1996 through 2012 to missions in Balkan area, Iraq, or Afghanistan respectively. Soldiers 'MHS utilization was also compared with a 5:1 sex-, age-, and calendar year-matched never-deployed background population. Postdeployment utilization of MHS was retrieved from national coverage registers. Using Cox survival analyses, participants were followed and compared with regard to receiving three different types of psychiatric services: (i) admission to psychiatric hospital, (ii) psychiatric outpatient contact, and (iii) prescriptions of psychotropics. Utilizing of psychiatric outpatient services and psychotropics was significantly higher in first-time deployed to Iraq and Afghanistan compared with deployed to Balkan. However, the rate of postdeployment admission to psychiatric hospital did not differ between missions. Postdeployment rates of psychiatric admission and psychiatric outpatient treatment were significantly higher in Afghanistan-deployed personnel compared with the background population. Utilization of MHS differed significantly between mission areas and was highest after the latest mission to Afghanistan. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Public Health Services for Foreign Workers in Malaysia.

PubMed

Noh, Normah Awang; Wahab, Haris Abd; Bakar Ah, Siti Hajar Abu; Islam, M Rezaul

2016-01-01

The objective of this study was to know the status of the foreign workers' access to public health services in Malaysia based on their utilization pattern. The utilization pattern covered a number of areas, such as frequency of using health services, status of using health services, choice and types of health institutions, and cost of health treatment. The study was conducted on six government hospitals in the Klang Valley area in Kuala Lumpur, Malaysia. Data were collected from 600 foreign patients working in the country, using an interview method with a structured questionnaire. The results showed that the foreign workers' access to public health services was very low. The findings would be an important guideline to formulate an effective health service policy for the foreign workers in Malaysia.

An economy-ralated equity analysis of health service utilization by women in economically underdeveloped regions of western China.

PubMed

Qian, Yuyan; Zhou, Zhongliang; Yan, Ju'e; Gao, Jianmin; Wang, Yuping; Yang, Xiaowei; Xu, Yongjian; Li, Yanli

2017-10-27

The Chinese government has long been committed to eliminating the inequality in the utilization of health services; however, it still lacks an analysis or measurement of the economy-related inequality in the utilization of women's health services. The economy-related utilization of health services in women aged 15 years and above was assessed by the horizontal inequity index of a two-week outpatient rate and annual inpatient rate from the 5th National Health Service Survey of Shaanxi Province. The concentration index of each factor was decomposed into the contribution of each factor to the economic-related inequality of health service utilization based on the Probit regression model. The horizontal inequity indexes of the two-week outpatient rate was 0.0493, and the horizontal inequity indexes of the annual impatient rate was 0.0869. The contributions of economic status to the two indexes were 190.71% and 115.80%, respectively. Economic status, age, basic medical insurance, educational status, marital status, urban/rural area, and self-rated health were the main impact factors that affected the inequality in women's health services utilization in Shaanxi. Health service utilization was different between women with different social demographic characteristics, and unequal health service utilization is evident among women in Shaanxi.

“Can community level interventions have an impact on equity and utilization of maternal health care” – Evidence from rural Bangladesh

PubMed Central

2013-01-01

Background Evidence from low and middle income countries (LMICs) suggests that maternal mortality is more prevalent among the poor whereas access to maternal health services is concentrated among the rich. In Bangladesh substantial inequities exist both in the use of facility-based basic obstetric care and for home births attended by skilled birth attendant. BRAC initiated an intervention on Improving Maternal, Neonatal, and Child Survival (IMNCS) in the rural areas of Bangladesh in 2008. One of the objectives of the intervention is to improve the utilization of maternal and child health care services among the poor. This study aimed to look at the impact of the intervention on utilization and also on equity of access to maternal health services. Methods A quasi-experimental pre-post comparison study was conducted in rural areas of five districts comprising three intervention (Gaibandha, Rangpur and Mymensingh) and two comparison districts (Netrokona and Naogaon). Data on health seeking behaviour for maternal health were collected from a repeated cross sectional household survey conducted in 2008 and 2010. Results Results show that the intervention appears to cause an increase in the utilization of antenatal care. The concentration index (CI) shows that this has become pro-poor over time (from CI: 0.30 to CI: 0.04) in the intervention areas. In contrast the use of ANC from medically trained providers has become pro-rich (from, CI: 0.18 to CI: 0.22). There was a significant increase in the utilisation of trained attendants for home delivery in the intervention areas compared to the comparison areas and the change was found to be pro-poor. Use of postnatal care cervices was also found to be pro-poor (from CI: 0.37 to CI: 0.14). Utilization of ANC services provided by medically trained provider did not improve in the intervention area. However, where the intervention had a positive effect on utilization it also seemed to have had a positive effect on equity. Conclusions To sustain equity in health care utilization, the IMNCS programme needs to continue providing free home based services. In addition to this, the programme should also continue to provide funding to bear the cost to those mothers who are not able to have the comprehensive ANC from medically trained providers. PMID:23547900

7 CFR 1944.514 - Comprehensive TSA grant projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF... growth or decline, the amount of inadequate housing, economic conditions, and trends of the rural areas...

7 CFR 1944.514 - Comprehensive TSA grant projects.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF... growth or decline, the amount of inadequate housing, economic conditions, and trends of the rural areas...

47 CFR 54.313 - Annual reporting requirements for high-cost recipients.

Code of Federal Regulations, 2012 CFR

2012-10-01

... planning with a focus on Tribal community anchor institutions; (ii) Feasibility and sustainability planning... annual report, any ETC that files annual financial reports with the Rural Utilities Service may instead file a copy of its report to the Rural Utilities Service. (g) Areas with No Terrestrial Backhaul...

Utilization of health services in a resource-limited rural area in Kenya: Prevalence and associated household-level factors.

PubMed

Ngugi, Anthony K; Agoi, Felix; Mahoney, Megan R; Lakhani, Amyn; Mang'ong'o, David; Nderitu, Esther; Armstrong, Robert; Macfarlane, Sarah

2017-01-01

Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services. 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05-0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.

Alternative beam configuration for a Canadian Ka-band satellite system

NASA Technical Reports Server (NTRS)

Hindson, Daniel J.; Caron, Mario

1995-01-01

Satellite systems operating in the Ka-band have been proposed to offer wide band personal communications services to fixed earth terminals employing small aperture antennas as well as to mobile terminals. This requirement to service a small aperture antenna leads to a satellite system utilizing small spot beams. The traditional approach is to cover the service area with uniform spot beams which have been sized to provide a given grade of service at the worst location over the service area and to place them in a honeycomb pattern. In the lower frequency bands this approach leads to a fairly uniform grade of service over the service area due to the minimal effects of rain on the signals. At Ka-band, however, the effects of rain are quite significant. Using this approach over a large service area (e.g. Canada) where the geographic distribution of rain impairment varies significantly yields an inefficient use of satellite resources to provide a uniform grade of service. An alternative approach is to cover the service area using more than one spot beam size in effect linking the spot beam size to the severity of the rain effects in a region. This paper demonstrates how for a Canadian Ka-band satellite system, that the use of two spot beam sizes can provide a more uniform grade of service across the country as well as reduce the satellite payload complexity over a design utilizing a single spot beam size.

Ancillary-service costs for 12 US electric utilities

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

Kirby, B.; Hirst, E.

1996-03-01

Ancillary services are those functions performed by electrical generating, transmission, system-control, and distribution-system equipment and people to support the basic services of generating capacity, energy supply, and power delivery. The Federal Energy Regulatory Commission defined ancillary services as ``those services necessary to support the transmission of electric power from seller to purchaser given the obligations of control areas and transmitting utilities within those control areas to maintain reliable operations of the interconnected transmission system.`` FERC divided these services into three categories: ``actions taken to effect the transaction (such as scheduling and dispatching services) , services that are necessary to maintainmore » the integrity of the transmission system [and] services needed to correct for the effects associated with undertaking a transaction.`` In March 1995, FERC published a proposed rule to ensure open and comparable access to transmission networks throughout the country. The rule defined six ancillary services and developed pro forma tariffs for these services: scheduling and dispatch, load following, system protection, energy imbalance, loss compensation, and reactive power/voltage control.« less

Guide to Cybersecurity, Resilience, and Reliability for Small and Under-Resourced Utilities

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

Ingram, Michael; Martin, Maurice

Small electricity utilities -- those with less than 100 employees or 50,000 meters -- provide essential services to large parts of the United States while facing a number of challenges unique to their mission. For instance, they often serve areas that are sparsely populated, meaning that their per-customer cost to provide service is higher. At the same time, they often serve customers that have moderate or fixed incomes, meaning that they are under strong pressure to keep costs down. This pressure puts them on a strict budget and creates a need for innovative solutions to common problems. Further, their servicemore » areas may include extreme climates, making severe weather events more frequent and their aftermaths more expensive to address. This guide considers challenges that small utilities face while ensuring the reliability, resilience, and cybersecurity of their electric service; approaches to address those challenges using existing guidance documents; ways that the federal government could provide support in these areas.« less

7 CFR 1940.304 - Special policy.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM... successor agency under Public Law 103-354 recognizes that its specific mission of assisting rural areas...

Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey.

PubMed

Tarekegn, Shegaw Mulu; Lieberman, Leslie Sue; Giedraitis, Vincentas

2014-05-07

Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women's autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people. Maternal health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women.

Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey

PubMed Central

2014-01-01

Background Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Methods Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Results Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women’s autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people. Conclusion Maternal health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women. PMID:24886529

7 CFR 4290.130 - Identified Rural Areas.

Code of Federal Regulations, 2010 CFR

2010-01-01

... specific Rural Area or Areas in which it intends to make Developmental Venture Capital investments and... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT COMPANY (âRBICâ) PROGRAM...

7 CFR 1980.318 - Flood or mudslide hazard area precautions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... dwelling location and construction plans and specifications for new buildings or improvements to existing... SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT... there is no practical alternative. (a) Dwelling location. Dwellings and building improvements located in...

Lack of Cost-Effectiveness Analyses to Address Healthy People 2020 Priority Areas.

PubMed

Neumann, Peter J; Farquhar, Megan; Wilkinson, Colby L; Lowry, Mackenzie; Gold, Marthe

2016-12-01

To examine the extent to which recently published cost-utility analyses (cost-effectiveness analyses using quality-adjusted life-years to measure health benefits) have covered the leading health concerns in the US Department of Health and Human Services Healthy People 2020 report. We examined data in the Tufts Medical Center Cost-Effectiveness Analysis Registry, a database containing 5000 published cost-utility analyses published in the MEDLINE literature through 2014. We focused on US-based cost-utility analyses published from 2011 through 2014 (n = 687). Two reviewers scanned abstracts and met for a consensus on categorization of cost-utility analyses that addressed the specific priorities listed in the 12 Healthy People 2020 areas (n = 120). Although 7.3% of recently published cost-utility analyses addressed key clinical preventive services, only about 2% of recently published cost-utility analyses covered each of the following Healthy People 2020 topics: reproductive and sexual health, nutrition/physical activity/obesity, maternal and infant health, and tobacco. Fewer than 1% addressed priorities such as injuries and violence, mental health or substance abuse, environmental quality, and oral health. Few cost-utility analyses have addressed Healthy People 2020 priority areas.

Self-reliance, mental health need, and the use of mental healthcare among island Puerto Ricans.

PubMed

Ortega, Alexander N; Alegría, Margarita

2002-09-01

This paper examines the relationship between self-reliance (preference to solve emotional problems on one's own) and 5 mental healthcare utilization outcomes for Puerto Ricans living in low-income areas. A random probability community sample of noninstitutionalized Puerto Ricans, ages 18-69, living in low-income areas of the island were selected and interviewed in 1992-93 and 1993-94. A series of logistic regression models tested the association between self-reliance and 5 mental health utilization measures, after adjusting for covariates measuring predisposing, enabling, need and barrier factors: any use of mental health services, any use of general health services for mental healthcare, any use of specialty care, use of psychotropic medications, and retention in mental healthcare. Self-reliance was found to be negatively associated with all 5 dependent service utilization measures. Those with a positive self-reliant attitude were 40% less likely to use care on any of the 5 outcome measures. An interaction was also observed between definite need for mental healthcare and having a self-reliant attitude when predicting mental health service use. Definite needers with a self-reliant attitude were 54%-58% less likely to use mental health services compared with definite needers who did not have a self-reliant attitude. Further, decreases in self-reliant attitude over the two data collection periods were associated with increases in mental health service use. Our findings suggest that self-reliance is a significant and robust predictor of mental healthcare utilization among Puerto Ricans living in low-income areas of the island.

Determinants of Utilization of Eye Care Services in a Rural Adult Population of a Developing Country

PubMed Central

Olusanya, Bolutife A.; Ashaye, Adeyinka O.; Owoaje, Eme T.; Baiyeroju, Aderonke M.; Ajayi, Benedictus G.

2016-01-01

Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South-Western Nigeria. Methods: A descriptive cross-sectional survey using a multistage sampling technique was conducted. The main outcome measure was self-reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of =70 years (odds ratio [OR] ≥ 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community-based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa. PMID:26957847

Quality of life and healthcare service utilization among methadone maintenance patients in a mountainous area of Northern Vietnam.

PubMed

Nguyen, Long Hoang; Nguyen, Lan Huong Thi; Boggiano, Victoria L; Hoang, Canh Dinh; Van Nguyen, Hung; Le, Huong Thi; Le, Hai Quan; Tran, Tho Dinh; Tran, Bach Xuan; Latkin, Carl A; Zary, Nabil; Vu, Minh Thuc Thi

2017-04-20

The expansion of methadone maintenance treatment in mountainous areas in still limited and little is known about its health impacts on drug users. This study aimed to examine health-related quality of life (HRQOL) and health care access among patients engaging in methadone maintenance treatment (MMT) in Tuyen Quang, a mountainous province in Vietnam. We conducted a cross-sectional survey with 241 patients conveniently recruited in two MMT clinics (Son Duong and Tuyen Quang). EuroQol-5 Dimensions - 5 levels (EQ-5D-5 L) and Visual analogue scale (VAS) were employed to measure HRQOL. Multivariate logistic and tobit regressions were used to determine the factors associated with HRQOL and health care utilization. The overall mean score of the EQ-5D index and EQ-VAS were 0.88 (SD = 0.20) and 81.8% (SD = 15.27%), respectively. Only 8.7% utilized inpatient services, and 14.9% used outpatient services. Being more highly educated, suffering acute diseases, and using health service within the last 12 months were associated with a decreased EQ-5D index. Individuals who were multiple substance abusers and those who recently had inpatient care were more likely to have a lower VAS. Older respondents, those taking their medications at the more impoverished clinic, substance abusers, and individuals who were struggling with anxiety/depression or their usual daily activities were more likely to use both inpatient and outpatient care. In summary, we observed good HRQOL, but high prevalence of anxiety/depression and low rates of service utilization among MMT patients in Tuyen Quang province. To improve the outcomes of MMT services in mountainous areas, it is necessary to introduce personalized and integrative services models with counseling and interventions on multiple substance use.

Countywide Cooperative Library Service, Lincoln County, Oregon. An Action Plan.

ERIC Educational Resources Information Center

Dalton, Phyllis I.

This comprehensive action plan addresses eight areas important to the development of county-wide cooperative library service: the utilization of total library resources and services, accessibility of library service, organization, financing, special services for special needs, short range action plans, and long-range planning. Additional sections…

45 CFR 2553.23 - What are a sponsor's program responsibilities?

Code of Federal Regulations, 2011 CFR

2011-10-01

... the project service area. (g) Conduct an annual assessment of the accomplishments and impact of the... RSVP resources to have a positive impact on critical human and social needs within the project service area. (b) Assess in collaboration with other community organizations or utilize existing assessments of...

45 CFR 2553.23 - What are a sponsor's program responsibilities?

Code of Federal Regulations, 2010 CFR

2010-10-01

... the project service area. (g) Conduct an annual assessment of the accomplishments and impact of the... RSVP resources to have a positive impact on critical human and social needs within the project service area. (b) Assess in collaboration with other community organizations or utilize existing assessments of...

45 CFR 2553.23 - What are a sponsor's program responsibilities?

Code of Federal Regulations, 2014 CFR

2014-10-01

... the project service area. (g) Conduct an annual assessment of the accomplishments and impact of the... RSVP resources to have a positive impact on critical human and social needs within the project service area. (b) Assess in collaboration with other community organizations or utilize existing assessments of...

45 CFR 2553.23 - What are a sponsor's program responsibilities?

Code of Federal Regulations, 2013 CFR

2013-10-01

... the project service area. (g) Conduct an annual assessment of the accomplishments and impact of the... RSVP resources to have a positive impact on critical human and social needs within the project service area. (b) Assess in collaboration with other community organizations or utilize existing assessments of...

Exploring Geographic Variation of Mental Health Risk and Service Utilization of Doctors and Hospitals in Toronto: A Shared Component Spatial Modeling Approach

PubMed Central

Perlman, Christopher

2018-01-01

Mental Health has been known to vary geographically. Different rates of utilization of mental health services in local areas reflect geographic variation of mental health and complexity of health care. Variations and inequalities in how the health care system addresses risks are two critical issues for addressing population mental health. This study examines these issues by analyzing the utilization of mental health services in Toronto at the neighbourhood level. We adopted a shared component spatial modeling approach that allows simultaneous analysis of two main health service utilizations: doctor visits and hospitalizations related to mental health conditions. Our results reflect a geographic variation of both types of mental health service utilization across neighbourhoods in Toronto. We identified hot and cold spots of mental health risks that are common to both or specific to only one type of health service utilization. Based on the evidence found, we discuss intervention strategies, focusing on the hotspots and provision of health services about doctors and hospitals, to improve mental health for the neighbourhoods. Limitations of the study and further research directions are also discussed. PMID:29587426

Residential segregation, geographic proximity and type of services used: Evidence for racial/ethnic disparities in mental health

PubMed Central

Dinwiddie, Gniesha Y.; Gaskin, Darrell J.; Chan, Kitty S.; Norrington, Janette; McCleary, Rachel

2014-01-01

Residential characteristics influence opportunities, life chances and access to health services in the United States but what role does residential segregation play in differential access and mental health service utilization? We explore this issue using secondary data from the 2006 Medical Expenditure Panel Survey, 2006 American Medical Association Area Research File and the 2000 Census. Our sample included 9737 whites, 3362 African Americans and 5053 Latinos living in Metropolitan Statistical Areas. Using logistic regression techniques, results show respondents high on Latino isolation and Latino centralization resided in psychiatrist shortage areas whereas respondents high on African American concentration had access to psychiatrists in their neighborhoods. Predominant race of neighborhood was associated with the type of mental health professional used where respondents in majority African American neighborhoods were treated by non-psychiatrists and general doctors whereas respondents in majority Latino neighborhoods saw general doctors. Respondents high on Latino Isolation and Latino Centralization were more likely to utilize non-psychiatrists. These findings suggest that living in segregated neighborhoods influence access and utilization of mental health services differently for race/ethnic groups which contradicts findings that suggest living in ethnic enclaves is beneficial to health. PMID:23312305

Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in taiwan.

PubMed

Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An

2012-01-01

To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences model was employed and estimated by the random-effect probit method. The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists. © 2011 National Rural Health Association.

Utilization of the Local Government Health Insurance Scheme (JKA) for Maternal Health Services Among Women Living in Underdeveloped Areas of Aceh Province, Indonesia.

PubMed

Kesuma, Zurnila Marli; Chongsuvivatwong, Virasakdi

2015-04-01

Aceh province of Indonesia created its own health coverage scheme called Jaminan Kesehatan Aceh (JKA) to cover Aceh's populations who were not registered under insurance for the poor (Jamkesmas). This study aims to compare the utilization rate of maternal health care (MHC) services and contraceptive prevalence rate (CPR) before JKA, during the transition period, and after JKA had been established. A cross-sectional household survey was conducted from June 2011 to July 2012. Utilization of MHC services and CPR during the 3 periods was assessed using a questionnaire. The Mantel-Haenszel χ(2) test was used to examine the association between period and coverage. Generalized estimating equations (GEEs) were used to examine utilization and type of service, period of service, and type of scheme. Coverage of utilization of skilled birth attendants significantly improved among the JKA holders (odds ratio = 1.84; 95% confidence interval = 1.18-2.89). JKA, thus, has shown its positive impact. © 2014 APJPH.

Barriers to using skilled birth attendants' services in mid- and far-western Nepal: a cross-sectional study.

PubMed

Choulagai, Bishnu; Onta, Sharad; Subedi, Narayan; Mehata, Suresh; Bhandari, Gajananda P; Poudyal, Amod; Shrestha, Binjwala; Mathai, Matthews; Petzold, Max; Krettek, Alexandra

2013-12-23

Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal. This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women's background characteristics. Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs. Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women's knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal's health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services.

7 CFR 1901.254 - Scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE PROGRAM REGULATIONS... buildings, schools, transportation, traffic, and law enforcement. (5) Loans to develop community irrigation..., development, and operation of farms and ranches. (2) Loans to individual families in rural areas for the...

7 CFR 1901.254 - Scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE PROGRAM REGULATIONS... buildings, schools, transportation, traffic, and law enforcement. (5) Loans to develop community irrigation..., development, and operation of farms and ranches. (2) Loans to individual families in rural areas for the...

Understanding the Psychosocial and Environmental Factors and Barriers Affecting Utilization of Maternal Healthcare Services in Kalomo, Zambia: A Qualitative Study

ERIC Educational Resources Information Center

Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H.; Ruiter, Robert A. C.

2014-01-01

This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age…

Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country.

PubMed

Wajid, Abdul; White, Franklin; Karim, Mehtab S

2013-01-01

As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress.

Community Health Workers and Health Care Delivery: Evaluation of a Women's Reproductive Health Care Project in a Developing Country

PubMed Central

Wajid, Abdul; White, Franklin; Karim, Mehtab S.

2013-01-01

Background As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. Methods A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. Results The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. Conclusions Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress. PMID:24086541

Regional Demonstration of Comprehensive Rehabilitation Services in a Rural, Mountainous, Economically Depressed Area, Eastern Kentucky.

ERIC Educational Resources Information Center

Kentucky State Dept. of Education, Frankfort. Bureau of Rehabilitation Services.

The purpose of this project was to demonstrate that comprehensive rehabilitation services can more effectively meet the needs of severely and chronically disabled persons living in an isolated, mountainous, and depressed area: the Appalachian region. Specific subsidiary purposes were (1) to demonstrate that utilization of various…

The Telepac Project: A Service Delivery Model for the Severely Handicapped in Rural Areas.

ERIC Educational Resources Information Center

Hofmeister, Alan M.; Atkinson, Charles A.

The Utah State University (USU) "Telepac Project" is a service delivery model for homebound handicapped children living in rural areas. Designed to effectively utilize limited numbers of professional personnel, Telepac makes use of: (1) telecommunications technology; (2) parents as a basic treatment resource; and (3) the technology of…

Providing Services for Handicapped Persons in Rural/Sparsely Populated Areas.

ERIC Educational Resources Information Center

Weatherman, Richard

The experiences of the 3-year Minnesota Severely Handicapped Delivery System Project have led to a model which utilizes resources of regional systems as key elements of a differentiated system for educational service delivery to the handicapped in rural areas and involves state education agencies, statewide regional centers, local education units,…

7 CFR 1944.662 - Eligibility of HPG assistance on rental properties or co-ops.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) HOUSING Housing... the HPG grantee. The dwelling must be located in a rural area and be in need of housing preservation...

Analysing the primacy of distance in the utilization of health services in the Ahafo-Ano South district, Ghana.

PubMed

Buor, Daniel

2003-01-01

Although the distance factor has been identified as key in the utilization of health services in rural areas of developing countries, it has been analysed without recourse to related factors of travel time and transport cost. Also, the influence of distance on vulnerable groups in utilization has not been an object of survey by researchers. This paper addresses the impact of distance on utilization, and how distance compares with travel time and transport cost that are related to it in the utilization of health services in the Ahafo-Ano South (rural) district in Ghana. The study, a cross-sectional survey, also identifies the position of distance among other important factors of utilization. A sample of 400, drawn through systematic random technique, was used for the survey. Data were analysed using the regression model and some graphic techniques. The main instruments used in data collection were formal (face-by-face) interview and a questionnaire. The survey finds that distance is the most important factor that influences the utilization of health services in the Ahafo-Ano South district. Other key factors are income, service cost and education. The effect of travel time on utilization reflects that of distance and utilization. Recommendations to reduce distance coverage, improve formal education and reduce poverty have been made.

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.

PubMed

Smith, Matthew Lee; Prohaska, Thomas R; MacLeod, Kara E; Ory, Marcia G; Eisenstein, Amy R; Ragland, David R; Irmiter, Cheryl; Towne, Samuel D; Satariano, William A

2017-02-10

Background : Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods : Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results : Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions : Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA

PubMed Central

Smith, Matthew Lee; Prohaska, Thomas R.; MacLeod, Kara E.; Ory, Marcia G.; Eisenstein, Amy R.; Ragland, David R.; Irmiter, Cheryl; Towne, Samuel D.; Satariano, William A.

2017-01-01

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients. PMID:28208610

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

PubMed

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

1996-01-01

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

Land mobile spectrum utilization: San Francisco, California and Chicago, Illinois

NASA Astrophysics Data System (ADS)

Reed, L. D.

1980-08-01

Radio frequency utilization by Federal Communication Commission licenses in the San Francisco and Chicago urbanized areas is described. The license include among others: police and fire departments; hospitals; public utilities; marine; and common carrier users. The extent of frequency utilization is described in terms of four occupancy categorizations (zero, low, substantial and very high). The rationale for these categories and their relationship to measured usage data is given. Summary tables enable direct comparison of the use by various individual, radio services, e.g., police, business, taxicab, etc. Separate analyses are given for utilization by each of the land mobile radio services and for each frequency band.

The effects of geography on spectrum-orbit utilization

NASA Technical Reports Server (NTRS)

Sawitz, P. H.

1979-01-01

With over forty satellites in geostationary orbit, and many more planned, it is becoming increasingly difficult to find suitable orbit positions for new systems operating at 4 and 6 GHz. Efficient spectrum-orbit utilization can be achieved with frequency-reuse techniques - orthogonal polarization, earth-station antenna discrimination, and satellite antenna discrimination - provided that service-area geography is considered. Service arc - that portion of the orbit which affords useful service to all points in a given area - is a function of the area's climate, terrain, and location as well as its size and shape. Of the three techniques, satellite antenna discrimination is the most sensitive to these factors. According to the BSS (broadcasting-satellite service) antenna reference pattern, the maximum discrimination possible is the on-axis gain, which can be as high as 49 dB for a beamwidth of 0.6 degrees, or as low as 32 dB for a 3.5-degree beamwidth. Unlike the Fixed-Satellite Service (FSS), the BSS will normally have beams that cover no more than one or two time zones.

Predictors of safe delivery service utilization in arsi zone, South-East ethiopia.

PubMed

Abera, Mulumebet; Gebremariam, Abebe; Belachew, Tefera

2011-08-01

Evidence show that lack of access to and use of, essential obstetric care services to be a crucial factor that contributes to the high maternal morbidity and mortality. Skilled attendance during labor, delivery and early post-partum period could reduce deaths due to obstructed labor, hemorrhage, sepsis and eclampsia. There is limited information on the mothers' use of skilled delivery services in the study area. This study assessed the predictors of safe delivery service utilization in Arsi Zone, Southeast Ethiopia. A cross- sectional community based study using quantitative and qualitative methods was conducted from February 15(th) to March 15(th) 2006. A total of 1089 women who had at least one birth one year prior to the study were involved in the study from nine rural and four urban kebeles in three Woredas (Districts) selected using a systematic sampling method from all households in the study area. A pre-tested structured interviewer administered questionnaire was used to collect data. Information on the utilization of safe delivery service and socio-demographic, individual and institutional factors and past obstetric history were collected. Focus Group Discussion guide was used for qualitative data collection. The data were edited, cleaned, and entered into a computer and analyzed using SPSS for windows version 12.0. One thousand seventy four women who had at least one birth were interviewed making a response rate 98.6%. Two hundred seventy one (75.0%) of urban and 373(52.0%) rural women received antenatal care from skilled health professional at least once during their last pregnancy. Thirty-one (4.3%) of rural and 145 (40.4%) of urban women delivered in health institution. In multivariate analysis showed that residential area OR= 8.5, 95%CI; (5.1,13.9), parity OR=0.18, 95%CI; (0.08, 0.42), and ANC service use OR= 4.5, 95%CI; (2.2,8.9), and maternal education OR=4.6, 95%CI; (1.7,12.8), were most significant predictors of safe delivery service use by mothers (P< 0.01). Birth attended by skilled personnel was low in the study area. Maternal education, her birth experience and her use of prenatal services are important predictors. Promoting information, education and communication on safe delivery service utilization, expansion of health service and empowerment of women are needed.

7 CFR 4290.120 - Plan to invest in Rural Areas.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Applicant must agree that if licensed as a RBIC, it will make Developmental Venture Capital investments in... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT COMPANY (âRBICâ...

Characteristics Associated with Home- and Community-Based Service Utilization for Medicare Managed Care Consumers

ERIC Educational Resources Information Center

Alkema, Gretchen E.; Reyes, Judy Y.; Wilber, Kathleen H.

2006-01-01

Purpose: We identified the types of home-and community-based services (HCBS) that high-risk older adults in Medicare managed care used, and we examined participant characteristics associated with service use in six areas: overall service use, four specific categories of HCBS, and referrals to insured medical services. Design and Methods: We used…

Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis.

PubMed

Jacobs, Choolwe; Moshabela, Mosa; Maswenyeho, Sitali; Lambo, Nildah; Michelo, Charles

2017-01-01

Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother's ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non-skilled health-care providers.

42 CFR 59.206 - Evaluation and grant award.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR FAMILY... and health services personnel; (iii) Improvement in the utilization and career development of..., particularly in rural areas, through new or improved approaches to program planning and deployment of resources...

The impact of different benefit packages of Medical Financial Assistance Scheme on health service utilization of poor population in rural China.

PubMed

Hao, Yanhua; Wu, Qunhong; Zhang, Zhenzhong; Gao, Lijun; Ning, Ning; Jiao, Mingli; Zakus, David

2010-06-17

Since 2003 and 2005, National Pilot Medical Financial Assistance Scheme (MFA) has been implemented in rural and urban areas of China to improve the poorest families' accessibility to health services. Local governments of the pilot areas formulated various benefit packages. Comparative evaluation research on the effect of different benefit packages is urgently needed to provide evidence for improving policy-making of MFA. This study was based on a MFA pilot project, which was one component of Health VIII Project conducted in rural China. This article aimed to compare difference in health services utilization of poor families between two benefit package project areas: H8 towns (package covering inpatient service, some designated preventive and curative health services but without out-patient service reimbursement in Health VIII Project,) and H8SP towns (package extending coverage of target population, covering out- patient services and reducing co-payment rate in Health VIII Supportive Project), and to find out major influencing factors on their services utilization. A cross-sectional survey was conducted in 2004, which used stratified cluster sampling method to select poor families who have been enrolled in MFA scheme in rural areas of ChongQing. All family members of the enrolled households were interviewed. 748 and 1129 respondents from two kinds of project towns participated in the survey. Among them, 625 and 869 respondents were included (age>/=15) in the analysis of this study. Two-level linear multilevel model and binomial regressions with a log link were used to assess influencing factors on different response variables measuring service utilization. In general, there was no statistical significance in physician visits and hospitalizations among all the respondents between the two kinds of benefit package towns. After adjusting for major confounding factors, poor families in H8SP towns had much higher frequency of MFA use (beta = 1.17) and less use of hospitalization service (OR = 0.7 (H8SP/H8), 95%CI (0.5, 1.0)) among all the respondents. While calculating use of hospital services among those who needed, there was significant difference (p = 0.032) in percentage of hospitalization use between H8SP towns (46%) and H8 towns (33%). Meanwhile, the non-use but ought-to-use hospitalization ratio of H8SP (54%) was lower than that of H8 (67 %) towns. This indicated that hospitalization utilizations had improved in H8SP towns among those who needed. Awareness of MFA detailed benefit package and presence of physician diagnosed chronic disease had significant association with frequency of MFA use and hospitalizations. There was no significant difference in rate of borrowing money for illness treatment between the two project areas. Large amount of medical debt had strong association with hospitalization utilization. The new extended benefit package implemented in pilot towns significantly increased the poor families' accessibility to MFA package in H8SP than that of H8 towns, which reduced poor families' demand of hospitalization services for their chronic diseases, and improved the poor population's utilization of out-patient services to some degree. It can encourage poor people to use more outpatient services thus reduce their hospitalization need. Presence of chronic disease and hospitalization had strong association with the presence of large amount of medical debt, which indicated that: although establishment of MFA had facilitated accessibility of poor families to this new system, and improved service utilization of poor families to some degree, but its role in reducing poor families' medical debt resulted from chronic disease and hospitalization was still very limited. Besides, the following requirements of MFA: co-payment for in-patient services, ceiling and deductibles for reimbursement, limitations on eligibility for diseases reimbursement, also served as most important obstacles for poor families' access to health care. Therefore, there is great need to improve MFA benefit package design in the future, including extending to cover out-patient services, raising ceiling for reimbursement, removing deductibles of MFA, reducing co-payment rate, and integrating MFA with New Rural Cooperative Medical Scheme more closely so as to provide more protection to the poor families.

GSA’s Guidance and Oversight Concerning Areawide Utility Contracts

DTIC Science & Technology

2001-12-17

providers enter into areawide contracts to cover the service needs of federal agencies within the utility’s franchise territory. The franchise territory...is a geographical area that a utility has a right to serve on the basis of a franchise or other legal means. Areawide contracts provide a

Sex education and family planning services for young adults: alternative urban strategies in Mexico.

PubMed

Townsend, J W; Diaz de May, E; Sepúlveda, Y; Santos de Garza, Y; Rosenhouse, S

1987-01-01

In Mexico, youth face difficulties in obtaining reliable information on sex education and family planning through existing community programs. Two alternative strategies to provide these services are being tested in poor urban areas of Monterrey. In one experimental area, Integrated Youth Centers were established, which provide sex education and family planning services as well as counseling, academic tutoring, and recreational activities. In another area, trained young adults and community counselors work through informal networks to provide sex education and family planning information. Both utilization and the cost of these services are examined in the context of plans for expanding coverage in Mexico-U.S. border areas.

A Look at How Agencies Can Utilize Outcome and Performance Data To Enhance Service Delivery.

ERIC Educational Resources Information Center

Resources for Welfare Decisions, 2002

2002-01-01

This issue focuses on a variety of performance measurement and outcome data resources as they relate to evaluating service delivery performance in areas that include employment (welfare-to-work and performance bonuses for work participation) and child welfare, as well as some general Temporary Assistance to Needy Families program areas. It also…

The gravitational force of mental health services: distance decay effects in a rural Swiss service area.

PubMed

Stulz, Niklaus; Pichler, Eva-Maria; Kawohl, Wolfram; Hepp, Urs

2018-02-05

Previous research suggested a distance decay effect in health services systems, with people living closer to service facilities being more likely to use them. In this ecological cross sectional study, we conducted spatial and statistical analyses in a Swiss mental health services system being legally bound to provide primary mental health care to approximately 620,000 inhabitants. We examined a cohort of all patients who were over 18 years old and who were treated in the mental health services system between January and December 2011. There were 5574 treatment cases during the 12-month period, 2161 inpatient cases and 3413 outpatient cases. Travel time by public transportation between patients' residence and the closest mental health service facility negatively predicted the utilization of outpatient services for all mental disorders, even after controlling for variability in ecological (e.g. socioeconomic) characteristics of the communities in the service provision area. For utilization of inpatient wards no geographical distance decay effect was observed, except for organic mental disorders. Based on these findings, outpatient clinics should be most effectively located decentralized and in the largest communities to meet the needs of the population as close as possible to where people live and to avoid remote areas being insufficiently supplied with mental health care. For mental hospitals and inpatient services decentralized location seems to be less important.

Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey.

PubMed

Gebrehiwot, Genet; Medhanyie, Araya Abrha; Gidey, Gebreamlak; Abrha, Kidan

2018-05-30

Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia. A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance. The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91-21.86) and (3.35, 95% CI: 1.10-10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06-9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55-27.75) than women who lacked knowledge about the services. Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.

[Determinants of dental services utilization by adults: a population-based study in Florianópolis, Santa Catarina State, Brazil].

PubMed

Miranda, Camila Dal-Bó Coradini; Peres, Marco Aurélio

2013-11-01

This study aimed to estimate the prevalence of dental services utilization by adults and to identify associated socioeconomic, demographic, behavioral, and self-awareness factors. A cross-sectional population-based study was conducted with adults living in the urban area of Florianópolis, Santa Catarina State, Brazil, in 2009. Associations were tested between use of dental services and predisposing, enabling, and needs-based variables. Multivariate analysis was conducted using Poisson regression with estimates of prevalence ratios and was stratified by place of last dental appointment. Prevalence of dental services utilization was 66% (95%CI: 62.9-70.7). Dental visits were 20% more frequent among women and 72% more frequent among individuals with more schooling (the latter in both public and private dental services). Individuals with private dental plans used dental services 13% more than those without. Schooling was the most important variable in predicting utilization. The study's results show the importance of monitoring associated factors in order to promote more equitable use of dental services.

1992 census of transportation, communications, and utilities : geographic area series summary

DOT National Transportation Integrated Search

1995-03-01

The 1992 Census of Transportation, Communications, and Utilities for the first time collected data for the communications, electric, gas, and sanitary service industries. In addition, the 1992 census expanded coverage of transportation industries to ...

Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

PubMed Central

2011-01-01

Background After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services? Methods A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics. Results Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector. Conclusions There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC services are indeed free, with little evidence of informal payments to providers. PMID:22176866

Management of busbar costs and spending tradeoffs for the transition to competitive markets in electricity

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

Corio, M.R.; Boyd, G.

Competition is changing the fundamental basis for doing business in the electricity generation market. As the market moves toward competitive market conditions, electricity will be viewed increasingly as a commodity--not only supplied to customers within a utility`s service area, but brokered and marketed outside its area as well. With movement toward retail wheeling being considered in California, Michigan, and New York, it may soon become a reality as well. This means that a utility can no longer feel secure as the monopoly supplier of electricity within its own franchise area. To remain the main supplier in its current service areamore » and compete for customers in other service areas, utilities will need to understand and examine all the components of ``busbar costs`` at its generating units. As competition drives the market to marginal costs, generating units with costs exceeding the market clearing price for electricity may soon have a limited role in the generation market. As the industry evolves, competition in the marketplace will force uneconomic plants to reduce costs or go out of business. This paper discusses results of studies addressing the evaluation of cost effectiveness, benchmarking of cost-efficiency, and development of marginal cost curves for busbar costs based on the development and aggregation of the three key measures which determine the cost and level of output (generation): (1) reliability; (2) heat rate; and (3) planned outage factor.« less

A cross-sectional study about associations between personality characteristics and mental health service utilization in a Korean national community sample of adults with psychiatric disorders.

PubMed

Park, Subin; Lee, Yeeun; Seong, Su Jeong; Chang, Sung Man; Lee, Jun Young; Hahm, Bong Jin; Hong, Jin Pyo

2017-05-05

Personality traits are not only associated with psychiatric symptoms, but also with treatment seeking behavior. Our purpose was to examine the relationship between mental health service utilization and personality characteristics in a nationwide community sample of Korean adults. Of the 6022 subjects aged 18-74 years who participated in the Korean Epidemiologic Catchment Area study, 1544 (25.6%) with a lifetime diagnosis of any DSM-IV psychiatric disorder were analyzed. Diagnostic assessments were based on the Composite International Diagnostic Interview and personality constructs were measured by Big Five Personality Inventory-10. Of the 1544 participants, 275 (17.8%) had used mental health services. Multivariate analyses revealed positive associations between mental health service utilization and both neuroticism and openness, and an inverse association between mental health service utilization and agreeableness. These findings suggest that specific personality traits may have a role in treatment-seeking behaviors for mental health problems independent of the psychiatric disorder.

Predictors of Healthcare Service Utilization for Mental Health Reasons

PubMed Central

Fleury, Marie-Josée; Ngamini Ngui, André; Bamvita, Jean-Marie; Grenier, Guy; Caron, Jean

2014-01-01

This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care. PMID:25321874

Variables contributing to an excellent customer service management profile within the regulated electric utility industry: A comparison of self-concept with customer satisfaction for customer service management

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

Johnson, L.E.

1991-01-01

This research sought to address the relationship between self-concept and customer satisfaction: can customer satisfaction with a major electric utility be explained in terms of the self-reported, self-concept of the utility's managers The population to which the results of this study were generalized consisted of customer service managers in public electric utilities across the United States. In order to represent this population, a sample was selected consisting of customer service managers at a midwestern electric utility based in a large metropolitan area. Participants in this study were managers of four direct customer contact service organizations within six geographic division organizations.more » The methodology included comparisons of these four customer contact service organizations on twelve independent, self-concept variables and six customer satisfaction dependent variables using Analysis of Variance (ANOVA), Scheffe' tests, Chi-Square, and Stepwise multiple regression. The groups were found not to be significantly different and knowledge of the self-concept scores for managers will not increase the ability to predict customer satisfaction over no knowledge of self-concept scores.« less

An equity analysis of health examination service utilization by women from underdeveloped areas in western China

PubMed Central

Gao, Jianmin; Zhou, Zhongliang; Yan, Ju’e; Xu, Yongjian; Yang, Xiaowei; Li, Yanli

2017-01-01

Objective This study sought to examine the sources of inequity in health examination service utilization by women from underdeveloped areas in western China. Methods Based on data from the 5th National Health Service Survey in Shaanxi province, women’s utilization of health examination services was examined according to gynecological, cervical smear, and breast examination rates. The equity of health examination service utilization by 15- to 64-year-old women and the factors contributing to inequity were determined using the health concentration index, decomposition of the concentration index, and the horizontal inequity index. Results The examination rates for gynecological, cervical smear, and breast exams for 15- to 64-year-old women in Shaanxi province were 40.61%, 27.08%, and 24.59%, respectively. The horizontal inequity indices of gynecological, cervical smear, and breast examination rates were 0.0480, 0.0423, and 0.0764, respectively, and each examination rate was higher for wealthy individuals. The contribution rates of economic status to the inequalities in gynecological, cervical smear, and breast examination rates were 65.80%, 74.31%, and 56.49%, respectively. The contribution rates of educational status to the inequalities in gynecological, cervical smear, and breast examination rates were 21.01%, 14.83% and 30.00%, respectively. The contribution rates of age to the inequalities in gynecological, cervical smear, and breast examination rates were 25.77%, 26.55%, and 18.40%, respectively. Conclusions Women’s health examination rates differed between populations with different socio-demographic characteristics. There is pro-wealth inequality in each examination rate. This study found that financial status, age, and education level were the main reasons for the unequal utilization of health examination services. PMID:29065129

Temporal and Spatial Patterns in Utilization of Mental Health Services During and After Hurricane Sandy: Emergency Department and Inpatient Hospitalizations in New York City.

PubMed

He, Fangtao Tony; Lundy De La Cruz, Nneka; Olson, Donald; Lim, Sungwoo; Levanon Seligson, Amber; Hall, Gerod; Jessup, Jillian; Gwynn, Charon

2016-06-01

Hurricane Sandy made landfall on October 29, 2012, causing a coastal storm surge and extensive flooding, which led to the closure of several health care facilities in New York City (NYC) and prolonged interruptions in service delivery. The impact on mental health-related emergency department (ED) and inpatient hospital service utilization was studied. Data came from the New York Statewide Planning and Research Cooperative System. We obtained mental health-related data among NYC residents from 2010 to 2013. Patients were grouped into 5 geographic areas, including service areas of closed hospitals, the Hurricane Sandy evaluation zone, and all of NYC. The Farrington method was used to detect increases in ED visits and hospitalizations for the post-Sandy period. Open hospitals experienced a substantial increase in psychiatric ED visits from patients living in the service areas of closed hospitals. This surge in psychiatric ED visits persisted for 4 to 6 months after Hurricane Sandy. However, the increase in psychiatric hospitalizations was observed for 1 to 3 months. Several NYC hospitals received a substantially larger number of ED patients from service areas of closed hospitals after Hurricane Sandy, unlike other hospitals that experienced a decrease. Because of potential surges in the number of psychiatric ED visits, resource allocation to hospitals should be considered. (Disaster Med Public Health Preparedness. 2016;10:512-517).

Barriers to using skilled birth attendants’ services in mid- and far-western Nepal: a cross-sectional study

PubMed Central

2013-01-01

Background Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal. Methods This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women’s background characteristics. Results Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs. Conclusions Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women’s knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal’s health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services. PMID:24365039

[Effects of artificial reef construction to marine ecosystem services value: a case of Yang-Meikeng artificial reef region in Shenzhen].

PubMed

Qin, Chuan-xin; Chem, Pi-mao; Jia, Xiao-ping

2011-08-01

Based on the researches and statistic data of Yangmeikeng artificial reef region in Shenzhen in 2008 and by the method of ecosystem services value, this paper analyzed the effects of artificial reef construction in the region on the marine ecosystem services. After the artificial reef construction, the tourism service value in the region decreased from 87% to 42%, food supply service value increased from 7% to 27%, and the services value of raw material supply, climatic regulation, air quality regulation, water quality regulation, harmful organism and disease regulation, and knowledge expansion had a slight increase, as compared to the surrounding coastal areas. The total services value per unit area of Yangmeikeng artificial reef region in 2008 was 1714.7 x 10(4) yuan x km(-2), far higher than the mean services value of coastal marine ecosystem in the surrounding areas of Shenzhen and in the world. Artificial reef construction affected and altered the structure of regional marine ecosystem services value, and improved the regional ecosystem services value, being of significance for the rational exploitation and utilization of marine resources and the successful recovery of damaged marine eco-environment and fish resources. Utilizing the method of ecosystem services value to evaluate artificial reef construction region could better elucidate the benefits of artificial reef construction, effectively promote the development of our artificial reef construction, and improve the management of marine ecosystem.

Stakeholder Analysis in Utilizing of Environmental Services and Natural Attractions in Tuk Semuncar Utilization Zone of Gunung Merbabu National Park: A literature review

NASA Astrophysics Data System (ADS)

Setiawan, Muhammad Arif; Muhammad, Fuad

2018-02-01

Many stakeholders in the utilizing of environmental services and natural attraction of Tuk Semuncar Utilization Zone needs to get the attention of the Gunung Merbabu National Park Officer. The existence of natural resources has an important role for the life of the community, making the complexity of the relationship between various parties who have interests in natural resource management. The existence of stakeholders and their interests should receive attention and be considered to be accommodated as an effort to prevent the occurrence of losses to the conservation area of Gunung Merbabu National Park. Every stakeholder's interest can have a positive and negative impact on other stakeholders. Stakeholder analysis can help in understanding the conflict on the utilizing of environmental services and natural attraction that is happening, as well as input strategy in involving stakeholders for the achievement of goals.

Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?

PubMed

Pulok, Mohammad Habibullah; Sabah, Md Nasim-Us; Uddin, Jalal; Enemark, Ulrika

2016-07-29

Universal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011. The data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services. The concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004-2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women's and their husbands' education were significantly associated with greater use of maternal health care services. In addition, women's exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services. Bangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.

Using Geographic Information Systems (GIS) to understand a community's primary care needs.

PubMed

Dulin, Michael F; Ludden, Thomas M; Tapp, Hazel; Blackwell, Joshua; de Hernandez, Brisa Urquieta; Smith, Heather A; Furuseth, Owen J

2010-01-01

A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

7 CFR 4284.513 - Evaluation criteria and weights.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 4284.513 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Rural Cooperative... Rural areas. (c) Economic development. The Agency will evaluate the applicant's demonstrated ability to...

7 CFR 4284.513 - Evaluation criteria and weights.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 4284.513 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Rural Cooperative... Rural areas. (c) Economic development. The Agency will evaluate the applicant's demonstrated ability to...

7 CFR 4284.513 - Evaluation criteria and weights.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 4284.513 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Rural Cooperative... Rural areas. (c) Economic development. The Agency will evaluate the applicant's demonstrated ability to...

7 CFR 4284.513 - Evaluation criteria and weights.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 4284.513 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE GRANTS Rural Cooperative... Rural areas. (c) Economic development. The Agency will evaluate the applicant's demonstrated ability to...

7 CFR 1751.101 - General.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE TELECOMMUNICATIONS SYSTEM PLANNING AND DESIGN CRITERIA, AND PROCEDURES State Telecommunications Modernization Plan... Plan must, at a minimum, apply to RUS Borrowers' wireline service areas. If a Modernization Plan is...

Effect of reducing cost sharing for outpatient care on children's inpatient services in Japan.

PubMed

Kato, Hirotaka; Goto, Rei

2017-08-15

Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013. A total of 366,566 inpatients from 1390 municipalities were identified. The impact of expanding outpatient care subsidy on the volume of inpatient care for 1390 Japanese municipalities was investigated using the generalized linear model with fixed effects. A decrease in cost sharing for outpatient care has no significant effect on overall hospital admissions, although this effect varies by region. The subsidy reduces the number of overall admissions in low-income areas, but increases it in high-income areas. In addition, the results for admissions by type show that admissions for diagnosis increase particularly in high-income areas, but emergency admissions and ambulatory-care-sensitive-condition admissions decrease in low-income areas. These results suggest that outpatient and inpatient services are substitutes in low-income areas but complements in high-income ones. Although the subsidy for children's healthcare would increase medical costs, it would not improve the health status in high-income areas. Nevertheless, it could lead to some health improvements in low-income areas and, to some extent, offset costs by reducing admissions in these regions.

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.

PubMed

Whitehead, J; Shaver, John; Stephenson, Rob

2016-01-01

Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

PubMed Central

Whitehead, J.; Shaver, John; Stephenson, Rob

2016-01-01

Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405

Market-based demand forecasting promotes informed strategic financial planning.

PubMed

Beech, A J

2001-11-01

Market-based demand forecasting is a method of estimating future demand for a healthcare organization's services by using a broad range of data that describe the nature of demand within the organization's service area. Such data include the primary and secondary service areas, the service-area populations by various demographic groupings, discharge utilization rates, market size, and market share by service line and organizationwide. Based on observable market dynamics, strategic planners can make a variety of explicit assumptions about future trends regarding these data to develop scenarios describing potential future demand. Financial planners then can evaluate each scenario to determine its potential effect on selected financial and operational measures, such as operating margin, days cash on hand, and debt-service coverage, and develop a strategic financial plan that covers a range of contingencies.

Utilization of a state run public private emergency transportation service exclusively for childbirth: the Janani (maternal) Express program in Madhya Pradesh, India.

PubMed

Sidney, Kristi; Ryan, Kayleigh; Diwan, Vishal; De Costa, Ayesha

2014-01-01

In 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service. A cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details. 35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay. The JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.

77 FR 35245 - Substantially Underserved Trust Areas (SUTA)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-13

... projects with the greatest need, financial analysis and underwriting will continue to be used to determine... Utilities Service (RUS) is issuing regulations related to loans and grants to finance the construction... INFORMATION CONTACT: Michele Brooks, Director, Program Development and Regulatory Analysis, Rural Utilities...

Comparison of Health Service Utilization for Febrile Children Before and After Introduction of Malaria Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Rural Papua New Guinea.

PubMed

Tsukahara, Takahiro; Sugahara, Takuma; Furusawa, Takuro; Hombhanje, Francis Wanak

2018-01-01

In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction. Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services. Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval -0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female. The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers' preferences toward girls.

[Use of health services by a population of 60-year olds and older in Mexico].

PubMed

Borges-Yáñez, S A; Gómez-Dantés, H

1998-01-01

To describe the sociodemographic characteristics and determinants of health services utilization by the Mexican population of 60 years of age or more. Information obtained from the National Health Survey II (ENSA-II) allowed analysis of 4,628 elderly people. Prevalence of chronic diseases was analyzed and the determinants of individuals who had used the health services in the two weeks prior to the interview. The chronic diseases most frequently reported were: hypertension, diabetes and heart disease. The utilization and hospitalization rates of that age group were 11.4 and 5.5%, respectively. The services most frequently used were: the private physician, social security (IMSS, ISSSTE) welfare services (Ministry of Health--SSA- and IMSS-Solidaridad). Interestingly, 25 to 45% of social security insurance holders did not use the services, instead they consulted a private physician. The most important explanatory variables for health services utilization were: the perceived illness, not having worked for the previous week and being a social security insurance holder. Gender, area of residence and level of education were not significant in the explanation of health services utilization. This study demonstrates the need to strengthen preventive and support programs for the elderly population, since they only demand health services when they feel sick.

Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh.

PubMed

Ahmed, Shakil; Khan, M Mahmud

2011-05-01

Demand-side financing (DSF) is used in the less-developed countries of the world to improve access to healthcare and to encourage market supply. Under DSF, households receive vouchers that can be used to pay for healthcare services. This study evaluated the effects of a universal DSF on maternal healthcare service utilization in Bangladesh. A household survey was conducted in and around the voucher scheme area one year after the initiation of the project. Women who gave birth within a year prior to the survey were interviewed. The utilization rates of maternal health services were found to be higher for all socioeconomic groups in the project area than in the comparison areas. Voucher recipients in the project area were 3.6 times more likely to be assisted by skilled health personnel during delivery, 2.5 times more likely to deliver the baby in a health facility, 2.8 times more likely to receive postnatal care (PNC), 2.0 times more likely to get antenatal care (ANC) services and 1.5 times more likely to seek treatment for obstetric complications than pregnant women not in the program. The degree of socioeconomic inequality in maternal health service utilization was also lower in the project area than in the comparison area. The use of vouchers evidenced much stronger demand-increasing effects on the poor. Poor voucher recipients were 4.3 times more likely to deliver in a health facility and two times more likely to use skilled health personnel at delivery than the non-poor recipients. Contrary to the inverse equity hypothesis, the voucher scheme reduced inequality even in the short run. Despite these improvements, socioeconomic disparity in the use of maternal health services has remained pro-rich, implying that demand-side financing alone will be insufficient to achieve the Millennium Development Goal for maternal health. A comprehensive system-wide approach, including supply-side strengthening, will be needed to adequately address maternal health concerns in poor developing countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

7 CFR 4290.370 - Evaluation criteria.

Code of Federal Regulations, 2010 CFR

2010-01-01

... serving Smaller Enterprises and Small Business Concerns located in the Rural Areas in which it intends to... Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT COMPANY (âRBICâ) PROGRAM...

Service use and financial performance in a replication program on adult day centers.

PubMed

Reifler, B V; Cox, N J; Jones, B N; Rushing, J; Yates, K

1999-01-01

The authors describe results from Partners in Caregiving: The Dementia Services Program, and present information on service utilization and financial performance among a group of 48 adult day centers across the United States from 1992 to 1996. Centers, with nonrandom assignment, received either grant support (average value: $93,000) or intensive technical assistance (average value: $39,000). Sites reported baseline data and submitted utilization information (enrollment and census) and financial data (revenue and expenses) quarterly. Overall, there were significant increases in enrollment, census, and financial performance (percent of cash expenses met through operating revenue) over the 4-year period. The grant-supported and technical-assistance sites had similar rates of improvement. Results provide data on service utilization and financial performance and demonstrate gains that can be achieved in these areas through improved marketing and financial management.

Age Cohort and Health Service Utilization Among Gay Men.

PubMed

Green, Daniel C; Goldbach, Jeremy T; Raymond, Henry F

2018-05-01

Gay men report unique health disparities and service utilization trends compared to their heterosexual peers including a lack of health-care participation which may lead to chronic health conditions. Limited research has been conducted analyzing group differences among gay men such as the influence of one's age cohort on disparities. The aim of this study was to examine the association age cohort has on health service utilization among gay men. A sample of 383 self-identified gay men was collected by the San Francisco Department of Public Health. Older men were less likely to have visited a medical provider in the past 12 months compared to middle-aged men (OR = 0.10; 95% CI [2.47, 39.8]) and younger men (OR = 0.35; 95% CI [1.28, 10.42]). However, older men were more likely to have a usual source of medical care compared to younger men (OR = 4.0; 95% CI [.05, .84]). Age cohort differences in health-care service utilization appear to exist among gay men. This study highlights additional areas for exploration including the impact HIV and socioeconomic status have on health-seeking behavior and health service utilization.

7 CFR 1710.103 - Area coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 11 2013-01-01 2013-01-01 false Area coverage. 1710.103 Section 1710.103 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... Basic Policies § 1710.103 Area coverage. (a) Borrowers shall make a diligent effort to extend electric...

Does NASA SMAP Improve the Accuracy of Power Outage Models?

NASA Astrophysics Data System (ADS)

Quiring, S. M.; McRoberts, D. B.; Toy, B.; Alvarado, B.

2016-12-01

Electric power utilities make critical decisions in the days prior to hurricane landfall that are primarily based on the estimated impact to their service area. For example, utilities must determine how many repair crews to request from other utilities, the amount of material and equipment they will need to make repairs, and where in their geographically expansive service area to station crews and materials. Accurate forecasts of the impact of an approaching hurricane within their service area are critical for utilities in balancing the costs and benefits of different levels of resources. The Hurricane Outage Prediction Model (HOPM) are a family of statistical models that utilize predictions of tropical cyclone windspeed and duration of strong winds, along with power system and environmental variables (e.g., soil moisture, long-term precipitation), to forecast the number and location of power outages. This project assesses whether using NASA SMAP soil moisture improves the accuracy of power outage forecasts as compared to using model-derived soil moisture from NLDAS-2. A sensitivity analysis is employed since there have been very few tropical cyclones making landfall in the United States since SMAP was launched. The HOPM is used to predict power outages for 13 historical tropical cyclones and the model is run using twice, once with NLDAS soil moisture and once with SMAP soil moisture. Our results demonstrate that using SMAP soil moisture can have a significant impact on power outage predictions. SMAP has the potential to enhance the accuracy of power outage forecasts. Improved outage forecasts reduce the duration of power outages which reduces economic losses and accelerates recovery.

7 CFR 1001.40 - Classes of utilization.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 9 2010-01-01 2009-01-01 true Classes of utilization. 1001.40 Section 1001.40 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE NORTHEAST MARKETING AREA Order Regulating...

Proceedings of the International Workshop on the Foundations of Service-Oriented Architecture (FSOA 2007)

DTIC Science & Technology

2008-06-01

agenda are summarized. x | CMU/SEI-2008-SR-011 SOFTWARE ENGINEERING INSTITUTE | 1 1 Introduction Service -oriented architecture (SOA... service -provision software systems. In this po- sition paper, we investigate an initial classification of challenge areas related to service orientation...decade we have witnessed a significant growth of software applications that are de- livered in the form of services utilizing a network infrastructure

7 CFR 1739.18 - Grant documents.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... feasibility and sustainability. The Agency may also prescribe terms and conditions applicable to the construction and operation of the Project and the delivery of Broadband Transmission Service to Rural Areas, as...

7 CFR 1739.18 - Grant documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... feasibility and sustainability. The Agency may also prescribe terms and conditions applicable to the construction and operation of the Project and the delivery of Broadband Transmission Service to Rural Areas, as...

7 CFR 1739.18 - Grant documents.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... feasibility and sustainability. The Agency may also prescribe terms and conditions applicable to the construction and operation of the Project and the delivery of Broadband Transmission Service to Rural Areas, as...

7 CFR 1739.18 - Grant documents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... feasibility and sustainability. The Agency may also prescribe terms and conditions applicable to the construction and operation of the Project and the delivery of Broadband Transmission Service to Rural Areas, as...

Measuring the Sensitivity and Construct Validity of 6 Utility Instruments in 7 Disease Areas.

PubMed

Richardson, Jeff; Iezzi, Angelo; Khan, Munir A; Chen, Gang; Maxwell, Aimee

2016-02-01

Health services that affect quality of life (QoL) are increasingly evaluated using cost utility analyses (CUA). These commonly employ one of a small number of multiattribute utility instruments (MAUI) to assess the effects of the health service on utility. However, the MAUI differ significantly, and the choice of instrument may alter the outcome of an evaluation. The present article has 2 objectives: 1) to compare the results of 3 measures of the sensitivity of 6 MAUI and the results of 6 tests of construct validity in 7 disease areas and 2) to rank the MAUI by each of the test results in each disease area and by an overall composite index constructed from the tests. Patients and the general public were administered a battery of instruments, which included the 6 MAUI, disease-specific QoL instruments (DSI), and 6 other comparator instruments. In each disease area, instrument sensitivity was measured 3 ways: by the unadjusted mean difference in utility between public and patient groups, by the value of the effect size, and by the correlation between MAUI and DSI scores. Content and convergent validity were tested by comparison of MAUI utilities and scores from the 6 comparator instruments. These included 2 measures of health state preferences, measures of subjective well-being and capabilities, and generic measures of physical and mental QoL derived from the SF-36. The apparent sensitivity of instruments varied significantly with the measurement method and by disease area. Validation test results varied with the comparator instruments. Notwithstanding this variability, the 15D, AQoL-8D, and the SF-6D generally achieved better test results than the QWB and EQ-5D-5L. © The Author(s) 2015.

Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study.

PubMed

Yamashita, Tadashi; Reyes Tuliao, Maria Teresa; Concel Meana, Magdalena; Suplido, Sherri Ann; Llave, Cecilia L; Tanaka, Yuko; Matsuo, Hiroya

2017-01-01

A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility ( P <0.01). There was significant difference in the utilization of antenatal checkup ( P <0.01) during pregnancy, whilst there was no significant difference in utilization of healthcare services during the postpartum period. Women who delivered at home were more likely to experience feeling of irritated eyes and headaches, and continuous abdominal pain ( P <0.05). Financial and environmental barriers might hinder the utilization of healthcare services by women who deliver at home in the Philippines. Low utilization of healthcare services in women who deliver at home might result in more frequent abnormal symptoms during postpartum.

Will available bit rate (ABR) services give us the capability to offer virtual LANs over wide-area ATM networks?

NASA Astrophysics Data System (ADS)

Ferrandiz, Ana; Scallan, Gavin

1995-10-01

The available bit rate (ABR) service allows connections to exceed their negotiated data rates during the life of the connections when excess capacity is available in the network. These connections are subject to flow control from the network in the event of network congestion. The ability to dynamically adjust the data rate of the connection can provide improved utilization of the network and be a valuable service to end users. ABR type service is therefore appropriate for the transmission of bursty LAN traffic over a wide area network in a manner that is more efficient and cost effective than allocating bandwdith at the peak cell rate. This paper describes the ABR service and discusses if it is realistic to operate a LAN like service over a wide area using ABR.

Working with sports organizations and teams.

PubMed

McDuff, David R; Garvin, Michelle

2016-12-01

Athletes and coaches at all competitive levels will utilize sports performance and psychiatric services at very high rates if the services are offered on-site and free of charge and are broad in scope and culturally sensitive. Services should be available throughout the team year and cover areas such as team building, mental preparation, stress control, substance prevention, sleep and energy regulation, injury recovery, crisis intervention, and mental disorder treatment. The staff offering these services should be diverse by gender, profession, and culture, and the fees should be paid by the organization. When these services are endorsed by the team's leaders and integrated with the athletic training/medical/player development staff, their utilization will grow quickly and lead to positive outcomes individually and collectively.

Evaluating the appropriate level of service for Michigan rest areas and welcome centers considering safety and economic factors.

DOT National Transportation Integrated Search

2012-04-30

Research was performed to determine the value of public rest areas in Michigan, including welcome : centers. A benefit/cost (B/C) economic analysis procedure was utilized to assess rest areas both : individually and as a system. The benefits associat...

An Examination of the Concept of Social Integration as Related to Preventive Medical Care in Poverty Families in Rural and Urban Areas.

ERIC Educational Resources Information Center

Slesinger, Doris P.

Based on an in-depth study of 125 mothers of young infants in both urban and rural areas of Wisconsin, this study analyzed the utilization of preventive medical services for the infant. The hypothesis that "mothers who are more socially integrated will be more likely to use preventive medical services than those who are less integrated,…

Perceptions of Pre-Service Teachers and Education Professors on the Abilities of Pre-Service Teachers to Effectively Instruct Students with Disabilities in an Inclusionary Environment

ERIC Educational Resources Information Center

Rogers, Wendy Lynn

2014-01-01

Utilizing intrinsic case study, the researcher compared the perceptions of dual certification pre-service teachers and education professors regarding the knowledge and ability of pre-service teachers to instruct students with disabilities in an inclusionary environment. The specific areas of inquiry were established in accordance with the…

Effect of public-private partnership in treatment of sexually transmitted infections among female sex workers in Andhra Pradesh, India.

PubMed

Kokku, Suresh Babu; Mahapatra, Bidhubhusan; Tucker, Saroj; Saggurti, Niranjan; Prabhakar, Parimi

2014-02-01

Providing sexually transmitted infection (STI) services to female sex workers (FSWs) in rural and resource constrained settings is a challenge. This paper describes an approach to address this challenge through a partnership with government health facilities, and examines the effect of this partnership on the utilization of STI services by FSWs in Andhra Pradesh, India. Partnerships were formed with 46 government clinics located in rural areas for providing STI treatment to FSWs in 2007. Government health facilities were supported by local and State level non-government organizations (NGOs) through provision of medicines, training of medical staff, outreach in the communities, and other coordination activities. Data from programme monitoring and behaviour tracking survey were used to examine the accessibility and acceptability in utilization of STI services from partnership clinics. The number of FSWs accessing services at the partnership clinics increased from 1627 in 2007 to over 15,000 in 2010. The average number of annual visits by FSWs to these clinics in 2010 was 3.4. In opinion surveys, the majority of FSWs accessing services at the partnership clinics expressed confidence that they would continue to receive effective services from the government facilities even if the programme terminates. The overall attitude of FSWs to visit government clinics was more positive among FSWs from partnership clinic areas compared to those from non-partnership clinic areas. The partnership mechanism between the NGO-supported HIV prevention programme and government clinic facilities appeared to be a promising opportunity to provide timely and accessible STI services for FSWs living in rural and remote areas.

Reproductive health service utilization and associated factors among adolescents (15–19 years old) in Gondar town, Northwest Ethiopia

PubMed Central

2013-01-01

Background The utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. It plays a vital role in safeguarding youth in Sub-Saharan African countries including Ethiopia, which accounts for a high proportion of the region’s new HIV infections as well as maternal and infant mortality ratios. Due to this, assessing adolescent reproductive health service utilization and associated factors has its own contribution in achieving the national Millennium Development Goals (MDG), especially goals 4 to 6. Methods A community based cross-sectional study was conducted from April 5–19, 2012, in 4 randomly selected administrative areas of Gondar town. A total of 1290 adolescents aged 15–19 were interviewed using a pre-tested and structured questionnaire. Data were entered in to the EPI INFO version 3.5.3 statistical software and analyzed using an adapted SPSS version 20 software package. Logistic regression was done to identify possible factors associated with family planning (FP), and voluntary counseling and testing (VCT) service utilization. Results Out of the total participants, 79.5% and 72.2% utilized FP and VCT services, respectively. In addition, among sexually experienced adolescents, 68.1% and 88.4% utilized contraceptive methods and VCT service during their first sexual encounter, respectively. Educational status, discussion with family/relatives, peer groups, sexual partners and teachers were significantly associated with FP service utilization. Also, adolescents who had a romantic sexual relationship, and those whose last sexual relationship was long-term, were about 6.5 times (Adjusted Odds Ratio [AOR] = 6.5, 95% CI: 1.23, 34.59), and about 3 times (AOR = 3, 95% CI: 1.02, 8.24) more likely to utilize FP services than adolescents who had no romantic relationship or long-term sexual relationship, respectively. In addition, the variables significantly associated with VCT service utilization were: participants who had secondary education and above, schooling attendance, co- residence with both parents, parental communication, discussion of services with peer groups, health workers, and perception of a risk of HIV/AIDS. Conclusions The majority of the adolescents were utilizing FP and VCT service in Northwest Ethiopia. But among the sexually experienced adolescents, utilization of FP at first sexual intercourse and VCT service were found to be low. Educational status, schooling attendance, discussion of services, type of sexual relationship and perception of risk were important factors affecting the utilization of FP and VCT services. Building life skill, facilitating parent to child communication, establishing and strengthening of youth centers and school reproductive health clubs are important steps to improve adolescents’ reproductive health (RH) service utilization. PMID:23915299

Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria

PubMed Central

Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

2015-01-01

ABSTRACT Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model. Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Conclusion: Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. PMID:25745123

How do migratory species add ecosystem service value to wilderness? Calculating the spatial subsidies provided by protected areas

USGS Publications Warehouse

Lopez-Hoffman, Laura; Semmens, Darius J.; Diffendorfer, Jay

2013-01-01

Species that migrate through protected and wilderness areas and utilize their resources, deliver ecosystem services to people in faraway locations. The mismatch between the areas that most support a species and those areas where the species provides most benefits to society can lead to underestimation of the true value of protected areas such as wilderness. We present a method to communicate the “off-site” value of wilderness and protected areas in providing habitat to migratory species that, in turn, provide benefits to people in distant locations. Using northern pintail ducks (Anas acuta) as an example, the article provides a method to estimate the amount of subsidy – the value of the ecosystem services provided by a migratory species in one area versus the cost to support the species and its habitat elsewhere.

32 CFR 199.15 - Quality and utilization review peer review organization program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Director, OCHAMPUS. These contractors may include contractors that have exclusive functions in the area of utilization and quality review, fiscal intermediary contractors (which perform these functions along with a... functions concerning management of the delivery and financing of health care services under CHAMPUS...

The effects of the Balanced Budget Act of 1997 on home health and hospice in older adult cancer patients.

PubMed

Kilgore, Meredith L; Grabowski, David C; Morrisey, Michael A; Ritchie, Christine S; Yun, Huifeng; Locher, Julie L

2009-03-01

Home health and hospice services can constitute important elements in the continuum of care for older adults diagnosed with cancer. The Balanced Budget Act (BBA) of 1997 included provisions affecting those services. The first objective of this study is to assess the effect of the BBA of 1997 on home health and hospice service utilization in older cancer patients. The second objective is to estimate the effect of the BBA of 1997 on costs associated specifically with home health and hospice services and on total costs of care. The final objective is to evaluate the effect of the BBA of 1997 on mortality in these patients. Longitudinal analysis using the Surveillance, Epidemiology, and End Results-Medicare Database, covering a service area that includes 26% of the US population. Community-dwelling Medicare beneficiaries 65 years of age and older. Utilization rates of home health and hospice services; costs associated with those services, and total costs of care; and mortality. Home health utilization rates dropped substantially and hospice utilization rates increased after the BBA. Medicare costs for home health services declined as did total Medicare costs but hospice costs increased. There was no discernable effect on mortality rates. The BBA was successful in containing the costs of home health services and resulted in savings in overall costs of care for older cancer patients. Reduction in utilization of home health services did not seem to negatively affect outcomes. The BBA may have contributed to the trend of increasing use of hospice care.

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study.

PubMed

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P; Krettek, Alexandra

2014-01-01

Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

Carrier account utilization at the Goddard Space Flight Center

NASA Technical Reports Server (NTRS)

Mathis, W. E.; Langmead, J. T.

1972-01-01

The system in use at Goddard Space Flight Center for the utilization of the Common Use Service Carrier Account and the R&D Inventory Carrier Account technique for budgeting, accounting, financial control, and management reporting, both for the individual functional area and on a Center-wide basis, is documented.

Distance from health facility and mothers' perception of quality related to skilled delivery service utilization in northern Ethiopia.

PubMed

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-01-01

Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.

Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

PubMed Central

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-01-01

Background Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. Subjects and methods A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). Results A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Conclusion Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem. PMID:29042819

Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature.

PubMed

Nelson, Kristin N; Wallace, Aaron S; Sodha, Samir V; Daniels, Danni; Dietz, Vance

2016-11-04

Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature

PubMed Central

Nelson, Kristin N.; Wallace, Aaron S.; Sodha, Samir V.; Daniels, Danni; Dietz, Vance

2016-01-01

Introduction Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. Methods We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. Results Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. Conclusion Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap. PMID:27692772

Dairy and functional foods research in the Agricultural Research Service

USDA-ARS?s Scientific Manuscript database

The Dairy and Functional Foods Research Unit is the only group in the Agricultural Research Service that is dedicated to solving critical problems in milk utilization and fruit and vegetable byproducts from specialty crops. The many areas of investigation include development of specialty cheese, c...

Local inpatient units may increase patients' utilization of outpatient services: a comparative cohort-study in Nordland County, Norway.

PubMed

Myklebust, Lars Henrik; Sørgaard, Knut; Wynn, Rolf

2015-01-01

In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care. Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays. The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients' use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays. Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care.

Local inpatient units may increase patients’ utilization of outpatient services: a comparative cohort-study in Nordland County, Norway

PubMed Central

Myklebust, Lars Henrik; Sørgaard, Knut; Wynn, Rolf

2015-01-01

Objectives In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care. Methods Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays. Results The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients’ use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays. Conclusion Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care. PMID:26604843

Managed care and the diffusion of endoscopy in fee-for-service Medicare.

PubMed

Mobley, Lee Rivers; Subramanian, Sujha; Koschinsky, Julia; Frech, H E; Trantham, Laurel Clayton; Anselin, Luc

2011-12-01

To determine whether Medicare managed care penetration impacted the diffusion of endoscopy services (sigmoidoscopy, colonoscopy) among the fee-for-service (FFS) Medicare population during 2001-2006. We model utilization rates for colonoscopy or sigmoidoscopy as impacted by both market supply and demand factors. We use spatial regression to perform ecological analysis of county-area utilization rates over two time intervals (2001-2003, 2004-2006) following Medicare benefits expansion in 2001 to cover colonoscopy for persons of average risk. We examine each technology in separate cross-sectional regressions estimated over early and later periods to assess differential effects on diffusion over time. We discuss selection factors in managed care markets and how failure to control perfectly for market selection might impact our managed care spillover estimates. Areas with worse socioeconomic conditions have lower utilization rates, especially for colonoscopy. Holding constant statistically the socioeconomic factors, we find that managed care spillover effects onto FFS Medicare utilization rates are negative for colonoscopy and positive for sigmoidoscopy. The spatial lag estimates are conservative and interpreted as a lower bound on true effects. Our findings suggest that managed care presence fostered persistence of the older technology during a time when it was rapidly being replaced by the newer technology. © Health Research and Educational Trust.

Inequities in utilization of reproductive and maternal health services in Ethiopia.

PubMed

Bobo, Firew Tekle; Yesuf, Elias Ali; Woldie, Mirkuzie

2017-06-19

Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.

Utilization of Antenatal HealthCare Services among Fishermen Population in Kanchipuram District, Tamil Nadu: A Cross-sectional Study.

PubMed

Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy

2017-01-01

Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.

Determinants of Maternity Care Services Utilization among Married Adolescents in Rural India

PubMed Central

Singh, Prashant Kumar; Rai, Rajesh Kumar; Alagarajan, Manoj; Singh, Lucky

2012-01-01

Background Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed. Methodology/Principal Findings Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions. Conclusions The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization. PMID:22355386

Determinants of postnatal care non-utilization among women in Nigeria.

PubMed

Somefun, Oluwaseyi Dolapo; Ibisomi, Latifat

2016-01-11

Although, there are several programs in place in Nigeria to ensure maternal and child health, maternal and neonatal mortality rates remain high with maternal mortality rates being 576/100,000 and neonatal mortality rates at 37/1000 live births (NDHS, 2013). While there are many studies on the utilization of maternal health services such as antenatal care and skilled delivery at birth, studies on postnatal care are limited. Therefore, the aim of this study is to examine the factors associated with the non-utilization of postnatal care among mothers in Nigeria using the Nigeria Demographic and Health Survey (NDHS) 2013. For analysis, the postnatal care uptake for 19,418 children born in the 5 years preceding the survey was considered. The dependent variable was a composite variable derived from a list of questions on postnatal care. A multinomial logistic regression model was applied to examine the adjusted and unadjusted determinants of non-utilization of postnatal care. Results from this study showed that 63% of the mothers of the 19,418 children did not utilize postnatal care services in the period examined. About 42% of the study population between 25 and 34 years did not utilize postnatal care and 61% of the women who did not utilize postnatal care had no education. Results from multinomial logistic regression show that antenatal care use, distance, education, place of delivery, region and wealth status are significantly associated with the non-utilization of postnatal care services. This study revealed the low uptake of postnatal care service in Nigeria. To increase mothers' utilization of postnatal care services and improve maternal and child health in Nigeria, interventions should be targeted at women in remote areas who don't have access to services and developing mobile clinics. In addition, it is crucial that steps should be taken on educating women. This would have a significant influence on their perceptions about the use of postnatal care services in Nigeria.

Skilled delivery care service utilization in Ethiopia: analysis of rural-urban differentials based on national demographic and health survey (DHS) data.

PubMed

Fekadu, Melaku; Regassa, Nigatu

2014-12-01

Despite the slight progress made on Antenatal Care (ANC) utilization, skilled delivery care service utilization in Ethiopia is still far-below any acceptable standards. Only 10% of women receive assistance from skilled birth attendants either at home or at health institutions, and as a result the country is recording a high maternal mortality ratio (MMR) of 676 per 100,000 live births (EDHS, 2011). Hence, this study aimed at identifying the rural-urban differentials in the predictors of skilled delivery care service utilization in Ethiopia. The study used the recent Ethiopian Demographic and Health Survey (EDHS 2011) data. Women who had at least one birth in the five years preceding the survey were included in this study. The data were analyzed using univariate (percentage), bivariate (chi-square) and multivariate (Bayesian logistic regression). The results showed that of the total 6,641 women, only 15.6% received skilled delivery care services either at home or at health institution. Rural women were at greater disadvantage to receive the service. Only 4.5% women in rural areas received assistance from skilled birth attendants (SBAs) compared to 64.1 % of their urban counter parts. Through Bayesian logistic regression analysis, place of residence, ANC utilization, women's education, age and birth order were identified as key predictors of service utilization. The findings highlight the need for coordinated effort from government and stakeholders to improve women's education, as well as strengthen community participation. Furthermore, the study recommended the need to scale up the quality of ANC and family planning services backed by improved and equitable access, availability and quality of skilled delivery care services.

Using volunteered geographic information to visualize community values and ecosystem services for habitat restoration and neighborhood revitalization

EPA Science Inventory

Volunteered geographic information (VGI), specifically geotagged photographs available from social media platforms, is a promising technology that can be utilized to identify public values for ecosystem goods and services in a defined geographic area. VGI can help researchers ind...

7 CFR 1744.202 - Borrowers may make qualified investments without prior approval of the Administrator.

Code of Federal Regulations, 2012 CFR

2012-01-01

... training and employment services, health care services, educational opportunities, energy utilization and... local government management capabilities, institutions, and programs related to rural development and... resources of rural areas. (e) As used in paragraph (d) of this section, the term rural development...

7 CFR 1744.202 - Borrowers may make qualified investments without prior approval of the Administrator.

Code of Federal Regulations, 2011 CFR

2011-01-01

... training and employment services, health care services, educational opportunities, energy utilization and... local government management capabilities, institutions, and programs related to rural development and... resources of rural areas. (e) As used in paragraph (d) of this section, the term rural development...

7 CFR 1744.202 - Borrowers may make qualified investments without prior approval of the Administrator.

Code of Federal Regulations, 2010 CFR

2010-01-01

... training and employment services, health care services, educational opportunities, energy utilization and... local government management capabilities, institutions, and programs related to rural development and... resources of rural areas. (e) As used in paragraph (d) of this section, the term rural development...

7 CFR 1744.202 - Borrowers may make qualified investments without prior approval of the Administrator.

Code of Federal Regulations, 2013 CFR

2013-01-01

... training and employment services, health care services, educational opportunities, energy utilization and... local government management capabilities, institutions, and programs related to rural development and... resources of rural areas. (e) As used in paragraph (d) of this section, the term rural development...

7 CFR 1744.202 - Borrowers may make qualified investments without prior approval of the Administrator.

Code of Federal Regulations, 2014 CFR

2014-01-01

... training and employment services, health care services, educational opportunities, energy utilization and... local government management capabilities, institutions, and programs related to rural development and... resources of rural areas. (e) As used in paragraph (d) of this section, the term rural development...

Health Needs of Urban Blacks.

ERIC Educational Resources Information Center

Blackwell, James E.; And Others

Interviews were conducted with 237 adult blacks in the Boston area to determine their most urgent needs and the most urgent needs of blacks in general, to characterize the information flow from health services agencies, and to characterize access to and utilization of health services. The respondents ranked better economic conditions, family and…

Using Baltimore HIV behavioral surveillance data for local HIV prevention planning.

PubMed

German, Danielle; Linton, Sabriya; Cassidy-Stewart, Hope; Flynn, Colin

2014-04-01

In response to the National HIV/AIDS Strategy (NHAS) and as part of CDC's Enhanced Comprehensive HIV Prevention Plan (ECHPP) project, Maryland developed a comprehensive local HIV prevention plan for the Baltimore-Towson Metropolitan Statistical Area and identified a series of priority HIV prevention and service goals. The current project sought to: (1) determine how well National HIV Behavioral Surveillance (NHBS) indicators were aligned with NHAS/ECHPP-informed local HIV prevention goals (2) facilitate on-going NHBS data utilization to inform on-going local HIV prevention and service planning, and (3) build a foundation for future NHBS data utilization in local HIV decision-making. Project activities identified key HIV-related indicators in NHBS that are directly or indirectly related to local HIV priorities as informed by NHAS/ECHPP, which can be used for HIV prevention planning in the Baltimore area. Areas for enhancing NHBS and local data collection to further inform HIV prevention priorities are highlighted.

78 FR 46177 - Third-Party Provision of Ancillary Services; Accounting and Financial Reporting for New Electric...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-30

...The Federal Energy Regulatory Commission (Commission) is revising its regulations to foster competition and transparency in ancillary services markets. The Commission is revising certain aspects of its current market-based rate regulations, ancillary services requirements under the pro forma open-access transmission tariff (OATT), and accounting and reporting requirements. Specifically, the Commission is revising its regulations to reflect reforms to its Avista policy governing the sale of ancillary services at market-based rates to public utility transmission providers. The Commission is also requiring each public utility transmission provider to add to its OATT Schedule 3 a statement that it will take into account the speed and accuracy of regulation resources in its determination of reserve requirements for Regulation and Frequency Response service, including as it reviews whether a self-supplying customer has made ``alternative comparable arrangements'' as required by the Schedule. The final rule also requires each public utility transmission provider to post certain Area Control Error data as described in the final rule. Finally, the Commission is revising the accounting and reporting requirements under its Uniform System of Accounts for public utilities and licensees and its forms, statements, and reports, contained in FERC Form No. 1, Annual Report of Major Electric Utilities, Licensees and Others, FERC Form No. 1-F, Annual Report for Nonmajor Public Utilities and Licensees, and FERC Form No. 3-Q, Quarterly Financial Report of Electric Utilities, Licensees, and Natural Gas Companies, to better account for and report transactions associated with the use of energy storage devices in public utility operations.

Dental Service Utilization: Patterns and Barriers among Rural Elderly in Guntur District, Andhra Pradesh

PubMed Central

Koka, Krishna Mohan; Pachava, Srinivas; Sanikommu, Suresh; Ravoori, Srinivas; Chandu, Viswa Chaitanya

2016-01-01

Introduction The biological process of ageing is outside human control and has its own dynamics. It is a known fact that elderly people have more treatment needs compared to the younger population and at the same time elderly people are facing a multitude of barriers in utilization of health care as well as oral health care. Aim To identify the utilization patterns of oral health care and barriers for utilization among rural population. Materials and Methods A cross-sectional study was done on 621 rural elderly subjects to identify the utilization of oral health care services and the barriers for utilization. Using stratified cluster sampling study area was stratified into 13 rural clusters, fifty houses were randomly selected from each stratum. All the elderly subjects, as defined by the age criteria were considered for study. The data were analysed using SPSS 20 v and Chi-square tests were used to analyse the data. Results Only 31.9% of participants reported visiting a dentist in the past while 36.7% reported experiencing a dental problem at some point in their life. There were no significant differences in utilization of dental services based on gender, socio-economic status, age groups and religion. However, significant differences were found in utilization of dental services based on the response of participants to past experience of dental problems. Conclusion The present study results conclude that fear was one of the most commonly reported barriers for utilisation of dental services and there is a need for oral health education and promotion among elderly population. PMID:27135000

Effect of public-private partnership in treatment of sexually transmitted infections among female sex workers in Andhra Pradesh, India

PubMed Central

Kokku, Suresh Babu; Mahapatra, Bidhubhusan; Tucker, Saroj; Saggurti, Niranjan; Prabhakar, Parimi

2014-01-01

Background & objectives: Providing sexually transmitted infection (STI) services to female sex workers (FSWs) in rural and resource constrained settings is a challenge. This paper describes an approach to address this challenge through a partnership with government health facilities, and examines the effect of this partnership on the utilization of STI services by FSWs in Andhra Pradesh, India. Methods: Partnerships were formed with 46 government clinics located in rural areas for providing STI treatment to FSWs in 2007. Government health facilities were supported by local and State level non-government organizations (NGOs) through provision of medicines, training of medical staff, outreach in the communities, and other coordination activities. Data from programme monitoring and behaviour tracking survey were used to examine the accessibility and acceptability in utilization of STI services from partnership clinics. Results: The number of FSWs accessing services at the partnership clinics increased from 1627 in 2007 to over 15,000 in 2010. The average number of annual visits by FSWs to these clinics in 2010 was 3.4. In opinion surveys, the majority of FSWs accessing services at the partnership clinics expressed confidence that they would continue to receive effective services from the government facilities even if the programme terminates. The overall attitude of FSWs to visit government clinics was more positive among FSWs from partnership clinic areas compared to those from non-partnership clinic areas. Interpretation & conclusions: The partnership mechanism between the NGO-supported HIV prevention programme and government clinic facilities appeared to be a promising opportunity to provide timely and accessible STI services for FSWs living in rural and remote areas. PMID:24718405

24 CFR 55.27 - Documentation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... FLOODPLAIN MANAGEMENT Procedures for Making Determinations on Floodplain Management § 55.27 Documentation. (a... outside the floodplain, but within the local housing market area, the local public utility service area..., documentation of compliance with this part must be included as a part of the record of decision (or...

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

PubMed Central

Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P.; Krettek, Alexandra

2014-01-01

Background Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps. PMID:25119066

Utilities` ``obligation to serve`` under deregulation

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

Alexander, C.B.

The utility no longer has protected status, and the traditional franchise concept is under attack. Exclusive rights once conveyed to the utilities are being denied and not just in the area of gas sales. Exclusive rights once conveyed to utilities will be denied in more areas. State by state, the utilities` franchise is being examined to see which, if any, of its provisions are necessary in a deregulated environment. Can the free market provide everything that`s been provided for many years under monopolistic arrangements? Some of the most critical and difficult of these provisions concern the obligation to serve, whichmore » utilities, in most states, have assumed as part of their franchise agreement. Regulators, courts, utilities, marketers and others are busy sorting through these issues, but resolution could take years. The paper discusses deregulation, universal service fee, representation without taxation, suppliers and marketer restrictions.« less

[The prevalence of asthma and the utilization of medical services among those insured by a health-services company in Puerto Rico, 1996-1997].

PubMed

Pérez-Perdomo, R; Súarez-Pérez, E; Torres, D; Morell, C

1999-01-01

To describe the prevalence and pattern of utilization of medical services in insured of SSS with a diagnosis of asthma during 1996 and 1997. The medical claims of SSS insured whose main diagnosis was asthma (ICD-9 9 493-493.9) were selected for analysis. The prevalence and medical service utilization (medical visits, emergency and hospital admissions) were estimated. Differences in health service utilization by age group were analyzed by the Poisson model. The asthma prevalence was 14.5%, being larger in patients younger than 18 years of age and in females. 54.3% of the asthmatic patients visited medical offices and the larger proportion of users was observed in the younger group (< 18 years). However, the larger proportion of users of the emergency room was observed in the 18-44 age group, while the hospital admissions was larger in the 45-64 age group. More than half (56%) of the cost per service was attributed to hospital admissions while 31% was for pharmacy services. 65.9% of the insurers with asthma had prescriptions for short relief beta-antagonist. The prevalence of asthma in this study was high and similar to rates of the disease reported in Puerto Ricans residing in the U. S. and in other areas of the island. Similarly, the prevalence differed by age in the utilization of medical services as well as the high cost of hospital admissions. Prevalence studies using other sources as well as a standard definition of the condition may be helpful to confirm these results.

Assessing the role of federal community assistance programs to develop biomass utilization capacity in the Western United States

Treesearch

Dennis R. Becker; Mark Nechodom; Adam Barnett; Tad Mason; Eini C. Lowell; John Shelly; Dean Graham

2008-01-01

As forest biomass utilization becomes cost effective to harvest, more areas at risk of catastrophic wildfire can be thinned of dense brush and small-diameter trees. In an effort to increase biomass utilization, the USDA Forest Service granted more than $36 million in National Fire Plan-Economic Action Program funds in the Western United States during fiscal years 2001...

Land utilization and ecological aspects in the Sylhet-Mymensingh Haor Region of Bangladesh: An analysis of LANDSAT data

NASA Technical Reports Server (NTRS)

Chowdhury, M. I.; Elahi, K. M.

1977-01-01

The use of remote sensing data from LANDSAT (ERTS) imageries in identifying, evaluating and mapping land use patterns of the Haor area in Bangladesh was investigated. Selected cloud free imageries of the area for the period 1972-75 were studied. Imageries in bands 4, 5 and 7 were mostly used. The method of analysis involved utilization of both human and computer services of information from ground, aerial photographs taken during this period and space imageries.

Pedestrian Levels of Service (LOS) at Muir Woods National Monument (California): An introduction to multi-modal LOS for parks and protected areas

Treesearch

Peter R. Pettengill; Robert E. Manning; William Valliere; Laura E. Anderson

2010-01-01

Historically, transportation planning and management have been guided largely by principles of efficiency. Specifically, the Transportation Research Board has utilized a levels of service (LOS) framework to assess quality of service in terms of traffic congestion, speed and travel time, and maximum road capacity. In the field of park and outdoor recreation management,...

Service Networks and Patterns of Utilization: Mental Health Programs, Indian Health Service (IHS). Volume 1: Overview and Recommendations.

ERIC Educational Resources Information Center

Attneave, Carolyn L.; Beiser, Morton

Constituting an overview of a 10-volume report on the historical development and contemporary activities (1966-1973) of each of the 8 administrative Area Offices of the Indian Health Service (IHS) Mental Health Programs, this volume includes: the methods used for data collection (personal interviews with both past and present IHS key officials,…

The Politics of Pipes: The Persistence of Small Water Networks in Post-Privatization Manila

NASA Astrophysics Data System (ADS)

Cheng, Deborah

This project examines the politics of water provision in low-income areas of large, developing cities. In the last two decades, water privatization has become a global paradigm, emerging as a potential means for addressing the urban water crisis. In Manila, the site of the world's largest water privatization project, service to low-income areas has improved significantly in the post-privatization era. But whereas expansion of a water utility typically involves the replacement of informal providers, the experience in Manila demonstrates that the rapid connection of low-income areas actually hinges, in part, on the selective inclusion and exclusion of these smaller actors. Based on an ethnography of the private utilities and community-based providers, I use the persistence of small water networks as a lens for exploring the limits of water privatization in Manila. I focus on what I call micro-networks---community-built infrastructure that extends the formal, private utilities into low-income neighborhoods that the utilities do not wish to serve directly. In such a setup, the utility provides water only as far as the community boundary; beyond that, the micro-network operator constructs internal infrastructure, monitors for leakage and theft, and collects bills. But while these communities may gain access to safer water, they are also subject to higher costs and heightened disciplinary measures. By tracing the ways in which the utilities selectively use micro-networks to manage sub-populations, I show how the utilities make low-income spaces more governable. Delegating localized water management to micro-network operators depoliticizes the utilities' roles, shifting the sociopolitical difficulties of water provision to community organizations, while allowing the utilities to claim that these areas are served. This research leads to three related arguments. First, the persistence of small water networks highlights lingering inequities in access to water, for micro-network consumers are subject to disparities in cost, materials, and personal freedoms. Though Manila's water privatization project has resulted in significant improvements to the centralized system, its success must be tempered by the inequalities that remain. Second, the two utilities are largely able to shape both the geographies of water access and the production of knowledge. For this reason, the utilities typically use micro-networks where cost recovery may be difficult---such as in areas with uncertain land tenure or where higher levels of nonpayment are perceived---while including these areas in their aggregate coverage statistics. Third, the presence of multiple providers of water and other basic services blurs the boundaries between public, private, and community. But that blurriness serves to consolidate the private utilities' power, while increasing the opacity by which citizens navigate processes related to urban water provision. The persistence of micro-networks thus allows us to understand the ways in which low-income spaces are made more governable. By focusing on this peri-urban frontier, this project asserts that differentiation and discipline serve simultaneously as tools of governance and as points of contestation. What emerges is a waterscape consisting not of one type of privatization---where service and access are uniformly provided---but multiple, coexisting, and differentiated privatizations.

Is Neighborhood Access to Health Care Provision Associated with Individual-Level Utilization and Satisfaction?

PubMed Central

Hiscock, Rosemary; Pearce, Jamie; Blakely, Tony; Witten, Karen

2008-01-01

Objective To explore whether travel time access to the nearest general practitioner (GP) surgery (which is equivalent to U.S. primary care physician [PCP] office) and pharmacy predicts individual-level health service utilization and satisfaction. Data Sources GP and pharmacy addresses were obtained from the New Zealand Ministry of Health in 2003 and merged with a geographic boundaries data set. Travel times derived from these data were appended to the 2002/03 New Zealand Health Survey (N = 12,529). Study Design Multilevel logistic regression was used to model the relationship between travel time access and five health service outcomes: GP consultation, blood pressure test, cholesterol test, visit to pharmacy, and satisfaction with latest GP consultation. Data Collection/Extraction Travel times between each census meshblock centroid and the nearest GP and pharmacy were calculated using Geographical Information System. Principal Findings When travel times were long, blood pressure tests were less likely in urban areas (odds ratio [OR] 0.75 [0.59–0.97]), GP consultations were less likely in rural centers (OR 0.42 [0.22–0.78]) and pharmacy visits were less likely in highly rural areas (OR 0.36 [0.13–0.99]). There was some evidence of lower utilization in rural areas. Conclusions Locational access to GP surgeries and pharmacies appears to sometimes be associated with health service use but not satisfaction. PMID:18671752

7 CFR 3570.61 - Eligibility for grant assistance

Code of Federal Regulations, 2010 CFR

2010-01-01

... grant assistance The essential community facility must primarily serve rural areas, be located in a.... Essential community facilities must be: (1) Located in rural areas, except for utility-type services, such.... (d) Economic feasibility. All projects financed under the provisions of this section must be based on...

43 CFR 27.6 - Equal opportunity implementation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ACTIVITIES CONDUCTED UNDER PERMITS, RIGHTS-OF-WAY, PUBLIC LAND ORDERS, AND OTHER FEDERAL AUTHORIZATIONS... in offering services, opportunities, or benefits to minority groups and women, and all areas of employment in which it could be deficient in the utilization of minority groups and women and all areas of...

43 CFR 27.6 - Equal opportunity implementation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ACTIVITIES CONDUCTED UNDER PERMITS, RIGHTS-OF-WAY, PUBLIC LAND ORDERS, AND OTHER FEDERAL AUTHORIZATIONS... in offering services, opportunities, or benefits to minority groups and women, and all areas of employment in which it could be deficient in the utilization of minority groups and women and all areas of...

43 CFR 27.6 - Equal opportunity implementation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ACTIVITIES CONDUCTED UNDER PERMITS, RIGHTS-OF-WAY, PUBLIC LAND ORDERS, AND OTHER FEDERAL AUTHORIZATIONS... in offering services, opportunities, or benefits to minority groups and women, and all areas of employment in which it could be deficient in the utilization of minority groups and women and all areas of...

Bacterial Composition in a Metropolitan Drinking Water Distribution System Utilizing Different Source Waters

EPA Science Inventory

The microbial community structure was investigated from bulk phase water samples of multiple collection sites from two service areas within the Cincinnati drinking water distribution system (DWDS). Each area is associated with a different primary source of water (i.e., groundwat...

Study of the Information Dissemination Service--Health Sciences Library, State University of New York at Buffalo.

PubMed Central

Brown, H J; Miller, J K; Pinchoff, D M

1975-01-01

The Information Dissemination Service at the Health Sciences Library, State University of New York at Buffalo, was established June 1970 through a three-year grant from the Lakes Area Regional Medical Program, Inc. Analysis of two samples of user request forms yielded results which significantly substantiate findings in prior biomedical literature utilization studies. The findings demonstrate comparable utilization patterns by user group, age of material, journal titles, language, time to process request, source of reference, and size of institution. PMID:1148441

Inequity in awareness and utilization of adolescent reproductive and sexual health services in union territory, Chandigarh, North India.

PubMed

Gupta, Madhu; Bhatnagar, Nidhi; Bahugana, Pankaj

2015-01-01

Adolescents are a heterogeneous, vulnerable, and sexually active group. Geographical and educational health disparities exist among urban, rural, and slum adolescents and among out-of-school and school-going adolescents, respectively. Adolescent reproductive and sexual health (ARSH) services should be implemented in a manner to minimize health inequities among them. To ascertain the extent of awareness and utilization of ARSH services provided under reproductive and child health(RCH) program among adolescents in Chandigarh. A cross-sectional study was conducted among 854 adolescents (402 household, 200 out-of-school, and 252 school-going adolescents) in Chandigarh using pretested validated interview schedule on awareness and utilization of adolescent reproductive and sexual health services from February to April 2011 in North Indian Union Territory of Chandigarh. Ordinal regression analysis was done to study the association of socio-demographic variables with awareness and utilization of ARSH. Results: Awareness about contraception and health services was significantly less among rural (12.7% and 1.1%, respectively) adolescents as compared to slum (17.9% and 4.6%, respectively) and urban adolescents (33.5% and 7.8%, respectively) (P < 0.05). Out-of-school adolescents were utilizing the preventive [odds ratio (OR) 0.39, P < 0.001] and curative services significantly lesser (OR = 0.54, P < 0.001) and had higher substance abuse (OR = 4.26, P= 0.006). Awareness was significantly associated with older age of adolescents (OR = 4.4,P < 0.001), poor education of father (OR = 0.5, P = 0.002), rural area (OR = 0.56, P = 0.001), and out-of-school status (OR = 0.35, P < 0.001). Awareness and utilization of ARSH services was inequitable and was more among urban and school-going adolescents. Educational status was the most important factor affecting it.

Franchise fees reexamined

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

Osteryoung, J.S.

The author examines franchise fees imposed by local governments and allocated by electric utilities to see if the fees are more equitably applied by the spread or direct method. Examples are drawn from Florida to illustrate how, under the spread method, customers living outside the franchise area contribute 60 percent of the allocated fees but have no control over how they are calculated or spent by the utility. Some cities use excess franchise fees to lower municipal taxes or to provide extra municipal services not available to those in the nonfranchise area. Also at issue is the value of themore » small amount of land used for utility right-of-way, which is of no value to the nonfranchise area customer. The author concludes that franchise fees imposed for the purpose of raising municipal revenues should be directly applied to only those customers living within the franchise area. Direct application of fees, by drawing the customer's attention to the total cost of utilities, could help to restrain future costs. (DCK)« less

An Assessment of Causes of PEV Success Across U.S. Metro Areas

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

Zhou, Y.; Santini, D.; Rood, M.

Using 2014 U.S. light duty PEV registrations by make and model, this paper assesses the causes of Plug-in Electric Vehicle (PEV) success across U.S. states focusing on areas that had incentive and utility programs supporting PEV adoption. Market segments investigated were (1) luxury/performance (>$60,000 list price), (2) mid-market ($40-50,000), (3) mass market (<$40.000), and (4) total. States with either exclusive or preferential BEV incentives are a focus. BEV-biased incentives proved to be very effective in promoting mass market BEVs. After controlling for these attributes, case studies for several utility service areas were conducted to gauge whether PEVs were more ormore » less successfully implemented via outreach by those utilities. These investigations suggest ways that utilities can successfully increase PEV registrations, after taking local climate and state incentives into consideration.« less

43 CFR 27.6 - Equal opportunity implementation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... in offering services, opportunities, or benefits to minority groups and women, and all areas of employment in which it could be deficient in the utilization of minority groups and women and all areas of... and thus to increase materially the participation of minorities and women in all aspects of its...

43 CFR 27.6 - Equal opportunity implementation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... in offering services, opportunities, or benefits to minority groups and women, and all areas of employment in which it could be deficient in the utilization of minority groups and women and all areas of... and thus to increase materially the participation of minorities and women in all aspects of its...

Factors associated with the utilization of institutional delivery services in Bangladesh.

PubMed

Yaya, Sanni; Bishwajit, Ghose; Ekholuenetale, Michael

2017-01-01

Bangladesh has made remarkable progress towards reducing its maternal mortality rate (MMR) over the last two decades and is one of the few countries on track to achieving the MMR-related Millennium Development Goals (MDG-5A). However, the provision of universal access to reproductive healthcare (MDG-5B) and the utilization of maternal healthcare services (MHS) such as institutional delivery, which are crucial to the reduction of maternal mortality, are far behind the internationally agreed-upon target. Effective policymaking to promote the utilization of MHS can be greatly facilitated by the identification of the factors that hinder service uptake. In this study, we therefore aim to measure the prevalence of institutional delivery services and explore the factors associated with their utilization in Bangladesh. Data for this study were extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS, 2011); participants were 7,313 women between the ages of 15 and 49 years, selected from both urban and rural households. Data were analyzed using Chi-square analysis, and conditional logistic regression. According to the findings, fewer than one in three women reported delivering at a health facility. The multivariable regression analysis showed that participants from rural areas were 46.9% less likely to have institutional deliveries compared to urban dwellers (OR = 0.531; p<0.001; 95%CI: 0.467-0.604), and participants aged between 30 and 49 years had a 23.6% higher prevalence of institutional delivery service utilization compared to those aged 15 to 29 years (OR = 1.236; p = 0.006; 95%CI: 1.062-1.437). Moreover, participants with higher educational attainment were about twice as likely to deliver at a standard health facility when compared to those without formal education (OR = 2.081; p<0.001; 95%CI: 1.650-2.624), and similarly, husbands with higher educational attainment exhibited an approximately 71% higher service utilization of institutional delivery facilities compared to those without formal education (OR = 1.709; p<0.001; 95%CI: 1.412-2.069). Wealth status was also a significant predictor of institutional delivery service use, with participants belonging to the highest economic stratum being more likely to receive skilled care compared to the lowest economic stratum (OR = 2.507; p<0.001; 95%CI: 2.118-2.968). In addition, results indicated that households of average economic class had a 27% higher level of institutional delivery service utilization compared to those of lower economic status (OR = 1.272; p = 0.011; 95%CI: 1.057-1.531). Furthermore, institutional health service use was 18% higher among participants who were aware of community clinical services compared to those who were hardly aware of these services (OR = 0.816; p = 0.012; 95%CI: 0.696-0.957). Lastly, the odds of utilizing delivery services was 1.553 times more likely for participants who use family planning compared to those who do not (p<0.001; 95%CI: 1.374-1.754), and 3.639 times more likely for those who receive antenatal care compared to those who do not (p<0.001; 95%CI: 3.074-4.308). These were found to be significant predictors of the choice of delivery services. Our results suggest that efforts towards reducing national maternal mortality in Bangladesh could be aided by investments into education, poverty reduction and the strengthening of reproductive healthcare services through community clinics, with particular focus on rural areas.

[Gingival health of adolescents and the utilization of dental services, state of São Paulo, Brazil].

PubMed

Antunes, José Leopoldo Ferreira; Peres, Marco Aurélio; Frias, Antonio Carlos; Crosato, Edgard Michel; Biazevic, Maria Gabriela Haye

2008-04-01

To evaluate the association between gingival health conditions and dental service utilization. An epidemiological survey of the oral health of 1,799 adolescents was carried out in 35 cities of the state of São Paulo, in 2002. Gingival health was assessed through the prevalence of gingival bleeding on probing and dental calculus (community periodontal index), and dental occlusion was assessed through the dental aesthetic index. The utilization of dental services was measured by means of the dental care index (F/DMFT) for each city. Multilevel logistic regression analysis was used to adjust explanatory models to factors associated with the outcome variables of interest. The prevalence of gingival bleeding on probing was 21.5%, whereas dental calculus was prevalent in 19.4%. Male participants, who were either black or dark-skinned, lived in crowded homes, in rural areas, and showed schooling delay, were at a significantly higher risk than their respective counterparts. The following dental occlusion characteristics were also associated with unhealthy gum: incisor segment crowding, vertical anterior open bite, and antero-posterior molar relationship. Cities with a higher utilization of dental services showed a smaller proportion of adolescents with gingival bleeding and dental calculus. The utilization of dental services was significantly associated with better gingival health conditions (gingival bleeding and dental calculus). This association did not depend on contextual and individual sociodemographic characteristics or dental occlusion.

The Persistence of Traditional Medicine in Urban Areas: The Case of Canada's Indians.

ERIC Educational Resources Information Center

Waldram, James B.

1990-01-01

Among 119 low-income Canada Natives living in Saskatoon, interview survey found utilization of traditional medicine (1) did not detract from utilization of Western medical services; (2) was related to proficiency in an Indian language; and (3) was not related to difficulty in using Western medicine, age, income, or education. Contains 24…

32 CFR 220.8 - Reasonable charges.

Code of Federal Regulations, 2013 CFR

2013-07-01

... standardized amounts, one for large urban, other urban/rural, and overseas area, utilizing the same... certain medications when these services are provided in a separate immunizations or shot clinic, are based...

32 CFR 220.8 - Reasonable charges.

Code of Federal Regulations, 2014 CFR

2014-07-01

... standardized amounts, one for large urban, other urban/rural, and overseas area, utilizing the same... certain medications when these services are provided in a separate immunizations or shot clinic, are based...

32 CFR 220.8 - Reasonable charges.

Code of Federal Regulations, 2011 CFR

2011-07-01

... standardized amounts, one for large urban, other urban/rural, and overseas area, utilizing the same... certain medications when these services are provided in a separate immunizations or shot clinic, are based...

32 CFR 220.8 - Reasonable charges.

Code of Federal Regulations, 2010 CFR

2010-07-01

... standardized amounts, one for large urban, other urban/rural, and overseas area, utilizing the same... certain medications when these services are provided in a separate immunizations or shot clinic, are based...

Shuttle interaction study extension

NASA Technical Reports Server (NTRS)

1982-01-01

The following areas of Space Shuttle technology were discussed: variable altitude strategy, spacecraft servicing, propellant storage, orbiter plume impingement, space based design, mating (docking and berthing), shuttle fleet utilization, and mission/traffic model.

Impact assessment and cost-effectiveness of m-health application used by community health workers for maternal, newborn and child health care services in rural Uttar Pradesh, India: a study protocol.

PubMed

Prinja, Shankar; Nimesh, Ruby; Gupta, Aditi; Bahuguna, Pankaj; Thakur, Jarnail Singh; Gupta, Madhu; Singh, Tarundeep

2016-01-01

An m-health application has been developed and implemented with community health workers to improve their counseling in a rural area of India. The ultimate aim was to generate demand and improve utilization of key maternal, neonatal, and child health services. The present study aims to assess the impact and cost-effectiveness of this project. A pre-post quasi-experimental design with a control group will be used to undertake difference in differences analysis for assessing the impact of intervention. The Annual Health Survey (2011) will provide pre-intervention data, and a household survey will be carried out to provide post-intervention data.Two community development blocks where the intervention was introduced will be treated as intervention blocks while two controls blocks are selected after matching with intervention blocks on three indicators: average number of antenatal care checkups, percentage of women receiving three or more antenatal checkups, and percentage of institutional deliveries. Two categories of beneficiaries will be interviewed in both areas: women with a child between 29 days and 6 months and women with a child between 12 and 23 months. Propensity score matched samples from intervention and control areas in pre-post periods will be analyzed using the difference in differences method to estimate the impact of intervention in utilization of key services.Bottom-up costing methods will be used to assess the cost of implementing intervention. A decision model will estimate long-term effects of improved health services utilization on mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per disability-adjusted life year averted and cost per unit increase in composite service coverage in intervention versus control groups. The study will generate significant evidence on impact of the m-health intervention for maternal, neonatal, and child services and on the cost of scaling up m-health technology for accredited social health activists in India.

Role of Community Based Savings Groups (CBSGs) enhancing the utilization of community midwives in Chitral district of Pakistan.

PubMed

Noorani, Qayyum Ali; Azam, Iqbal; Shaikh, Babar T; Ranasinghe, Tharanga; Abbas, Shazia; Wali, Shakeela; Rippey, Paul; Javed, Wajiha

2013-10-11

Maternal and infant mortality rates in the district of Chitral in Pakistan are alarmingly high. One of the major reasons for this is the inability of women to access skilled care due to the high costs associated with traveling and utilizing such services. The Aga Khan Health Services, Pakistan (AKHSP) in partnership with the national and provincial Maternal, Neonatal and Child Health (MNCH) program, deployed 28 community midwives (CMWs) in remote villages of Chitral district. This program has also established Community-Based Savings Groups (CBSGs) to support and facilitate access to MNCH services, in particular those delivered by the CMWs. CBSGs are a simple yet cost-effective and sustainable means of providing basic financial services to low income, marginalized, rural populations.The link between CBSGs and utilization of MNCH services is not well understood. This study will assess the relationship between women membership of CBSGs and their utilization of MNCH services, specifically those offered by CMWs, in the community. The research question will be answered through guided interviews of women in the target population who have delivered within one month. The outcome variable will be the utilization of full continuum of skilled MNCH care (disaggregated by 1+ ANC, 1+ PNC and skilled delivery). The primary independent variable of interest will be participation in a CBSG.Focus Group Discussions (FGDs) will be conducted to generate further understanding and information about the social and financial factors that contribute to health behavior and health provider decision-making during pregnancy.Analysis will be tailored to answer how CBSGs, directly or indirectly, facilitate greater financial and/or social access to CMW services for pregnant women. Furthermore, the extent to which financial or social empowerment through a CBSG leads to greater utilization of CMW services. The role of CBSGs and their interlink with the CMWs services to be replicated in other comparable areas in Pakistan as a viable mean to increase MNCH service utilization amongst rural, low income, and marginalized communities. Findings from this research will be disseminated through community, national, and international channels consisting of policy makers and social society groups.

Establishing sustainable strategies in urban underground engineering.

PubMed

Curiel-Esparza, Jorge; Canto-Perello, Julian; Calvo, Maria A

2004-07-01

Growth of urban areas, the corresponding increased demand for utility services and the possibility of new types of utility systems are overcrowding near surface underground space with urban utilities. Available subsurface space will continue to diminish to the point where utilidors (utility tunnels) may become inevitable. Establishing future sustainable strategies in urban underground engineering consists of the ability to lessen the use of traditional trenching. There is an increasing interest in utility tunnels for urban areas as a sustainable technique to avoid congestion of the subsurface. One of the principal advantages of utility tunnels is the substantially lower environmental impact compared with common trenches. Implementing these underground facilities is retarded most by the initial cost and management procedures. The habitual procedure is to meet problems as they arise in current practice. The moral imperative of sustainable strategies fails to confront the economic and political conflicts of interest. Municipal engineers should act as a key enabler in urban underground sustainable development.

Community Determinants of Latinos’ Use of Mental Health Services

PubMed Central

Aguilera, Adrian; Regeser López, Steven

2014-01-01

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

Related factors and use of free preventive health services among adults with intellectual disabilities in Taiwan

PubMed Central

2014-01-01

Background This study aimed to investigate the utilization of preventive health services in the adults with intellectual disabilities from the nationwide database. Methods The research method of this study is secondary data analysis. The data was obtained from three nationwide databases from 2006 to 2008. This study employed descriptive statistics to analyze the use and rate of preventive health services by intellectual disabled adults. Chi-square test was used to determine the relationship between the utilization of preventive health services and these variables. Multivariate logistic regression analysis was used to explore the factors that affect intellectual disabled adults’ use of preventive health services. Results Our findings indicated 16.65% of people with intellectual disabilities aged over 40 years used the preventive health services. Females were more frequent users than males (18.27% vs. 15.21%, p <0.001). The utilization rate decreased with increasing severity of intellectual disabilities. The utilization was lowest (13.83%) for those with very severe disability, whereas that was the highest (19.38%) for those with mild severity. The factors significantly influencing utilization of the services included gender, age, and marital status, urbanization of resident areas, monthly payroll, low-income household status, catastrophic illnesses status and relevant chronic diseases and severity of disability. Conclusions Although Taiwan’s Health Promotion Administration (HPA) has provided free preventive health services for more than 15 years, people with intellectual disabilities using preventive health care tend to be low. Demographics, economic conditions, health status, relevant chronic diseases, environmental factor, and severity of disability are the main factors influencing the use of preventive healthcare. According to the present findings, it is recommended that the government should increase the reimbursement of the medical staff performing health examinations for the persons with intellectual disabilities. It is also suggested to conduct media publicity and education to the public and the nursing facilities for the utilization of adult preventive health services. PMID:24923548

Related factors and use of free preventive health services among adults with intellectual disabilities in Taiwan.

PubMed

Yen, Suh-May; Kung, Pei-Tseng; Chiu, Li-Ting; Tsai, Wen-Chen

2014-06-12

This study aimed to investigate the utilization of preventive health services in the adults with intellectual disabilities from the nationwide database. The research method of this study is secondary data analysis. The data was obtained from three nationwide databases from 2006 to 2008. This study employed descriptive statistics to analyze the use and rate of preventive health services by intellectual disabled adults. Chi-square test was used to determine the relationship between the utilization of preventive health services and these variables. Multivariate logistic regression analysis was used to explore the factors that affect intellectual disabled adults' use of preventive health services. Our findings indicated 16.65% of people with intellectual disabilities aged over 40 years used the preventive health services. Females were more frequent users than males (18.27% vs. 15.21%, p <0.001). The utilization rate decreased with increasing severity of intellectual disabilities. The utilization was lowest (13.83%) for those with very severe disability, whereas that was the highest (19.38%) for those with mild severity. The factors significantly influencing utilization of the services included gender, age, and marital status, urbanization of resident areas, monthly payroll, low-income household status, catastrophic illnesses status and relevant chronic diseases and severity of disability. Although Taiwan's Health Promotion Administration (HPA) has provided free preventive health services for more than 15 years, people with intellectual disabilities using preventive health care tend to be low. Demographics, economic conditions, health status, relevant chronic diseases, environmental factor, and severity of disability are the main factors influencing the use of preventive healthcare. According to the present findings, it is recommended that the government should increase the reimbursement of the medical staff performing health examinations for the persons with intellectual disabilities. It is also suggested to conduct media publicity and education to the public and the nursing facilities for the utilization of adult preventive health services.

Utilization of tooth filling services by people with disabilities in Taiwan.

PubMed

Chen, Ming-Chuan; Kung, Pei-Tseng; Su, Hsun-Pi; Yen, Suh-May; Chiu, Li-Ting; Tsai, Wen-Chen

2016-04-05

The oral condition of people with disabilities has considerable influence on their physical and mental health. However, nationwide surveys regarding this group have not been conducted. For this study, we used the National Health Insurance Research Database to explore the tooth filling utilization among people with disabilities. Using the database of the Ministry of the Interior in 2008 which included people with disabilities registered, we merged with the medical claims database in 2008 of the Bureau of National Health Insurance to calculate the tooth filling utilization and to analyze relative factors. We recruited 993,487 people with disabilities as the research sample. The tooth filling utilization was 17.53 %. The multiple logistic regression result showed that the utilization rate of men was lower than that of women (OR = 0.78, 95 % CI = 0.77-0.79) and older people had lower utilization rates (aged over 75, OR = 0.22, 95 % CI = 0.22-0.23) compared to those under the age of 20. Other factors that significantly influenced the low tooth filling utilization included a low education level, living in less urbanized areas, low economic capacity, dementia, and severe disability. We identified the factors that influence and decrease the tooth-filling service utilization rate: male sex, old age, low education level, being married, indigenous ethnicity, residing in a low urbanization area, low income, chronic circulatory system diseases, dementia, and severe disabilities. We suggest establishing proper medical care environments for high-risk groups to maintain their quality of life.

Spatial Shift in the Utilization of Mental Health Services After Hurricane Sandy Among New York City Residents Enrolled in Medicaid.

PubMed

Hall, Gerod; Jessup, Jillian; Lim, Sungwoo; Olson, Donald; Seligson, Amber Levanon; He, Fangtao Tony; De La Cruz, Nneka; Gwynn, Charon

2016-06-01

Closure of several New York City (NYC) hospitals after Hurricane Sandy caused an unanticipated, extended surge in patient demand at open hospitals. This study identified hospitals with a significant increase in mental-health-related emergency department, inpatient, and outpatient visits from Medicaid patients displaced by Hurricane Sandy. NYC Medicaid patients were classified into non-mutually-exclusive geographic categories corresponding to residence in areas served by Bellevue Hospital Center and Coney Island Hospital, the hurricane impact area, and all of NYC. For each geographic region, we compared the observed to the expected number of service visits in the 6 months after the storm. The expected number of visits was calculated from 2-year trends in mental health claims. Twenty-four facilities in all 5 NYC boroughs experienced patient redistribution from storm-affected areas. Eighteen facilities had a concurrent surge in total Medicaid patients, which suggested that redistribution had a greater impact on resource use at these locations. The redistribution of Medicaid patients after Hurricane Sandy increased mental health service utilization at facilities not near flooded areas. Our findings can aid in surge capacity planning and thereby improve the continuity of mental health care after a natural disaster. (Disaster Med Public Health Preparedness. 2016;10:420-427).

Interconnected operations services in a vertically integrated utility

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

Hoffman, S.P.

1999-11-01

The North American electric industry has historically been composed of regulated Vertically Integrated Utilities (VIU). Vertical integration means that the same company owns generation, transmission, and distribution facilities. Regulated utilities were ensured cost recovery for all justifiable expenses. The entire industry is in the process of deregulation. The industry-wide trend is to competitive generation, while transmission and distribution remain regulated. Many variations, in both timing and structure, exist in states that have enacted deregulation and retail choice legislation. Some have combined retail choice with an ISO and power exchange; others have opted for retail choice without either. In the past,more » Interconnected Operations Services (IOS) were obtained by informal means within the same company. Generation is now being actively bought and sold as companies align their strategic direction with different sectors of the emerging electric industry. In the future, these IOS will have to be obtained by formal arrangements. The formal arrangements will need to encompass parameters including service definitions, compensation, performance measurement, and performance incentives. These formal arrangements are presently taking different forms in the industry depending on the stage of deregulation in each area, and on the particular agreements made by each Control Area. This paper describes how VIUs obtained and dispatched the IOS needed for reliability, and what challenges will be faced with respect to these services.« less

Planning an organizational wellness initiative at a multi-state social service agency.

PubMed

Miller, J Jay; Grise-Owens, Erlene; Addison, Donia; Marshall, Midaya; Trabue, Donna; Escobar-Ratliff, Laura

2016-06-01

Increasingly, organizations in general, and social service organizations, specifically, are recognizing the importance of planning and evaluating organizational wellness initiatives. Yet, few participatory models for carrying out these aims exist. For this study, researchers utilized concept mapping (CM) to explicate a conceptual framework for planning, and subsequently evaluating, a wellness initiative at a multi-state social service organization. CM is a participatory approach that analyzes qualitative data via multi-dimensional scaling and hierarchical cluster analyses. Outputs include a number of visual depictions that allow researchers to explore complex relationships among sets of the data. Results from this study indicated that participants (N=64), all of whom were employees of the agency, conceptualized organizational wellness via an eight-cluster solution, or Concept Map. Priority areas of this framework, specifically importance and feasibility, were also explored. After a brief review of pertinent literature, this article explicates the CM methodology utilized in this study, describes results, discusses lessons learned, and identifies apt areas for future research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Sustainable sewerage servicing options for peri-urban areas with failing septic systems.

PubMed

Sharma, A K; Tjandraatmadja, G; Grant, A L; Grant, T; Pamminger, F

2010-01-01

The provision of water and wastewater services to peri-urban areas faces very different challenges to providing services to cities. Sustainable solutions for such areas are increasingly being sought, in order to solve the environmental and health risks posed by failing septic systems. These solutions should have the capability to reduce potable water demand, provide fit for purpose reuse options, and minimise impacts on the local and global environment. A methodology for the selection of sustainable sewerage servicing systems and technologies is presented in this paper. This paper describes the outcomes of applying this methodology to a case study in rural community near Melbourne, Australia, and describes the economic and environmental implications of various sewerage servicing options. Applying this methodology has found that it is possible to deliver environmental improvements at a lower community cost, by choosing servicing configurations not historically used by urban water utilities. The selected solution is currently being implemented, with the aim being to generate further transferable learnings for the water industry.

Identifying role of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context.

PubMed

Karim, Rizwanul M; Abdullah, Mamun S; Rahman, Anisur M; Alam, Ashraful M

2016-06-24

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire. About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach's α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach's α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues played significant role on community clinic's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in community clinic service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers to improve quality of primary health care services, realizing providers' and patients' ideas of community clinic service quality.

Personal communications: An extension to the mobile satellite

NASA Technical Reports Server (NTRS)

Epstein, Murray; Draper, Francois

1990-01-01

As time progresses, customer demands become far more universal, involving integrated, simple to operate, cost effective services, with technology virtually transparent to the operator. Industry will be in a position of providing the necessary services to meet the subscribers' needs. Our resource based industries, transportation services, and utilities in the more rural and unserviced areas will require quality and affordable services that can only be supplied via satellite. One answer to these needs will be one- and two-way interoperable data messaging.

Leaf area index (LAI) of loblolly pine and emergent vegetation following a harvest

Treesearch

D.A. Sampson; D.M. Amatya; C.D. Blanton Lawson; R.W. Skaggs

2011-01-01

Forests provide goods and services to society and, often, refugia for plants and animals; forest managers utilize silviculture to provide ecosystem services and to create habitat. On the Coastal Plain of North Carolina, forest management objectives typically include wood fiber production but may also include the maintenance of environmental quality and, sometimes,...

42 CFR 414.410 - Phased-in implementation of competitive bidding programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... variables: (1) The total population of an MSA. (2) The Medicare allowed charges for DMEPOS items per fee-for-service beneficiary in an MSA. (3) The total number of DMEPOS suppliers per fee-for-service beneficiary... area with low population density based on one or more of the following factors— (1) Low utilization of...

An Analysis of Training Needs for Providers of Transition Services for the Deaf/Blind

ERIC Educational Resources Information Center

Castino, Kelly

2017-01-01

There is a lack of knowledge in the area of training needs for Deaf/Blind vocational rehabilitation and/or independent living service providers in Florida. This quantitative study utilized self-report surveys of Deaf/Blind providers in Florida to determine what needs to be done related to professional development. The researcher attempted to…

Utilization of the Elderly in Child Welfare Services. Final Report.

ERIC Educational Resources Information Center

Dannenberg, George; And Others

A study of the potential of using older people as aides in child welfare services involved interviews with 467 older people and 95 social work professionals in New Jersey. Focus was on relationships among individual differences such as attitudes and beliefs, potential areas of conflict between staff and the elderly volunteer, and what roles and…

Empowered women from rural areas of Bolivia promote community development.

PubMed

Ríos, Roxana; Olmedo, Catón; Fernández, Luis

2007-01-01

Abstract: The United States Agency for Development in Bolivia (USAID/Bolivia) created in 2002 PROSALUD- Partners for Development Project (PfD) with the aim of improving the population's well-being. The project used three components: small grant scheme, technical assistance and database system management. Through the small grants scheme, the PfD supported a Community Participation Strategy (CPS) project over a three year period. The project involved the rural areas of six Bolivian departments and suburban areas of three Bolivian cities. The main objective was to increase health service utilization with a particular emphasis on empowerment of women, strengthening of local organizations and increasing the demand for health services. Women from both the urban and rural areas, and from different indigenous groups, were trained in project management, health promotion, reproductive health and family planning, advocacy and community participation. Participatory methodologies have allowed empowering women in decision making and capacity building throughout the entire project process. The experience shows that it is important to work with formally established grass-root community organizations and strengthen leadership within them. Additionally, the sub-projects demonstrated that interventions are more successful when promoters speak and write native languages, women are more motivated and empowered, projects are designed to be responsive to daily necessities identified by the communities and health services are culturally suitable. A preliminary evaluation, in both quantitative and qualitative terms, shows an overall improvement in health knowledge and practice, and utilization of health services.

Acculturation and cross-border utilization of health services.

PubMed

Su, Dejun; Wang, Daphne

2012-08-01

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

Urban poverty and utilization of maternal and child health care services in India.

PubMed

Prakash, Ravi; Kumar, Abhishek

2013-07-01

Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005-06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.

Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study

PubMed Central

Ahmed, Waled Amen Mohammed; Shokai, Sara Boutros; Abduelkhair, Insaf Hassan; Boshra, Amira Yahia

2015-01-01

This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses. PMID:29546129

Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study.

PubMed

Ahmed, Waled Amen Mohammed; Shokai, Sara Boutros; Abduelkhair, Insaf Hassan; Boshra, Amira Yahia

2015-01-01

This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County. This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes. The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes. The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses.

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

PubMed Central

2012-01-01

Background Inequity of accessibility to and utilization of reproductive health (RH) services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. Methods A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Results Although geographical accessibility was high (79.3%), financial accessibility was low (19.1%) resulting in a low overall accessibility (34.5%) to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge on types of providers and services significantly influenced the unmet needs of youths towards RH services. Conclusion Despite the availability of RH services, youth’s accessibility to and utilization of those services were unsatisfactory. The levels of youths’ unmet RH needs were alarmingly high. PMID:23241510

Determinants and patterns of service utilization and recourse to professionals for mental health reasons

PubMed Central

2014-01-01

Background This study has a dual purpose: 1) identify determinants of healthcare service utilization for mental health reasons (MHR) in a Canadian (Montreal) catchment area; 2) determine the patterns of recourse to healthcare professionals in terms of frequency of visits and type of professionals consulted, and as it relates to the most prevalent mental disorders (MD) and psychological distress. Methods Data was collected from a random sample of 1,823 individuals interviewed after a two-year follow-up period. A regression analysis was performed to identify variables associated with service utilization and complementary analyses were carried out to better understand participants’ patterns of healthcare service utilization in relation to the most prevalent MD. Results Among 243 individuals diagnosed with a MD in the 12 months preceding an interview, 113 (46.5%) reported having used healthcare services for MHR. Determinants of service utilization were emotional and legal problems, number of MD, higher personal income, lower quality of life, inability of individuals to influence events occurring in their neighborhood, female gender and, marginally, lack of alcohol dependence in the past 12 months. Emotional problems were the most significant determinant of healthcare service utilization. Frequent visits with healthcare professionals were more likely associated with major depression and number of MD with or without dependence to alcohol or drugs. People suffering from major depression, psychological distress and social phobia were more likely to consult different professionals, while individuals with panic disorders relied on their family physician only. Concerning social phobia, panic disorders and psychological distress, more frequent visits with professionals did not translate into involvement of a higher number of professionals or vice-versa. Conclusions This study demonstrates the impact of emotional problems, neighborhood characteristics and legal problems in healthcare service utilization for MHR. Interventions based on inter-professional collaboration could be prioritized to increase the ability of healthcare services to take care especially of individuals suffering from social phobia, panic disorders and psychological distress. Others actions that could be prioritized are training of family physicians in the treatment of MD, use of psychiatric consultants, internet outreach, and reimbursement of psychological consultations for individuals with low income. PMID:24712834

Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

PubMed

Perkowski, Patryk; Rodberg, Leonard

2016-01-01

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. © The Author(s) 2015.

Tracking spending among commercially insured beneficiaries using a distributed data model.

PubMed

Colla, Carrie H; Schpero, William L; Gottlieb, Daniel J; McClurg, Asha B; Albert, Peter G; Baum, Nancy; Finison, Karl; Franzini, Luisa; Kitching, Gary; Knudson, Sue; Parikh, Rohan; Symes, Rebecca; Fisher, Elliott S

2014-08-01

To explore the feasibility of using a distributed data model for ongoing reporting of local healthcare spending, specifically to investigate the contribution of utilization and pricing to geographic variation and trends in reimbursements for commercially insured beneficiaries younger than 65 years. Retrospective descriptive analysis. Commercial claims were obtained for beneficiaries in 5 states for the years 2008 to 2010 using a distributed data model. Claims were aggregated to the hospital service area (HSA) level and healthcare utilization was quantified using a novel, National Quality Forum-endorsed measure that is independent of price and allows for the calculation of resource use across all services in standardized units. We examined trends in utilization, prices, and reimbursements over time. To examine geographic variation, we mapped resource use by HSA in the 3 states from which we had data from multiple insurers. We calculated the correlation between commercial and Medicare reimbursements and utilization. Medicare claims were obtained from the Dartmouth Atlas. We found that much of the recent growth in reimbursements for the commercially insured from 2008 to 2010 was due to increases in prices, particularly for outpatient services. As in the Medicare population, resource use by this population varied by HSA. While overall resource use patterns in the commercially insured did not mirror those among Medicare beneficiaries, we observed a strong correlation in inpatient hospital use. This research demonstrates the feasibility and value of public reporting of standardized area-level utilization and price data using a distributed data model to understand variation and trends in reimbursements.

Applying geo-spatial analysis in community needs assessment: Implications for planning and prioritizing based on data.

PubMed

Baig, Kamran; Shaw-Ridley, Mary; Munoz, Oscar J

2016-10-01

Colonias are sub standardized and unincorporated areas located along the US-Mexico border, with severely lacking infrastructure. Residents have poor health and limited availability, accessibility and/or utilization of healthcare services in the region. Using 2006-2007 community needs assessment (CNA) surveys collected by the Center for Housing and Urban Development of Texas A&M University, 410 randomly selected surveys from Hidalgo County, Texas were analyzed. Descriptive and spatial analyses were performed and Odds ratio (OR) was calculated. Out of 410 surveys, 333 were geo-coded to identify areas most in need of dental and vision care. Two hospitals existed within 5 miles radius of the mean centers for the two areas. Distance to health care facility was not statistically predictive of the need of dental care OR=0.96 (95% CI=0.855-1.078, p value=0.492) and vision care OR=1.083 (95% CI=0.968-1.212, p value=0.164). Integrating spatial analysis and CNA enhances planning to improve service accessibility and utilization in underserved areas. Copyright © 2016 Elsevier Ltd. All rights reserved.

Relocating from out-of-area treatments: service users' perspective.

PubMed

Rambarran, D D

2013-10-01

Asylum closures over recent decades resulted in mental health services being increasingly sited in the community. However, under provision of highly supported accommodation led to service users being placed away from their local area in 'out-of-area treatments' (OATs). OATs have raised major concerns in relation to enabling service users' recovery, owing to limitations in promoting autonomy, social dislocation and costs. In 2004, an OATs project was set up in a London Borough to address these concerns. In the first 4 years, the project succeeded in relocating 22 service users to less restrictive environments locally. This study aims to explore the outcome of relocation from service users' perspective. A qualitative methodology was utilized. Semi-structured interviews were carried out with seven service users who relocated. All seven service users shared a strong aspiration for independent living but there was associated loneliness. Five welcomed increased contact with family and friends, but lacked social confidence, inhibiting social inclusion. Service users with long-term and consistent care managers were more able to address fears. Five out of seven service users concluded that relocation increased their autonomy thus enhanced their quality of life. © 2012 John Wiley & Sons Ltd.

Green Pricing Program Marketing Expenditures: Finding the Right Balance

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

Friedman, B.; Miller, M.

In practice, it is difficult to determine the optimal amount to spend on marketing and administering a green pricing program. Budgets for marketing and administration of green pricing programs are a function of several factors: the region of the country; the size of the utility service area; the customer base and media markets encompassed within that service area; the point or stage in the lifespan of the program; and certainly, not least, the utility's commitment to and goals for the program. All of these factors vary significantly among programs. This report presents data on programs that have funded both marketingmore » and program administration. The National Renewable Energy Laboratory (NREL) gathers the data annually from utility green pricing program managers. Programs reporting data to NREL spent a median of 18.8% of program revenues on marketing their programs in 2008 and 16.6% in 2007. The smallest utilities (those with less than 25,000 in their eligible customer base) spent 49% of revenues on marketing, significantly more than the overall median. This report addresses the role of renewable energy credit (REC) marketers and start-up costs--and the role of marketing, generally, in achieving program objectives, including expansion of renewable energy.« less

MSAT system and service description

NASA Astrophysics Data System (ADS)

Sward, D. J.; Lok, M. F.

1986-09-01

A satellite based mobile communications system known as MSAT, was developed in Canada. It will be used primarily in rural and remote regions where the wide-area coverage and extended range features are of greatest benefit. Applications can be found in trucking, mineral exploration, forestry, law enforcement, coastal and in-land shipping, light aircraft communications, national paging, environmental sensing, remote monitoring and control of utilities, and emergency relief. The services which are likely to be offered initially on MSAT include mobile radio, mobile telephone, mobile data, wide-area paging, supervisory control, and data collection. Maritime and aeronautical services can also be provided as well as conventional telephone service to locations which for technical and economic reasons cannot be served by the fixed terrestrial and satellite infrastructures.

Optimization of orbital assignment and specification of service areas in satellite communications

NASA Technical Reports Server (NTRS)

Wang, Cou-Way; Levis, Curt A.; Buyukdura, O. Merih

1987-01-01

The mathematical nature of the orbital and frequency assignment problem for communications satellites is explored, and it is shown that choosing the correct permutations of the orbit locations and frequency assignments is an important step in arriving at values which satisfy the signal-quality requirements. Two methods are proposed to achieve better spectrum/orbit utilization. The first, called the delta S concept, leads to orbital assignment solutions via either mixed-integer or restricted basis entry linear programming techniques; the method guarantees good single-entry carrier-to-interference ratio results. In the second, a basis for specifying service areas is proposed for the Fixed Satellite Service. It is suggested that service areas should be specified according to the communications-demand density in conjunction with the delta S concept in order to enable the system planner to specify more satellites and provide more communications supply.

Are Stressful Life Events (SLEs) Associated with the Utilization of Substance Use Treatment-Related Services?

PubMed

Cruz-Feliciano, Miguel A; Ferraro, Aimee; Witt Prehn, Angela

2017-03-01

This study described herein explored the association of stressful life events with the utilization of substance use treatment-related services among substance users living in Puerto Rico. A secondary data analysis was conducted using data collected by a research project entitled Puerto Rico Drug Abuse Research Development Program II (PRDARDP II). The study population consisted of 378 individuals from 18 to 35 years of age who were residents of the San Juan metropolitan area and who presented evidence of substance use in the 30 days prior to the interview. The analysis considered demographic data, information on patterns of substance use, substance use treatment history, stressful events, and depression and anxiety symptomatology. As the number of stressful life events increased, substance users were more likely to report having utilized substance use treatment-related services (OR = 1.11, 95% CI [1.06, 1.17], p < 0.001). Relapsing, the inability to afford drugs, and poor working conditions were statistically significant stressful life events associated with the utilization of substance use treatment-related services. Despite the structural limitations associated with access to and with the quality of the services in the substance use treatment-related system of Puerto Rico, findings suggest that stressful life events play a significant role in the utilization of those services. Researchers and clinicians should consider screening for stressful life events in outreach and engagement strategies. At the same time, the assessment of stressful life events should be integrated into the treatment planning stage to support the recovery process of people with substance use disorders.

Factors associated with institutional delivery service utilization in Ethiopia.

PubMed

Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew

2016-01-01

Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government's efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel-Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I (2) test. People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women's autonomy was not significantly associated with institutional delivery service utilization. Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended.

Factors associated with institutional delivery service utilization in Ethiopia

PubMed Central

Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew

2016-01-01

Background Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. Objective The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. Methods The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel–Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I2 test. Results People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization. Conclusion and recommendation Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended. PMID:27672342

Should "standard gamble" and "'time trade off" utility measurement be used more in mental health research?

PubMed

Flood, Chris

2010-06-01

This review and discussion paper demonstrates that utility and preference measurement in mental health research is increasing. However there is still a general reluctance around using the methods due to methodological challenges and concerns around the capacity of users to understand utility methods during the research process. This paper sets out to describe and review some of the previously documented difficulties of using utility measurements in mental health services research and to highlight where they have been used successfully as measures. Additionally the paper aims to discuss a means of improving the methods used to capture service user utility and preference measurement and why decision making would be better informed as a result. International literature on utility measurement is reviewed, specifically examining the use of standard gamble and time trade off methods in mental health. Utility measurement in mental health is increasing though as the review demonstrates, concerns still exist over its application. A number of methods can be used to improve the approach overall and these are discussed as well as specific areas worthy of utility measurement including 'disutility' of admission, medication and medication side effects. Overall this paper argues that it is necessary to persist with efforts to conduct utility measurement calculation albeit with a critical eye on the methods in an attempt to ensure improvements are continually made. Utility and preference scores may be limited in that they only provide a rough score but they are defended as a means of providing some form of strength of preference for health states. The review is limited to English only texts. The debate on whether to use standard gamble and time trade off has implications for health services resource allocations, decision making, health economics research, policy making and health services research generally involving psychiatric service users. The paper argues that the absence of utility measurement in mental health runs the risk of mental health being disadvantaged in decisions around resource allocation. Institutions involved in decision making like the United Kingdom's National Institute for Health and Clinical Excellence, would be better served in their decision making and calculation of Quality Adjusted Life Years if more utility measurement in psychiatric research was carried out. Other arguments for using utility measurement include the desirability of using utility measurement to elicit a patient dimension of risk. Future utility research should aim for better involvement of service users in the design stage, the changing of time frames offered to users in health state scenarios used, a greater need for comparative work of utilities scoring across illness and between standard gamble and time trade off and more staff training in the use of utility methodology with mental health service users.

Sociodemographic and socioeconomic determinants of health services utilization in Greece: the Hellas Health I study.

PubMed

Tountas, Yannis; Oikonomou, Nikolaos; Pallikarona, Georgia; Dimitrakaki, Christine; Tzavara, Chara; Souliotis, Kyriakos; Mariolis, Anargiros; Pappa, Evelina; Kontodimopoulos, Nick; Niakas, Dimitris

2011-02-01

The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services. Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample (N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design. The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals during the past 12 months were found less for men than women, for individuals without private insurance and for individuals of lower education. More out-of-pocket payments were reported by the 34-44 age group, rural area residents and individuals with private insurance. Higher use of private health care services was reported by participants of higher social classes and residents of rural areas and private insurance. Only hospital admissions were not directly influenced by demographic and socioeconomic factors. The findings imply the existence of inequities in access and use of primary health services with clear implications to related policies.

Trading Water Conservation Credits: A Coordinative Approach for Enhanced Urban Water Reliability

NASA Astrophysics Data System (ADS)

Gonzales, P.; Ajami, N. K.

2016-12-01

Water utilities in arid and semi-arid regions are increasingly relying on water use efficiency and conservation to extend the availability of supplies. Despite spatial and institutional inter-dependency of many service providers, these demand-side management initiatives have traditionally been tackled by individual utilities operating in a silo. In this study, we introduce a new approach to water conservation that addresses regional synergies—a novel system of tradable water conservation credits. Under the proposed approach, utilities have the flexibility to invest in water conservation measures that are appropriate for their specific service area. When utilities have insufficient capacity for local cost-effective measures, they may opt to purchase credits, contributing to fund subsidies for utilities that do have that capacity and can provide the credits, while the region as whole benefits from more reliable water supplies. While similar programs have been used to address water quality concerns, to our knowledge this is one of the first studies proposing tradable credits for incentivizing water conservation. Through mathematical optimization, this study estimates the potential benefits of a trading program and demonstrates the institutional and economic characteristics needed for such a policy to be viable, including a proposed web platform to facilitate transparent regional planning, data-driven decision-making, and enhanced coordination of utilities. We explore the impacts of defining conservation targets tailored to local realities of utilities, setting credit prices, and different policy configurations. We apply these models to the case study of water utility members of the Bay Area Water Supply and Conservation Agency. Preliminary work shows that the diverse characteristics of these utilities present opportunities for the region to achieve conservation goals while maximizing the benefits to individual utilities through more flexible coordinative efforts.

Utilization of photovoltaic for broadband satellite communications in rural area of Thailand

NASA Astrophysics Data System (ADS)

Jinayim, Theerawut; Mungkung, Narong; Kasayapanand, Nat

2013-06-01

Electricity, Information and Communication Technologies (ICTs) are very important not only in urban areas but also in rural areas. To provide ICTs service in rural areas, sources of electricity and communication infrastructures must be implemented. Electricity is a major condition due to the fact that all electronic devices needed it in order to power on, so that it is impossible to operate any forms of ICTs in areas where the main national grid line is unavailable. Almost rural areas of Thailand where the main national grid line is unavailable have very good sunlight intensity. Photovoltaic is the most effective renewable energy technologies in those areas for meeting electricity needed in areas that are not connected to the main national grid line. In this paper, the efficiency utilization of photovoltaic as source of electricity for broadband satellite communication systems as well as social and economic impact and quality of life of people in rural areas of Thailand are presented. The results show that most rural communities would be able to universally access to the basic telecommunications services such as internet access and public telephone via satellite communication systems. However, in some field case study, broadband internet access via satellite communication may be unnecessary for some rural communities and the most exactly rural communities needed are electricity for household usage and battery charger.

Project appleseed electric rate incentives

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

Manak, J.R.

1988-11-01

Consolidated Edison Co. of N.Y., Inc. (Con Edison) has an economic development program to assist business grow and prosper in New York City and Westchester County. In 1981, the utility introduced a program of reduced electric rates (Area Development Rate) for economic development to help revitalize eight areas of the South Bronx and Brooklyn that were economically disadvantaged neighborhoods. This program has been very successful. It has helped produce jobs; it has helped to raise business activity in some of the most economically depressed areas of the nation; and, by increasing the usage of underutilized Company distribution facilities, it hasmore » increased Con Edison's efficiency to benefit all customers. It is established that this program resulted in a more than 24 percent average reduction of electric costs for participating companies. After recognition of this successful area development program, in late 1983, the N.Y. State legislature announced that as a matter of public policy electric utility rate incentives should, where appropriate, be used to foster economic activity in the state. The legislature found that ''the cost of utility services can be a significant factor in retaining and attracting healthy businesses and the employment opportunities and economic activity that they provide. The Law empowered the N.Y. State Public Service Commission to approve (after joint consideration with the Department of Commerce) economic incentive electricity rates that are cost based and will lead to jobs and economic vitality.« less

Airship operation in Alaska

DOT National Transportation Integrated Search

1980-05-28

An evaluation of the utility of lighter-than-air vehicles (airships) for Alaskan service suggests that very large vehicles operating at low speeds would transport heavy loads to remote areas with excellent fuel economy, but that the potential market ...

A net-centric system of services model for the Integrated Earth Observation System (IEOS) and the Integrated Ocean Observing System (IOOS)

NASA Astrophysics Data System (ADS)

Ardanuy, Philip; Bensman, Ed; Bergen, Bill; Chen, Bob; Griffith, Frank; Sutton, Cary; Hood, Carroll; Ritchie, Adrian; Tarro, Andre

2006-08-01

This paper considers an evolved technique for significantly enhanced enterprise-level data processing, reprocessing, archival, dissemination, and utilization. There is today a robust working paradigm established with the Advanced Weather Interactive Processing System (AWIPS)-NOAA/NWS's information integration and fusion capability. This process model extends vertically, and seamlessly, from environmental sensing through the direct delivery of societal benefit. NWS, via AWIPS, is the primary source of weather forecast and warning information in the nation. AWIPS is the tested and proven "the nerve center of operations" at all 122 NWS Weather Forecast Offices (WFOs) and 13 River Forecast Centers (RFCs). However, additional line organizations whose role in satisfying NOAA's five mission goals (ecosystems, climate, weather & water, commerce & transportation, and mission support) in multiple program areas might be facilitated through utilization of AWIPS-like functionalities, including the National Marine Fisheries Service (NMFS); National Environmental Satellite, Data, and Information Service (NESDIS); Office of Oceanic & Atmospheric Research (OAR); and the National Ocean Service (NOS). In addition to NOAA's mission goals, there are nine diverse, recommended, and important societal benefit areas in the US Integrated Earth Observation System (IEOS). This paper shows how the satisfaction of this suite of goals and benefit areas can be optimized by leveraging several key ingredients: (1) the evolution of AWIPS towards a net-centric system of services concept of operations; (2) infusion of technologies and concepts from pathfinder systems; (3) the development of new observing systems targeted at deliberate, and not just serendipitous, societal benefit; and (4) the diverse, nested local, regional, national, and international scales of the different benefits and goal areas, and their interoperability and interplay across the system of systems.

Introducing quality improvement management methods into primary health care services in Uganda.

PubMed

Omaswa, F; Burnham, G; Baingana, G; Mwebesa, H; Morrow, R

1996-01-01

Uganda's National Quality Assurance Program was established in 1994 to monitor the process of decentralization of primary health care services. Guidelines were developed to address problems (e.g., in obtaining health funds channeled through local government) identified at district meetings. Bringing together District Health Teams with local administrators and political leaders to share responsibility for strengthening health services has been a significant program achievement. A smoother functioning referral system from health units to district hospitals has resulted. The response to a measles outbreak in the Arua district in 1993-94 confirmed the utility of the quality management approach. Weaknesses in the district cold chain, problems with diagnostic accuracy, and a poorly functioning information system were identified as key causative factors, and corrective action in these areas led to a subsequent decline in measles cases. Patient dissatisfaction with long waiting times at Masaka Hospital was another concern addressed through the quality assurance approach. Five salient areas were identified for action: low health worker morale, supply shortages, inadequate supervision by hospital management, poor patient flow, and inefficient drug dispensing. As a result, long delays were eliminated and utilization of hospital outpatient services increased by 28%.

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

PubMed

Adhikari, Ramesh

2016-05-13

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

Socioeconomic disparities in home health care service access and utilization: a scoping review.

PubMed

Goodridge, Donna; Hawranik, Pamela; Duncan, Vicky; Turner, Hollie

2012-10-01

Home health care services are expanding at a rapid pace in order to meet the needs of the growing population of older adults and those with chronic illnesses. Because of current restrictions on home health care as an insured service in some countries, individuals may be required to pay for some or all of their home care services out of pocket. These payments may potentially limit access to needed home care services for persons in the lowest socioeconomic strata. Previous research demonstrates a clear socioeconomic gradient in access to acute and primary care services, where those most in need of services are the most disadvantaged and under-serviced. There has been little attention paid thus far, however, to the way in which socioeconomic status may affect the receipt of home health care services. To determine what is known from existing literature about socioeconomic disparities in home health care access and utilization. A scoping review was used to map the extent and nature of the literature in this area. A search of the databases CINAHL, Medline, SocIndex and Sociological Abstracts as well as Dissertations International. A total of 206 potentially relevant articles were published between 2000 and April 2011. Two reviewers independently reviewed the articles, leaving 15 research articles to be included in the scoping review. The majority of articles reported secondary analyses of administrative datasets related to utilization of home health care. Several studies examined access and utilization using qualitative approaches. The distinction between professional and supportive home care services was not always clear in the articles. Individual and composite measures of socioeconomic status were reported, with the most frequently used indicator being income. Several studies used more complex composite ecological indicators of socieconomic status. There was general agreement that utilization of home health services favored persons with greater economic disadvantage. Education, rurality and race were less frequently reported. In contrast to well-documented socioeconomic gradient seen with primary and acute care services, we found general agreement that persons of lower socioeconomic status are favored and not disadvantaged in terms of home health care services. Copyright © 2012 Elsevier Ltd. All rights reserved.

A comparative study of family functioning, health, and mental health awareness and utilization among female Bedouin-Arabs from recognized and unrecognized villages in the Negev.

PubMed

Al-Krenawi, Alean; Graham, John R

2006-02-01

A good portion of geography is contested by the Israeli state and the country's Bedouin-Arab population. There are two categories of Bedouin villages: those areas that are "officially" recognized by the state and those that are not. In this article we determine utilization and awareness of health and mental health services among 376 Bedouin-Arab women in recognized and unrecognized villages in the Negev. Although there are differences between them, primary health care (PHC) services usually are available within recognized villages, accessible to those from unrecognized villages, and tend to precipitate user satisfaction. We conclude with various suggestions for improving health service delivery and making PHC and mental health delivery more accessible. Through this article we intend to help mental health practitioners on two levels: the policy level, regarding the design of mental health services for societies in transition, such as the Bedouin Arab, and the practical level by helping practitioners better appreciate the psychosocial status of women in Bedouin-Arab societies and the factors associated with Bedouin-Arab PHC utilization.

A Condom Distribution Program for Adolescents: The Findings of a Feasibility Study.

ERIC Educational Resources Information Center

Arnold, Charles B.; Cogswell, Betty E.

This paper describes a family planning service for adolescent males in an inner-city area. The program utilized the distribution of free condoms through local commercial outlets (barber shops, grocery stores, pool hall, restaurant). The proprietors agreed to distribute condoms in the target area which included approximately 3,000 males aged 12-26…

Disparities in the use of mobile phone for seeking childbirth services among women in the urban areas: Bangladesh Urban Health Survey.

PubMed

Bishwajit, Ghose; Hoque, Md Rakibul; Yaya, Sanni

2017-12-29

In Bangladesh, similar to its other South Asian counterparts, shortage of health workers along with inadequate infrastructure constitute some of the major obstacles for the equitable provision of reproductive healthcare services, particularly among the marginalized and underserved neighbourhoods. However, given the rapidly expanding broadband communication and mobile phone market in the country, the application of eHealth and mHealth technologies offer a window of opportunities to minimise the impact of socioeconomic barriers and promote the utilization of maternal healthcare services thereby. In the present study we aimed to investigate 1) the prevalence of usage of mobile phones for seeking childbirth services, 2) neighbourhood and socioeconomic disparities in the use, and 3) association between using mobile phones and the uptake of postnatal care among mothers and neonates. Data for the present study came from Bangladesh Urban Health Survey 2013. Study subjects were 9014 married women aged between 15 and 49 years. The overall rate of use of mobile phone was highest in City Corporation non-Slum areas (16.2%) and lowest in City Corporation Slum areas (7.4%). The odds of using mobile for seeking childbirth services were significantly higher among those who were living in non-slum areas, and lower among those who never attended school and lived in poorer households. Results also indicated that women in the slum areas who used mobile phone for childbirth service seeking, were 4.3 times [OR = 4.250;95% CI = 1.856-9.734] more likely to receive postnatal care for themselves, and those from outside the city-corporation areas were 2.7 times [OR = 2.707;95% CI = 1.712-4.279] more likely to receive postnatal care for the newborn. Neighbourhood, educational and economic factors were significantly associated with the mobile phone utilization status among urban women. Promoting access to better education and sustainable income earning should be regarded as an integral part to the expansion of mHealth for maternal healthcare seeking behaviour.

Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: A community - based cross sectional study

PubMed Central

2012-01-01

Background Reduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia. Methods Community-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software. Results The study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%), home delivery is usual practice (57.7%), unexpected labour (33.4%), not being sick or no problem at the time of delivery (21.6%) and family influence (14.4%). Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9]), ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4]), maternal education level (AOR [95%CI] =11.98 [3.36, 41.4]) and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6]) had significant associations with institutional delivery service utilization. Conclusions Very low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of knowledge on pregnancy and delivery services were found to be associated with delivery service utilization. Strategies with focus on increasing ANC uptake and building knowledge of the mothers and their partners would help to increase utilization of the service. Training and assigning skilled attendants at Health Posta level to provide skilled home delivery would improve utilization of the service. PMID:22849421

Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, north west of Ethiopia: a community-based cross sectional study.

PubMed

Teferra, Alemayehu Shimeka; Alemu, Fekadu Mazengia; Woldeyohannes, Solomon Meseret

2012-07-31

Reduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia. Community-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software. The study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%), home delivery is usual practice (57.7%), unexpected labour (33.4%), not being sick or no problem at the time of delivery (21.6%) and family influence (14.4%). Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9]), ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4]), maternal education level (AOR [95%CI] =11.98 [3.36, 41.4]) and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6]) had significant associations with institutional delivery service utilization. Very low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of knowledge on pregnancy and delivery services were found to be associated with delivery service utilization. Strategies with focus on increasing ANC uptake and building knowledge of the mothers and their partners would help to increase utilization of the service. Training and assigning skilled attendants at Health Posta level to provide skilled home delivery would improve utilization of the service.

Influence of psychiatric morbidity and sociodemographic determinants on use of service in a catchment area in the city of São Paulo, Brazil.

PubMed

Andrade, Laura Helena; Viana, Maria Carmen; Tófoli, Luis Fernando Farah; Wang, Yuan-Pang

2008-01-01

Recent population-based studies in Latin American and the Caribbean (LAC) countries brought evidence of the growing burden of mental illness in this region. The objective of this study is to examine determinants of health service utilization by individuals with psychiatric disorders in a defined area in the city of São Paulo, Brazil. Data were derived from São Paulo Catchment Area Study (SP-ECA), a cross-sectional household prevalence survey, based on a representative adult sample (N=1,464) living in two defined boroughs. The psychiatric diagnosis was assessed through the CIDI 1.1 interview, yielding ICD-10 diagnoses. The past-month use of health services--for general medical (GM) care and mental health (MH) care sectors--was investigated in their relationship with sociodemographic features, insurance coverage, GM conditions, and psychiatric morbidity. Nearly one-third (32.2%) of the total sample used health services in the last month: 29.0% attended GM care and 7.8% used MH care. Logistic regression models showed that being female, older than 60 years, having private insurance coverage, and presence of psychiatric morbidity increased the level GM care seeking in the total sample. For those with 12-month psychiatric disorders, the determinants for GM sector use were female gender, age 45-59 years old, and private insurance coverage, whereas separated, divorced, or widowed women had the highest odds (OR 9.9; 95% CI: 2.7-36.5) for using MH service. Low-income people were less likely to seek MH services. The major contribution of this article is to underscore the impact of MH on health care systems, in a LAC country where service use information is scarce. The main finding is that inequalities in the access to MH care occurred, with low-income people having less likelihood of receiving treatment for their mental disorder. Access to health service in this catchment area reflected the great degree of deregulation and lack of integration. Additional efforts should address the barriers to the utilization of MH services in Brazil, including social inequities in the access to care.

Solar Heating And Cooling Of Buildings (SHACOB): Requirements definition and impact analysis-2. Volume 3: Customer load management systems

NASA Astrophysics Data System (ADS)

Cretcher, C. K.; Rountredd, R. C.

1980-11-01

Customer Load Management Systems, using off-peak storage and control at the residences, are analyzed to determine their potential for capacity and energy savings by the electric utility. Areas broadly representative of utilities in the regions around Washington, DC and Albuquerque, NM were of interest. Near optimum tank volumes were determined for both service areas, and charging duration/off-time were identified as having the greatest influence on tank performance. The impacts on utility operations and corresponding utility/customer economics were determined in terms of delta demands used to estimate the utilities' generating capacity differences between the conventional load management, (CLM) direct solar with load management (DSLM), and electric resistive systems. Energy differences are also determined. These capacity and energy deltas are translated into changes in utility costs due to penetration of the CLM or DSLM systems into electric resistive markets in the snapshot years of 1990 and 2000.

Southwest Research Institute assistance to NASA in biomedical areas of the technology utilization program

NASA Technical Reports Server (NTRS)

1973-01-01

Applications of aerospace technology to biomedical science are described. Recent research and development of specific techniques, services, and equipment adopted by physicians to help combat disease and disability are reviewed.

A retrospective case-control analysis of the outpatient expenditures for western medicine and dental treatment modalities in CKD patients in Taiwan.

PubMed

Huang, Ren-Yeong; Lin, Yuh-Feng; Kao, Sen-Yeong; Shieh, Yi-Shing; Chen, Jin-Shuen

2014-01-01

To determine if expenditures for dentistry (DENT) correlate with severity of chronic kidney disease (CKD). A total of 10,457 subjects were enrolled from January 2008 to December 2010, divided into three groups: healthy control (HC) group (n = 1,438), high risk (HR) group (n = 3,392), and CKD group (n = 5,627). Five stages were further categorized for the CKD group. OPD utilization and expenditures for western medicine (WM), DENT, and TCM (traditional Chinese medicine) were analyzed retrospectively (2000-2008) using Taiwan's National Health Insurance Research Database. Three major areas were analyzed among groups CKD, HR and HC in this study: 1) demographic data and medical history; 2) utilization (visits/person/year) and expenditures (9-year cumulative expenditure, expenditure/person/year) for OPD services in WM, DENT, and TCM; and 3) utilization and expenditures for dental OPD services, particularly in dental filling, root canal and periodontal therapy. OPD utilization and expenditures of WM increased significantly for the CKD group compared with the HR and HC groups, and increased steadily along with the severity of CKD stages. However, overall DENT and TCM utilization and expenditures did not increase for the CKD group. In comparison among different CKD stages, the average expenditures and utilization for DENT including restorative filling and periodontal therapy, but not root canal therapy, showed significant decreases according to severity of CKD stage, indicating less DENT OPD utilization with progression of CKD. Patients with advanced CKD used DENT OPD service less frequently. However, the connection between CKD and DENT service utilization requires further study.

Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14 385 communities in 292 districts.

PubMed

Singh, Prashant Kumar; Kumar, Chandan; Rai, Rajesh Kumar; Singh, Lucky

2014-08-01

Studies have often ignored examining the role of community- and district-level factors in the utilization of maternity healthcare services, particularly in Indian contexts. The Social Determinants of Health framework emphasizes the role of governance and government policies, the measures for which are rarely incorporated in single-level individual analysis. This study examines factors associated with maternal healthcare utilization in nine high focus states in India, which shares more than half of the total maternal deaths in the country; accounting for individual-, household-, community- and district-level characteristics. The required data are extracted from the third round of the nationally representative District Level Household and Facility Survey conducted during 2007-08. Multilevel analyses were applied to three maternity outcomes, namely, four or more antenatal care visits, skilled birth attendance and post-natal care after birth. Results show that along with individual-/household-level factors, community and district-level factors influence the pattern of utilization of maternal healthcare services significantly. At the community level, the odds of maternal healthcare utilization were lower in rural areas and in communities with a high concentration of poor and illiterate women. Moreover, the average population coverage of primary health centres (PHCs), availability of labour room in PHC and percentage of registered pregnancies were significant factors at the district level that influenced the use of maternity care services. The study also found a strong association between the extent of previous use of maternal healthcare and its effect on subsequent usage patterns. This study highlights the role of strengthening public health infrastructure at district level in the study area, and promoting awareness about available healthcare services and subsidized schemes in the community. To reach out to rural and underprivileged communities and to apply a participatory approach from the programme officials are issues to delve into. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Hospice Enrollment, Local Hospice Utilization Patterns, and Rehospitalization in Medicare Patients

PubMed Central

Holden, Timothy R.; Smith, Maureen A.; Bartels, Christie M.; Campbell, Toby C.; Yu, Menggang

2015-01-01

Abstract Background: Rehospitalizations are prevalent and associated with decreased quality of life. Although hospice has been advocated to reduce rehospitalizations, it is not known how area-level hospice utilization patterns affect rehospitalization risk. Objectives: The study objective was to examine the association between hospice enrollment, local hospice utilization patterns, and 30-day rehospitalization in Medicare patients. Methods: With a retrospective cohort design, 1,997,506 hospitalizations were assessed between 2005 and 2009 from a 5% national sample of Medicare beneficiaries. Local hospice utilization was defined using tertiles representing the percentage of all deaths occurring in hospice within each Hospital Service Area (HSA). Cox proportional hazard models were used to assess the relationship between 30-day rehospitalization, hospice enrollment, and local hospice utilization, adjusting for patient sociodemographics, medical history, and hospital characteristics. Results: Rates of patients dying in hospice were 27% in the lowest hospice utilization tertile, 41% in the middle tertile, and 53% in the highest tertile. Patients enrolled in hospice had lower rates of 30-day rehospitalization than those not enrolled (2.2% versus 18.8%; adjusted hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.118–0.131). Patients residing in areas of low hospice utilization were at greater rehospitalization risk than those residing in areas of high utilization (19.1% versus 17.5%; HR, 1.05; 95% CI, 1.04–1.06), which persisted beyond that accounted for by individual hospice enrollment. Conclusions: Area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees. PMID:25879990

Searching for solutions for territorial disputes

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

LaBella, J.W.

Late in 1986 the boards of directors of the American Public Power Association and the National Rural Electric Cooperative Association appointed a joint task force to examine and propose solutions to the pervasive problem of territorial disputes. Municipal electric systems and rural electric cooperatives have many common interests. In the legislative and regulatory halls of Washington, they jointly work for fair treatment and low costs for electric customers and they support each other on issues related to power supply. But the backyard brawls over which utility will serve which group of customers are fierce and potentially crippling to the nationalmore » alliance. The disputes typically arise when a municipality annexes territory. In communities served by a local publicly owned electric system, the new larger city wants to provide electric service in the newly annexed area. The rural electric cooperative that brought electricity to the area is not economically positioned to simply turn over those customers. Cities that provide other utility services feel they should also be permitted to provide electric service. Twenty-one suggestions (or possible solutions identified) are listed here.« less

Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

PubMed Central

Steinhardt, Laura C; Aman, Iqbal; Pakzad, Iqbalshah; Kumar, Binay; Singh, Lakhwinder P; Peters, David H

2011-01-01

Background User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees. Methods Data on utilization and observed structural and perceived overall quality of health care were compared from before-and-after facility assessments, patient exit interviews and catchment area household surveys from eight facilities where fees were removed and 14 facilities where fee levels remained constant, as part of a larger health financing pilot study from 2005 to 2007. After a national user fee ban was instituted in 2008, health facility administrative data were analysed to assess subsequent changes in utilization and quality. Results The pilot study analysis indicated that observed and perceived quality increased across facilities but did not differ by fee removal status. Difference-in-difference analysis showed that utilization at facilities previously charging both service and drug fees increased by 400% more after fee removal, prompting additional inputs from service providers, compared with facilities that previously only charged service fees or had no change in fees (P = 0.001). Following the national fee ban, visits for curative care increased significantly (P < 0.001), but institutional deliveries did not. Services typically free before the ban—immunization and antenatal care—had immediate increases in utilization but these were not sustained. Conclusion Both pilot and nationwide data indicated that curative care utilization increased following fee removal, without differential changes in quality. Concerns raised by non-governmental organizations, health workers and community leaders over the effects of lost revenue and increased utilization require continued effort to raise revenues, monitor health worker and patient perceptions, and carefully manage health facility performance. PMID:22027924

A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal.

PubMed

Choulagai, Bishnu P; Onta, Sharad; Subedi, Narayan; Bhatta, Dharma N; Shrestha, Binjwala; Petzold, Max; Krettek, Alexandra

2017-10-01

Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Identifying demand for health resources using waiting times information.

PubMed

Blundell, R; Windmeijer, F

2000-09-01

In this paper the differences in average waiting times are utilized to identify the determinants of demand for health services. The equilibrium waiting time framework is used, but the full equilibrium assumption is relaxed by selecting areas with low waiting times and by estimating a (semi-)parametric selection model. Determinants of supply are used as instruments for the endogeneity of waiting times. A model for the demand for acute services at the ward level in the UK is estimated. The model estimates, and their implications for health service allocations in the UK, are contrasted against more standard allocation models. The present results show that it is critically important to account for rationing by waiting times when identifying needs from care utilization data. Copyright 2000 John Wiley & Sons, Ltd.

Health needs and concerns of male adolescents.

PubMed

Pinch, W J; Heck, M; Vinal, D

1986-01-01

Lifestyle factors established within the family help determine health-care functioning. Adolescents first may be challenged to meet their own health needs as freshmen in college. A 153-item questionnaire was utilized to examine concerns in the areas of alcohol and other drug use, auto safety, weight and dieting, smoking, sexuality, coping and stress, and selection and utilization of health-care services. One hundred fifty-nine male college students responded. Major problems with alcohol use, auto safety, weight control, stress and sexuality were identified. Positive lifestyle factors that were strongly supported included regular exercise, nonsmoking, regular medical and dental checkups, and the development of some support systems to cope with stress. Health-care services designated by respondents to meet their own needs were significantly different from those services they pointed out as needed for their peers.

The development of landscape-scale ecological units and their application to the greater Huachuca Mountains fire planning process

Treesearch

Larry E. Laing; David Gori; James T. Jones

2005-01-01

The multi-partner Greater Huachuca Mountains fire planning effort involves over 500,000 acres of public and private lands. This large area supports distinct landscapes that have evolved with fire. Utilizing GIS as a tool, the United States Forest Service (USFS), General Ecosystem Survey (GES), and Natural Resources Conservation Service (NRCS) State Soil Geographic...

The Environmental Assessment and Management (TEAM) Guide: Colorado Supplement

DTIC Science & Technology

2010-03-01

toluene, elthylbenzene, xylene CAR control area responsible party CAS Chemical Abstract Service CEM continuous emission monitoring CERCLA...for electric utility steam generators for which construction is commenced after 18 September 1978 (40 CFR 60, Subpart Da, effective 16 September 1998...except for certain electric generating stations owned and operated by the Public Service Company of Colorado.) Verify that the averaging time for all

Is Donor Service Area Market Competition Associated With Organ Procurement Organization Performance?

PubMed

Adler, Joel T; Yeh, Heidi; Markmann, James F; Axelrod, David A

2016-06-01

Organ procurement organizations (OPOs) are currently evaluated on donation rates and number of organs per donor. However, there is significant variability in market characteristics which affect transplant programs' donor organ acceptance practices and OPOs' ability to successfully place higher risk organs. The impact of transplant market characteristics on OPO performance metrics has not been evaluated. The OPO performance measures were correlated annually with the Herfindahl Hirschman Index, a standard measure of market competition for centers within the OPO donor service areas from 2003 to 2011. More competitive donor service areas were associated with increased number of donors (P = 0.01) and eligible deaths (P < 0.001). Market competition was associated with increased use of high Donor Risk Index for kidney (P = 0.03) and liver (P = 0.01) allografts. The OPOs with increased competition in liver transplant also were noted to have a higher donor conversion rate (P < 0.001), more donors per million population (P < 0.001), and a higher utilization rate for liver allografts (P = 0.007). These data suggest that proposals to increase district size to increase competition among transplant programs could result in improved organ utilization over time by incentivizing the use of marginal donor organs and increasing access to transplantation.

Expanding technology in the ICU: the case for the utilization of telemedicine.

PubMed

Deslich, Stacie; Coustasse, Alberto

2014-05-01

Telemedicine has been utilized in various healthcare areas to achieve better patient outcomes, lower costs of providing services, and increase patient access to care. Tele-intensive care unit (ICU) technology has been introduced as a way to provide effective ICU services to patients with reduced access, as well as to decrease costs and improve patient care. The methodology for this qualitative study was a literature search and review of case studies. The search was limited to sources published in the last 10 years (2003-2013) in the English language. In total, 55 references were used for this research exploration inquiry. Tele-ICU was found to be an effective way to use technology to decrease costs of providing intensive care, while improving patient outcomes such as mortality and length of stay. Several case studies supported the use of telemedicine in ICUs to provide intensive care to patients who lived in rural areas and lacked access to traditional ICUs. Furthermore, it was noted that, although the initial costs for tele-ICU startup were significant, as much as $100,000 per bed, the benefits of the utilization of this technology can offset those costs by reducing costs by 24% via decreased length of stay for patients. The findings of this study have suggested that the implementation of tele-ICU may have been more beneficial than costly, and it may have provided healthcare organizations the opportunity to increase quality of care and decrease mortality, while it might have decreased costs of delivering ICU services in both rural and urban areas.

“Health inequalities in Armenia - analysis of survey results”

PubMed Central

2012-01-01

Introduction Prevailing sociopolitical and economic obstacles have been implicated in the inadequate utilization and delivery of the Armenian health care system. Methods A random survey of 1,000 local residents, from all administrative regions of Armenia, concerned with health care services cost and satisfaction was conducted. Participation in the survey was voluntary and the information was collected using anonymous telephone interviews. Results The utilization of health care services was low, particularly in rural areas. This under-utilization of services correlated with low income of the population surveyed. The state funded health care services are inadequate to ensure availability of free-of-charge services even to economically disadvantaged groups. Continued reliance on direct out-of pocket and illicit payments, for medical services, are serious issues which plague healthcare, pharmaceutical and medical technology sectors of Armenia. Conclusions Restructuring of the health care system to implement a cost-effective approach to the prevention and treatment of diseases, especially disproportionately affect the poor, should be undertaken. Public payments, increasing the amount of subsidies for poor and lower income groups through a compulsory health insurance system should be evaluated and included as appropriate in this health system redesign. Current medical services reimbursement practices undermine the principle of equity in financing and access. Measures designed to improve healthcare access and affordability for poor and disadvantaged households should be enacted. PMID:22695079

A Basic Manual for Physical Plant Administration.

ERIC Educational Resources Information Center

Weber, George O., Ed.; Fincham, Michael W., Ed.

This book provides practical advice on problems of institutional plant management to physical plant administrators. Areas covered include the role, organization, and facilities of the physical plant department; personnel administration; financial administration; buildings maintenance and operation; custodial services; utilities distribution…

Satisfaction and Healthcare Utilization of Transgender and Gender Non-Conforming Individuals in NYC: A Community-Based Participatory Study.

PubMed

Radix, Anita E; Lelutiu-Weinberger, Corina; Gamarel, Kristi E

2014-12-01

Transgender and gender non-conforming (TGNC) individuals face high levels of discrimination and mistreatment, including within social and medical service settings, which may lead to negative health and psychosocial sequelae. Given the many barriers to competent care, we sought to determine points of intervention by assessing the current needs, satisfaction, and health care utilization of TGNC individuals in New York City as reported by TGNC individuals. In January 2013, fifty TGNC individuals were recruited via flyers and direct referrals from healthcare professionals within community spaces and pertinent venues. We administered a brief survey and conducted four focus groups exploring participants' health care utilization and perceived barriers to care, routine care, hormone and silicone use, and recommendations for improving transgender services. Participants were 18- to 64-years-old, racially/ethnically diverse, and the majority were medically insured, underwent routine health care in the last year, and received an HIV test in their lifetime. A significant proportion reported taking hormones prescribed by a medical provider and were in the care of knowledgeable providers. Participants perceived four areas where barriers persisted: utilization of preventive services, access to transition-related procedures, access to legal assistance, and inclusion of TGNC individuals in public health education and campaigns. Structural interventions are needed, such as comprehensive provider training programs for all level staff to better serve the needs of TGNC individuals, increase service utilization and improve wellbeing, while effecting lasting institutional change. Service provision establishments should hire more TGNC staff and integrate transgender care into existing practices.

Inadequate Utilization of Prenatal Care Services, Socioeconomic Status, and Educational Attainment Are Associated with Low Birth Weight in Zimbabwe.

PubMed

Yaya, Sanni; Bishwajit, Ghose; Ekholuenetale, Michael; Shah, Vaibhav

2017-01-01

Globally, low birth weight (LBW) remains a leading cause of neonatal and infant mortality and poses significant challenges toward the progress of achieving infant mortality-related goals. Experience from developed countries shows that two major causes of LBW (premature delivery and intrauterine growth restriction) can be averted to a great extent by adequate utilization of maternal health-care services, during pregnancy. In this study, we attempt to measure the prevalence of LBW in Zimbabwe and explore the association between adequate utilization of prenatal care (PNC) services and LBW in Zimbabwe. We also explore other possible associations with LBW. This study was based on nationally representative, cross-sectional data from Multiple Indicator Cluster Survey round 5, conducted in 2014. Participants included 3,221 mothers from both rural and urban areas. The participants were selected regardless of their current pregnancy status. Sample characteristics were presented using descriptive statistics. Association between utilization status of ANC and LBW was measured by chi-square (bivariate) test and logistic regression methods. Prevalence of LBW was 12.8%. There was 11% reduction in the odds of having LBW babies for participants from urban area when compared with rural area (AOR = 0.897; 95% CI = 0.707-1.138). When compared to women with higher education, those having primary/below primary and secondary level qualification had higher odds of experiencing LBW babies by 73 and 56%, respectively. Participants who had less than four PNC/ANC visits had 34% higher odds (AOR = 1.340; 95% CI = 1.065-1.685) than those with at least four visits, and those who had given birth more than once, had 38% lower odds (AOR = 0.620; 95% CI = 0.493-0.780) of giving birth to LBW babies when compared to those who had given birth only once. The findings of this study have programmatic and policy implications for low-resource nations and suggest that promoting access to ANC services especially in the rural areas is likely to reduce prevalence of LBW in Zimbabwe. This is important as LBW babies consume lot of health resources per se and not only in terms of hospitalization but also in terms of outpatient and physician visits during the first year of their life.

Health provider perspectives on mental health service provision for Chinese people living in Christchurch, New Zealand

PubMed Central

ZHANG, Qiuhong; GAGE, Jeffrey; BARNETT, Pauline

2013-01-01

Background Migration imposes stress and may contribute to the incidence of mental illness among natives of mainland China living overseas. Both cultural norms and service inadequacies may act as barriers to accessing needed mental health services. Objective Assess New Zealand health providers' perspectives on the utilization of mental health services by immigrants from mainland China. Methods A qualitative study in Christchurch, New Zealand involved in-depth interviews with nine mental health professionals with experience in providing services to Chinese clients. The interviews were transcribed and thematically analysed. Results Four main themes emerged from the interviews: (1) specific mental health concerns of Chinese migrants; (2) subgroups of migrants most likely to manifest mental health problems; (3) barriers to accessing services; and (4) the centrality of social support networks to the mental health of Chinese migrants. Conclusions Qualitative research with health providers in high-income countries who provide mental health services to the growing numbers of migrants from mainland China can identify areas where improved cultural sensitivity could increase both the utilization of mental health services by Chinese immigrants and the effectiveness of these services. PMID:24991180

CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks

PubMed Central

Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

2016-01-01

Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes. PMID:27171085

Out-of-pocket expenditures on traditional and Western medicine in Taiwan.

PubMed

Yen, Steven T; Chang, Hung-Hao; Lin, Tsui-Fang

2013-08-01

Coexistence of traditional and modern medicine is common in Asian countries. This paper investigates out-of-pocket expenditures on traditional medicine, traditional medical service, and Western medicine by households in Taiwan. Using a national sample of 13,765 households, the three expenditure equations are estimated with a censored system procedure. Effects of socio-demographic variables are explored by calculating marginal effects on probabilities and levels of medical expenses. Different types of medical expenditures are correlated. Households with higher income and more aging members use more traditional medicine than others, as do households in agricultural sector and in urban areas. In addition, households living in rural areas relative to those in the cities are more likely to use and also spend more on traditional service. Regional disparity of health care utilization is found. Higher income households spend more on traditional medicine, likely due to the fact that patients usually pay out-of-pocket for herbal materials needed in preparation of traditional medicine. To ensure equity in health care utilization, establishment of hospitals and clinics in rural areas should be considered.

The Rural – Urban Divide: Health Services Utilization Among Older Mexicans in Mexico

PubMed Central

Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

2010-01-01

Context Mexico Purpose Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen’s “model of health services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Findings Results showed that older Mexicans living in the most rural areas (populations of 2500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health. PMID:21029168

Cross-Border Utilization of Health Care: Evidence from a Population-Based Study in South Texas

PubMed Central

Su, Dejun; Richardson, Chad; Wen, Ming; Pagán, José A

2011-01-01

Objective To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region. PMID:21158855

Food management for the aging population.

PubMed

Militello, J; Coleman, L J; Haran, E

1996-01-01

The older population is becoming more important to our society everyday. These individuals are being studied for their past, present, and potential impact on markets and marketing. Evaluated as a user of products or services in the marketplace or an employee or volunteer within the marketing system, this segment is gaining a visibility and importance. An interview was conducted with five Nutrition Project Directors to obtain an overview of Federally Funded Nutrition Programs for the Elderly. The areas which were highlighted were service delivery, site activities, management styles, barriers to service, clientele composition, food planning and preparation, staffing, USDA funding, coordination, marketing, transportation, and volunteerism. The Second Quarter Service Provider Output Reports for 1991, which are compiled by the Nutrition Projects and submitted to the Area Agency on Aging, were utilized to obtain client profile information (Reports, 1991). The analysis sought to compare the programs offered in the five counties on a number of factors which could be quantified. It was hoped that by looking at the numerical ratios, and depicting them graphically, any trends or unique characteristics of the programs could be identified. In that the percentage of Florida's present elder population (17%) far exceeds the national average (12%) these findings could be utilized by nutrition programs outside of Florida to plan for future funds. Analysis of quantitative information on the five programs yielded information on cost comparisons and on services.

The Approval-Built Collection in the Medium-Sized Academic Library

ERIC Educational Resources Information Center

DeVilbiss, Mary Lee

1975-01-01

Compares the approval-built collection with the collection which is created when traditional select and order procedures are used. The study was limited to 1974 imprints in four subject areas and utilized the services of two major vendors. (Author)

7 CFR 4280.101 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE LOANS AND GRANTS Renewable Energy Systems and Energy Efficiency... agricultural producers and rural small businesses for the purpose of purchasing and installing renewable energy systems and energy efficiency improvements in rural areas. Financial assistance to any single entity may...

7 CFR 1739.18 - Grant documents.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... feasibility and sustainability. The Agency may also prescribe terms and conditions applicable to the... Rural Areas, as well as other terms and conditions applicable to the individual Project. Dividend...

7 CFR 1717.651 - General.

Code of Federal Regulations, 2010 CFR

2010-01-01

... encouraged to utilize their own funds to participate in the economic development of rural areas, provided... infrastructure projects (such as water and waste systems, garbage collection services, etc.) and in job creation... promote business development and economic diversification in rural communities. Nonetheless, RUS believes...

Elements of Successful Plant Management.

ERIC Educational Resources Information Center

Sweitzer, John H.

The physical plant administrator manages men, money and materials to create the best possible physical environment for the educational processes at his institution. Areas of concern of the plant administrator are administration, building maintenance, janitorial services, traffic, security and safety, utilities, grounds, alterations, and…

Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR.

PubMed

Chankham, Tengbriacheu; Yamamoto, Eiko; Reyer, Joshua A; Arafat, Rahman; Khonemany, Innoukham; Panome, Sayamoungkhoun; Hongkham, Dalavong; Bounfeng, Phommalaysith; Anonh, Xeuthvongsa; Hamajima, Nobuyuki

2017-02-01

To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its "Free Maternal Health Services Policy" in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P<0.0001) and receiving transportation support (P=0.005) had significant associations with the knowledge level. The women were highly satisfied with the quality of the services, health care providers, and health facilities. However, most mothers were not satisfied with accessibility to health facilities. To increase utilization of health facilities and reduce the maternal mortality ratio in rural areas, the government needs to improve people's education status and health care accessibility.

The role of patient experience surveys in quality assurance and improvement: a focus group study in English general practice.

PubMed

Boiko, Olga; Campbell, John L; Elmore, Natasha; Davey, Antoinette F; Roland, Martin; Burt, Jenni

2015-12-01

Despite widespread adoption of patient feedback surveys in international health-care systems, including the English NHS, evidence of a demonstrable impact of surveys on service improvement is sparse. To explore the views of primary care practice staff regarding the utility of patient experience surveys. Qualitative focus groups. Staff from 14 English general practices. Whilst participants engaged with feedback from patient experience surveys, they routinely questioned its validity and reliability. Participants identified surveys as having a number of useful functions: for patients, as a potentially therapeutic way of getting their voice heard; for practice staff, as a way of identifying areas of improvement; and for GPs, as a source of evidence for professional development and appraisal. Areas of potential change stimulated by survey feedback included redesigning front-line services, managing patient expectations and managing the performance of GPs. Despite this, practice staff struggled to identify and action changes based on survey feedback alone. Whilst surveys may be used to endorse existing high-quality service delivery, their use in informing changes in service delivery is more challenging for practice staff. Drawing on the Utility Index framework, we identified concerns relating to reliability and validity, cost and feasibility acceptability and educational impact, which combine to limit the utility of patient survey feedback. Feedback from patient experience surveys has great potential. However, without a specific and renewed focus on how to translate feedback into action, this potential will remain incompletely realized. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Ordinal preference elicitation methods in health economics and health services research: using discrete choice experiments and ranking methods.

PubMed

Ali, Shehzad; Ronaldson, Sarah

2012-09-01

The predominant method of economic evaluation is cost-utility analysis, which uses cardinal preference elicitation methods, including the standard gamble and time trade-off. However, such approach is not suitable for understanding trade-offs between process attributes, non-health outcomes and health outcomes to evaluate current practices, develop new programmes and predict demand for services and products. Ordinal preference elicitation methods including discrete choice experiments and ranking methods are therefore commonly used in health economics and health service research. Cardinal methods have been criticized on the grounds of cognitive complexity, difficulty of administration, contamination by risk and preference attitudes, and potential violation of underlying assumptions. Ordinal methods have gained popularity because of reduced cognitive burden, lower degree of abstract reasoning, reduced measurement error, ease of administration and ability to use both health and non-health outcomes. The underlying assumptions of ordinal methods may be violated when respondents use cognitive shortcuts, or cannot comprehend the ordinal task or interpret attributes and levels, or use 'irrational' choice behaviour or refuse to trade-off certain attributes. CURRENT USE AND GROWING AREAS: Ordinal methods are commonly used to evaluate preference for attributes of health services, products, practices, interventions, policies and, more recently, to estimate utility weights. AREAS FOR ON-GOING RESEARCH: There is growing research on developing optimal designs, evaluating the rationalization process, using qualitative tools for developing ordinal methods, evaluating consistency with utility theory, appropriate statistical methods for analysis, generalizability of results and comparing ordinal methods against each other and with cardinal measures.

300 Area Building Retention Evaluation Mitigation Plan

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

D. J. McBride

2007-07-03

Evaluate the long-term retention of several facilities associated with the PNNL Capability Replacement Laboratory and other Hanfor mission needs. WCH prepared a mitigation plan for three scenarios with different release dates for specific buildings. The evaluations present a proposed plan for providing utility services to retained facilities in support of a long-term (+20 year) lifespan in addition to temporary services to buildings with specified delayed release dates.

Social determinants of mental health service utilization in Switzerland.

PubMed

Dey, Michelle; Jorm, Anthony Francis

2017-01-01

To investigate whether mental health services utilization in Switzerland is equitably distributed (i.e., predicted only by the need of a person). Data on 17,789 participants of the Swiss Health Survey 2012 (≥15 years) was analysed. Logistic regression analyses were conducted to predict: having been in treatment for a psychological problem; having used psychotropic medication; having had medical treatment for depression; and having visited a psychologist or psychotherapist. Need (depression severity and risky alcohol consumption) and socio-demographic variables were used as independent variables. Depression severity was the strongest predictor for using mental health services. In contrast, risky alcohol consumption was not associated with an increased likelihood of using mental health services. After adjusting for need, the following groups were less likely to use (some of) the mental health services: males, young people, participants who (almost) work full-time, single/unmarried, non-Swiss people and those living in rural areas. Education and income were not significantly associated with the outcomes in the adjusted analyses. Some socio-demographic subgroups are less likely to use mental health services despite having the same need.

Satellite communications for the Pacific islands. Second year report

NASA Technical Reports Server (NTRS)

Young, E.; Hurd, J. N.

1982-01-01

Requirements, options and costs for use of communications satellites in underserved areas of the Pacific Basin are described with emphasis on extended utilization of INTELSAT. The economic structures within and among Pacific Basin entities are examined, particularly the relationship between the growth of regional trade and telecommunications potential for the region. Suitable satellite services are recommended and the financial implications for extended utilization of communications satellites in the Pacific Basin are considered.

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan.

PubMed

Riaz, Atif; Zaidi, Shehla; Khowaja, Asif Raza

2015-03-06

A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies. © 2015 by Kerman University of Medical Sciences.

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

PubMed Central

Riaz, Atif; Zaidi, Shehla; Khowaja, Asif Raza

2015-01-01

Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users’ perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Results: Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Conclusion: Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies. PMID:25905478

Scope of Work for Integration Management and Installation Services of the National Ignition Facility Beampath Infrastructure System

NASA Astrophysics Data System (ADS)

Coyle, P. D.

2000-03-01

The goal of the National Ignition Facility (NIF) project is to provide an above ground experimental capability for maintaining nuclear competence and weapons effects simulation and to provide a facility capable of achieving fusion ignition using solid-state lasers as the energy driver. The facility will incorporate 192 laser beams, which will be focused onto a small target located at the center of a spherical target chamber-the energy from the laser beams will be deposited in a few billionths of a second. The target will then implode, forcing atomic nuclei to sufficiently high temperatures and densities necessary to achieve a miniature fusion reaction. The NIF is under construction, at Livermore, California, located approximately 50 miles southeast of San Francisco, California. The University of California, Lawrence Livermore National Laboratory (LLNL), operating under Prime Contract W-7405-ENG. 48 with the U.S. Department of Energy (DOE), shall subcontract for Integration Management and Installation (IMI) Services for the Beampath Infrastructure System (BIS). The BIS includes Beampath Hardware and Beampath Utilities. Conventional Facilities work for the NIF Laser and Target Area Building (LTAB) and Optics Assembly Building (OAB) is over 86 percent constructed. This Scope of Work is for Integration Management and Installation (IMI) Services corresponding to Management Services, Design Integration Services, Construction Services, and Commissioning Services for the NIB BIS. The BIS includes Beampath Hardware and Beampath Utilities. Beampath Hardware and Beampath Utilities include beampath vessels, enclosures, and beam tubes; auxiliary and utility systems; and support structures. A substantial amount of GFE will be provided by the University for installation as part of the infrastructure packages.

Executive summary: Benefit-cost evaluation of an intra-regional air service in the Bay Area and a technology assessment of transportation system investments. [regional planning for the San Francisco Bay area of California

NASA Technical Reports Server (NTRS)

Haefner, L. E.

1978-01-01

The benefits and costs that would result from an intra-regional air service operation in the San Francisco Bay area were determined by utilizing an iterative statistical decision model to evaluate combinations of commuter airport sites and surface transportation facilities in conjunction with service by a given commuter aircraft type in light of area regional growth alternatives and peak and off-peak regional travel patterns. The model evaluates such transportation option with respect to criteria of airline profitability, public acceptance, and public and private non-user costs. In so doing, it incorporates information on modal split, peak and off-peak use of the air commuter fleet, terminal and airport costs, development costs and uses of land in proximity to the airport sites, regional population shifts, and induced zonal shifts in travel demand. The model is multimodal in its analytic capability, and performs exhaustive sensitivity analysis.

Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis.

PubMed

Masters, Samuel H; Burstein, Roy; Amofah, George; Abaogye, Patrick; Kumar, Santosh; Hanlon, Michael

2013-09-01

Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

High Coverage and Utilization of Fortified Take-Home Rations among Children 6-35 Months of Age Provided through the Integrated Child Development Services Program: Findings from a Cross-Sectional Survey in Telangana, India.

PubMed

Leyvraz, Magali; Wirth, James P; Woodruff, Bradley A; Sankar, Rajan; Sodani, Prahlad R; Sharma, Narottam D; Aaron, Grant J

2016-01-01

The Integrated Child Development Services (ICDS) in the State of Telangana, India, freely provides a fortified complementary food product, Bal Amrutham, as a take-home ration to children 6-35 months of age. In order to understand the potential for impact of any intervention, it is essential to assess coverage and utilization of the program and to address the barriers to its coverage and utilization. A two-stage, stratified cross-sectional cluster survey was conducted to estimate the coverage and utilization of Bal Amrutham and to identify their barriers and drivers. In randomly selected catchment areas of ICDS centers, children under 36 months of age were randomly selected. A questionnaire, constructed from different validated and standard modules and designed to collect coverage data on nutrition programs, was administered to caregivers. A total of 1,077 children were enrolled in the survey. The coverage of the fortified take-home ration was found to be high among the target population. Nearly all caregivers (93.7%) had heard of Bal Amrutham and 86.8% had already received the product for the target child. Among the children surveyed, 57.2% consumed the product regularly. The ICDS program's services were not found to be a barrier to product coverage. In fact, the ICDS program was found to be widely available, accessible, accepted, and utilized by the population in both urban and rural catchment areas, as well as among poor and non-poor households. However, two barriers to optimal coverage were found: the irregular supply of the product to the beneficiaries and the intra-household sharing of the product. Although sharing was common, the product was estimated to provide the target children with significant proportions of the daily requirements of macro- and micronutrients. Bal Amrutham is widely available, accepted, and consumed among the target population in the catchment areas of ICDS centers. The coverage of the product could be further increased by improving the supply chain.

Brief Report: Use of Interactive Television in Identifying Autism in Young Children--Methodology and Preliminary Data

ERIC Educational Resources Information Center

Reese, R. Matthew; Jamison, T. Rene; Braun, Matt; Wendland, Maura; Black, William; Hadorn, Megan; Nelson, Eve-Lynn; Prather, Carole

2015-01-01

Children living in rural and underserved areas experience decreased access to health care services and are often diagnosed with autism at a later age compared to those living in urban or suburban areas. This study examines the utility and validity of an ASD assessment protocol conducted via video conferencing (VC). Participants (n = 17) included…

7 CFR 1778.10 - Restrictions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... areas from submitting joint proposals for assistance under this part. Each entity applying for financial... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE..., cost, and are not directly related to correcting the potable water quantity or quality problem. (4) Pay...

Maximizing Educational Opportunity through Community Resources.

ERIC Educational Resources Information Center

Maradian, Steve

In the face of increased demands and diminishing resources, educational administrators at correctional facilities should look beyond institutional resources and utilize the services of area community colleges. The community college has an established track record in correctional education. Besides the nationally recognized correctional programs…

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2012 CFR

2012-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2014 CFR

2014-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2013 CFR

2013-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

Community Report Card.

ERIC Educational Resources Information Center

Rural Development Service (USDA), Washington, DC.

Designed to facilitate rural development efforts, this pamphlet presents a grading key for ranking community factors in each of four key areas of progress as follows: (1) People Building (education, health services, cultural satisfaction, outreach to the disadvantaged, and leadership); (2) Community Facilities (housing, transportation, utilities,…

12 CFR 613.3100 - Domestic lending.

Code of Federal Regulations, 2013 CFR

2013-01-01

... cooperatives or agricultural credit bank for energy-related or public utility-related purposes that cannot be... electric, telecommunication, cable television, water, or waste treatment services. (4) Rural area means all... cooperatives. (b) Cooperatives and other entities that serve agricultural or aquatic producers—(1) Eligibility...

12 CFR 613.3100 - Domestic lending.

Code of Federal Regulations, 2012 CFR

2012-01-01

... cooperatives or agricultural credit bank for energy-related or public utility-related purposes that cannot be... electric, telecommunication, cable television, water, or waste treatment services. (4) Rural area means all... cooperatives. (b) Cooperatives and other entities that serve agricultural or aquatic producers—(1) Eligibility...

12 CFR 613.3100 - Domestic lending.

Code of Federal Regulations, 2011 CFR

2011-01-01

... cooperatives or agricultural credit bank for energy-related or public utility-related purposes that cannot be... electric, telecommunication, cable television, water, or waste treatment services. (4) Rural area means all... cooperatives. (b) Cooperatives and other entities that serve agricultural or aquatic producers—(1) Eligibility...

12 CFR 613.3100 - Domestic lending.

Code of Federal Regulations, 2014 CFR

2014-01-01

... cooperatives or agricultural credit bank for energy-related or public utility-related purposes that cannot be... electric, telecommunication, cable television, water, or waste treatment services. (4) Rural area means all... cooperatives. (b) Cooperatives and other entities that serve agricultural or aquatic producers—(1) Eligibility...

The LiveWire Project final report

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

Brown, C.D.; Nelson, T.T.; Kelly, J.C.

Utilities across the US have begun pilot testing a variety of hardware and software products to develop a two-way communications system between themselves and their customers. Their purpose is to reduce utility operating costs and to provide new and improved services for customers in light of pending changes in the electric industry being brought about by deregulation. A consortium including utilities, national labs, consultants, and contractors, with the support of the Department of Energy (DOE) and the Electric Power Research Institute (EPRI), initiated a project that utilized a hybrid fiber-coax (HFC) wide-area network integrated with a CEBus based local areamore » network within the customers home. The system combined energy consumption data taken within the home, and home automation features to provide a suite of energy management services for residential customers. The information was transferred via the Internet through the HFC network, and presented to the customer on their personal computer. This final project report discusses the design, prototype testing, and system deployment planning of the energy management system.« less

[Differences in influenza vaccination coverage among subgroups of adult immigrants residing in Italy at risk for complications (2012-2013)].

PubMed

Fabiani, Massimo; Di Napoli, Anteo; Riccardo, Flavia; Gargiulo, Lidia; Declich, Silvia; Petrelli, Alessio

2017-01-01

to evaluate differences in influenza vaccination coverage (IVC) in immigrants at risk for influenza-related complications, according to their area of origin and length of stay in Italy. cross-sectional survey conducted on the sample of foreign citizens included in the survey on health conditions and use of health services of the Italian resident population (Italian national institute of statistics, 2012-2013). analysis conducted on 885 foreign adult citizens (≥18 years) at risk for influenza-related complications (elderly residents ≥65 years and residents with specific chronic diseases). vaccination coverage ratios (VCR) comparison between long-term immigrants (≥10 years) and recent immigrants (<10 years), and between non-African and African immigrants, adjusted by demographic and socioeconomic characteristics and level of health services utilization. IVC among immigrants was 15.6%, significantly higher in long-term immigrants (18.3%) compared to recent immigrants (10.2%) (VCR: 1.79; 95%CI 1.21-2.66), and in non-African immigrants (17.1%) compared to African immigrants (9.4%) (VCR: 1.82; 95%CI 1.04-3.17). After adjusting on the basis of demographic and socioeconomic characteristics and for level of health services utilization between the compared subgroups, the difference in IVC according to the length of stay was greatly reduced (VCR: 1.41; 95%CI 0.94- 2.10), while IVC difference reduction according to area of origin was less relevant (VCR: 1.66; 95%CI 0.95-2.91). demographic and socioeconomic characteristics and level of health services utilization explained part of the difference in IVC between the compared subgroups, particularly between long-term and recent immigrants. The difference in IVC between African immigrants and immigrants from other areas remained quite pronounced even after adjusting on the basis of these factors. This suggests that IVC, especially in African immigrants, is affected by other informal barriers, such as cultural and linguistic barriers, that need to be addressed when planning effective immunization access strategies.

Patients’ perception of pharmaceutical services available in a community pharmacy among patients living in a rural area of the United Kingdom

PubMed Central

2016-01-01

Objective: Patients’ opinion about prevalence of pharmaceutical services available in a community pharmacy among patients living in a rural area of the United Kingdom. The secondary objective was to identify appropriate action(s) to enhance patients’ awareness of pharmaceutical services in rural areas. Methods: A self-administered, anonymous questionnaire was distributed to patients visiting a community pharmacy in Eye, Suffolk, United Kingdom between July and August, 2015. The main inclusion criterion was living in a rural area. Comparisons were performed using chi-square tests and logistic regression. Results: The study included 103 respondents: 70 women (69.0%) and 33 men (32.0%), aged 16–85 years. Most respondents declared the primary tasks of a community pharmacy were dispensing medicines (86.4% of respondents) and repeat dispensing (72.8% of respondents). Additionally, 23.3% of respondents treated minor ailments at the pharmacy, including bacterial/viral infections, minor injuries, stomach problems, and allergies. The Medicines Use Review service was the only advanced service used in this pharmacy (12.6% of respondents), primarily by men. Younger patients were more familiar with the term of pharmaceutical care (p<0.05; OR=0.33). Conclusions: Only a few pharmaceutical services are utilized by people living in rural areas in the UK, namely prescription dispensing, repeat dispensing, and sale of medications that support self-care for minor ailments. We found an overall poor awareness of the expanded variety of pharmaceutical services encouraged by the community pharmacy contract introduced in the UK in 2005. Therefore, politicians, pharmacists, and pharmacy experts should actively promote these advanced pharmaceutical services in rural areas. PMID:27785163

Can the Medical-nursing Combined Care Promote the Accessibility of Health Services for the Elderly in Nursing Home? A Study Protocol of Analysis of the Effectiveness Regarding Health Service Utilization, Health Status and Satisfaction with Care.

PubMed

Bao, J; Wang, X-J; Yang, Y; Dong, R-Q; Mao, Z-F

2015-12-01

Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China.

Female health workers at the doorstep: a pilot of community-based maternal, newborn, and child health service delivery in northern Nigeria.

PubMed

Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

2015-03-01

Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008-2010 (before introduction of the pilot) with data from 2011-2013 (during and after the pilot) to gauge sustainability of the model. Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. © Uzondu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-14-00117.

Satellite communication for public services

NASA Technical Reports Server (NTRS)

Cooper, R. S.; Redisch, W. N.

1977-01-01

Public service programs using NASA's ATS-6 and CTS satellites are discussed. Examples include the ATS-6 Health and Education Telecommunications experimental program and the use of CTS to enable students in one university to take courses presented at another distant university. Possible applications of satellite communication systems to several areas of public service are described, and economic and political obstacles hindering the implementation of these programs are considered. It is suggested that a federally sponsored program demonstrating the utility of satellites accomodating a large number of small terminals is needed to encourage commercial satellite operations.

Emergency eye care in rural Australia: role of internet.

PubMed

Kumar, S; Yogesan, K; Hudson, B; Tay-Kearney, M-L; Constable, I J

2006-12-01

Significant differences exist in the utilization of emergency eye care services in rural and urban Australia. Meanwhile, influence of internet-based technology in emergency eye care service utilization has not been established. This study aims to demonstrate, from a health provider perspective, an internet-based service's impact on emergency eye care in rural Australia. The teleophthalmology service was initiated in the Carnarvon Regional Hospital (CRH) of the Gascoyne region in Western Australia. A digital, slit lamp and fundus camera were used for the service. Economic data was gathered from the Department of Health of Western Australia (DOHWA), the CRH and the Lions Eye Institute. During the study period (January-December, 2003) 118 persons took part in teleophthalmology consultations. Emergency cases constituted 3% of these consultations. Previous year, there were seven eye-related emergency evacuations (inter-hospital air transfers) from the Gascoyne region to City of Perth. Analysis demonstrates implementation of internet-based health services has a marked impact on rural emergency eye care delivery. Internet is well suited to ophthalmology for the diagnosis and management of acute conditions in remote areas. Integration of such services to mainstream health care is recommended.

Latency of TCP applications over the ATM-WAN using the GFR service category

NASA Astrophysics Data System (ADS)

Chen, Kuo-Hsien; Siliquini, John F.; Budrikis, Zigmantas

1998-10-01

The GFR service category has been proposed for data services in ATM networks. Since users are ultimately interested in data service that provide high efficiency and low latency, it is important to study the latency performance for data traffic of the GFR service category in an ATM network. Today much of the data traffic utilizes the TCP/IP protocol suite and in this paper we study through simulation the latency of TCP applications running over a wide-area ATM network utilizing the GFR service category using a realistic TCP traffic model. From this study, we find that during congestion periods the reserved bandwidth in GFR can improve the latency performance for TCP applications. However, due to TCP 'Slow Start' data segment generation dynamics, we show that a large proportion of TCP segments are discarded under network congestion even when the reserved bandwidth is equal to the average generated rate of user data. Therefore, a user experiences worse than expected latency performance when the network is congested. In this study we also examine the effects of segment size on the latency performance of TCP applications using the GFR service category.

Exploring the Influence of Income and Geography on Access to Services for Older Adults in British Columbia: A Multivariate Analysis Using the Canadian Community Health Survey (Cycle 3.1)

ERIC Educational Resources Information Center

Allan, Diane E.; Funk, Laura M.; Reid, R. Colin; Cloutier-Fisher, Denise

2011-01-01

Existing research on the health care utilization patterns of older Canadians suggests that income does not usually restrict an individual's access to care. However, the role that income plays in influencing access to health services by older adults living in rural areas is relatively unknown. This article examines the relationship between income…

Exploratory Study to Determine the Feasibility of a Comprehensive Program for the Development of Special Education Services for Emotionally Disturbed Children in Arizona, Nevada, New Mexico, and Utah. Final Report.

ERIC Educational Resources Information Center

Holmberg, Gerald R.

Group conferences, individual study groups, personal visitations, and communication by the principal investigator were utilized to determine the availability and suitability of services for emotionally disturbed children in the four-state area o f Arizona, New Mexico, Utah, and Nevada which has a low incidence of population in vast territorial…

Comparing and explaining differences in the magnitude, content, and sensitivity of utilities predicted by the EQ-5D, SF-6D, HUI 3, 15D, QWB, and AQoL-8D multiattribute utility instruments.

PubMed

Richardson, Jeff; Khan, Munir A; Iezzi, Angelo; Maxwell, Aimee

2015-04-01

Cost utility analysis permits the comparison of disparate health services by measuring outcomes in comparable units, namely, quality-adjusted life-years, which equal life-years times the utility of the health state. However, comparability is compromised when different utility instruments predict different utilities for the same health state. The present paper measures the extent of, and reason for, differences between the utilities predicted by the EQ-5D-5L, SF-6D, HUI 3, 15D, QWB, and AQoL-8D. Data were obtained from patients in seven disease areas and members of the healthy public in six countries. Differences between public and patient utilities were estimated using each of the instruments. To explain discrepancies between the estimates, the measurement scales and content of the instruments were compared. The sensitivity of instruments to independently measured health dimensions was measured in pairwise comparisons of all combinations of the instruments. The difference between public and patient utilities varied with the choice of instrument by more than 50% for every disease group and in four of the seven groups by more than 100%. Discrepancies were associated with differences in both the instrument content and their measurement scales. Pairwise comparisons of instruments found that variation in the sensitivity to physical and psychosocial dimensions of health closely reflected the items in the instrument's descriptive systems. Results indicate that instruments measure related but different constructs. They imply that commonly used instruments systematically discriminate against some classes of services, most notably mental health services. Differences in the instrument scales imply the need for transformations between the instruments to increase the comparability of measurement. © The Author(s) 2014.

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

PubMed

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

2007-06-01

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

Health needs and health care utilization among rural, low-income women.

PubMed

Simmons, Leigh Ann; Anderson, Elaine A; Braun, Bonnie

2008-01-01

This study examined the correlates of health service utilization in a sample of low-income, rural women. Self-reported data were from Rural Families Speak (N = 275), a multi-state study of low-income, rural families in the U.S. collected in 2002. Findings indicated that women with health insurance, a regular doctor, and poorer overall physical health had higher incident rates of physician visits. Women who were divorced, separated or widowed and had more chronic health problems had higher incidence rates of emergency department (ED) use, while women living in counties with higher primary care physician rates had lower incidence rates of ED use. Future research and policies should focus on improved access to health insurance, increasing physician availability in rural areas, and providing rural women with a usual source of care, so as to reduce emergency services utilization for non-emergent needs and improve health status for this population.

Assessing the community clinic replacement effect on private Medicaid practices in oral health care within rural environments.

PubMed

Squillace, Joe

2013-01-01

Children in Medicaid/CHIP public coverage programs who reside in rural counties have limited access to dental care services. Shortages of dental professionals in rural areas impede utilization of dental care. Public and private initiatives are attempting to address this crisis. Missourians instituted deregulatory policies and invested in community-based initiatives. Using a Medicaid/CHIP claims administrative dataset from 2004 to 2007, this research explored patterns of utilization to assess the impact of these efforts. The number of participating private dental office providers declined over the study period, and the number of children utilizing clinics increased. Trends are being observed within the public health dental care market demonstrating clinics are replacing private dentists as providers of Medicaid/CHIP dental services. Allowing greater market entry through deregulation could provide states with greater improvements to their public dental health infrastructure. © 2012 American Association of Public Health Dentistry.

Healthful School Environment.

ERIC Educational Resources Information Center

Wilson, Charles C., Ed.; Wilson, Elizabeth Avery, Ed.

A broad range of topics deals with the development, maintenance, and full utilization of a healthful school environment, encompassing such areas as--(1) school organizations which affect the student environment, (2) accident prevention, (3) the criteria for healthful food services, (4) physical education and the necessary athletic facilities, (5)…

Oregon's Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures.

PubMed

McConnell, K John; Renfro, Stephanie; Lindrooth, Richard C; Cohen, Deborah J; Wallace, Neal T; Chernew, Michael E

2017-03-01

In 2012 Oregon initiated an ambitious delivery system reform, moving the majority of its Medicaid enrollees into sixteen coordinated care organizations, a type of Medicaid accountable care organization. Using claims data, we assessed measures of access, appropriateness of care, utilization, and expenditures for five service areas (evaluation and management, imaging, procedures, tests, and inpatient facility care), comparing Oregon to the neighboring state of Washington. Overall, the transformation into coordinated care organizations was associated with a 7 percent relative reduction in expenditures across the sum of these services, attributable primarily to reductions in inpatient utilization. The change to coordinated care organizations also demonstrated reductions in avoidable emergency department visits and improvements in some measures of appropriateness of care, but also exhibited reductions in primary care visits, a potential area of concern. Oregon's coordinated care organizations could provide lessons for controlling health care spending for other state Medicaid programs. Project HOPE—The People-to-People Health Foundation, Inc.

Racial/Ethnic Disparities in the Mental Health Care Utilization of Fifth Grade Children

PubMed Central

Coker, Tumaini R.; Elliott, Marc N.; Kataoka, Sheryl; Schwebel, David C.; Mrug, Sylvie; Grunbaum, Jo Anne; Cuccaro, Paula; Peskin, Melissa F.; Schuster, Mark A.

2015-01-01

Objective The aim of this study was to examine racial/ethnic differences in fifth grade children’s mental health care utilization. Methods We analyzed cross-sectional data from a study of 5147 fifth graders and their parents in 3 US metropolitan areas from 2004–06. Multivariate logistic regression was used to examine racial/ethnic differences in mental health care utilization. Results Nine percent of parents reported that their child had ever used mental health care services; fewer black (6%) and Hispanic (8%) children had used services than white children (14%). Fewer black and Hispanic children with recent symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, and fewer black children with symptoms of depression had ever utilized services compared with white children. In multivariate analyses controlling for demographic factors, parental mental health, social support, and symptoms of the 4 mental health conditions, we found that black children were less likely than white children to have ever used services (Odds ratio [OR] 0.3, 95% confidence interval [95% CI], 0.2–0.4, P <.001). The odds ratio for black children remained virtually unchanged when the analysis was restricted to children with symptoms of ≥1 mental health condition, and when the analysis was stratified by mental health condition. The difference in utilization for Hispanic compared with white children was fully explained by sociodemographics in all multivariate models. Conclusions Disparities exist in mental health care utilization for black and Hispanic children; the disparity for black children is independent of sociodemographics and child mental health need. Efforts to reduce this disparity may benefit from addressing not only access and diagnosis issues, but also parents’ help-seeking preferences for mental health care for their children. PMID:19329099

Utilization of Norway’s Emergency Wards: The Second 5 Years after the Introduction of the Patient List System

PubMed Central

Goth, Ursula S.; Hammer, Hugo L.; Claussen, Bjørgulf

2014-01-01

Utilization of services is an important indicator for estimating access to healthcare. In Norway, the General Practitioner Scheme, a patient list system, was established in 2001 to enable a stable doctor-patient relationship. Although satisfaction with the system is generally high, people often choose a more accessible but inferior solution for routine care: emergency wards. The aim of the article is to investigate contact patterns in primary health care situations for the total population in urban and remote areas of Norway and for major immigrant groups in Oslo. The primary regression model had a cross-sectional study design analyzing 2,609,107 consultations in representative municipalities across Norway, estimating the probability of choosing the emergency ward in substitution to a general practitioner. In a second regression model comprising 625,590 consultations in Oslo, we calculated this likelihood for immigrants from the 14 largest groups. We noted substantial differences in emergency ward utilization between ethnic Norwegians both in rural and remote areas and among the various immigrant groups residing in Oslo. Oslo utilization of emergency ward services for the whole population declined, and so did this use among all immigrant groups after 2009. Other municipalities, while overwhelmingly ethnically Norwegian, showed diverse patterns including an increase in some and a decrease in others, results which we were unable to explain. PMID:24662997

Noah's Ark-Red Cross Foundation: a Swedish model.

PubMed

Florence, M E

1993-01-01

During the Spring of 1991, the author spent many weeks at the Noah's Ark-Red Cross Foundation, a support service for HIV infected persons, and their families and friends, located in Stockholm, Sweden. The purpose was to study, through interviews, observation and participation, the foundation's interactive model in order to discover what makes it work and share that knowledge with other professionals. The Noah's Ark Model consists of three spheres of activity: service, including reception services and the volunteer programme; information and education, including the Hot Line and the Newsletter; and counselling and support, including the guest house. Staff from each area interact freely with and participate in the activities of other areas. The foundation also utilizes the services of carefully trained volunteers. This use of volunteers makes it unique in Sweden. It is the dedication and flexibility of the staff and volunteers that make this model work. The report of the study follows.

Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis.

PubMed

Worku, Abebaw Gebeyehu; Yalew, Alemayehu Worku; Afework, Mesganaw Fantahun

2013-04-15

The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve "kebeles" of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Factors operating at individual and "kebele" levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women.

Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area.

PubMed

Pappa, Evelina; Niakas, Dimitris

2006-11-02

Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

Why Women Living in an Obstetric Care Underserved Area Do Not Utilize Their Local Hospital Supported by Korean Government for Childbirth.

PubMed

Kim, Jung-Eun; Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

2016-09-01

This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities. Copyright © 2016. Published by Elsevier B.V.

Factors associated with utilization of maternal serum screening for Down syndrome in mainland China: a cross-sectional study.

PubMed

Li, Chuanlin; Shi, Leiyu; Huang, Jiayan; Qian, Xu; Chen, Yingyao

2016-01-14

Knowledge of the factors that influence maternal serum screening (MSS) service utilization can be used to develop health policies to promote equitable access to MSS and further diagnostic tests. The purpose of this study was to find the factors associated with utilization of MSS as well as the current status of service utilization in mainland China. This was a hospital-based cross-sectional study with respondents interviewed with a questionnaire designed based on Andersen's behavioral model. Descriptive statistics, univariate analysis, and multilevel logistic regression analysis were used to identify the factors associated with MSS utilization, and to explore potential methods to improve screening uptake. A total of 8110 women who had given birth within the previous 7 days in one of 111 participating institutions from six provinces in mainland China were interviewed. Approximately 36% of the participants had used MSS. Women between 20 and 35 years, who resided in urban areas, were educated, were in a stable occupation, who had health knowledge, who attended maternal preparation classes, who had received eight or more prenatal checkups, who were from a region of higher social economic status, and who delivered in a tertiary healthcare institution were significantly more likely to use MSS than their counterparts. As compared with other factors, insufficient education is the single most important demographic factor for service underutilization. Efforts should not only be made to target the population that underuses MSS, but the overall organization of MSS service delivery should be assessed during policy development to make access to MSS equitable to the entire population of mainland China.

Thailand's universal coverage scheme and its impact on health-seeking behavior.

PubMed

Paek, Seung Chun; Meemon, Natthani; Wan, Thomas T H

2016-01-01

Thailand's Universal Coverage Scheme (UCS) has improved healthcare access and utilization since its initial introduction in 2002. However, a substantial proportion of beneficiaries has utilized care outside the UCS boundaries. Because low utilization may be an indication of a policy gap between people's health needs and the services available to them, we investigated the patterns of health-seeking behavior and their social/contextual determinants among UCS beneficiaries in the year 2013. The study findings from the outpatient analysis showed that the use of designated facilities for care was significantly higher in low-income, unemployed, and chronic status groups. The findings from the inpatient analysis showed that the use of designated facilities for care was significantly higher in the low-income, older, and female groups. Particularly, for the low-income group, we found that they (1) had greater health care needs, (2) received a larger number of services from designated facilities, and (3) paid the least for both inpatient and outpatient services. This pro-poor impact indicated that the UCS could adequately respond to beneficiaries' needs in terms of vertical equity. However, we also found that a considerable proportion of beneficiaries utilized out-of-network services, which implied a lack of universal access to policy services from a horizontal equity point of view. Thus, the policy should continue expanding and diversifying its service benefits to strengthen horizontal equity. Particularly, private sector involvement for those who are employed as well as the increased unmet health needs of those in rural areas may be important policy priorities for that. Lastly, methodological issues such as severity adjustment and a detailed categorization of health-seeking behaviors need to be further considered for a better understanding of the policy impact.

Patient satisfaction with health care services at a national institute of ophthalmology.

PubMed

Van Huy, Nguyen; Dung, Nguyen Ngoc; Thang, Cao Duc; Hanh, Le Thuy

2018-01-01

Little is known about how patients in developing countries, such as Vietnam, are satisfied with eye care services. The purpose of this study was to assess the satisfaction with health services and its associated factors among patients attending a national institute of ophthalmology in Vietnam. In a cross-sectional study utilizing quantitative methods, 500 inpatients and their relatives attending a national institute of ophthalmology in Vietnam were approached for data collection. The results indicated that under 50% of the patients were satisfied with eye care services. However, when classified by level of satisfaction, only 6.8% were very satisfied with all domains of care. There was no significant difference in satisfaction by gender and income, while significant differences by department, residence, and education were found. Patients who were from rural areas, were better educated, and used the services of the glaucoma department, were more satisfied with eye care than those from urban areas, were less educated, and used the services of treatment-on-demand department. Multivariable regression detected 2 main factors, gender and location, associated with patient satisfaction. Patients who were female and came from rural and remote areas were more likely to be satisfied than patients who were male and living in urban areas. The study suggests that to continue to improve health care quality, it is important to eliminate differences in providing eye care services regardless of whether patients are male or female, and whether they come from a rural or urban area. Copyright © 2017 John Wiley & Sons, Ltd.

Need, Enabling, Predisposing, and Behavioral Determinants of Access to Preventative Care in Argentina: Analysis of the National Survey of Risk Factors

PubMed Central

Jahangir, Eiman; Irazola, Vilma; Rubinstein, Adolfo

2012-01-01

Introduction Health care utilization is an important step to disease management, providing opportunities for prevention and treatment. Anderson’s Health Behavior Model has defined utilization by need, predisposing, and enabling determinants. We hypothesize that need, predisposing, and enabling, highlighting behavioral factors are associated with utilization in Argentina. Methods We performed a logistic regression analysis of the 2005 and 2009 Argentinean Survey of Risk Factors, a cohort of 41,392 and 34,732 individuals, to explore the association between need, enabling, predisposing, and behavioral factors to blood pressure measurement in the last year. Results In the 2005 cohort, blood pressure measurement was associated with perception of health, insurance coverage, basic needs met, and income. Additionally, female sex, civil state, household type, older age groups, education, and alcohol use were associated with utilization. The 2009 cohort showed similar associations with only minor differences between the models. Conclusions We explored the association between utilization of clinical preventive services with need, enabling, predisposing, and behavioral factors. While predisposing and need determinants are associated with utilization, enabling factors such as insurance coverage provides an area for public intervention. These are important findings where policies should be focused to improve utilization of preventive services in Argentina. PMID:22984608

Pediatric Dentist Density and Preventive Care Utilization for Medicaid Children.

PubMed

Heidenreich, James F; Kim, Amy S; Scott, JoAnna M; Chi, Donald L

2015-01-01

The purpose of this study was to evaluate county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children. This was a cross-sectional analysis of 604,885 zero- to 17-year-olds enrolled in the Washington State Medicaid Program for 11-12 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models. In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children utilizing preventive dental services. County-level density was significantly associated with county-level dental care utilization (Slope equals 1.67, 95 percent confidence interval equals 0.02, 3.32, P<.05). There is a significant relationship between pediatric dentist density and the proportion of Medicaid-enrolled children who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children.

Traveler Information Services in Rural Tourism Areas. Appendix C: Observations at Tourist Interactions with Kiosks

DOT National Transportation Integrated Search

2000-06-30

In originally designing the qualitative research, the researchers had expected to find well-utilized kiosks in highly visible locations. They expected that travelers would understand the uses of the kiosks and would be using them for practical trip p...

75 FR 8895 - Basin Electric Power Cooperative: Deer Creek Station

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-26

.... The purpose of the proposed Project is to help serve increased load demand for electric power in the... Basin Electric Power Cooperative: Deer Creek Station AGENCY: Rural Utilities Service, USDA. ACTION...) and the Western Area Power Administration (Western) have issued a Draft Environmental Impact Statement...

An Environmental Experience. Man: Steward of His Environment.

ERIC Educational Resources Information Center

New York State Education Dept., Albany.

Environmental awareness experiences described in this guide are designed to serve as models or suggestions for teachers conducting activities directed toward environmental improvement. "Man: Steward of His Environment" is the theme of the 14 experiences utilizing behavior profiles, audio-visual exhibits, area studies, service projects, mass…

Habitat Evaluation Procedures (HEP) Report; Tacoma/Trimble Area Management Plan, Technical Report 2001-2003.

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

Entz, Ray; Lockwood, Jr., Neil; Holmes, Darren

2003-10-01

In 2000 and 2001, the Kalispel Natural Resource Department (KNRD) continued to mitigate the wildlife habitat losses as part of the Albeni Falls Wildlife Mitigation Project. Utilizing Bonneville Power Administration (BPA) funds, the Kalispel Tribe of Indians (Tribe) purchased three projects totaling nearly 1,200 acres. The Tacoma/Trimble Wildlife Management Area is a conglomeration of properties now estimated at 1,700 acres. It is the Tribe's intent to manage these properties in cooperation and collaboration with the Pend Oreille County Public Utility District (PUD) No. 1 and the U.S. Fish and Wildlife Service (USFWS) to benefit wildlife habitats and associated species, populations,more » and guilds.« less

Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and RH status: Bangladesh

PubMed Central

2011-01-01

Background Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by the government and/or development partners. Broadly termed "Demand-Side Financing" or "Output-Based Aid", includes a range of interventions that channel government or donor subsidies to the service user rather than the service provider. Initial findings from the few assessments of reproductive health voucher-and-accreditation programs suggest that, if implemented well, these programs have great potential for achieving the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality. At this point in time, however, there is a paucity of evidence describing how the various voucher programs function in different settings, for various reproductive health services. Methods/Design Population Council-Nairobi, funded by the Bill and Melinda Gates Foundation, intends to address the lack of evidence around the pros and cons of 'voucher and accreditation' approaches to improving the reproductive health of low income women in five developing countries. In Bangladesh, the activities will be conducted in 11 accredited health facilities where Demand Side Financing program is being implemented and compared with populations drawn from areas served by similar non-accredited facilities. Facility inventories, client exit interviews and service provider interviews will be used to collect comparable data across each facility for assessing readiness and quality of care. In-depth interviews with key stakeholders will be conducted to gain a deeper understanding about the program. A population-based survey will also be carried out in two types of locations: areas where vouchers are distributed and similar locations where vouchers are not distributed. Discussion This is a quasi-experimental study which will investigate the impact of the voucher approach on improving maternal health behaviors and status and reducing inequities at the population level. We expect a significant increase in the utilization of maternal health care services by the accredited health facilities in the experimental areas compared to the control areas as a direct result of the interventions. If the voucher scheme in Bangladesh is found effective, it may help other countries to adopt this approach for improving utilization of maternity care services for reducing maternal mortality. PMID:21513528

Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and RH status: Bangladesh.

PubMed

Rob, Ubaidur; Rahman, Moshiur; Bellows, Benjamin

2011-04-22

Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by the government and/or development partners. Broadly termed "Demand-Side Financing" or "Output-Based Aid", includes a range of interventions that channel government or donor subsidies to the service user rather than the service provider. Initial findings from the few assessments of reproductive health voucher-and-accreditation programs suggest that, if implemented well, these programs have great potential for achieving the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality. At this point in time, however, there is a paucity of evidence describing how the various voucher programs function in different settings, for various reproductive health services. Population Council-Nairobi, funded by the Bill and Melinda Gates Foundation, intends to address the lack of evidence around the pros and cons of 'voucher and accreditation' approaches to improving the reproductive health of low income women in five developing countries. In Bangladesh, the activities will be conducted in 11 accredited health facilities where Demand Side Financing program is being implemented and compared with populations drawn from areas served by similar non-accredited facilities. Facility inventories, client exit interviews and service provider interviews will be used to collect comparable data across each facility for assessing readiness and quality of care. In-depth interviews with key stakeholders will be conducted to gain a deeper understanding about the program. A population-based survey will also be carried out in two types of locations: areas where vouchers are distributed and similar locations where vouchers are not distributed. This is a quasi-experimental study which will investigate the impact of the voucher approach on improving maternal health behaviors and status and reducing inequities at the population level. We expect a significant increase in the utilization of maternal health care services by the accredited health facilities in the experimental areas compared to the control areas as a direct result of the interventions. If the voucher scheme in Bangladesh is found effective, it may help other countries to adopt this approach for improving utilization of maternity care services for reducing maternal mortality.

Effect of Free Maternal Health Care Program on Health-seeking Behaviour of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study.

PubMed

Edu, Betta Chimaobim; Agan, Thomas U; Monjok, Emmanuel; Makowiecka, Krystyna

2017-06-15

Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of "PROJECT HOPE" where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria. A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program. Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system. Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.

Skilled delivery service utilization and its association with the establishment of Women's Health Development Army in Yeky district, South West Ethiopia: a multilevel analysis.

PubMed

Negero, Melese Girmaye; Mitike, Yifru Berhan; Worku, Abebaw Gebeyehu; Abota, Tafesse Lamaro

2018-01-30

Because of the unacceptably high maternal and perinatal morbidity and mortality, the government of Ethiopia has established health extension program with a community-based network involving health extension workers (HEWs) and a community level women organization which is known as "Women's Health Development Army" (WHDA). Currently, the HEWs and WHDA network is the approach preferred by the government to register pregnant women and encourage them to link in the healthcare system. However, its association with skilled delivery service utilization is not well known. A community-based cross-sectional study was conducted from January to February 2015. Within 380 clusters of WHDA, a total of 748 reproductive-age women who gave birth in 1 year preceding the study, were included using multistage sampling technique. The data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Multilevel analysis technique was applied to check for an association of selected variables with a utilization of skilled delivery service. About 45% of women have received skilled delivery care. A significant heterogeneity was observed between "Women's Health Development Teams (clusters)" for skilled delivery care service utilization which explains about 62% of the total variation. Individual-level predictors including urban residence [AOR (95% CI) 35.10 (4.62, 266.52)], previous exposure of complications [AOR (95% CI) 3.81 (1.60, 9.08)], at least four ANC visits [AOR (95% CI) 7.44 (1.48, 37.42)] and preference of skilled personnel [AOR (95% CI) 8.11 (2.61, 25.15)] were significantly associated with skilled delivery service use. Among cluster level variables, the distance of clusters within 2 km radius from the nearest health facility was significantly associated [AOR (95% CI) 6.03 (1.92, 18.93)] with skilled delivery service utilization. In this study, significant variation among clusters of WHDA was observed. Both individual and cluster level variables were identified to predict skilled delivery service utilization. Encouraging women to have frequent ANC visits (- 4 and above), enhancing awareness creation towards the delivery care attendance, constructing more health facilities and roads in hard to reach areas and establishing telemedicine services are recommended.

RH knowledge and service utilization among unmarried rural-to-urban migrants in three major cities, China

PubMed Central

2011-01-01

Background Large numbers of unmarried migrants are on the continuous move from rural-to-urban areas within China mainland, meanwhile their Reproductive Health (RH) is underserved when it is compared with the present urban RH policies. The purpose of this study is to investigate the RH knowledge and the utilization of RH services among unmarried migrants. Methods A cross-section survey was performed in three cities in China-Shenzhen, Guangzhou and Wuhan. A total of 3,450 rural-to-urban unmarried migrants were chosen according to a purposive sampling method. Around 3,412 (male: 1,680, female: 1,732) were qualified for this study. A face-to-face structured questionnaire survey was used, which focused on the knowledge concerning "fertility, contraception and STD/AIDS," as well as RH service utilization. Results Among unmarried migrants the RH knowledge about pregnancy-fertilization (29.4%) and contraception (9.1%) was at its lowest level. Around 21% of unmarried migrants had pre-marital sexual experience and almost half (47.4%) never used condoms during sexual intercourse. The most obtained RH services was about STD/AIDS health education (female: 49.6%, male: 50.2%) and free prophylactic use of contraceptives and/or condoms (female: 42.5%, male: 48.3%). As for accessing RH checkup services it was at its lowest level among females (16.1%). Those who migrated to Shenzhen (OR = 0.64) and Guangzhou (OR = 0.53) obtained few RH consultations compared to those in Wuhan. The white collar workers received more RH consultations and checkup services than the blue collar workers (all group P < 0.01). Conclusion RH knowledge and the utilization of RH services amongst unmarried migrants remain insufficient in the three studied major cities. This study reveals the important gaps in the RH services' delivery, and highlights the requirements for tailored interventions, including further research, to address more effectively the demands and the needs of the unmarried migrant populations. PMID:21284893

Innovations in health service organization and delivery in northern rural and remote regions: a review of the literature.

PubMed

Mitton, Craig; Dionne, Francois; Masucci, Lisa; Wong, Sabrina; Law, Susan

2011-01-01

To identify and review innovations relevant to improving access, quality, efficiency and/or effectiveness in the organization and delivery of health care services in rural and remote areas. Literature review. Key bibliographic databases that index health research were searched: MEDLINE, EMBASE and CINAHL. Other databases relevant to Arctic health were also accessed. Abstracts were assessed for relevancy and full articles were reviewed and categorized according to emergent themes. Many innovations in delivering services to rural and remote areas were identified, particularly in the public health realm. These innovations were grouped into 4 key themes: organizational structure of health services; utilization of telehealth and ehealth; medical transportation; and public health challenges. Despite the challenges facing rural and remote regions, there is a distinctly positive message from this broad literature review. Evidence-based initiatives exist across a range of areas - which include operational efficiency and integration, access to care, organizational structure, public health, continuing education and workforce composition - that have the potential to positively impact health care quality and health-related outcomes.

Exploiting Aura OMI Level 2 Data with High Resolution Visualization

NASA Astrophysics Data System (ADS)

Wei, J. C.; Yang, W.; Johnson, J. E.; Zhao, P.; Gerasimov, I. V.; Pham, L.; Vicente, G. A.; Shen, S.

2014-12-01

Satellite data products are important for a wide variety of applications that can bring far-reaching benefits to the science community and the broader society. These benefits can best be achieved if the satellite data are well utilized and interpreted, such as model inputs from satellite, or extreme event (such as volcano eruption, dust storm, …etc) interpretation from satellite. Unfortunately, this is not always the case, despite the abundance and relative maturity of numerous satellite data products provided by NASA and other organizations. One way to help users better understand the satellite data is to provide data along with 'Images', including accurate pixel-level (Level 2) information, pixel coverage area delineation, and science team recommended quality screening for individual geophysical parameters. Goddard Earth Sciences Data and Information Services Center (GES DISC) always strives to best support (i.e., Software-as-a-service, SaaS) the user-community for NASA Earth Science Data. In this case, we will present a new visualization tool that helps users exploiting Aura Ozone Monitoring Instrument (OMI) Level 2 data. This new visualization service utilizes Open Geospatial Consortium (OGC) standard-compliant Web Mapping Service (WMS) and Web Coverage Service (WCS) calls in the backend infrastructure. The functionality of the service allows users to select data sources (e.g., multiple parameters under the same measurement, like NO2 and SO2 from OMI Level 2 or same parameter with different methods of aggregation, like NO2 in OMNO2G and OMNO2D products), defining area-of-interest and temporal extents, zooming, panning, overlaying, sliding, and data subsetting and reformatting. The interface will also be able to connect to other OGC WMS and WCS servers, which will greatly enhance its expandability to integrate additional outside data/map sources (such as Global Imagery Browse Services (GIBS)).

Coordinating water conservation efforts through tradable credits: A proof of concept for drought response in the San Francisco Bay area

NASA Astrophysics Data System (ADS)

Gonzales, Patricia; Ajami, Newsha; Sun, Yujie

2017-09-01

Water utilities are increasingly relying on water efficiency and conservation to extend the availability of supplies. Despite spatial and institutional interdependency of many utilities, these demand-side management initiatives have traditionally been tackled by individual utilities operating in isolation. In this study, we introduce a policy framework for water conservation credits that enables collaboration at the regional scale. Under the proposed approach, utilities have the flexibility to invest in water conservation measures that are appropriate for their specific service area. When utilities have insufficient capacity for local cost-effective measures, they may opt to purchase credits, contributing to fund subsidies for utilities that do have that capacity and can provide the credits, while the region as a whole benefits from more reliable water supplies. This work aims to provide insights on the potential impacts of a water conservation credit policy framework when utilities are given the option to collaborate in their efforts. We model utility decisions as rational cost-minimizing actors subject to different decision-making dynamics and water demand scenarios, and demonstrate the institutional characteristics needed for the proposed policy to be effective. We apply this model to a counterfactual case study of water utility members of the Bay Area Water Supply and Conservation Agency in California during the drought period of June 2015 to May 2016. Our scenario analysis indicates that when the institutional structure and incentives are appropriately defined, water agencies can achieve economic benefits from collaborating in their conservation efforts, especially if they coordinate more closely in their decision-making.

Deployment Area Selection and Land Withdrawal/Acquisition. M-X/MPS (M-X/Multiple Protective Shelter) Environmental Technical Report. Native Americans Nevada/Utah.

DTIC Science & Technology

1981-10-02

Northern Paiute, Shoshone, Ute, and Southern Paiute peoples developed solutions to natural limitations based upon botanical and zoological expertise and...Land Management and the Forest Service. Other Land-based Activities (3.1.5.2.2) The tribe intends to build a hydroponic greenhouse which will utilize the...other development goals--notably the development of a hydroponic greenhouse utilizing flow from natural wdrm springs on the reservation, and development

Interactions among Variables Affecting Hospital Utilization

PubMed Central

Ro, Kong-kyun

1973-01-01

For purposes of developing a more refined basis for prediction of hospital utilization using readily available demographic variables, data for some 9000 patients admitted to 22 short-term general hospitals in the Pittsburgh area are analyzed to determine the relationship of age, sex, and race to hospital use. Significant differences in length of stay and number of services used are found for various combinations of these variables when a form of multiple regression is used that allows for interaction effects among the variables. PMID:4783753

Mixed Methods in Prostate Cancer Prevention and Service Utilization Planning: Combining Focus Groups, Survey Research, and Community Engagement.

PubMed

Tataw, David Besong; Ekúndayò, Olúgbémiga T

2017-01-01

This article reports on the use of sequential and integrated mixed-methods approach in a focused population and small-area analysis. The study framework integrates focus groups, survey research, and community engagement strategies in a search for evidence related to prostate cancer screening services utilization as a component of cancer prevention planning in a marginalized African American community in the United States. Research and data analysis methods are synthesized by aggregation, configuration, and interpretive analysis. The results of synthesis show that qualitative and quantitative data validate and complement each other in advancing our knowledge of population characteristics, variable associations, the complex context in which variables exist, and the best options for prevention and service planning. Synthesis of findings and interpretive analysis provided two important explanations which seemed inexplicable in regression outputs: (a) Focus group data on the limitations of the church as an educational source explain the negative association between preferred educational channels and screening behavior found in quantitative analysis. (b) Focus group data on unwelcoming provider environments explain the inconsistent relationship between knowledge of local sites and screening services utilization found in quantitative analysis. The findings suggest that planners, evaluators, and scientists should grow their planning and evaluation evidence from the community they serve.

Relationship of self-reported asthma severity and urgent health care utilization to psychological sequelae of the September 11, 2001 terrorist attacks on the World Trade Center among New York City area residents.

PubMed

Fagan, Joanne; Galea, Sandro; Ahern, Jennifer; Bonner, Sebastian; Vlahov, David

2003-01-01

Posttraumatic psychological stress may be associated with increases in somatic illness, including asthma, but the impact of the psychological sequelae of the September 11, 2001 terrorist attacks on physical illness has not been well documented. The authors assessed the relationship between the psychological sequelae of the attacks and asthma symptom severity and the utilization of urgent health care services for asthma since September 11. The authors performed a random digit dial telephone survey of adults in the New York City (NYC) metropolitan area 6 to 9 months after September 11, 2001. Two thousand seven hundred fifty-five demographically representative adults including 364 asthmatics were recruited. The authors assessed self-reported asthma symptom severity, emergency room (ER) visits, and unscheduled physician office visits for asthma since September 11. After adjustment for asthma measures before September 11, demographics, and event exposure in multivariate models posttraumatic stress disorder (PTSD) were a significant predictor of self-reported moderate-to-severe asthma symptoms (OR = 3.4; CI = 1.2-9.4), seeking care for asthma at an ER since September 11 (OR = 6.6; CI = 1.6-28.0), and unscheduled physician visits for asthma since September 11 (OR = 3.6; CI = 1.1-11.5). The number of PTSD symptoms was also significantly related to moderate-to-severe asthma symptoms and unscheduled physician visits since September 11. Neither a panic attack on September 11 nor depression since September 11 was an independent predictor of asthma severity or utilization in multivariate models after September 11. PTSD related to the September 11 terrorist attacks contributed to symptom severity and the utilization of urgent health care services among asthmatics in the NYC metropolitan area.

A systematic review of help-seeking and mental health service utilization among military service members.

PubMed

Hom, Melanie A; Stanley, Ian H; Schneider, Matthew E; Joiner, Thomas E

2017-04-01

Research has demonstrated that military service members are at elevated risk for a range of psychiatric problems, and mental health services use is a conduit to symptom reduction and remission. Nonetheless, there is a notable underutilization of mental health services in this population. This systematic review aimed to identify and critically examine: (1) rates of service use; (2) barriers and facilitators to care; and (3) programs and interventions designed to enhance willingness to seek care and increase help-seeking behaviors among current military personnel (e.g., active duty, National Guard, Reserve). Overall, 111 peer-reviewed articles were identified for inclusion. Across studies, the rate of past-year service use among service members with mental health problems during the same time frame was 29.3% based on weighted averages. Studies identified common barriers to care (e.g., concerns regarding stigma, career impact) and facilitators to care (e.g., positive attitudes toward treatment, family/friend support, military leadership support) among this population. Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization. Critical areas for future research on treatment engagement among this high-risk population are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

77 FR 4275 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-27

... number. Rural Utilities Service Title: 7 CFR Part 1724 and Part 1738 Electric Engineering, Architectural... improving of electric energy to persons in rural areas. Title 7 CFR 1724 requires each borrower to select a... forms provide standardized contract agreements between the electric or broadband borrower and the...

Piedmont Export Expansion Program Monograph: A Final Report.

ERIC Educational Resources Information Center

Brown, Ralph W., Jr.; Peniche, Eduardo A.

The Piedmont Export Expansion Program (PEEP) was developed to increase the number of businesses in central Virginia entering or expanding export trade; to increase the utilization of the services of Central Virginia Community College's (CVCC's) Cross-Cultural and Foreign Language Resource Center by area export businesses; to increase the number of…

Technology utilization in a non-urban region: Further impact and technique of the Technology Use Studies Center (6)

NASA Technical Reports Server (NTRS)

Gold, H. C.; Moore, A. M.; Dodd, B.; West, S. G.

1976-01-01

The activities of the TU Center are reported. Areas reported include: TUSC clientele informaton, dissemination and assistance, faculty information service, and cooperation with other agencies. The general aviation news letter is included along with transfer and impact reports.

10 CFR 63.112 - Requirements for preclosure safety analysis of the geologic repository operations area.

Code of Federal Regulations, 2014 CFR

2014-01-01

... emergency power to instruments, utility service systems, and operating systems important to safety if there... include: (a) A general description of the structures, systems, components, equipment, and process... of the performance of the structures, systems, and components to identify those that are important to...

10 CFR 63.112 - Requirements for preclosure safety analysis of the geologic repository operations area.

Code of Federal Regulations, 2013 CFR

2013-01-01

... emergency power to instruments, utility service systems, and operating systems important to safety if there... include: (a) A general description of the structures, systems, components, equipment, and process... of the performance of the structures, systems, and components to identify those that are important to...

10 CFR 63.112 - Requirements for preclosure safety analysis of the geologic repository operations area.

Code of Federal Regulations, 2012 CFR

2012-01-01

... emergency power to instruments, utility service systems, and operating systems important to safety if there... include: (a) A general description of the structures, systems, components, equipment, and process... of the performance of the structures, systems, and components to identify those that are important to...

10 CFR 63.112 - Requirements for preclosure safety analysis of the geologic repository operations area.

Code of Federal Regulations, 2011 CFR

2011-01-01

... emergency power to instruments, utility service systems, and operating systems important to safety if there... include: (a) A general description of the structures, systems, components, equipment, and process... of the performance of the structures, systems, and components to identify those that are important to...

Community Resources: A Partnership in Career Education.

ERIC Educational Resources Information Center

Prince George's County Board of Education, Upper Marlboro, MD.

A directory of local community resource personnel and their services which have been utilized by the Prince George's County Public Schools, Maryland for their career education program is presented. A standardized form was used to gain information from area industries and businesses regarding field trips, field activities, day long observations,…

What Presidents Need To Know about the Impact of Networking.

ERIC Educational Resources Information Center

Leadership Abstracts, 1993

1993-01-01

Many colleges and universities are undergoing cultural changes as a result of extensive voice, data, and video networking. Local area networks link large portions of most campuses, and national networks have evolved from specialized services for researchers in computer-related disciplines to general utilities on many campuses. Campuswide systems…

Managerial Occupations; Commercial Cooking and Baking: 9193.24.

ERIC Educational Resources Information Center

Dade County Public Schools, Miami, FL.

Especially designed for students who show management potential, this course is designed to teach effective management and control of the food service area of an establishment. Emphasis is placed on labor control, supplies (other than food), utilities, laundry, and uniforms. Course content includes goals, specific objectives, management, labor…

Effects of mutual health organizations on use of priority health-care services in urban and rural Mali: a case-control study.

PubMed

Franco, Lynne Miller; Diop, François Pathé; Burgert, Clara R; Kelley, Allison Gamble; Makinen, Marty; Simpara, Cheick Hamed Tidiane

2008-11-01

To examine the effects of a community-based mutual health organization (MHO) on utilization of priority health services, financial protection of its members and inclusion of the poor and other target groups. Four MHOs were established in two districts in Mali. A case-control study was carried out in which household survey data were collected from 817 MHO member households, 787 non-member households in MHO catchment areas, and 676 control households in areas without MHOs. We compiled MHO register data by household for a 22-month period. Outcome measures included utilization of priority services, health expenditures and out-of-pocket payments. Independent variables included individual, household and community demographic, socioeconomic and access characteristics, as determined through a household survey in 2004. MHO members who were up to date on premium payments (controlling for education, distance to the nearest health facility and other factors) were 1.7 times more likely to get treated for fevers in modern facilities; three times more likely to take children with diarrhoea to a health facility and/or treat them with oral rehydration salts at home; twice as likely to make four or more prenatal visits; and twice as likely, if pregnant or younger than 5 years, to sleep under an insecticide-treated net (P < 0.10 or better in all cases). However, distance was also a significant negative predictor for the utilization of many services, particularly assisted deliveries. Household and individual enrolment in an MHO were not significantly associated with socioeconomic status (with the exception of the highest quintile), and MHOs seemed to provide some financial protection for their members. MHOs are one mechanism that countries strengthening the supply of primary care can use to increase financial access to - and equity in - priority health services.

Physical therapists familiarity and beliefs about health services utilization and health seeking behaviour.

PubMed

Clewley, Derek; Rhon, Dan; Flynn, Tim; Koppenhaver, Shane; Cook, Chad

2018-02-21

Physical therapists' familiarity, perceptions, and beliefs about health services utilization and health seeking behaviour have not been previously assessed. The purposes of this study were to identify physical therapists' characteristics related to familiarity of health services utilization and health seeking behaviour, and to assess what health seeking behaviour factors providers felt were related to health services utilization. We administered a survey based on the Andersen behavioural model of health services utilization to physical therapists using social media campaigns and email between March and June of 2017. In addition to descriptive statistics, we performed binomial logistic regression analysis. We asked respondents to rate familiarity with health services utilization and health seeking behaviour and collected additional characteristic variables. Physical therapists are more familiar with health services utilization than health seeking behaviour. Those who are familiar with either construct tend to be those who assess for health services utilization, use health services utilization for a prognosis, and believe that health seeking behaviour is measurable. Physical therapists rated need and enabling factors as having more influence on health services utilization than predisposing and health belief factors. Physical therapists are generally familiar with health services utilization and health seeking behaviour; however, there appears to be a disconnect between what is familiar, what is perceived to be important, and what can be assessed for both health services utilization and health seeking behaviour. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. All rights reserved.

Homelessness among a nationally representative sample of US veterans: prevalence, service utilization, and correlates.

PubMed

Tsai, Jack; Link, Bruce; Rosenheck, Robert A; Pietrzak, Robert H

2016-06-01

To examine the prevalence of lifetime homelessness among veterans and use of Veterans Affairs (VA) homeless services, as well as their association with sociodemographic and clinical characteristics. A nationally representative sample of 1533 US veterans was surveyed July-August 2015. Among all veterans, 8.5 % reported any lifetime homelessness in their adult life, but only 17.2 % of those reported using VA homeless services. Prevalence of homelessness and VA homeless service use did not significantly differ by gender. Being low income, aged 35-44, and having poor mental and physical health were each independently associated with lifetime homelessness. Veterans who were White or lived in rural areas were significantly less likely to have used VA homeless services. Homelessness remains a substantial problem across different generations of veterans. The low reported uptake of VA homeless services suggests there are barriers to care in this population, especially for veterans who live in rural areas. Governmental resources dedicated to veteran homelessness should be supported, and obtaining accurate prevalence estimates are important to tracking progress over time.

Bacterial composition in a metropolitan drinking water distribution system utilizing different source waters.

PubMed

Gomez-Alvarez, Vicente; Humrighouse, Ben W; Revetta, Randy P; Santo Domingo, Jorge W

2015-03-01

We investigated the bacterial composition of water samples from two service areas within a drinking water distribution system (DWDS), each associated with a different primary source of water (groundwater, GW; surface water, SW) and different treatment process. Community analysis based on 16S rRNA gene clone libraries indicated that Actinobacteria (Mycobacterium spp.) and α-Proteobacteria represented nearly 43 and 38% of the total sequences, respectively. Sequences closely related to Legionella, Pseudomonas, and Vibrio spp. were also identified. In spite of the high number of sequences (71%) shared in both areas, multivariable analysis revealed significant differences between the GW and SW areas. While the dominant phylotypes where not significantly contributing in the ordination of samples, the populations associated with the core of phylotypes (1-10% in each sample) significantly contributed to the differences between both service areas. Diversity indices indicate that the microbial community inhabiting the SW area is more diverse and contains more distantly related species coexisting with local assemblages as compared with the GW area. The bacterial community structure of SW and GW service areas were dissimilar, suggesting that their respective source water and/or water quality parameters shaped by the treatment processes may contribute to the differences in community structure observed.

The Effect of Medicaid Physician Fee Increases on Health Care Access, Utilization, and Expenditures.

PubMed

Callison, Kevin; Nguyen, Binh T

2018-04-01

To evaluate the effect of Medicaid fee changes on health care access, utilization, and spending for Medicaid beneficiaries. We use the 2008 and 2012 waves of the Medical Expenditure Panel Survey linked to state-level Medicaid-to-Medicare primary care reimbursement ratios obtained through surveys conducted by the Urban Institute. We also incorporate data from the Current Population Survey and the Area Resource Files. Using a control group made up of the low-income privately insured, we conduct a difference-in-differences analysis to assess the relationship between Medicaid fee changes and access to care, utilization of health care services, and out-of-pocket medical expenditures for Medicaid enrollees. We find that an increase in the Medicaid-to-Medicare payment ratio for primary care services results in an increase in outpatient physician visits, emergency department utilization, and prescription fills, but only minor improvements in access to care. In addition, we report an increase in total annual out-of-pocket expenditures and spending on prescription medications. Compared to the low-income privately insured, increased primary care reimbursement for Medicaid beneficiaries leads to higher utilization and out-of-pocket spending for Medicaid enrollees. © Health Research and Educational Trust.

Equity in maternal health care service utilization: a systematic review for developing countries.

PubMed

Çalışkan, Zafer; Kılıç, Dilek; Öztürk, Selcen; Atılgan, Emre

2015-11-01

The objective was to explore progress of equity in the utilization of maternal health care services in developing countries since maternal care is a crucial factor in reducing maternal mortality, which is targeted by the Millennium Development Goal 5. A systematic review of quantitative studies was done. PubMed Central, Web of Science, and Science Direct databases were searched for peer-reviewed and English-language articles published between 2005 and 2015. Thirty-six articles were included in the review. The results reveal the lack of equity in the utilization of maternal health care in developing countries. Thirty-three out of 36 studies found evidence supporting severe inequities while three studies found evidence of equity or at least improvement in terms of equity. Most of the literature devoted to utilization of maternal health care generally provides information on the level of maternal care used and ignore the equity problem. Research in this area should focus not only on the level of maternal care used but also on the most disadvantaged segments of the population in terms of utilization of maternal care in order to reach the set targets.

Misuse of antenatal care and its association with adverse outcomes of pregnancy in a Southern rural area of Vietnam.

PubMed

Ngo, Thi-Thuy-Dung; Nguyen, The-Dung; Goyens, Philippe; Robert, Annie

2018-04-01

Researchers in Vietnam reported a high percentage of pregnant women attending ANC at least once, but an insufficient utilization of ANC services remains. The evidence demonstrating how the utilization of these services affect pregnancy outcome is not documented in Vietnam. We investigated the association between the misuse of ANC services and pregnancy outcome, and assessed other determinants associated with ANC services utilization. We conducted a prospective community-based study in Trang Bom district, Dong Nai, during 12 consecutive months. Data were collected using a structured questionnaire and medical records. Women were followed up to delivery. Misuse of ANC services, related factors and its association with adverse events were assessed using logistic regression. Out of 3301 pregnant women, 91% initiated an ANC visit within first trimester, 95% attended at least three ANC visits, but a low percentage of pregnant women underwent blood and urine tests at least once (20% and 39%, respectively). Factors significantly associated with a higher risk of adverse outcomes were lack of blood test and urine test, parity ≥ 3, ANC visits < 3, history of an adverse outcome, and having a clinical condition. Blood and urine tests were less frequently used by young women, women from ethnic minorities, women using only private facilities for ANC attendance, and women with a low number of ANC visits. Despite a high percentage of early entry into ANC and of at least three ANC visits, misuse of ANC services still exists and contributes to adverse outcomes. There is a need to increase the awareness of women on the benefits of ANC services by educating young women as well as women with several children. Health workers should be encouraged to propose suitable ANC services to pregnant women.

An evaluation of rural health care research.

PubMed

Kane, R; Dean, M; Solomon, M

1979-05-01

Reviews the state of the art of rural health research and evaluation in the U.S. with particular emphasis on the questions of access, health personnel, and financing. The current state of knowledge both in the published and unpublished literature in each area is summarized and a series of unresolved issues is proposed. A strategy for further research to include the various types of rural health care programs is described. Major findings suggest that, although rural populations do have somewhat less access to care than do urban populations, our ability to quantify precisely the extent and importance of this discrepancy is underdeveloped. Despite a substantial investment in a variety of rural health care programs there is inadequate information as to their effectiveness. Programs designed to increase the supply of health personnel to rural areas have met with mixed success. Sites staffed by National Health Service Corps personnel show consistently lower productivity than do sites under other sponsorship. Nonphysician personnel (physician assistants and nurse practitioners) offer a promising source of primary care for rural areas: recent legislation that reimburses such care should increase their utilization. A persistent problem is the expectation (often a mandate) incorporated into many rural health care demonstration efforts that the programs become financially self-sufficient in a finite period of time. Self-sufficiency is a function of utilization, productivity, and the ability to recover charges for services. In many instances stringent enforcement of the self-sufficiency requirement may mean those who need services most will be least likely to receive them.

Auditing a court assessment and advice service for defendants with mental health difficulties: utilizing electronic patient records.

PubMed

Gough, Karen; Magness, Laura; Winstanley, Julia

2012-07-01

This study is an audit of the Somerset Court Advice and Assessment Service (CAAS) throughout its first year of implementation. It reports that the service successfully met the six desired objectives as set out in its Service Level Agreement. Further to this, it reports that the use of National Health Service electronic patient records within a court setting facilitated the provision of apposite and timely information to the court. Specific findings were that deliberate self-harm/suicidal ideation and mood disorders were the primary reasons for a person requiring CAAS involvement. Violence against the person, breach of orders and theft were the most prevalent categories of offending within this referred group. The prevalence of previous psychiatric history was significantly higher than found in comparable audits. It is likely that this is due to the efficacy of proactive and in vivo utilization of electronic patient records. Conclusions include the need to work in partnership with drug and alcohol agencies and the importance of recognizing that these services have significant clinical benefits for defendants with mental health problems, and the court system in terms of financial savings. We suggest ongoing audit is necessary to guide the development of other schemes in this pioneering service area.

Development of a Web-based tool to collect and display water system customer service areas for public health action.

PubMed

Wong, Michelle; Wolff, Craig; Collins, Natalie; Guo, Liang; Meltzer, Dan; English, Paul

2015-01-01

Significant illness is associated with biological contaminants in drinking water, but little is known about health effects from low levels of chemical contamination in drinking water. To examine these effects in epidemiological studies, the sources of drinking water of study populations need to be known. The California Environmental Health Tracking Program developed an online application that would collect data on the geographic location of public water system (PWS) customer service areas in California, which then could be linked to demographic and drinking water quality data. We deployed the Water Boundary Tool (WBT), a Web-based geospatial crowdsourcing application that can manage customer service boundary data for each PWS in California and can track changes over time. We also conducted a needs assessment for expansion to other states. The WBT was designed for water system operators, local and state regulatory agencies, and government entities. Since its public launch in 2012, the WBT has collected service area boundaries for about 2300 individual PWS, serving more than 90% of the California population. Results of the needs assessment suggest interest and utility for deploying such a tool among states lacking statewide PWS service area boundary data. Although the WBT data set is incomplete, it has already been used for a variety of applications, including fulfilling legislatively mandated reporting requirements and linking customer service areas to drinking water quality data to better understand local water quality issues. Development of this tool holds promise to assist with outbreak investigations and prevention, environmental health monitoring, and emergency preparedness and response.

Standby Rates for Combined Heat and Power Systems

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

Sedano, Richard; Selecky, James; Iverson, Kathryn

2014-02-01

Improvements in technology, low natural gas prices, and more flexible and positive attitudes in government and utilities are making distributed generation more viable. With more distributed generation, notably combined heat and power, comes an increase in the importance of standby rates, the cost of services utilities provide when customer generation is not operating or is insufficient to meet full load. This work looks at existing utility standby tariffs in five states. It uses these existing rates and terms to showcase practices that demonstrate a sound application of regulatory principles and ones that do not. The paper also addresses areas formore » improvement in standby rates.« less

Transfusion medicine's role in hospital performance improvement. An administrator's view.

PubMed

Krempel, G; Jarosz, C

1999-06-01

Historically, hospital administrators have viewed all laboratory sections as cost centers. The major expenses in the transfusion service are those associated with labor and blood products. However, few administrators take the time to look past this cost to see the impact of an active transfusion medicine section in other areas of the hospital. This article examines the impact of inventory management, blood component utilization and waste, group purchasing, and new program implementation on transfusion service expense and revenue.

Self-reported utilization of mental health services in the adult German population--evidence for unmet needs? Results of the DEGS1-Mental Health Module (DEGS1-MH).

PubMed

Mack, Simon; Jacobi, Frank; Gerschler, Anja; Strehle, Jens; Höfler, Michael; Busch, Markus A; Maske, Ulrike E; Hapke, Ulfert; Seiffert, Ingeburg; Gaebel, Wolfgang; Zielasek, Jürgen; Maier, Wolfgang; Wittchen, Hans-Ulrich

2014-09-01

This paper provides up-to-date data on service use for mental health problems and disorders among adults aged 18-79 years in Germany derived from the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH; N=4483). Data are based exclusively on self-report. Respondents were examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview DIA-X/M-CIDI to assess diagnoses according to the criteria of DSM-IV-TR. Service use, i.e. contact to mental health care services, due to mental health problems was assessed for the past 12 months and lifetime, by type of sector and type of institution. Among respondents with a 12-month diagnosis of a mental disorder, 23.5% of the women and 11.6% of the men reported any service use in the past 12 months. Service use depends on type of diagnosis, comorbidity and socio-demographic characteristics. Lowest 12-month utilization rates were found for substance use disorders (15.6%; lifetime use 37.3%), highest for psychotic disorders (40.5%; lifetime 72.1%). Further, a considerable time lap was found between disorder onset and subsequent service use among the majority of cases with anxiety and mood disorders. This paper provides self-reported epidemiological data on mental health service use in Germany, complementing administrative statistics and the predecessor mental health module of the German Health Interview and Examination Survey (GHS-MHS) from 1998. Despite considerable changes in the mental health field in Germany and the existence of a comprehensive mental health care system without major financial barriers, we find no indications of substantially higher utilization rates for mental disorders as compared to other comparable European countries. Further, no indications of major overall changes in utilization rates are apparent. To pinpoint areas with unmet needs, more detailed analyses of the data are needed taking into account type, frequency, and adequacy of service use and treatment of mental disorders. Appropriately matched comparisons with the GHS-MHS are needed to identify changes in patterns of utilization and interventions by type of disorder. Copyright © 2014 John Wiley & Sons, Ltd.

Factors contributing to practice variation in post-stroke rehabilitation.

PubMed Central

Lee, A J; Huber, J H; Stason, W B

1997-01-01

OBJECTIVE: To analyze geographic variability in the utilization and cost of post-stroke medical care using multiple linear regression. DATA SOURCES/STUDY SETTING: A 20 percent random sample of Medicare beneficiaries with an admission to an acute care hospital for stroke during the first six months of 1991, supplemented by data from their Medicare claims and beneficiary records, the Medicare Cost Reports for hospitals and nursing homes, and the Area Resource File. STUDY DESIGN: Weighted least squares regression is used to analyze variations in post-stroke practice patterns across 151 MSAs (Metropolitan Statistical Areas). Average post-stroke costs, utilization rates, and facility lengths of stay are regressed on patient and market characteristics. DATA COLLECTION/EXTRACTION METHODS: For a six-month post-stroke interval, beneficiary-level post-stroke costs and service utilization are averaged by MSA. Variables describing market conditions are then added to these MSA-level records. PRINCIPAL FINDINGS: Patient variables rarely explain more than a third of practice variation, and often they explain substantially less than that. Market variables (with some exception) tend to be relatively less important. Finally, one-half to two-thirds of the practice variation across MSAs is unexplained by the patient and market factors measured in our data. CONCLUSIONS: A substantial portion of inter-MSA variability in utilization and intensity of post-stroke rehabilitation services cannot be explained by differences in patient characteristics. Given the large practice differences observed across MSAs, it seems unlikely that unmeasured patient differences can account for much more of the practice differences. PMID:9180616

Using Administrative Data for Longitudinal Substance Abuse Research

PubMed Central

Evans, Elizabeth; Grella, Christine E.; Murphy, Debra A.; Hser, Yih-Ing

2008-01-01

The utilization of administrative data in substance abuse research has become more widespread than ever. This selective review synthesizes recent extant research from 31 articles to consider what has been learned from using administrative data to conduct longitudinal substance abuse research in four overlapping areas: (1) service access and utilization, (2) underrepresented populations, (3) treatment outcomes, and (4) cost analysis. Despite several notable limitations, administrative data contribute valuable information, particularly in the investigation of service system interactions and outcomes among substance abusers as they unfold and influence each other over the long term. This critical assessment of the advantages and disadvantages of using existing administrative data within a longitudinal framework should stimulate innovative thinking regarding future applications of administrative data for longitudinal substance abuse research purposes. PMID:18679805

Standalone Mobile Application for Shipping Services Based on Geographic Information System and A-Star Algorithm

NASA Astrophysics Data System (ADS)

Gunawan, D.; Marzuki, I.; Candra, A.

2018-03-01

Geographic Information Systems (GIS) plays an essential role in shipping service related application. By utilizing GIS, the courier can find the route to deliver goods for its customer. This research proposes a standalone mobile application to provide the shortest route to the destinations by utilizing geographic information systems with A-Star algorithm. This application is intended to be used although the area has no Internet network available. The developed application can handle several drop off points then calculates the shortest route that passes through all the drop off points. According to the conducted testing, the number of drop off points that can be calculated is influenced by the specification of the smartphone. More destinations require more smartphone resources and time to process.

Utilization of maternal health care services among married adolescent women: insights from the Nigeria Demographic and Health Survey, 2008.

PubMed

Rai, Rajesh Kumar; Singh, Prashant Kumar; Singh, Lucky

2012-01-01

An ongoing social catastrophe of very poor performance in maternal health coupled with an unacceptably high number of maternal deaths is evident in Nigeria, especially among adolescent women. This study examines the factors associated with selected maternity services-married adolescent women who have had at least four antenatal care (ANC) visits, those who have undergone safe delivery care, and those who received postnatal care within 42 days of delivery. Data from Nigeria Demographic and Health Survey, 2008, were used. An eligible sample of 2,434 married adolescent (aged 15-19 years) women was included in the analysis. Pearson chi-square test and binary logistic regression were performed to fulfill the study objective. It was found that about 35% of adolescent women had at least four ANC visits, a little over 25% had undergone safe delivery care, and nearly 32% received postnatal care within 42 days of delivery. Women's education, husband's education, wealth quintile, and region of residence were documented as the most important factors associated with maternal healthcare service utilization. The ANC visit was found to be vital in the utilization of safe delivery and postnatal care. Findings indicate that programs to improve maternal healthcare have not succeeded in overcoming the socioeconomic obstacles in the way of adolescents' utilizing maternity services. In the long run, the content and service delivery strategy of maternity programs must be designed in keeping with the socioeconomic context with special attention to adolescent women who are uneducated, poor, and residing in rural areas. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Primary health care utilization by immigrants as compared to the native population: a multilevel analysis of a large clinical database in Catalonia.

PubMed

Muñoz, Miguel-Angel; Pastor, Esther; Pujol, Joan; Del Val, José Luis; Cordomí, Silvia; Hermosilla, Eduardo

2012-06-01

Immigration is a relevant public health issue and there is a great deal of controversy surrounding its impact on health services utilization. To determine differences between immigrants and non-immigrants in the utilization of primary health care services in Catalonia, Spain. Population based, cross-sectional, multicentre study. We used the information from 16 primary health care centres in an area near Barcelona, Spain. We conducted a multilevel analysis for the year 2008 to compare primary health care services utilization between all immigrants aged 15 or more and a sample of non-immigrants, paired by age and sex. Overall, immigrants living in Spain used health services more than non-immigrants (Incidence Risk Ratio (IRR) 1.16 (95% Confidence Interval (CI): 1.15-1.16) and (IRR 1, 26, 95% CI: 1.25-1.28) for consultations with GPs and referrals to specialized care, respectively. People coming from the Maghreb and the rest of Africa requested the most consultations involving a GP and nurses (IRR 1.34, 95% CI: 1.33-1.36 and IRR 1.06, 95% CI: 1.03-1.44, respectively). They were more frequently referred to specialized care (IRR 1.44, 95% CI: 1.41-1.46) when compared to Spaniards. Immigrants from Asia had the lowest numbers of consultations with a GP and referrals (IRR 0.76, 95% CI: 0.66-0.88 and IRR 0.76, 95% CI: 0.61-0.95, respectively. On average, immigrants living in Catalonia used the health services more than non-immigrants. Immigrants from the Maghreb and other African countries showed the highest and those from Asia the lowest, number of consultations and referrals to specialized care.

Emergency Medical Service (EMS) Utilization by Syrian Refugees Residing in Ankara, Turkey.

PubMed

Altıner, Ali Osman; Yeşil, Sıdıka Tekeli

2018-04-01

Introduction Many Syrians have left their country and migrated to other countries since March 2011, due to the civil war. As of March 2016, a total of 2,747,946 Syrian refugees had immigrated to Turkey. Some Syrian refugees have been living in camps, while 2,475,134 have been living in metropolitan areas, such as Ankara. Study Objective This study investigated Emergency Medical Service (EMS) utilization among Syrian refugees residing in Ankara. This study was a descriptive, cross-sectional database analysis using data obtained from the Department of EMS of the Ankara Provincial Health Directorate. Five stations in the Altındağ region of Ankara responded to 42% of all calls from Syrian refugees. Prehospital EMS in Ankara have been used mostly by Syrian refugees younger than 18-years-old. Study findings also suggest that medical staff in regions where Syrian refugees are likely to be treated should be supported and provided with the ability to overcome language barriers and cultural differences. Altıner AO , Tekeli Yeşil S . Emergency Medical Service (EMS) utilization by Syrian refugees residing in Ankara, Turkey. Prehosp Disaster Med. 2018;33(2):160-164.

Snohomish County Public Utility District Geothermal Energy Exploration Study Final Technical Report

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

Lewis, Adam; Collar, Craig W.

2012-10-04

Supported by funds from this award, the District thoroughly explored the feasibility of a hydrothermal geothermal development within its service territory. The District successfully planned and drilled six exploratory geothermal wells and added significantly to the knowledge of the geology of the area. The Straight Creek Fault region, which was the sole location that showed significant potential for hydrothermal development in the District's service territory, was determined not to be feasible for development. The District subsequently expanded its search for geothermal development locations to include all of Washington State. Mount Baker has been identified as the area of the statemore » with the greatest potential for geothermal development. Having gathered additional information about the Mount Baker region with support from this award, the District is actively pursuing exploration and development in the area.« less

Census Cities Project and Atlas of Urban and Regional Change

NASA Technical Reports Server (NTRS)

Wray, J. R.

1971-01-01

The Census Cities Project has several related purposes: (1) to assess the role of remote sensors on high altitude platforms for the comparative study of urban areas; (2) to detect changes in selected U.S. urban areas between the 1970 census and the time of launching of an earth-orbiting sensor platform prior to the next census; (3) to test the utility of the satellite sensor platform to monitor urban change (When the 1970 census returns become available for small areas, they will serve as a control for sensor image interpretation.); (4) to design an information system for incorporating graphic sensor data with census-type data gathered by traditional techniques; (5) to identify and design user-oriented end-products or information services; and (6) to plan an effective organizational capability to provide such services on a continuing basis.

Can the Medical-nursing Combined Care Promote the Accessibility of Health Services for the Elderly in Nursing Home? A Study Protocol of Analysis of the Effectiveness Regarding Health Service Utilization, Health Status and Satisfaction with Care

PubMed Central

Bao, J; Wang, X-J; Yang, Y; Dong, R-Q; Mao, Z-F

2015-01-01

ABSTRACT Background: Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. Methods: The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. Conclusion: The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China. PMID:27398940

Pediatric dentist density and preventive care utilization for Medicaid children

PubMed Central

Heidenreich, James F.; Kim, Amy S.; Scott, JoAnna M.; Chi, Donald L.

2014-01-01

Purpose This study evaluates the relationship between county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children in Washington State. Methods This is a cross-sectional analysis of 604,885 children ages 0-17 enrolled in the Washington State Medicaid Program for ≥11 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models. Results In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children in Washington utilizing preventive dental services. After adjusting for confounders, county-level density was significantly associated with county-level dental care utilization (β=1.67, 95 percent CI=0.02, 3.32, p=0.047). Conclusions There is a significant relationship between pediatric dentist density and the proportion of Medicaid-enrolled children who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children. PMID:26314606

Use of geographic information systems technology to track critical health code violations in retail facilities available to populations of different socioeconomic status and demographics.

PubMed

Darcey, Valerie L; Quinlan, Jennifer J

2011-09-01

Research shows that community socioeconomic status (SES) predicts, based on food service types available, whether a population has access to healthy food. It is not known, however, if a relationship exists between SES and risk for foodborne illness (FBI) at the community level. Geographic information systems (GIS) give researchers the ability to pinpoint health indicators to specific geographic locations and detect resulting environmental gradients. It has been used extensively to characterize the food environment, with respect to access to healthy foods. This research investigated the utility of GIS in determining whether community SES and/or demographics relate to access to safe food, as measured by food service critical health code violations (CHV) as a proxy for risk for FBI. Health inspection records documenting CHV for 10,859 food service facilities collected between 2005 and 2008 in Philadelphia, PA, were accessed. Using an overlay analysis through GIS, CHV were plotted over census tracts of the corresponding area. Census tracts (n = 368) were categorized into quintiles, based on poverty level. Overall, food service facilities in higher poverty areas had a greater number of facilities (with at least one CHV) and had more frequent inspections than facilities in lower poverty areas. The facilities in lower poverty areas, however, had a higher average number of CHV per inspection. Analysis of CHV rates in census tracts with high concentrations of minority populations found Hispanic facilities had more CHV than other demographics, and Hispanic and African American facilities had fewer days between inspections. This research demonstrates the potential for utilization of GIS mapping for tracking risks for FBI. Conversely, it sheds light on the subjective nature of health inspections, and indicates that underlying factors might be affecting inspection frequency and identification of CHV, such that CHV might not be a true proxy for risk for FBI.

Mapping mental health service access: achieving equity through quality improvement.

PubMed

Green, Stuart A; Poots, Alan J; Marcano-Belisario, Jose; Samarasundera, Edgar; Green, John; Honeybourne, Emmi; Barnes, Ruth

2013-06-01

Improving access to psychological therapies (IAPTs) services deliver evidence-based care to people with depression and anxiety. A quality improvement (QI) initiative was undertaken by an IAPT service to improve referrals providing an opportunity to evaluate equitable access. QI methodologies were used by the clinical team to improve referrals to the service. The collection of geo-coded data allowed referrals to be mapped to small geographical areas according to deprivation. A total of 6078 patients were referred to the IAPT service during the period of analysis and mapped to 120 unique lower super output areas (LSOAs). The average weekly referral rate rose from 17 during the baseline phase to 43 during the QI implementation phase. Spatial analysis demonstrated all 15 of the high deprivation/low referral LSOAs were converted to high deprivation/high or medium referral LSOAs following the QI initiative. This work highlights the importance of QI in developing clinical services aligned to the needs of the population through the analysis of routine data matched to health needs. Mapping can be utilized to communicate complex information to inform the planning and organization of clinical service delivery and evaluate the progress and sustainability of QI initiatives.

A Unified Model for BDS Wide Area and Local Area Augmentation Positioning Based on Raw Observations.

PubMed

Tu, Rui; Zhang, Rui; Lu, Cuixian; Zhang, Pengfei; Liu, Jinhai; Lu, Xiaochun

2017-03-03

In this study, a unified model for BeiDou Navigation Satellite System (BDS) wide area and local area augmentation positioning based on raw observations has been proposed. Applying this model, both the Real-Time Kinematic (RTK) and Precise Point Positioning (PPP) service can be realized by performing different corrections at the user end. This algorithm was assessed and validated with the BDS data collected at four regional stations from Day of Year (DOY) 080 to 083 of 2016. When the users are located within the local reference network, the fast and high precision RTK service can be achieved using the regional observation corrections, revealing a convergence time of about several seconds and a precision of about 2-3 cm. For the users out of the regional reference network, the global broadcast State-Space Represented (SSR) corrections can be utilized to realize the global PPP service which shows a convergence time of about 25 min for achieving an accuracy of 10 cm. With this unified model, it can not only integrate the Network RTK (NRTK) and PPP into a seamless positioning service, but also recover the ionosphere Vertical Total Electronic Content (VTEC) and Differential Code Bias (DCB) values that are useful for the ionosphere monitoring and modeling.

A Unified Model for BDS Wide Area and Local Area Augmentation Positioning Based on Raw Observations

PubMed Central

Tu, Rui; Zhang, Rui; Lu, Cuixian; Zhang, Pengfei; Liu, Jinhai; Lu, Xiaochun

2017-01-01

In this study, a unified model for BeiDou Navigation Satellite System (BDS) wide area and local area augmentation positioning based on raw observations has been proposed. Applying this model, both the Real-Time Kinematic (RTK) and Precise Point Positioning (PPP) service can be realized by performing different corrections at the user end. This algorithm was assessed and validated with the BDS data collected at four regional stations from Day of Year (DOY) 080 to 083 of 2016. When the users are located within the local reference network, the fast and high precision RTK service can be achieved using the regional observation corrections, revealing a convergence time of about several seconds and a precision of about 2–3 cm. For the users out of the regional reference network, the global broadcast State-Space Represented (SSR) corrections can be utilized to realize the global PPP service which shows a convergence time of about 25 min for achieving an accuracy of 10 cm. With this unified model, it can not only integrate the Network RTK (NRTK) and PPP into a seamless positioning service, but also recover the ionosphere Vertical Total Electronic Content (VTEC) and Differential Code Bias (DCB) values that are useful for the ionosphere monitoring and modeling. PMID:28273814

Inequalities in maternal health care utilization in Benin: a population based cross-sectional study.

PubMed

Yaya, Sanni; Uthman, Olalekan A; Amouzou, Agbessi; Ekholuenetale, Michael; Bishwajit, Ghose

2018-05-31

Ensuring equitable access to maternal health care including antenatal, delivery, postnatal services and fertility control methods, is one of the most critical challenges for public health sector. There are significant disparities in maternal health care indicators across many geographical locations, maternal, economic, socio-demographic factors in many countries in sub-Sahara Africa. In this study, we comparatively explored the utilization level of maternal health care, and examined disparities in the determinants of major maternal health outcomes. This paper used data from two rounds of Benin Demographic and Health Survey (BDHS) to examine the utilization and disparities in factors of maternal health care indicators using logistic regression models. Participants were 17,794 and 16,599 women aged between15-49 years in 2006 and 2012 respectively. Women's characteristics were reported in percentage, mean and standard deviation. Mean (±SD) age of the participants was 29.0 (±9.0) in both surveys. The percentage of at least 4 ANC visits was approximately 61% without any change between the two rounds of surveys, facility based delivery was 93.5% in 2012, with 4.9% increase from 2006; postnatal care was currently 18.4% and contraceptive use was estimated below one-fifth. The results of multivariable logistic regression models showed disparities in maternal health care service utilization, including antenatal care, facility-based delivery, postnatal care and contraceptive use across selected maternal factors. The current BHDS showed age, region, religion were significantly associated with maternal health care services. Educated women, those from households of high wealth index and women currently working were more likely to utilize maternal health care services, compared to women with no formal education, from poorest households or not currently employed. Women who watch television (TV) were 1.31 (OR = 1.31; 95% CI = 1.13-1.52), 1.69 (OR = 1.69; 95% CI = 1.20-2.37) and 1.38 (OR = 1.38; 95% CI = 1.16-1.65) times as likely to utilize maternal health care services after adjusting for other covariates. The findings would guide stakeholders to address inequalities in maternal health care services. More so, health care programmes and policies should be strengthened to enhance accessibility as well as improve the utilization of maternal care services, especially for the disadvantaged, uneducated and those who live in hard-to-reach rural areas in Benin. The Benin government needs to create strategies that cover both the supply and demand side factors at attain the universal health coverage.

What limits the utilization of health services among china labor force? analysis of inequalities in demographic, socio-economic and health status.

PubMed

Lu, Liming; Zeng, Jingchun; Zeng, Zhi

2017-02-02

Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy. Data were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC). Migrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer self-perceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration (Hosmer-Lemeshow test's P range of 0.258-0.987) and discrimination (AUC range of 0.626-0.725). This study has shown that there are inequalities of demographic, socio-economic and health status in the utilization of health services for China labor force. Prudent health policy with equitable utilization of health services eliminating mentioned inequalities should be a priority in shaping China's healthcare system reform.

Perceptions of the Importance and Utilization of Clinical Supervision among Certified Rural School Counselors

ERIC Educational Resources Information Center

Duncan, Kelly; Brown-Rice, Kathleen; Bardhoshi, Gerta

2014-01-01

This study explored rural school counselors' perceptions of clinical supervision. School counselors working in rural communities commonly encounter issues that challenge their ability to provide competent counseling services to the students they serve. School counselors serving in these areas are often the only rural mental health provider in…

77 FR 14307 - Water and Waste Disposal Loans and Grants

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-09

... CFR 1777 RIN 0572-AC26 Water and Waste Disposal Loans and Grants AGENCY: Rural Utilities Service, USDA... pertaining to the Section 306C Water and Waste Disposal (WWD) Loans and Grants program, which provides water... to assist areas designated as colonias that lack access to water or waste disposal systems and/or...

Receipt of Cancer Screening Services: Surprising Results for Some Rural Minorities

ERIC Educational Resources Information Center

Bennett, Kevin J.; Probst, Janice C.; Bellinger, Jessica D.

2012-01-01

Background: Evidence suggests that rural minority populations experience disparities in cancer screening, treatment, and outcomes. It is unknown how race/ethnicity and rurality intersect in these disparities. The purpose of this analysis is to examine the cancer screening rates among minorities in rural areas. Methods: We utilized the 2008…

75 FR 16066 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-31

..., electric, and water and waste facilities in rural areas with a loan portfolio that totals nearly $42.... Rural Utilities Service Title: 7 CFR Part 1778, Emergency and Imminent Community Water Assistance Grants... under Section 306A of the Consolidated Farm and rural Development Act, (7 U.S.C. 1926(a) to provide...

Development of a Validated Instructional System for Hospitality Education. First Annual Report.

ERIC Educational Resources Information Center

Powers, Thomas F.

Funded by a grant from Pennsylvania's Research Coordinating Unit, three key seminar-practicum courses were designed for psychomotor and cognitive skills development in the food service area of post-secondary hospitality education. This 36-week, 3-course sequence utilizes weekly seminars, self-instructional packages, and "real-life"…

Inventorying recreation use

Treesearch

George A. James

1971-01-01

Part I is a general discussion about the estimation of recreation use, with descriptions of selected sampling techniques for estimating recreation use on a wide variety of different sites and areas. Part II is a brief discussion of an operational computer oriented information system designed and developed by the USDA Forest Service to fully utilize the inventories of...

Statewide Curriculum Articulation Project for Vocational-Technical Education in Minnesota. Final Report.

ERIC Educational Resources Information Center

Burger, Laura J.; And Others

The goal of this project was to develop, validate, and utilize a process for vertically articulating curriculum between secondary and post secondary levels of vocational technical education throughout the state of Minnesota. Procedures involved the identification of two areas of staff responsibility: research and development, and service to local…

The Assessment of a Community's Mental Health Needs.

ERIC Educational Resources Information Center

Zautra, Alex; Simons, Lynn Stanley

In this study social indicators and survey measures were used to predict three-year service utilization rates at a community mental health center on a geographic basis. Ten social indicators were selected from available census tract statistics and seven survey measures were taken from an epidemiological survey of the catchment area of the mental…

Transportation Services, Utilization and Needs of the Elderly in Non-Urban Areas; Patterns in Two Kentucky Communities

DOT National Transportation Integrated Search

1994-12-01

It is now axiomatic that America's population is growing older. Primary : indicators of this aging are the number of individuals age 65 years and over : (which increased from about 26 million in 1980 to over 33 million by 1990) and : the elderly perc...

The Effectiveness and Feasibility of a TRISNET Regional Center in Information Transfer. Final Report.

ERIC Educational Resources Information Center

Rath, Gustave J.; And Others

A study was conducted to assess the feasibility of establishing a regional information transfer center within the context of the National Network of Transportation Research Information Services (TRISNET). The principle areas of investigation were: (1) the transportation information needs of the public and private sectors; (2) the utility of…

School Age Multihandicapped Project: Capital Area Rehabilitation Center. Final Report 1977-1980.

ERIC Educational Resources Information Center

Capital Area Rehabilitation Center, Austin, TX.

The document contains the final report of a model project to provide a therapeutically based educational program for severely handicapped, orthopedically impaired children (6 to 21 years old) utilizing the skills of teachers, aides, therapists, and a nurse to provide individualized hands on services. Section I contains an overview of the…

Area-wide management of Aedes albopictus: choice of study sites based on geospatial characteristics, socioeconomic factors, and mosquito populations

USDA-ARS?s Scientific Manuscript database

Aedes (Stegomyia) albopictus (Skuse), the Asian tiger mosquito, is an introduced invasive species in the U.S. responsible for a significant proportion of service requests to local mosquito control programs. This container-utilizing mosquito is refractory to standard mosquito abatement measures in th...

Area-wide management of Aedes albopictus: II. Gauging the efficacy of traditional integrated pest control measures against urban container mosquitoes

USDA-ARS?s Scientific Manuscript database

Aedes (Stegomyia) albopictus (Skuse), the Asian tiger mosquito, is an introduced invasive species in the U.S. responsible for a significant proportion of service requests to local mosquito control programs. This container-utilizing mosquito is refractory to standard mosquito abatement measures in th...

7 CFR 1780.3 - Definitions and grammatical rules of construction.

Code of Federal Regulations, 2011 CFR

2011-01-01

... water and waste disposal loans and grants. Similar system cost means the average annual EDU user cost of... purposes of this part: Agency means the Rural Utilities Service and any United States Department of... latest decennial census of the United States. Rural Development means the mission area of the Under...

7 CFR 1780.3 - Definitions and grammatical rules of construction.

Code of Federal Regulations, 2013 CFR

2013-01-01

... water and waste disposal loans and grants. Similar system cost means the average annual EDU user cost of... purposes of this part: Agency means the Rural Utilities Service and any United States Department of... latest decennial census of the United States. Rural Development means the mission area of the Under...

7 CFR 1780.3 - Definitions and grammatical rules of construction.

Code of Federal Regulations, 2014 CFR

2014-01-01

... water and waste disposal loans and grants. Similar system cost means the average annual EDU user cost of... purposes of this part: Agency means the Rural Utilities Service and any United States Department of... latest decennial census of the United States. Rural Development means the mission area of the Under...

7 CFR 1780.3 - Definitions and grammatical rules of construction.

Code of Federal Regulations, 2012 CFR

2012-01-01

... water and waste disposal loans and grants. Similar system cost means the average annual EDU user cost of... purposes of this part: Agency means the Rural Utilities Service and any United States Department of... latest decennial census of the United States. Rural Development means the mission area of the Under...

Census Cities Project and atlas of urban and regional change

NASA Technical Reports Server (NTRS)

Wray, J. R.

1970-01-01

The research design and imagery utilization for urban applications of remote sensing are reviewed, including the combined use of sensor and census data and aircraft and spacecraft sensor platforms. The related purposes of the Census Cities Project are elucidated: (1) to assess the role of remote sensors on high altitude platforms for comparative study of urban areas; (2) to detect changes in selected U.S. urban areas between the 1970 census and the time of launching of an earth-orbiting sensor platform prior to next census; (3) to test the satellite sensor platform utility to monitor urban change and serve as a control for sensor image interpretation; (4) to design an information system for incorporating graphic sensor data with census-type data gathered by traditional techniques; (5) to identify and to design user-oriented end-products or information services; and (6) to ascertain what organizational capability would be needed to provide such services on a continuing basis. A need to develop not only a spatial data information system, but also a methodology for detecting and interpreting change is implied.

The cost of chronic pain: an analysis of a regional pain management service in Ireland.

PubMed

Gannon, Brenda; Finn, David P; O'Gorman, David; Ruane, Nancy; McGuire, Brian E

2013-10-01

The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. Our study showed a cost per patient of US$24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden. Wiley Periodicals, Inc.

We Work with Them? Healthcare Workers Interpretation of Organizational Relations Mined from Electronic Health Records

PubMed Central

Chen, You; Lorenzi, Nancy; Nyemba, Steve; Schildcrout, Jonathan S.; Malin, Bradley

2014-01-01

Objective Models of healthcare organizations (HCOs) are often defined up front by a select few administrative officials and managers. However, given the size and complexity of modern healthcare systems, this practice does not scale easily. The goal of this work is to investigate the extent to which organizational relationships can be automatically learned from utilization patterns of electronic health record (EHR) systems. Method We designed an online survey to solicit the perspectives of employees of a large academic medical center. We surveyed employees from two administrative areas: 1) Coding & Charge Entry and 2) Medical Information Services and two clinical areas: 3) Anesthesiology and 4) Psychiatry. To test our hypotheses we selected two administrative units that have work-related responsibilities with electronic records; however, for the clinical areas we selected two disciplines with very different patient responsibilities and whose accesses and people who accessed were similar. We provided each group of employees with questions regarding the chance of interaction between areas in the medical center in the form of association rules (e.g., Given someone from Coding & Charge Entry accessed a patient’s record, what is the chance that someone from Medical Information Services access the same record?). We compared the respondent predictions with the rules learned from actual EHR utilization using linear-mixed effects regression models. Results The findings from our survey confirm that medical center employees can distinguish between association rules of high and non-high likelihood when their own area is involved. Moreover, they can make such distinctions between for any HCO area in this survey. It was further observed that, with respect to highly likely interactions, respondents from certain areas were significantly better than other respondents at making such distinctions and certain areas’ associations were more distinguishable than others. Conclusions These results illustrate that EHR utilization patterns may be consistent with the expectations of HCO employees. Our findings show that certain areas in the HCO are easier than others for employees to assess, which suggests that automated learning strategies may yield more accurate models of healthcare organizations than those based on the perspectives of a select few individuals. PMID:24845147

Key design elements of a data utility for national biosurveillance: event-driven architecture, caching, and Web service model.

PubMed

Tsui, Fu-Chiang; Espino, Jeremy U; Weng, Yan; Choudary, Arvinder; Su, Hoah-Der; Wagner, Michael M

2005-01-01

The National Retail Data Monitor (NRDM) has monitored over-the-counter (OTC) medication sales in the United States since December 2002. The NRDM collects data from over 18,600 retail stores and processes over 0.6 million sales records per day. This paper describes key architectural features that we have found necessary for a data utility component in a national biosurveillance system. These elements include event-driven architecture to provide analyses of data in near real time, multiple levels of caching to improve query response time, high availability through the use of clustered servers, scalable data storage through the use of storage area networks and a web-service function for interoperation with affiliated systems. The methods and architectural principles are relevant to the design of any production data utility for public health surveillance-systems that collect data from multiple sources in near real time for use by analytic programs and user interfaces that have substantial requirements for time-series data aggregated in multiple dimensions.

Quality of life in epilepsy (QOLIE): insights about epilepsy and support groups from people with epilepsy (San Francisco Bay Area, USA).

PubMed

Chung, Kenny; Liu, Yuan; Ivey, Susan L; Huang, Debbie; Chung, Corina; Guo, Wenting; Tseng, Winston; Ma, Daveena

2012-06-01

This study evaluated quality of life (QOL) in people with epilepsy (PWE) in the San Francisco Bay Area. This was a qualitative study examining QOL through the use of focus groups and of the QOLIE-31-P survey instrument. Six focus groups were conducted to examine self-reported challenges due to epilepsy. Focus groups were conducted for individuals who did and did not attend support groups. Individuals with epilepsy reported substantial difficulties with finances, physical and psychosocial functioning. Also, limited knowledge about services and relatively negative feelings toward self were common among newly diagnosed participants. Many of the issues surrounding QOL and challenges were shared across groups. Epilepsy-related social services appeared to be useful in helping PWE cope and in increasing PWE's awareness of key enabling services. Although many individuals with epilepsy reported poor QOL and other challenges, epilepsy-related services may be under-utilized due to a lack of awareness. Copyright © 2012 Elsevier Inc. All rights reserved.

Spatio-temporal evolution of water-related ecosystem services: Taihu Basin, China.

PubMed

Chen, Junyu; Cui, Tao; Wang, Huimin; Liu, Gang; Gilfedder, Mat; Bai, Yang

2018-01-01

Water-related ecosystem services (WESs) arise from the interaction between water ecosystems and their surrounding terrestrial ecosystems. They are critical for human well-being as well as for the whole ecological circle. An urgent service-oriented reform for the utilization and supervision of WESs can assist in avoiding ecological risks and achieving a more sustainable development in the Taihu Basin, China (THB). Spatially distributed models allow the multiple impacts of land use/land cover conversion and climate variation on WESs to be estimated and visualized efficiently, and such models can form a useful component in the toolbox for integrated water ecosystem management. The Integrated Valuation of Ecosystem Services and Tradeoffs model is used here to evaluate and visualize the spatio-temporal evolution of WESs in the THB from 2000 to 2010. Results indicate that water retention service experienced a decline from 2000 to 2005 with a recovery after 2005, while there was ongoing water scarcity in urban areas. Both the water purification service and the soil retention service underwent a slight decrease over the study period. Nutrients export mainly came from developed land and cultivated land, with the hilly areas in the south of the THB forming the primary area for soil loss. The quantity and distribution of WESs were impacted significantly by the shrinkage of cultivated land and the expansion of developed land. These findings will lay a foundation for a service-oriented management of WESs in the THB and support evidence-based decision making.

Delivery of health services to migrant and seasonal farmworkers.

PubMed

Arcury, Thomas A; Quandt, Sara A

2007-01-01

Farmworkers are low-paid, uninsured employees in an extremely hazardous industry, and they provide an essential service for U.S. society. This review evaluates the delivery of health services to farmworkers. It describes the farmworker population in the United States, noting characteristics (e.g., migratory and immigration status) that limit their access to and utilization of health services. It describes the health services needs of this population, including occupational health, mental health, oral health, and chronic disease treatment. Cultural, structural, legal, financial, and geographic barriers to health services utilization are described. Existing research on health services utilization among farmworkers is discussed. Programs that have been developed to address the barriers to health services utilization among farmworkers are reviewed. Finally, research needed to improve knowledge of farmworker health services utilization is suggested. These research needs include formal evaluations of existing programs and basic research to characterize the health services utilization patterns of farmworkers.

Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis

PubMed Central

2013-01-01

Background The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. Methods A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve “kebeles” of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. Result About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Conclusion Factors operating at individual and “kebele” levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women. PMID:23587369

Telemental health for our soldiers: a brief review and a new pilot program.

PubMed

Nieves, J Edwin; Candelario, Joseph; Short, Delmar; Briscoe, Gregory

2009-12-01

This small but significant telemental health clinical pilot could easily serve as a "best practice" model for resource utilization between the nation's VHA/DOD institutions that wish to form partnerships and capitalize on resources. It demonstrates several potential areas of collaboration for TMH projects. For example, this study also points out requisite preparation needs, e.g., an information technology (IT) needs assessment, and gap analysis between neighboring VHA/DOD installations should be considered beforehand. This would address equipment compatibility and address protected health information privacy concerns. This preparation would also lead to savings by avoiding equipment redundancy and minimize infrastructure (space) investment. While in this instance the equipment proved compatible, that may not always be the case. Second, regional strategic mapping of staff and services between institutions could help in specialty service utilization. This would improve recourse allocation, trim numerous costs, and avoid service duplication. A third area of collaboration would be the creation of a DOD/VHA electronic credentialing packet. This would simplify the preparation phase for TMH delivery and expand the availability of scarce medical specialty consultants for both the VHA and DOD. This would serve to streamline medical care and expedite the deployment of "virtual" practitioners in the event of a national disaster or emergency. To date there have not been any technical difficulties at either site and PC-PTSD-positive soldiers continue to be evaluated at the SVMAC. Anecdotal reports from both clinicians and patients are that they are highly satisfied with TMH delivery services.

Utilization of Services Provided by Village-Based Ethnic Minority Midwives in Vietnam: Lessons From Implementation Research.

PubMed

Doan, Duong Thi Thuy; Mirzoev, Tolib; Nguyen, Canh Chuong; Bui, Ha Thi Thu

Global progress in reducing maternal mortality requires improving access to maternal and child health services for the most vulnerable groups. This article reports results of implementation research that aimed to increase the acceptability of village-based ethnic minority midwives (EMMs) by local communities in Vietnam through implementing an integrated interventions package. The study was carried out in 2 provinces in Vietnam, Dien Bien and Kon Tum. A quasi-experimental survey with pretest/posttest design was adopted, which included 6 months of intervention implementation. The interventions package included introductory "launch" meetings, monthly review meetings at community health centers, and 5-day refresher training for EMMs. A mixed-methods approach was used involving both quantitative and qualitative data. A structured questionnaire was used in the pre- and posttest surveys, complemented by in-depth interviews and focus group discussions with EMMs, relatives of pregnant women, community representatives, and health managers. Introductions of EMMs to their local communities by local authorities and supervision of performance of EMMs contributed to significant increases in utilization of services provided by EMMs, from 58.6% to 87.7%. Key facilitators included information on how to contact EMMs, awareness of services provided by EMMs, and trust in services provided by EMMs. The main barriers to utilization of EMM services, which may affect sustainability of the EMM scheme, were low self-esteem of EMMs and small allowances to EMMs, which also affected the recognition of EMMs in the community. Providing continuous support and integration of EMMs within frontline service provision and ensuring adequate local budget for monthly allowances are the key factors that should allow sustainability of the EMM scheme and continued improvement of access to maternal and child health care among poor ethnic minority people living in mountainous areas in Vietnam.

Results of a survey of U.S. Fish and Wildlife Service Endangered Species and Ecological Services Field Offices, Refuges, Hatcheries, and Research Centers

USGS Publications Warehouse

Gladwin, Douglas N.; Asherin, Duane A.; Manci, Karen M.

1988-01-01

The National Ecology Research Center (Center), as part of an ongoing research study on the effects of low altitude aircraft operations on fish and wildlife, conducted a survey in January 1987 of all U.S. Fish and Wildlife Service (Service) regional directors, research center directors, Ecological Services and Endangered Species field offices supervisors, refuge manager, and hatchery manager. The objective of the survey was to determine the nature and extent of aircraft-induced impacts on fish and wildlife species, populations, and habitat utilization. The field installation managers and biologists were asked to provide background information or data on fish and wildlife reactions to low-altitude aircraft disturbances, including physiological, behavioral, and reproductive/population effects. Specifically, the survey asked for information such as: (1) observations of animal reaction(s) to aircraft operations, e.g., desert bighorn sheep scare behavior in response to aircraft overflights and hatchery fish seizures and death following intense sonic booms; and instances of areas where aircraft noise is known or believed to be responsible for reduced population size, e.g. areas along heavily used aircraft flight corridors where breeding waterfowl densities are lower than in similar habitat away from the noise area.

The Impact of a Change in the Price of VA Health Care on Utilization of VA and Medicare Services.

PubMed

Nelson, Richard E; Hicken, Bret; Vanneman, Megan; Liu, Chuan-Fen; Rupper, Randall

2018-05-15

The passage of the Veterans Access, Choice, and Accountability Act of 2014 has expanded the non-Veteran Affairs (VA) care options for eligible US Veterans. In order for these new arrangements to provide the best care possible for Veterans, it is important to understand the relationship between VA and non-VA care options. The purpose of this study was to use another recent VA policy change, one that increased the reimbursement rate that eligible Veterans receive for travel for health care to VA, to understand the use of VA and Medicare services among Medicare-enrolled Veterans. We used a difference-in-difference technique to compare inpatient and outpatient utilization and cost in VA and Medicare between Veterans who were eligible for travel reimbursement and those who were not eligible following 2 increases in the travel reimbursement rate. We used generalized estimating equation models and 2-part models when cost outcomes were rare. Our cohort consisted of 110,007 Medicare-enrolled Veterans, including 25,076 under 65 and 84,931 over 65 years old. Following the travel reimbursement rate increases, the number of VA outpatient encounters increased for Veterans in our cohort regardless of age group or whether living in an urban or rural area. The number of non-VA outpatient encounters decreased significantly for Veterans in both age groups living in rural areas following these policy changes. Our estimates suggest that VA outpatient care may be a substitute for Medicare outpatient care for Medicare-enrolled Veterans living in rural areas. These results are important because they indicate how Veteran health care utilization might be affected by future policy changes designed to increase access to VA services. They also indicate the ripple effects that may occur in other health systems due to changes in the VA system.

Assistance to NASA in biomedical areas of the technology utilization program

NASA Technical Reports Server (NTRS)

Culclasure, D. F.; Eckhardt, L.

1972-01-01

The applications of aerospace technology to biomedical research are reported. The medical institutions participating in the Biomedical Applications Program are listed along with the institutions currently utilizing the services of the Southwest Research Institute Biomedical Applications Team. Significant accomplishments during this period include: ultra-low bandpass amplifier for gastro-intestinal electric potentials; non-encumbering EEG electrode assembly suitable for long term sleep research; accurate cardiac telemetry system for active subjects; warning system for the deaf; tracking cane for the blind; and an improved control mechanism to expand the self-sufficiency of quadriplegics.

Factors Influencing Health Service Utilization Among Asian Immigrant Nail Salon Workers in the Greater New York City Area.

PubMed

Seo, Jin Young; Chao, Ying-Yu; Yeung, Ka Man; Strauss, Shiela M

2018-06-23

Most nail salon workers in the greater New York City area are Asian immigrant women. They are exposed daily to potentially toxic chemicals and hazards in their workplace, making them more vulnerable for possible health problems. The study's primary purpose was to identify factors influencing past year healthcare utilization among Asian immigrant women working in nail salons. A cross-sectional study was conducted based on a modification of Andersen's behavioral model of healthcare utilization in which 148 Korean and Chinese immigrant women currently working in nail salons were surveyed. The questionnaire included: (1) individual health determinants, (2) health service utilization in the past year, and (3) work environment, work-related health concerns, and work-related health problems. Descriptive statistics and multivariate logistic regression models assessed factors related to past year healthcare utilization. Women who had health insurance (p < .01), a usual source of care (p < .01), low educational attainment (p < .05), and more work-related health symptoms (p < .05) were more likely to visit a primary care provider. Women who had health insurance (p < .01), a usual source of care (p < .05), and low educational attainment (p < .05), were also more likely to visit a woman's health provider. Korean (rather than Chinese) women (p < .05) and women who perceived themselves to be in fair/poor health (p < .05) were more likely to see a traditional provider of Eastern medicine. Asian immigrant women who work in nail salons have workplace health and safety concerns. They generally use Western rather than traditional medicine, with different factors related to these two types of medicine.

Local, national, and service component cost variations in the management of low back pain: Considerations for the clinician.

PubMed

Babu, Ashwin N; McCormick, Zachary; Kennedy, David J; Press, Joel

2016-11-21

In the past two decades, the cost associated with managing low back pain has increased significantly. Improved consciousness of how clinicians utilize resources when managing low back pain is necessary in the current economic climate. The goal of this review is to examine the component costs associated with managing low back pain and provide practical solutions for reducing healthcare costs. This is accomplished by utilizing examples from a major metropolitan area with several major academic institutions and private health care centers. It is clear that there is considerable local and national variation in the component costs of managing low back pain, including physician visits, imaging studies, medications, and therapy services. By being well informed about these variations in one's environment, clinicians and patients alike can make strides towards reducing the financial impact of low back pain. Investigation of the cost discrepancies for services within one's community of practice is important. Improved public access to both cost and outcomes data is needed.

Utilization of Preventive Dental Services Before and After Health Insurance Covered Dental Scaling in Korea.

PubMed

Jang, Young-Eun; Kim, Chun-Bae; Kim, Nam-Hee

2017-01-01

Health insurance reduces the economic burden of diseases and enhances access to medical services. This study compared, among social classes, the utilization of preventive dental service before and after health insurance covered dental scaling. We analyzed time-series secondary data for 3  175  584 participants from 253 survey areas nationwide in the Community Health Survey (2009-2014) in Korea. The weighted proportion of participants who underwent dental scaling was defined as the scaling rate. Data regarding demographic and socioeconomic characteristics were collected. Scaling rates continuously increased over the 6-year period, particularly in 2014. College graduates had significantly higher scaling rates. Monthly income and scaling rate were positively related. Differences by education decreased over time. Differences by income were particularly high between 2012 and 2014. For women, the temporal rate was 2 times higher for professionals than for the unemployed. Despite increased dental scaling rates since the health coverage change in 2013, socioeconomic differences persist.

Mobile messaging services-based personal electrocardiogram monitoring system.

PubMed

Tahat, Ashraf A

2009-01-01

A mobile monitoring system utilizing Bluetooth and mobile messaging services (MMS/SMSs) with low-cost hardware equipment is proposed. A proof of concept prototype has been developed and implemented to enable transmission of an Electrocardiogram (ECG) signal and body temperature of a patient, which can be expanded to include other vital signs. Communication between a mobile smart-phone and the ECG and temperature acquisition apparatus is implemented using the popular personal area network standard specification Bluetooth. When utilizing MMS for transmission, the mobile phone plots the received ECG signal and displays the temperature using special application software running on the client mobile phone itself, where the plot can be captured and saved as an image before transmission. Alternatively, SMS can be selected as a transmission means, where in this scenario, dedicated application software is required at the receiving device. The experimental setup can be operated for monitoring from anywhere in the globe covered by a cellular network that offers data services.

Mobile Messaging Services-Based Personal Electrocardiogram Monitoring System

PubMed Central

Tahat, Ashraf A.

2009-01-01

A mobile monitoring system utilizing Bluetooth and mobile messaging services (MMS/SMSs) with low-cost hardware equipment is proposed. A proof of concept prototype has been developed and implemented to enable transmission of an Electrocardiogram (ECG) signal and body temperature of a patient, which can be expanded to include other vital signs. Communication between a mobile smart-phone and the ECG and temperature acquisition apparatus is implemented using the popular personal area network standard specification Bluetooth. When utilizing MMS for transmission, the mobile phone plots the received ECG signal and displays the temperature using special application software running on the client mobile phone itself, where the plot can be captured and saved as an image before transmission. Alternatively, SMS can be selected as a transmission means, where in this scenario, dedicated application software is required at the receiving device. The experimental setup can be operated for monitoring from anywhere in the globe covered by a cellular network that offers data services. PMID:19707531

Socioeconomic status and utilization of amblyopia services at a tertiary pediatric hospital in Canada.

PubMed

Sharma, Abhishek; Wong, Agnes M F; Colpa, Linda; Chow, Amy H Y; Jin, Ya-Ping

2016-12-01

To evaluate whether socioeconomic status is associated with equal utilization of amblyopia services at The Hospital for Sick Children (SickKids), a pediatric tertiary hospital in Canada. This is a retrospective, cross-sectional study. The medical records of children aged under 7 years diagnosed with amblyopia at SickKids from 2007 to 2009 were reviewed. Socioeconomic status was derived from patients' residential postal codes through linking with income data in the 2006 Canadian census report. Patients were divided into 5 income quintiles to compare with amblyopia service utilization. The main outcome measure was the observed distribution of amblyopia patients by socioeconomic status versus the expected distribution of 20% for each quintile. The analyses included 336 patients. Children with amblyopia at SickKids were more likely to come from the richest neighbourhood (32.5%), whereas children from each of the 3 lowest quintiles (14.6%-15.5%) were less likely to present at SickKids. These results differed significantly from the expected 20% for each quintile (p < 0.0001). All types of amblyopia were significantly under-represented for children from the lower socioeconomic groups. When analyses were stratified by travel distance to the hospital, a significant inequality between the lower and higher income quintiles remained for nonmetropolitan Toronto patients, but not for metropolitan Toronto patients. Despite a publicly funded health-care system in Canada, children from lower socioeconomic neighbourhoods in distant areas utilize the amblyopia services in a tertiary pediatric centre less often than those from higher socioeconomic status. Copyright © 2016 Canadian Ophthalmological Society. All rights reserved.

Competition and rural primary care programs.

PubMed

Ricketts, T C

1990-04-01

Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.

Changes in the selected reproductive health indicators among married women of reproductive age in low performing areas of Bangladesh: findings from an evaluation study

PubMed Central

2014-01-01

Background Three-year duration Demand-Based Reproductive Commodity Project (DBRHCP) was launched in three low performing areas: rural Nabiganj (population 323,357), Raipur (population 260,983) and urban slum in Dhaka (population 141,912). Objectives: Assessing changes in knowledge among married women of reproductive age on selected reproductive health issues and to explore their service utilization patterns over the project period in selected low performing areas of Bangladesh. Methods The study adopted a pre- posts design. In the project areas, the entire chain of service provision were modified through the interventions under the DBRHCP, including training of the providers, enhanced behavioral change communication activities, follow-up and counseling, record keeping, reporting and monitoring, as well as improvement in logistics and supplies. Peer promoters were established as linkages between clients and service providers. All households were enlisted. Baseline and end line surveys were done using representative simple random sampling method, capturing changes over one year intervention period. Descriptive analysis was done using SPSS package, version 10. Proportional tests using Stata, version 8 were done to assess changes from baseline to end line. Results The overall contraceptive prevalence was markedly different in the three study areas but significantly increased in both Dhaka urban slums and Nabiganj. In the rural areas, a higher proportion of the women in endline compared to baseline obtained contraceptive methods from the public sectors. Irrespective of study sites, significantly higher proportion of women received ANC (Antenatal Care) and PNC (Post natal care) in endline compared to baseline. In all study sites higher proportions of women were aware of maternal complications at endline. Services were obtained from qualified persons for reported symptoms of sexually transmitted infections by a higher proportion of women at endline compared to baseline. There were improvements in other RH indicators, such as use of skilled birth attendants and overall utilization of health care facilities by women. Conclusions The improvements in several important RH indicators in the intervention areas suggest that the interventions affected selected outcomes reported in the study. The study findings also suggest that investment in the reproductive health sector, particularly in existing government programs, improves RH outcomes. PMID:24886357

SolarSoft Web Services

NASA Astrophysics Data System (ADS)

Freeland, S.; Hurlburt, N.

2005-12-01

The SolarSoft system (SSW) is a set of integrated software libraries, databases, and system utilities which provide a common programming and data analysis environment for solar physics. The system includes contributions from a large community base, representing the efforts of many NASA PI team MO&DA teams,spanning many years and multiple NASA and international orbital and ground based missions. The SSW general use libraries include Many hundreds of utilities which are instrument and mission independent. A large subset are also SOLAR independent, such as time conversions, digital detector cleanup, time series analysis, mathematics, image display, WWW server communications and the like. PI teams may draw on these general purpose libraries for analysis and application development while concentrating efforts on instrument specific calibration issues rather than reinvention of general use software. By the same token, PI teams are encouraged to contribute new applications or enhancements to existing utilities which may have more general interest. Recent areas of intense evolution include space weather applications, automated distributed data access and analysis, interfaces with the ongoing Virtual Solar Observatory efforts, and externalization of SolarSoft power through Web Services. We will discuss the current status of SSW web services and demonstrate how this facilitates accessing the underlying power of SolarSoft in more abstract terms. In this context, we will describe the use of SSW services within the Collaborative Sun Earth Connector environment.

Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years.

PubMed

Santas, Fatih; Celik, Yusuf; Eryurt, Mehmet Ali

2018-01-01

This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth. Copyright © 2017 John Wiley & Sons, Ltd.

Marital Distress and Mental Health Care Service Utilization

ERIC Educational Resources Information Center

Schonbrun, Yael Chatav; Whisman, Mark A.

2010-01-01

Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for…

Benefit-cost evaluation of an intra-regional air service in the Bay area

NASA Technical Reports Server (NTRS)

Haefner, L. E.

1977-01-01

Utilization of an iterative statistical model is presented to evaluate combinations of commuter airport sites and surface transportation facilities in confunction with service by a given commuter aircraft type in light of Bay Area regional growth alternatives and peak and off-peak regional travel patterns. The model evaluates such transportation options with respect to criteria of airline profitability, public acceptance, and public and private nonuser costs. It incorporates information modal split, peak and off-peak use of the air commuter fleet, terminal and airport cost, development costs and uses of land in proximity to the airport sites, regional population shifts, and induced zonal shifts in travel demand. The model is multimodal in its analytical capability, and performs exhaustive sensitivity analysis.

Spatial analysis of elderly access to primary care services.

PubMed

Mobley, Lee R; Root, Elisabeth; Anselin, Luc; Lozano-Gracia, Nancy; Koschinsky, Julia

2006-05-15

Admissions for Ambulatory Care Sensitive Conditions (ACSCs) are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance) are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates. We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas. The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across the landscape may not be optimal. The finding that elderly who reside in sprawling urban areas have access impediments about equal to residents of poor rural communities is new, and demonstrates the value of conceptualizing and modelling impedance based on place and local context.

Program impact pathway analysis of a social franchise model shows potential to improve infant and young child feeding practices in Vietnam.

PubMed

Nguyen, Phuong H; Menon, Purnima; Keithly, Sarah C; Kim, Sunny S; Hajeebhoy, Nemat; Tran, Lan M; Ruel, Marie T; Rawat, Rahul

2014-10-01

By mapping the mechanisms through which interventions are expected to achieve impact, program impact pathway (PIP) analysis lays out the theoretical causal links between program activities, outcomes, and impacts. This study examines the pathways through which the Alive & Thrive (A&T) social franchise model is intended to improve infant and young child feeding (IYCF) practices in Vietnam. Mixed methods were used, including qualitative interviews with franchise management board members (n = 12), surveys with health providers (n = 120), counseling observations (n = 160), and household surveys (n = 2045). Six PIP components were assessed: 1) franchise management, 2) training and IYCF knowledge of health providers, 3) service delivery, 4) program exposure and utilization, 5) maternal behavioral determinants (knowledge, beliefs, and intentions) toward optimal IYCF practices, and 6) IYCF practices. Data were collected from A&T-intensive areas (A&T-I; mass media + social franchise) and A&T-nonintensive areas (A&T-NI; mass media only) by using a cluster-randomized controlled trial design. Data from 2013 were compared with baseline where similar measures were available. Results indicate that mechanisms are in place for effective management of the franchise system, despite challenges to routine monitoring. A&T training was associated with increased capacity of providers, resulting in higher-quality IYCF counseling (greater technical knowledge and communication skills during counseling) in A&T-I areas. Franchise utilization increased from 10% in 2012 to 45% in 2013 but fell below the expected frequency of 9-15 contacts per mother-child dyad. Improvements in breastfeeding knowledge, beliefs, intentions, and practices were greater among mothers in A&T-I areas than among those in A&T-NI areas. In conclusion, there are many positive changes along the impact pathway of the franchise services, but challenges in utilization and demand creation should be addressed to achieve the full intended impact. © 2014 American Society for Nutrition.

Financing geriatric programs in community health centers.

PubMed Central

Yeatts, D E; Ray, S; List, N; Duggar, B

1991-01-01

There are approximately 600 Community and Migrant Health Centers (C/MHCs) providing preventive and primary health care services principally to medically underserved rural and urban areas across the United States. The need to develop geriatric programs within C/MHCs is clear. Less clear is how and under what circumstances a comprehensive geriatric program can be adequately financed. The Health Resources and Services Administration of the Public Health Service contracted with La Jolla Management Corporation and Duke University Center on Aging to identify successful techniques for obtaining funding by examining 10 "good practice" C/MHC geriatric programs. The results from this study indicated that effective techniques included using a variety of funding sources, maintaining accurate cost-per-user information, developing a marketing strategy and user incentives, collaborating with the area agency on aging and other community organizations, and developing special services for the elderly. Developing cost-per-user information allowed for identifying appropriate "drawing card" services, negotiating sound reimbursement rates and contracts with other providers, and assessing the financial impact of changing service mixes. A marketing strategy was used to enhance the ability of the centers to provide a comprehensive package of services. Collaboration with the area agency on aging and other community organizations and volunteers in the aging network was found to help establish referral networks and subsequently increase the number of elderly patients served. Finally, development of special services for the elderly, such as adult day care, case management, and health education, was found to increase program visibility, opportunities to work with the network of services for the aging, and clinical utilization. PMID:1908588

Impact of medical subsidy disqualification on children's healthcare utilization: A difference-in-differences analysis from Japan.

PubMed

Miyawaki, Atsushi; Noguchi, Haruko; Kobayashi, Yasuki

2017-10-01

Financial support for children's medical expenses has been introduced in many countries. Limited work has been done on price elasticity in children's healthcare demand, especially in countries other than the United States. Moreover, it remains unclear how the effects of a change in the cost sharing rate on healthcare demand would differ by medical condition. We investigated the impact of an increase in the cost sharing rate on medical service utilization among school children as a whole and for each of nine common conditions, applying a difference-in-differences approach. The study period ranged from April 1, 2012, to March 30, 2014. Participants were elementary school children in an urban area who were eligible for National Health Insurance (a community-based public insurance) during the study period and who were enrolled in the 2nd, 3rd, or 4th grade in April 2013. We collected observations from 2896 persons and 69,504 (2896 × 24 months) person-months. When elementary school children were promoted to the 4th grade, they became disqualified for a municipal medical subsidy. The control group was the children promoted to the 2nd or the 3rd grade, who remained eligible for the subsidy. All data were obtained from health insurance claims. We identified the nine most common medical conditions among the subject children, and stratified the analyses by the condition diagnosed. We found that an increase in the cost sharing rate reduced outpatient service utilization as a whole. Also, we observed an increase in inpatient service utilization, not because of worsened health conditions, but rather due to substitution of inpatient service for outpatient service. The reductions in outpatient service were heterogeneous across medical conditions; declines were sharper for mild or chronic conditions. These findings may help to characterize how a change in cost sharing rate affects health outcomes in children. Copyright © 2017 Elsevier Ltd. All rights reserved.

Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria.

PubMed

Adedokun, Sulaimon T; Adekanmbi, Victor T; Uthman, Olalekan A; Lilford, Richard J

2017-01-01

To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria. The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1), nested within 896 communities (level 2) from 37 states (level 3). About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%). While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31-2.03), from rich households (aOR = 1.76; 95% CrI = 1.35-2.25), with access to media (radio, television or magazine) (aOR = 1.18; 95% CrI = 1.08-1.29), and engaging in employment (aOR = 1.18; 95% CrI = 1.02-1.37) were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75-0.99) were less likely to have used health service for their children. Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of mobile clinics and establishment of more primary health care centres.

Understanding Service Utilization Disparities and Depression in Latinos: The Role of Fatalismo.

PubMed

Anastasia, Elizabeth A; Bridges, Ana J

2015-12-01

Research demonstrates a disparity between need and utilization of mental health services for Latinos. Cultural variations in perceptions of mental illness may be partially responsible for this discrepancy. Past research with Latinos has shown links between fatalismo, a cultural value similar to external locus of control, and both depression and lower service utilization in medical care, while links to psychiatric care have not been investigated. The current study therefore aimed to explore the associations between fatalismo, depression, and past year mental health service utilization by Latinos. A community sample of 83 Latino adults were recruited during local cultural events. Participants completed self-report measures of depression, fatalism, and past year service utilization. Analyses using structural equation modeling showed fatalismo was directly negatively related to past year medical service utilization (β = -.35). In contrast, the link between fatalismo and past year mental health service utilization was mediated by self-reported depressive symptoms (indirect β = .19, p < .001). We conclude that while fatalismo is associated with depression in Latinos, other barriers likely serve as more salient deterrents of service utilization.

Outpatient physical therapy utilization for children and adolescents with intellectual disabilities in Taiwan: a population-based nationwide study.

PubMed

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

2014-02-01

This study analyzed the utilization and utilization determinants of outpatient physical therapy (PT) among children and adolescents with intellectual disabilities (ID) in Taiwan. A cross-sectional study was conducted to analyze 2007 national health insurance (NHI) claim data from 35,802 eighteen-year-old and younger persons with intellectual disabilities. A total of 3944 (11.02%) claimants received outpatient physical therapy. Variables that affected PT utilization included age, residence urbanization level, ID level, copayment status and major co-morbidity. The average annual PT visit frequency was 25.4 ± 33.0; pre-school children, claimants suffering from catastrophic disease and ID co-occurring with cerebral palsy had a higher mean cost per visit. Age, ID level, copayment status and co-morbidity were factors that influenced expenditure. Pre-school children, males, individuals who resided in the lowest urbanization areas and individuals with a catastrophic disease tended to use hospital services. The point prevalence of epilepsy and cerebral palsy were 12.10% and 19.80%, respectively. Despite the NHI program and government regulations to provide special services, the use of physical therapy for children and adolescents with intellectual disabilities was low, and the utilization decreased as the subjects aged. Copyright © 2013 Elsevier Ltd. All rights reserved.

County Context and Mental Health Service Utilization by Older Hispanics.

PubMed

Kim, Kyeongmo

2018-04-16

Although older Hispanics experience high rates of depression, they tend to underuse mental health services. The study examined the association between county characteristics and mental health service use among older Hispanics, controlling for individual characteristics. The study used the 2008-2012 Medical Expenditure Panel Study and linked county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse, using the Federal Information Processing Standard county code. The sample includes 1,143 community-dwelling Hispanics ages 60 years or older (Level 1) and 156 counties (Level 2) where the sample resides. The single dichotomous measure of mental health service utilization was based on whether or not the respondent met one or more of three conditions: (1) the respondent received care from a mental health professional, (2) received a service including mental health counseling or psychotherapy, or (3) received a service that was related to the International Classification of Diseases. Multilevel logistic regression analysis was used to examine the role of county context. The proportion of older adults and the existence of community mental health centers at the county-level were associated with mental health services use among this population. At the individual-level, education and mental health status were also associated with using mental health services. The county context plays an important role in understanding mental health services use among older Hispanics, indicating the need for intervention strategies at the county level.

Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor?

PubMed

Pariyo, George W; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Rahman, Mohammed Hafizur; Peterson, Stefan; Bishai, David M; Lucas, Henry; Peters, David H

2009-11-12

Uganda implemented health sector reforms to make services more accessible to the population. An assessment of the likely impact of these reforms is important for informing policy. This paper describes the changes in utilization of health services that occurred among the poor and those in rural areas between 2002/3 and 2005/6 and associated factors. Secondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset based index derived from Principal Components Analysis (PCA). The probability of choice of health care provider was assessed using multinomial logistic regression and multi-level statistical models. The odds of not seeking care in 2005/6 were 1.79 times higher than in 2002/3 (OR = 1.79; 95% CI 1.65 - 1.94). The rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access (OR = 0.57; 95% CI 0.48 - 0.67). The risk of not seeking care due to high costs did not change significantly. Private for profit providers (PFP) were the major providers of services in 2002/3 and 2005/6. Using PFP as base category, respondents were more likely to have used private not for profit (PNFP) in 2005/6 than in 2002/3 (OR = 2.15; 95% CI 1.58 - 2.92), and also more likely to use public facilities in 2005/6 than 2002/3 (OR = 1.31; 95% CI 1.15 - 1.48). The most poor, females, rural residents, and those from elderly headed households were more likely to use public facilities relative to PFP. Although overall utilization of public and PNFP services by rural and poor populations had increased, PFP remained the major source of care. The odds of not seeking care due to distance decreased in rural areas but cost continued to be an important barrier to seeking health services for residents from poor, rural, and elderly headed households. Policy makers should consider targeting subsidies to the poor and rural populations. Public private partnerships should be broadened to increase access to health services among the vulnerable.

DISTRIBUTION AND UTILISATION OF IVERMECTIN (MECTIZAN): A CHEMOTHERAPEUTIC APPROACH TO THE CONTROL OF ONCHOCERCIASIS IN OLD OHAOZARA LGA, EBONYI STATE, EASTERN NIGERIA.

PubMed

Okpara, Elom Michael; Mnaemeka, Alo Moses; Iyioku, Ugah Uchenna; Udoh, Usanga Victor

2015-12-01

Onchocerciasis (river blindness) is a devastating, debilitating Stigmatising and incapacitating parasitic disease that is endemic in tropical and subtropical regions of the world, including Nigeria. Mass distribution of ivermectin (Mectizan) to the endemic parts of the world was initiated by the Onchocerciasis Control Programmes (OCPs). Absolute compliance to the regimen for up to 15 years has been reported to be effective in the control of the disease. The study was carried out in Ohaozara LGA, Onicha LGA and Ivo LGA. The three (3) LGAs made up the defunct Old Ohaozara LGA. A structured questionnaire was used to generate information on knowledge of Onchocerciasis and on the use of ivermectin by the inhabitants of the communities of the study areas. The distribution coverage of ivermectin in the study areas dating from 2010 to 2014 was ascertained with drug distribution charts obtained from Ebonyi State Health Management Board (ESHMB), Abakaliki (the point source of distribution in the state), and from the health centres in communities of old Ohaozara LGA (the service delivery points (SDPs) to inhabitants of the communities. Data was analysed using descriptive statistics. Utilization of the regimen was ascertained by determining the actual number of tablets of mectizan that was administered to the patients at the various health cenrtes (service delivery points (SDPs) in the communities. The percentage utilization of the regimen was determined by dividing the number of mectizan tablets administered to the patients at SDPs with the number of mectizan tablets supplied from state point source of distribution and multiplying by 100. A total of 347, 299 out of 1, 919135 tablets of mectizan supplied to the study areas from 2010 to 2014 were actually utilized, forming an overall percentage utilization of 18.10%. There was adequate supply but very poor utilization of the regimen. The poor utilization resulted from factors including locating of health centres very far from homes of some of the rural villagers, non-yearly compliance with regimen administration, poor health sensitization and education and lack of incentives orpoor incentives to the village-based health workers (VBHWs). Intensification of efforts to cover the lapses in the utilization of the regimen is advocated for a more effective control of the disease.

How did market competition affect outpatient utilization under the diagnosis-related group-based payment system?

PubMed

Kim, Seung Ju; Park, Eun-Cheol; Kim, Sun Jung; Han, Kyu-Tae; Jang, Sung-In

2017-06-01

Although competition is known to affect quality of care, less is known about the effects of competition on outpatient health service utilization under the diagnosis-related group payment system. This study aimed to evaluate these effects and assess differences before and after hospitalization in South Korea. Population-based retrospective observational study. We used two data set including outpatient data and hospitalization data from National Health Claim data from 2011 to 2014. Participants who were admitted to the hospital for hemorrhoidectomy were included. A total of 804 884 hospitalizations were included in our analysis. The outcome variables included the costs associated with outpatient examinations and the number of outpatient visits within 30 days before and after hospitalization. High-competition areas were associated with lower pre-surgery examination costs (rate ratio [RR]: 0.88, 95% confidence interval [CI]: 0.88-0.89) and fewer outpatient visits before hospitalization (RR: 0.98, 95% CI: 0.98-0.99) as well as after hospitalization compared with moderate-competition areas. Our study reveals that outpatient health service utilization is affected by the degree of market competition. Future evaluations of hospital performance should consider external factors such as market structure and hospital location. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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

PubMed

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

2016-01-01

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

Planning guidelines for computerized transaxial tomography (CT)

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

Not Available

1976-11-23

Guidelines to assist local communities in review and decisionmaking related to computerized tomography (CT) 'head' and 'whole body' scanner needs and placement are presented. Although medical benefits for head scanning are well established, the proper role of whole body scanning in relation to other diagnostic procedures has not been determined. It is recommended that a 20 percent weighted consideration could be given to a potential CT scanner applicant's present capabilities in diagnostic 'body' work. The following guidelines for CT are recommended for use in assessing work qualifications of potential CT scanner applicants: (1) The facility must have an active neurosurgicalmore » service, with a geographically full-time board - certified neurosurgeon and at least 50 intracranial procedures performed annually. (2) The facility must have an active neurological service, with a geographically full-time board - certified neurologist. (3) The facility must have on staff a qualified neuroradiologist. It is recommended that the CT scanner utilization level be a minimum of 3,000 examinations per year per unit of new equipment. The applicant must submit financial data and must be committed to providing care to all patients, independent of ability to pay. The applicant must submit letters from area hospitals agreeing to utilize the scanner services. Additional criteria are given for body scanning work and for the number of scanners in a specific area. Detailed information is presented about scanner development and use in southeastern Pennsylvania and neighboring planning areas, and the cost of scanner operations is compared with revenues. The CT scanner committee membership is included.« less

Network of Black Students Hopes to Create a New Generation of Civil-Rights Leaders.

ERIC Educational Resources Information Center

Collison, Michelle N-K

1992-01-01

A network of African-American students begun at Howard University (District of Columbia) combines community service with political activism. Students working in a variety of areas urge other young African Americans to become active about local and state policies concerning utilities costs, children, and schools and to empower teenagers for…

The Utility of the Personal Wellbeing Index Intellectual Disability Scale in an Australian Sample

ERIC Educational Resources Information Center

McGillivray, J. A.; Lau, A. L. D.; Cummins, R. A.; Davey, G.

2009-01-01

Background: Subjective wellbeing (SWB) in people with intellectual disabilities has been the focus of increased interest in the identification of support needs and as an outcome measure for interventions and service delivery evaluations. It is therefore important to conduct further research in this area, and to develop appropriate scales to…

Using search engine query data to track pharmaceutical utilization: a study of statins.

PubMed

Schuster, Nathaniel M; Rogers, Mary A M; McMahon, Laurence F

2010-08-01

To examine temporal and geographic associations between Google queries for health information and healthcare utilization benchmarks. Retrospective longitudinal study. Using Google Trends and Google Insights for Search data, the search terms Lipitor (atorvastatin calcium; Pfizer, Ann Arbor, MI) and simvastatin were evaluated for change over time and for association with Lipitor revenues. The relationship between query data and community-based resource use per Medicare beneficiary was assessed for 35 US metropolitan areas. Google queries for Lipitor significantly decreased from January 2004 through June 2009 and queries for simvastatin significantly increased (P <.001 for both), particularly after Lipitor came off patent (P <.001 for change in slope). The mean number of Google queries for Lipitor correlated (r = 0.98) with the percentage change in Lipitor global revenues from 2004 to 2008 (P <.001). Query preference for Lipitor over simvastatin was positively associated (r = 0.40) with a community's use of Medicare services. For every 1% increase in utilization of Medicare services in a community, there was a 0.2-unit increase in the ratio of Lipitor queries to simvastatin queries in that community (P = .02). Specific search engine queries for medical information correlate with pharmaceutical revenue and with overall healthcare utilization in a community. This suggests that search query data can track community-wide characteristics in healthcare utilization and have the potential for informing payers and policy makers regarding trends in utilization.

Information infrastructure for emergency medical services.

PubMed

Orthner, Helmuth; Mishra, Ninad; Terndrup, Thomas; Acker, Joseph; Grimes, Gary; Gemmill, Jill; Battles, Marcie

2005-01-01

The pre-hospital emergency medical and public safety information environment is nearing a threshold of significant change. The change is driven in part by several emerging technologies such as secure, high-speed wireless communication in the local and wide area networks (wLAN, 3G), Geographic Information Systems (GIS), Global Positioning Systems (GPS), and powerful handheld computing and communication services, that are of sufficient utility to be more widely adopted. We propose a conceptual model to enable improved clinical decision making in the pre-hospital environment using these change agents.

Methods for measuring utilization of mental health services in two epidemiologic studies

PubMed Central

NOVINS, DOUGLAS K.; BEALS, JANETTE; CROY, CALVIN; MANSON, SPERO M.

2015-01-01

Objectives of Study Psychiatric epidemiologic studies often include two or more sets of questions regarding service utilization, but the agreement across these different questions and the factors associated with their endorsement have not been examined. The objectives of this study were to describe the agreement of different sets of mental health service utilization questions that were included in the American Indian Service Utilization Psychiatric Epidemiology Risk and Protective Factors Project (AI-SUPERPFP), and compare the results to similar questions included in the baseline National Comorbidity Survey (NCS). Methods Responses to service utilization questions by 2878 AI-SUPERPFP and 5877 NCS participants were examined by calculating estimates of service use and agreement (κ) across the different sets of questions. Logistic regression models were developed to identify factors associated with endorsement of specific sets of questions. Results In both studies, estimates of mental health service utilization varied across the different sets of questions. Agreement across the different question sets was marginal to good (κ = 0.27–0.69). Characteristics of identified service users varied across the question sets. Limitations Neither survey included data to examine the validity of participant responses to service utilization questions. Recommendations for Further Research Question wording and placement appear to impact estimates of service utilization in psychiatric epidemiologic studies. Given the importance of these estimates for policy-making, further research into the validity of survey responses as well as impacts of question wording and context on rates of service utilization is warranted. PMID:18767205

Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda

PubMed Central

AkiiBua, Douglas; Aleni, Carol; Chitayi, Michael; Niwaha, Anxious; Kazibwe, Andrew; Sunya, Elizabeth; Mumbere, Eliud W.; Mutesi, Carol; Tukei, Cathy; Kasangaki, Arabat; Nakubulwa, Sarah

2015-01-01

Introduction Globally every year 529,000 maternal deaths occur, 99% of this in developing countries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda; these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. Method Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number “#REC REF 2012-117” before conducting the study. Results A total of four hundred one were enrolled with the majority being in the age group 20 – 24 years (mean age, 25.87 ± 6.26). Health workers played a great role (72.04%), followed by the media (15.46%) and friends (12.50%) in creating awareness about ANC. A significant number of respondents went to TBAs with reasons such as “near and accessible”, “my husband decided”, and “they are the only people I know”. 37.63% of the respondents considered getting an antenatal Card as an importance of ANC. 71 (19.67%) respondents gave a wrong opinion (late) on booking time with reasons like demands at work, no problems during pregnancy, advised by friends, just to get a card, long distance and others didn’t know. Almost half of the respondents never knew the recommended number of visits. Religion, occupation, level of education, and parity were found to influence place of ANC attendance, number of ANC visits and booking time. Husbands were necessary to provide financial support, accompany their wives ANC clinic, and ensure that they complete the visits. But their response was poor due to: fear of routine investigations and constrained economically. Conclusion The study findings show the actual rural setting of ANC services attendance and utilization. Much sensitization has to be done specifically in these rural areas to empower pregnant women and their husbands as to improve ANC attendance and utilization. PMID:26042190

Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda.

PubMed

Kawungezi, Peter Chris; AkiiBua, Douglas; Aleni, Carol; Chitayi, Michael; Niwaha, Anxious; Kazibwe, Andrew; Sunya, Elizabeth; Mumbere, Eliud W; Mutesi, Carol; Tukei, Cathy; Kasangaki, Arabat; Nakubulwa, Sarah

2015-03-01

Globally every year 529,000 maternal deaths occur, 99% of this in developing countries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda; these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number "#REC REF 2012-117" before conducting the study. A total of four hundred one were enrolled with the majority being in the age group 20 - 24 years (mean age, 25.87 ± 6.26). Health workers played a great role (72.04%), followed by the media (15.46%) and friends (12.50%) in creating awareness about ANC. A significant number of respondents went to TBAs with reasons such as "near and accessible", "my husband decided", and "they are the only people I know". 37.63% of the respondents considered getting an antenatal Card as an importance of ANC. 71 (19.67%) respondents gave a wrong opinion (late) on booking time with reasons like demands at work, no problems during pregnancy, advised by friends, just to get a card, long distance and others didn't know. Almost half of the respondents never knew the recommended number of visits. Religion, occupation, level of education, and parity were found to influence place of ANC attendance, number of ANC visits and booking time. Husbands were necessary to provide financial support, accompany their wives ANC clinic, and ensure that they complete the visits. But their response was poor due to: fear of routine investigations and constrained economically. The study findings show the actual rural setting of ANC services attendance and utilization. Much sensitization has to be done specifically in these rural areas to empower pregnant women and their husbands as to improve ANC attendance and utilization.

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

Preparedness of County Referral Health Facilities in Implementing Adolescent Friendly Health Services: A Case Study of Mama Lucy Kibaki Hosptal

PubMed Central

Owuondo, Pacific Akinyi; Mwaura-Tenembergen, Wanja; Adoyo, Maureen; Kiilu, Elizabeth M.

2015-01-01

Health service delivery is a key pillar of the health system management .The World Health Organization recently emphasized the need to develop adolescent -friendly health services to improve the care provided to young people throughout the world. However, there is limited peer reviewed literature on this subject therefore necessitating assessment of whether the existing health facilities are prepared to implement the adolescent friendly health services. Adolescent friendly health services remains a relatively new and sensitive area mainly due to restrictive norms and policies guiding the services. After International Conference on Population and Development in 1994, countries started implementing adolescent friendly health services. The Government of Kenya together with partners in an attempt to address the health challenges came up with the Adolescent package of care (APOC) in 2013 whose guidelines were finalized in November 2014 and released for use by service providers . Despite this package of care, there is still ineffective staff capacity in relation to skills and knowledge gap of health professionals, training needs, health resources as well as health system factors that can affect implementation of AFHS. The study explored ways of mitigating or addressing the barriers to implementation of these services. The study used both quantitative and qualitative approaches to collect data. The study utilized survey research adapting descriptive cross sectional design and semi-structured questionnaire to interview 348 health care providers and 472 adolescents in Mam Lucy Kibaki Hospital from 3rd May 2014 to 16 June 2014 .The key informants were mainly nurses, clinical officers and Medical doctors who were working at the health service delivery area at the time of study and were interviewed using an interview guide. The managers at the hospital were interviewed using an in-depth interview guide while the adolescents were interviewed through interview guide and focused group discussion. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) Version 18.0. Descriptive statistics and chi-square tests were performed to determine significant associations. The study established that sex, age, level of education and adolescent awareness about existence of friendly health services offered were significantly associated with utilization at p<0.05. Long queues, unfavorable working hours and lack of money negatively affected consumption of AFHS.The study concluded that the utilization of health services among the adolescents was low largely due to unfriendliness of the health care providers at health facilities and lack of awareness of AFHS services. In view of the findings, this study recommends need for the Government through the Ministry of Health and partners in health service provision to increase the number of AFHS and ensure that the recommendations of Adolescent Package of care is implemented fully with good evaluation strategies in place. Laborious awareness drives to sensitize the adolescents about the available services through rigorous health education and increased involvement of both parents/guardians and teachers to scale up implementation are also recommended. PMID:26153176

Preparedness of County Referral Health Facilities in Implementing Adolescent Friendly Health Services: A Case Study of Mama Lucy Kibaki Hospital.

PubMed

Owuondo, Pacific Akinyi; Mwaura-Tenembergen, Wanja; Adoyo, Maureen; Kiilu, Elizabeth M

2015-03-25

Health service delivery is a key pillar of the health system management. The World Health Organization recently emphasized the need to develop adolescent -friendly health services to improve the care provided to young people throughout the world. However, there is limited peer reviewed literature on this subject therefore necessitating assessment of whether the existing health facilities are prepared to implement the adolescent friendly health services. Adolescent friendly health services remains a relatively new and sensitive area mainly due to restrictive norms and policies guiding the services. After International Conference on Population and Development in 1994, countries started implementing adolescent friendly health services. The Government of Kenya together with partners in an attempt to address the health challenges came up with the Adolescent package of care (APOC) in 2013 whose guidelines were finalized in November 2014 and released for use by service providers . Despite this package of care, there is still ineffective staff capacity in relation to skills and knowledge gap of health professionals, training needs, health resources as well as health system factors that can affect implementation of AFHS. The study explored ways of mitigating or addressing the barriers to implementation of these services. The study used both quantitative and qualitative approaches to collect data. The study utilized survey research adapting descriptive cross sectional design and semi-structured questionnaire to interview 348 health care providers and 472 adolescents in Mam Lucy Kibaki Hospital from 3rd May 2014 to 16 June 2014. The key informants were mainly nurses, clinical officers and Medical doctors who were working at the health service delivery area at the time of study and were interviewed using an interview guide. The managers at the hospital were interviewed using an in-depth interview guide while the adolescents were interviewed through interview guide and focused group discussion. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) Version 18.0. Descriptive statistics and chi-square tests were performed to determine significant associations. The study established that sex, age, level of education and adolescent awareness about existence of friendly health services offered were significantly associated with utilization at p<0.05. Long queues, unfavorable working hours and lack of money negatively affected consumption of AFHS. The study concluded that the utilization of health services among the adolescents was low largely due to unfriendliness of the health care providers at health facilities and lack of awareness of AFHS services. In view of the findings, this study recommends need for the Government through the Ministry of Health and partners in health service provision to increase the number of AFHS and ensure that the recommendations of Adolescent Package of care is implemented fully with good evaluation strategies in place. Laborious awareness drives to sensitize the adolescents about the available services through rigorous health education and increased involvement of both parents/guardians and teachers to scale up implementation are also recommended.

Solar Heating And Cooling Of Buildings (SHACOB): Requirements definition and impact analysis-2. Volume 1: Energy-conserving design for residential structures

NASA Astrophysics Data System (ADS)

Cretcher, C. K.

1980-11-01

The impact of stringent energy conserving building standards on electric utility service areas and their customers was analyzed. The demands on the seven broadly representative electric utilities were aggregated to represent the total new construction electric heating demands in the years 1990 and 2000 to be compared to the aggregate obtained similarly for a nominal, less stringent standard, viz., ASHRAE 90-75. Results presented include the percentage of energy savings achieved in both heating and cooling seasons and typical demand profile changes. A utility economic impact analysis was performed for the cases investigated to determine changes in operating costs and potential capacity sales. A third cost component considered is the incremental cost of superinsulation (over ASHRAE 90-75) to the customer. The aggregate net cost to the utility/customer entity is utilized as a measure of overall economic benefit.

Air pollution and general practitioner access and utilization: a population based study in Sarnia, 'Chemical Valley,' Ontario

PubMed Central

2011-01-01

Background Health impacts of poor environmental quality have been identified in studies around the world and in Canada. While many of the studies have identified associations between air pollution and mortality or morbidity, few have focused on the role of health care as a potential moderator of impacts. This study assessed the determinants of health care access and utilization in the context of ambient air pollution in Sarnia, Ontario, Canada. Methods Residents of Sarnia participated in a Community Health Study administered by phone, while several ambient air pollutants including nitrogen dioxide (NO2), sulphur dioxide (SO2) and the volatile organic compounds benzene, toluene, ethylbenzene, mp- and o-xylene (BTEX) were monitored across the city. Land Use Regression models were used to estimate individual exposures to the measured pollutants and logistic regression models were utilized to assess the relative influence of environmental, socioeconomic and health related covariates on general practitioner access and utilization outcomes. Results The results show that general practitioner use increased with levels of exposure to nitrogen dioxide (NO2- Odds Ratio [OR]: 1.16, p < 0.05) and sulphur dioxide (SO2- OR: 1.61, p < 0.05). Low household income was a stronger predictor of having no family doctor in areas exposed to high concentrations of NO2 and SO2. Respondents without regular care living in high pollution areas were also more likely to report travelling or waiting for care in excess of 20 minutes (OR: 3.28, p < 0.05) than their low exposure counterparts (OR: 1.11, p > 0.05). Conclusions This study provides evidence for inequitable health care access and utilization in Sarnia, with particular relevance to its situation as a sentinel high exposure environment. Levels of exposure to pollution appears to influence utilization of health care services, but poor access to primary health care services additionally burden certain groups in Sarnia, Ontario, Canada. PMID:21827645

Restoring ecosystem services to littoral zones of rivers in the urban core of Chongqing, China.

PubMed

Xian, Xu-Dong; Feng, Yi-Long; Willison, J H Martin; Ai, Li-Jiao; Wang, Ping; Wu, Zhi-Neng

2015-08-01

Two examples of the creation of naturalized areas in the littoral zone of the Three Gorges Reservoir in the urban core of Chongqing City, China, are described. The areas were created for the purpose of restoring ecological functions and services. Plants were selected based on surveys of natural wetland vegetation in the region, and experiments were conducted to discover the capacity of species of interest to survive the sometimes extreme hydrological regimes at the sites. Novel methods were developed to stabilize the plants against the rigors of extreme summer floods and constant swash, notably zigzag berms of rocks wrapped in iron mesh. The areas include native reeds, grasses, shrubs, and trees. Plant communities in the areas are zoned according to flooding stress, and their structure is less stable at lower elevations that are subjected to greater stress. The tall grass Saccharum spontaneum (widespread in Southern Asia) and the tree Pterocarya stenoptera (native to Southwest China) are notable for their utility at these sites in the center of a large city. Communities of tall reeds and grasses have become so dense and stable that they now provide the ecosystem services of capturing river sediments and resisting erosion of the river banks. It is recommended that extensive greening of the riparian zones in urban areas of the Three Gorges Reservoir be conducted for the purpose of providing ecosystem services, based in part on the experiences described here.

JSC Pharmacy Services for Remote Operations

NASA Technical Reports Server (NTRS)

Stoner, Paul S.; Bayuse, Tina

2005-01-01

The Johnson Space Center Pharmacy began operating in March of 2003. The pharmacy serves in two main capacities: to directly provide medications and services in support of the medical clinics at the Johnson Space Center, physician travel kits for NASA flight surgeon staff, and remote operations, such as the clinics in Devon Island, Star City and Moscow; and indirectly provide medications and services for the International Space Station and Space Shuttle medical kits. Process changes that occurred and continued to evolve in the advent of the installation of the new JSC Pharmacy, and the process of stocking medications for each of these aforementioned areas will be discussed. Methods: The incorporation of pharmacy involvement to provide services for remote operations and supplying medical kits was evaluated. The first step was to review the current processes and work the JSC Pharmacy into the existing system. The second step was to provide medications to these areas. Considerations for the timeline of expiring medications for shipment are reviewed with each request. The third step was the development of a process to provide accountability for the medications. Results: The JSC Pharmacy utilizes a pharmacy management system to document all medications leaving the pharmacy. Challenges inherent to providing medications to remote areas were encountered. A process has been designed to incorporate usage into the electronic medical record upon return of the information from these remote areas. This is an evolving program and several areas have been identified for further improvement.

An analysis of the field service function of selected electronics firms

NASA Astrophysics Data System (ADS)

Hull, Dennis Lee

For the purposes of this study, field service was defined as the function concerned with the servicing and maintaining, by the manufacturer or supplier, of products (usually owned by customers) used away from the manufacturer's or supplier's site. Field service is an important component of the service sector and of customer service. Field service availability and quality of this service are increasingly being used by customers as a means of product selection. Many companies have recognized this trend and have identified field service as a competitive edge. A review of the field service literature and discussions with field service consultants and professionals indicated a lack of field service research--more specifically, a systems analysis of the area was lacking. The purpose of this research was to examine, utilizing a systems perspective, the field service practices of leading electronics firms in order to develop field service management propositions (empirical generalizations) and a prescriptive model of best practice. The electronics industry was selected due to the critical relation of service-based competition to company profitability.

Use of human remains detection dogs for wide area search after wildfire: a new experience for TexasTask Force 1 Search and Rescue resources.

PubMed

Migala, Alexandre F; Brown, Susann E

2012-12-01

In September 2011, wildfires in Bastrop County, TX, were the most destructive in the state's history, consuming more than 34000 acres (13759 hectares) and more than 1600 homes in the process. The wildfires began by consuming more than 30 homes across 2 miles (3.2 km) in 17 minutes, raising the fear that local residents may not have had sufficient time to escape the conflagration. Texas Task Force 1 deployed for a new mission, the search and recovery of human remains. Although there have been other larger and more widespread fires in the past, it was the speed at which this fire spread that created the environment requiring such a search. The mission was focused primarily on human detection, searching an area almost 72 square miles (186 km(2)) between September 7 and 11, 2011. To our knowledge, never before have human remains detection dogs been tasked with such an undertaking. Lessons learned from this event will educate all levels of government agencies, emergency medical services, fire departments, law enforcement, utilities, veterinary services, and search and rescue/recovery activities in the future. The utilization of human remains detection canines integrated with search teams trained in larger scale events is one such area that will benefit from this experience, with a final area searched of 15 598 acres (6312 hectares). Copyright © 2012 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Estimating Air Pollution Removal Through an Analysis of Vegetation Communities in Government Canyon State Natural Area

NASA Astrophysics Data System (ADS)

Medrano, Nicolas W.

Ambient air pollution is a major issue in urban environments, causing negative health impacts and increasing costs for metropolitan economies. Vegetation has been shown to remove these pollutants at a substantial rate. This study utilizes the i-Tree Eco (UFORE) and i-Tree Canopy models to estimate air pollution removal services provided by trees in Government Canyon State Natural Area (GCSNA), an approximately 4,700 hectare area in San Antonio, Texas. For i-Tree Eco, a stratified project of the five prominent vegetation types was completed. A comparison of removal services provided by vegetation communities indicated there was no significant difference in removal rates. Total pollution removal of GCSNA was estimated to be 239.52 metric tons/year at a rate of 64.42 kg/ha of tree cover/year. By applying this value to the area within Bexar County, Texas belonging to the Balcones Canyonlands ecoregion, it was determined that for 2013 an estimated 2,598.45 metric tons/year of air pollution was removed at a health value to society of 19.4 million. This is a reduction in pollution removal services since 2003, in which 3,050.35 metric tons/year were removed at a health value of 22.8 million. These results suggest urban sprawl taking place in San Antonio is reducing air pollution removal services provided by trees.

Development of geothermal energy in the Gulf Coast: socio-economic, demographic, and political considerations

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

Letlow, K.; Lopreato, S.C.; Meriwether, M.

The institutional aspect of the study attempts to identify possible effects of geothermal research, development, and utilization on the area and its inhabitants in three chapters. Chapters I and II address key socio-economic and demographic variables. The initial chapter provides an overview of the area where the resource is located. Major data are presented that can be used to establish a baseline description of the region for comparison over time and to delineate crucial area for future study with regard to geothermal development. The chapter highlights some of the variables that reflect the cultural nature of the Gulf Coast, itsmore » social characteristics, labor force, and service in an attempt to delineate possible problems with and barriers to the development of geothermal energy in the region. The following chapter focuses on the local impacts of geothermal wells and power-generating facilities using data on such variables as size and nature of construction and operating crews. Data are summarized for the areas studied. A flow chart is utilized to describe research that is needed in order to exploit the resource as quickly and effectively as possible. Areas of interface among various parts of the research that will include exchange of data between the social-cultural group and the institutional, legal, environmental, and resource utilization groups are identified. (MCW)« less

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam.

PubMed

Ngo, Anh D; Hill, Peter S

2011-09-27

With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level. This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services. Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS. Women choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services.

Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study.

PubMed

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

2014-11-01

Inequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals. The objective of this study is to examine the extent to which maternal health services are utilised in Ghana, and whether inequities in accessibility to and utilization of services have been eliminated following the implementation of a user-fee exemption policy, that aims to reduce financial barriers to access, reduce inequities in access, and improve access to and use of birthing services. We analyzed data from the 2007 Ghana Maternal Health Survey for inequities in access to and utilization of maternal health services. In measuring the inequities, frequency tables and cross-tabulations were used to compare rates of service utilization by region, residence and selected socio-demographic variables. Findings show marginal increases in accessibility to and utilisation of skilled antenatal, delivery and postnatal care services following the policy implementation (2003-2007). However, large gradients of inequities exist between geographic regions, urban and rural areas, and different socio-demographic, religious and ethnic groupings. More urban women (40%) than rural, 53% more women in the highest wealth quintile than women in the lowest, 38% more women in the best performing region (Central Region) than the worst (Upper East Region), and 48% more women with at least secondary education than those with no formal education, accessed and used all components of skilled maternal health services in the five years preceding the survey. Our findings raise questions about the potential equity and distributional benefits of Ghana's user-fee exemption policy, and the role of non-financial barriers or considerations. Exempting user-fees for maternal health services is a promising policy option for improving access to maternal health care, but might be insufficient on its own to secure equitable access to maternal health services in Ghana. Ensuring equity in access will require moving beyond user-fee exemption to addressing wider issues of supply and demand factors and the social determinants of health, including redistributing healthcare resources and services, and redressing the positional vulnerability of women in their communities.

REDD and PINC: A new policy framework to fund tropical forests as global 'eco-utilities'

NASA Astrophysics Data System (ADS)

Trivedi, M. R.; Mitchell, A. W.; Mardas, N.; Parker, C.; Watson, J. E.; Nobre, A. D.

2009-11-01

Tropical forests are 'eco-utilities' providing critical ecosystem services that underpin food, energy, water and climate security at local to global scales. Currently, these services are unrecognised and unrewarded in international policy and financial frameworks, causing forests to be worth more dead than alive. Much attention is currently focused on REDD (Reducing Emissions from Deforestation and forest Degradation) and A/R (Afforestation and Reforestation) as mitigation options. In this article we propose an additional mechanism - PINC (Proactive Investment in Natural Capital) - that recognises and rewards the value of ecosystem services provided by standing tropical forests, especially from a climate change adaptation perspective. Using Amazonian forests as a case study we show that PINC could improve the wellbeing of rural and forest-dependent populations, enabling them to cope with the impacts associated with climate change and deforestation. By investing pro-actively in areas where deforestation pressures are currently low, the long-term costs of mitigation and adaptation will be reduced. We suggest a number of ways in which funds could be raised through emerging financial mechanisms to provide positive incentives to maintain standing forests. To develop PINC, a new research and capacity-building agenda is needed that explores the interdependence between communities, the forest eco-utility and the wider economy.

Inequalities in dental services utilization among Brazilian low-income children: the role of individual determinants.

PubMed

Baldani, Marcia Helena; Mendes, Yasmine Bittencourt Emílio; Lawder, Juliana Aparecida de Campos; de Lara, Ana Paula Ingles; Rodrigues, Michelli Marta Azevedo da Silva; Antunes, Jose Leopoldo Ferreira

2011-01-01

To assess the role of the individual determinants on the inequalities of dental services utilization among low-income children living in the working area of Brazilian's federal Primary Health Care program, which is called Family Health Program (FHP), in a big city in Southern Brazil. A cross-sectional population-based study was performed. The sample included 350 children, ages 0 to 14 years, whose parents answered a questionnaire about their socioeconomic conditions, perceived needs, oral hygiene habits, and access to dental services. The data analysis was performed according to a conceptual framework based on Andersen's behavioral model of health services use. Multivariate models of logistic regression analysis instructed the hypothesis on covariates for never having had a dental visit. Thirty one percent of the surveyed children had never had a dental visit. In the bivariate analysis, higher proportion of children who had never had a dental visit was found among the very young, those with inadequate oral hygiene habits, those without perceived need of dental care, and those whose family homes were under absent ownership. The mechanisms of social support showed to be important enabling factors: children attending schools/kindergartens and being regularly monitored by the FHP teams had higher odds of having gone to the dentist, even after adjusting for socioeconomic, demographic, and need variables. The conceptual framework has confirmed the presence of social and psychosocial inequalities on the utilization pattern of dental services for low-income children. The individual determinants seem to be important predictors of access.

Measures of Social Deprivation That Predict Health Care Access and Need within a Rational Area of Primary Care Service Delivery

PubMed Central

Butler, Danielle C; Petterson, Stephen; Phillips, Robert L; Bazemore, Andrew W

2013-01-01

Objective To develop a measure of social deprivation that is associated with health care access and health outcomes at a novel geographic level, primary care service area. Data Sources/Study Setting Secondary analysis of data from the Dartmouth Atlas, AMA Masterfile, National Provider Identifier data, Small Area Health Insurance Estimates, American Community Survey, Area Resource File, and Behavioural Risk Factor Surveillance System. Data were aggregated to primary care service areas (PCSAs). Study Design Social deprivation variables were selected from literature review and international examples. Factor analysis was used. Correlation and multivariate analyses were conducted between index, health outcomes, and measures of health care access. The derived index was compared with poverty as a predictor of health outcomes. Data Collection/Extraction Methods Variables not available at the PCSA level were estimated at block level, then aggregated to PCSA level. Principal Findings Our social deprivation index is positively associated with poor access and poor health outcomes. This pattern holds in multivariate analyses controlling for other measures of access. A multidimensional measure of deprivation is more strongly associated with health outcomes than a measure of poverty alone. Conclusions This geographic index has utility for identifying areas in need of assistance and is timely for revision of 35-year-old provider shortage and geographic underservice designation criteria used to allocate federal resources. PMID:22816561

Measuring change in health status of older adults at the population level: the transition probability model.

PubMed

Moineddin, Rahim; Nie, Jason X; Wang, Li; Tracy, C Shawn; Upshur, Ross E G

2010-11-09

The current demographic transition will lead to increasing demands on health services. However, debate exists as to the role age plays relative to co-morbidity in terms of health services utilization. While age has been identified as a critical factor in health services utilization, health services utilization is not simply an outcome of ill health, nor is it an inevitable outcome of aging. Most data on health service utilization studies assess utilization at one point in time, and does not examine transitions in health service utilization. We sought to measure health services utilization and to investigate patterns in the transition of levels of utilization and outcomes associated with different levels of utilization. We conducted a population-based retrospective cohort study of all Ontario residents aged 65+ eligible for public healthcare coverage from January 1998-December 2006. The main outcome measure was total number of utilization events. The total is computed by summing, on a per annum basis, the number of family physician visits, specialist visits, Emergency Department visits, drug claims, lab claims, X-rays, CT scans, MRI scans, and inpatient admissions. Three categories of utilization were created: low, moderate, and high. There is heterogeneity in health services utilization across the late lifespan. Utilization increased consistently in the 9-year study period. The probability of remaining at the high utilization category when the person was in the high category the previous year was more than 0.70 for both males and females and for all age groups. Overall healthcare utilization increases more rapidly among the high users compared to the low users. There was negligible probability for moving from high to low utilization category. Probability of death increased exponentially as age increased. Older adults in the low utilization category had the lowest probability of death. The number of male nonagenarians increased more rapidly than female nonagenarians. There are measurable and identifiable differences in the patterns of health services utilization among older adults. This data will permit clinicians and policy makers to tailor interventions appropriate to the risk class of patients.

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

PubMed

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

2008-01-01

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

Antenatal care and women's decision making power as determinants of institutional delivery in rural area of Western Ethiopia.

PubMed

Tekelab, Tesfalidet; Yadecha, Birhanu; Melka, Alemu Sufa

2015-12-11

Delivery by skilled birth attendance serves as an indicator of progress towards reducing maternal mortality. In Ethiopia, the proportions of births attended by skilled personnel were very low 15 % and Oromia region 14.7 %. The current study identified factors associated with utilization of institutional delivery among married women in rural area of Western Ethiopia. A community based cross-sectional study was employed from January 2 to January 31, 2015 among mothers who gave birth in the last 2 years in rural area of East Wollega Zone. A multi-stage sampling procedure was used to select 798 study participants. A pre-tested structured questionnaire was used to collect data and female high school graduates data collectors were involved in the data collection process. Bivariate and multivariable logistic regression model was fit and statistical significance was determined through a 95 % confidence level. The study revealed that 39.7 % of the mothers delivered in health facilities. Age 15-24 years (AOR 4.20, 95 % CI 2.07-8.55), 25-34 years (AOR 2.21, 95 % CI 1.32-3.69), women's educational level (AOR 2.00, 95 % CI 1.19-3.34), women's decision making power (AOR 2.11, 95 % CI 1.54-2.89), utilization of antenatal care (ANC) during the index pregnancy (AOR 1.56, 95 % CI 1.08-2.23) and parity one (AOR 2.20, 95 % CI 1.10-4.38) showed significant positive association with utilization of institutional delivery. In this study proportion of institutional delivery were low (39.7 %). Age, women's literacy status, women's decision making power, ANC practice and numbers of live birth were found important predictors of institutional delivery. The findings of current study highlight the importance of boosting women involvement in formal education and decision making power. Moreover since ANC is big pillar for the remaining maternal health services effort should be there to increase ANC service utilization.

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

PubMed Central

Chartier, Karen G.; Caetano, Raul

2011-01-01

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

Institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia: A Community-based cross sectional study.

PubMed

Darega, Birhanu; Dida, Nagasa; Tafese, Fikru; Ololo, Shimeles

2016-07-07

Delivery at health institutions under the care of trained health-care providers and utilization of postnatal cares services plays vital roles in promoting child survival and reducing the risk of maternal mortality. More than 80 % of maternal deaths can be prevented if pregnant women access to essential maternity cares like antenatal care, institutional delivery and postnatal care services. Thus, this study aimed to assess institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Regional State, Ethiopia. A community-based cross-sectional study design was employed among 703 randomly identified mothers of Abuna Gindeberet district in March, 2013. Data were collected through interviewer-administered questionnaires and analyzed using SPSS version 16.0. Descriptive, bivariate and multivariate analyses were used to determine prevalence and to identify associated factors with institutional delivery and postnatal care, considering p-value of less than 0.05 as significant. The results were presented in a narrative forms, tables and graphs. One hundred one (14.4 %) of mothers gave birth to their last baby in health institutions. From 556 (79.1 %) of respondents who heard about postnatal care services, only 223 (31.7 %) of them utilized postnatal care services for their recent childbirth. From the total postnatal care users, 204 (91.5 %) of them took the services from health extension workers. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were found to be statistically significant with both institutional delivery and postnatal care services utilizations. But educational status of husbands was statistically significant with only postnatal care services utilizations. Both institutional delivery and postnatal care services utilizations from health institutions were low. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were the common factors that affect institutional delivery and postnatal care services utilizations from health institutions. Therefore, giving attention to the identified factors could improve and sustain institutional delivery and postnatal care services utilizations from health institutions.

47 CFR 101.521 - Spectrum utilization.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Spectrum utilization. 101.521 Section 101.521 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES 24 GHz Service and Digital Electronic Message Service § 101.521 Spectrum utilization. All...

47 CFR 101.521 - Spectrum utilization.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Spectrum utilization. 101.521 Section 101.521 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES 24 GHz Service and Digital Electronic Message Service § 101.521 Spectrum utilization. All...

47 CFR 101.521 - Spectrum utilization.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Spectrum utilization. 101.521 Section 101.521 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES 24 GHz Service and Digital Electronic Message Service § 101.521 Spectrum utilization. All...

48 CFR 41.202 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and/or distribution service, quality assurance, system reliability, system operation and maintenance... CONTRACTING ACQUISITION OF UTILITY SERVICES Acquiring Utility Services 41.202 Procedures. (a) Prior to executing a utility service contract, the contracting officer shall comply with parts 6 and 7 and 41.201 (d...

Identifying influence of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context.

PubMed

Karim, R M; Abdullah, M S; Rahman, A M; Alam, A M

2015-04-01

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic (CC) services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 Community Clinics (CCs). Since most of the outcome indicators focus mainly on women and children, women having children less than two years of age were randomly assigned and interviewed for the study purpose. Data for the development of perceived service quality and satisfaction tools were collected through Focus Group Discussion (FGD), key informants interview and data for measuring the utilization status were collected by an interviewer administered pretested semi-structured questionnaire. About 95% of the respondents were Muslims and 5% were Hindus. The average age of the respondents was 23.38 (SD ± 4.15) years and almost all of them are home makers. The average monthly expenditure of their family was 7462.92 (SD ± 2545) BDT equivalent to 95 (SD ± 32) US$. To measure lay peoples' perception and satisfaction regarding primary health care service quality two scales e.g. Slim Haddad's 20-item scale for measuring perceived quality of primary health care services (PQPCS) validated in Guinea and Burkina Fuso and primary care satisfaction survey for women (PCSSW) developed by Scholle and colleagues 2004; is a 24-item survey tool validated in Turkey were chosen as a reference tools. Based on those, two psychometric research instruments; 24 items PQPCS scale (chronbach's α =0.89) and 22-items Community Clinic Service Satisfaction (CCSS) scale (chronbach's α = 0.97), were constructed and validated for measuring perceived service quality and satisfaction in Bangladesh context. This study showed mothers with preprimary education [(χ2 = 4.20, p = 0.04), AOR with 95% CI = 1.89 (1.03, 3.53)] utilized the limited curative care services more than educated mothers. On the contrary, higher income families [for income group 5000-10,000 BDT χ2 = 8.83, p = 0.003 and AOR with 95% CI = 0.37(0.19, 0.71)] and [for income group above 10,000 BDT χ2 = 5.02, p = 0.025 and AOR with 95% CI = 0.40 (0.18, 0.89)] and families having cultivable lands [for 5-10 decimal group χ2 = 5.51, p = 0.19, and AOR with 95% CI = 0.56 (0.35, 0.91)] and [for > 10 decimal group χ2 = 6.70, p = 0.010, and AOR with 95% CI = 0.50 (0.29, 0.84)] utilized the limited curative care services less than their poorer and landless counterpart. The same relationship was observed in case of health education and Antenatal Care (ANC) and Postnatal Care (PNC) services. Women who lived in their own residence used health education services more frequently than those who lived in a rental house [χ2 = 24.00, p = 0.000 and AOR with 95% CI = 1.21, (1.12, 1.30)] and they also increasingly used maternal and child health services χ2 = 27.49, p = 0.000 and AOR with 95% CI 1.61, (1.35, 1.93)]. Perceptions concerning skill and competence of the health care provider [χ2 = 16.90, p = 0.000 and AOR with 95% CI = 1.14, (1.07, 1.22)] and satisfaction indicating interpersonal communication and attitude of the care provider [χ2 = 7.07, p = 0.008 AOR with 95% CI = 1.08, (1.02, 1.15)] were found significant predictors for limited curative care service utilization of CC. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues also played significant role on CC's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in CC service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers .to improve quality of primary health care services, realizing providers' and patients' ideas of CC service quality.

Perceived need for care and mental health service utilization among college students with suicidal ideation.

PubMed

Nam, Boyoung; Wilcox, Holly C; Hilimire, Matthew; DeVylder, Jordan E

2018-01-31

This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.

[Urban greenbelt eco-service value of Hangzhou City under effects of land use change: an evaluation with CITYgreen model].

PubMed

Zhang, Kan; Zhang, Jianying; Chen, Yingxu; Zhu, Yinmei

2006-10-01

Based on the Landset TM information of land use/cover change and greenbelt distribution in Hangzhou city in 1994 and 2004, and by using CITYgreen model, this paper estimated the eco-service value of urban greenbelt in the city under the effects of land use change and economic development. The results showed that in the 10 years from 1994 to 2004, the greenbelt area in the city decreased by 20. 4% , while its eco-service value increased by 168 million yuan. The annual increment of greenbelt eco-service value and GDP was 111.92% and 5. 32% , respectively. Suitable adjustment of land use pattern in the city harmonized the relationships between urban economic development and urban eco-function, and achieved higher eco-service efficiency of land utilization.

Perspectives on utilization of community based health information systems in Western Kenya.

PubMed

Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje

2017-01-01

Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers.

Trends in the utilization of dental outpatient services affected by the expansion of health care benefits in South Korea to include scaling: a 6-year interrupted time-series study

PubMed Central

2018-01-01

Purpose This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. Methods A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. Results After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. Conclusions The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population. PMID:29535886

Trends in the utilization of dental outpatient services affected by the expansion of health care benefits in South Korea to include scaling: a 6-year interrupted time-series study.

PubMed

Park, Hee-Jung; Lee, Jun Hyup; Park, Sujin; Kim, Tae-Il

2018-02-01

This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population.

Health services and policy research in hepatology.

PubMed

Talwalkar, Jayant A

2014-05-01

This article examines recent health services and policy research studies in hepatology and liver transplantation. Critical issues include access to medical care, timeliness of referral and consultation, resource utilization in clinical practice, comparative effectiveness research, and the evaluation of care delivery models. Despite policymaking efforts, there continues to be unwarranted variation in access to subspecialty care and liver transplantation services based on race and geographic location. Variations in primary care and specialist awareness of practice guidelines for liver disease contribute to disparities in appropriateness and timeliness of treatments. Defining the cost-effectiveness of increased resource utilization for novel antiviral therapies and liver transplantation continues to stimulate controversy. Few comparative effectiveness studies in hepatology exist to date, yet a growing number of analyses using national datasets will help inform policy in this arena. Identifying care delivery models that demonstrate high value for populations with chronic liver disease is critical in the context of recent healthcare reform efforts. Health services and policy research is a growing field of investigation in hepatology and liver transplantation. Further emphasis on research training and workforce development in this area will be critical for understanding and improving patient-centered outcomes for this population.

NASA spinoffs to public service

NASA Technical Reports Server (NTRS)

Ault, L. A.; Cleland, J. G.

1989-01-01

The National Aeronautics and Space Administration (NASA) Technology Utilization (TU) Division of the Office of Commercial Programs has been quite successful in directing the transfer to technology into the public sector. NASA developments of particular interest have been those in the areas of aerodynamics and aviation transport, safety, sensors, electronics and computing, and satellites and remote sensing. NASA technology has helped law enforcement, firefighting, public transportation, education, search and rescue, and practically every other sector of activity serving the U.S. public. NASA works closely with public service agencies and associations, especially those serving local needs of citizens, to expedite technology transfer benefits. A number of examples exist to demonstrate the technology transfer method and opportunities of NASA spinoffs to public service.

The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan.

PubMed

Tian, Wei-Hua

2016-07-01

The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals' utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program. © Australian Council for Educational Research 2016.

Utility Energy Services Contracts: Enabling Documents

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

Thomas, Karen; Vasquez, Deb

The Federal Energy Management Program's 'Utility Energy Service Contracts: Enabling Documents' provide legislative information and materials that clarify the authority for federal agencies to enter into utility energy service contracts, or UESCs.

Preparing Special Educators in Eastern North Carolina To Use Assistive Technology: A Multimedia Approach to Addressing Training Needs Unique to Rural Areas.

ERIC Educational Resources Information Center

Darrow, Melissa; And Others

This paper describes a project addressing the assistive technology training needs of teachers of children with disabilities in rural eastern North Carolina, through development of a multimedia software tutorial service. The project utilized both a special education/assistive technology professional and an instructional technology professional to…

Korean Domestic Third Party Logistics Providers: Reach for a Global Market

DTIC Science & Technology

2010-03-01

receiving resources from oversea, parts production , assembling finished goods, sales, and customer service become more important. This is...businesses. Production can be located in an optimal area while efficient logistics systems allow world-wide distribution. Global logistics is activities...logistics is managing and utilizing production flow from resources to finished goods by gathering scattered production and sales footholds, and

The Influence of Bush Identity on Attitudes to Mental Health in a Queensland Community

ERIC Educational Resources Information Center

McColl, Lisa

2007-01-01

There are many factors that impact on mental health and the utilization of these services in the bush. The results from a three year ethnographic study in a bush community indicate that attitudes to mental health in this area of Queensland are influenced by bush identity, defined by reference to historical and current characteristics which include…

77 FR 52352 - Notice of Intent To Prepare an Environmental Impact Statement for the Rio Mesa Gen-Tie Project...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-29

... this area as a utility corridor. Additionally two pathways for 33-kV lines providing electrical service to the Project and two pathways for roads providing access to the Project are proposed on BLM-administered lands. If approved, project construction would begin in 2013 and would take approximately 24...

Coping With Their Lives Women, Learning Disabilities, Self-Harm And The Secure Unit: A Q-Methodological Study

ERIC Educational Resources Information Center

James, Melissa; Warner, Sam

2005-01-01

Deliberate self-harm represents a significant, yet it can be argued, a poorly theorized area of concern with respect to women who have learning disabilities particularly in the context of secure service provision. Utilizing ideas from social constructionism we explore how some ways of understanding dominate the professional literature and,…

The Utilization of Psychologists for Staff Development in a Large Public School System: A Staff Development Director's Perspective.

ERIC Educational Resources Information Center

Stone, James L., Jr.

This model proposes the TAP Team approach as an on-site delivery system for local school staff development in large, urban school systems. TAP emphasizes in-service training for both upgrading skills of staff and for helping staff acquire new skills in the areas of coping strategies, classroom management, communication skills, instructional…

Multi-stakeholder perspectives on access, availability and utilization of emergency obstetric care services in Lagos, Nigeria: A mixed-methods study

PubMed Central

Wright, Kikelomo; Sonoiki, Olatunji; Ilozumba, Onaedo; Ajayi, Babatunde; Okikiolu, Olawunmi; Akinola, Oluwarotimi

2017-01-01

Globally, Nigeria is the second most unsafe country to be pregnant, with Lagos, its economic nerve center having disproportionately higher maternal deaths than the national average. Emergency obstetric care (EmOC) is effective in reducing pregnancyrelated morbidities and mortalities. This mixed-methods study quantitatively assessed women’s satisfaction with EmOC received and qualitatively engaged multiple key stakeholders to better understand issues around EmOC access, availability and utilization in Lagos. Qualitative interviews revealed that regarding access, while government opined that EmOC facilities have been strategically built across Lagos, women flagged issues with difficulty in access, compounded by perceived high EmOC cost. For availability, though health workers were judged competent, they appeared insufficient, overworked and felt poorly remunerated. Infrastructure was considered inadequate and paucity of blood and blood products remained commonplace. Although pregnant women positively rated the clinical aspects of care, as confirmed by the survey, satisfaction gaps remained in the areas of service delivery, care organization and responsiveness. These areas of discordance offer insight to opportunities for improvements, which would ensure that every woman can access and use quality EmOC that is sufficiently available. PMID:29456825

Texas Disasters II: Utilizing NASA Earth Observations to Assist the Texas Forest Service in Mapping and Analyzing Fuel Loads and Phenology in Texas Grasslands

NASA Technical Reports Server (NTRS)

Brooke, Michael; Williams, Meredith; Fenn, Teresa

2016-01-01

The risk of severe wildfires in Texas has been related to weather phenomena such as climate change and recent urban expansion into wild land areas. During recent years, Texas wild land areas have experienced sequences of wet and dry years that have contributed to increased wildfire risk and frequency. To prevent and contain wildfires, the Texas Forest Service (TFS) is tasked with evaluating and reducing potential fire risk to better manage and distribute resources. This task is made more difficult due to the vast and varied landscape of Texas. The TFS assesses fire risk by understanding vegetative fuel types and fuel loads. To better assist the TFS, NASA Earth observations, including Landsat and Moderate Resolution Imaging Specrtoradiometer (MODIS) data, were analyzed to produce maps of vegetation type and specific vegetation phenology as it related to potential wildfire fuel loads. Fuel maps from 2010-2011 and 2014-2015 fire seasons, created by the Texas Disasters I project, were used and provided alternating, complementary map indicators of wildfire risk in Texas. The TFS will utilize the end products and capabilities to evaluate and better understand wildfire risk across Texas.

The tradeoff between centralized and decentralized health services: evidence from rural areas in Mexico.

PubMed

Vargas Bustamante, Arturo

2010-09-01

This study investigates the effectiveness of centralized and decentralized health care providers in rural Mexico. It compares provider performance since both centralized and decentralized providers co-exist in rural areas of the country. The data are drawn from the 2003 household survey of Oportunidades, a comprehensive study of rural families from seven states in Mexico. The analyses compare out-of-pocket health care expenditures and utilization of preventive care among rural households with access to either centralized or decentralized health care providers. This study benefits from differences in timing of health care decentralization and from a quasi-random distribution of providers. Results show that overall centralized providers perform better. Households served by this organization report less regressive out-of-pocket health care expenditures (32% lower), and observe higher utilization of preventive services (3.6% more). Decentralized providers that were devolved to state governments in the early 1980s observe a slightly better performance than providers that were decentralized in the mid-1990s. These findings are robust to decentralization timing, heterogeneity in per capita government health expenditures, state and health infrastructure effects, and other confounders. Copyright (c) 2010 Elsevier Ltd. All rights reserved.