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Examples for the British health service from the Canadian experience; management, finance, service provision, and accountability issues. Summaries in English and French.

У статті проаналізовано здоров'язбереження як аспект удосконалення уроку в початковій школі. Здоров'язбереження охарактеризоване з точки зору освітньої та соціальної категорій. З'ясовано, що проблематика збереження здоров'я дитини не нова і досить ґрунтовно висвітлювалася видатними педагогами минулого. Накопичено чималий зарубіжний досвід із залученням учнів до здорового способу життя. Розкрито певні педагогічні технології, які можна реалізувати в контексті здоров'язбереження. Проаналізовано роль шкільного середовища загалом і вчителя зокрема у справі формування здорового способу життя молодших школярів в Україні. ; The article analyzes health care as an aspect of improving a lesson in primary school. Health care is characterized from the point of view of educational and social categories. It was found out that the problem of preserving the health of a child is not a new one and was highlighted by outstanding teachers of the past. There has been gained a great foreign experience of attracting students to a healthy lifestyle. Certain pedagogical techniques that can be implemented in the context of health care were disclosed. The role of school environment in general and teachers in particular in the formation of healthy lifestyle of younger pupils in Ukraine is analyzed. Students' health from year to year is getting worse. The issue of maintaining the health of the younger generation in society nowadays is of great importance and requires specific solutions in daily school practice. The pupils' illnesses rate, decreased working capacity, fatigue and, as a consequence, the decreasing in the quality of knowledge are the objects of main concern. Therefore the problem of health care in the educational process has become for us of highest priority and relevance. Progressive ideas of health care for a long time attracted the attention of famous teachers, such as V. Sukhomlinsky, K. Ushinsky, A. Makarenko, G. Skovoroda etc. Many democratic educators, such as G. Skovoroda had a significant influence on the development of educational traditions of a healthy lifestyle. The concept of a healthy lifestyle can be also found in Western literature (D. Bell, P. Berger, N. Geyser, A. Gehlen, I. Richter, and others). In Particular, D. Bell believes that the ideal of a «healthy society» is a «paternalistic type» of social structure. Thus, the afore said allows concluding that contemporary school practice has considerable developments in the implementation of health care perspectives of primary school lessons improvement. It was found out that health care technology helped teachers to resist school forms of pathology with the help of pedagogical means. However, at present stage the conceptual and practical developments in health care in the educational process are not actually been taken into account. Theoretical significance and the lack of practical research of this problem open many prospects for its further studies.

The purpose of this study was to investigate the incidence of elevated lead levels in children ages 1 to 6 years who received health care in a military facility.

The federal trust doctrine developed out of the legal relationship between European sovereigns--and later, the United States government--and American Indian tribes. By signing treaties with Indian tribes, the settler governments entered into an ongoing relationship with sovereign tribal governments. The United States government has a duty to fulfill the promises inherent in these treaties, including the provision of such services as health care to Indian tribes. The trust doctrine embodies these obligations. When Congress legislates with respect to American Indians and Indian tribes for the provision of services, such as the Indian Health Care Improvement Act of 1976 (IHCIA), Congress acts in fulfillment of its historic trust obligations. But the Indian Health Service (IHS) is drastically underfunded. Patients go without critical care. Hospitals cannot keep their doors open. Tribes have sought to enjoin the U.S. government to provide necessary health care under the trust doctrine and the IHCIA. This Comment *1100 analyzes divergent approaches in the Eighth and Ninth Circuit Courts of Appeals regarding the judicial enforceability of federal trust obligations under the IHCIA. This Comment argues that, in recent years, the Supreme Court has interpreted the trust doctrine and its enforceability under statutes too narrowly to be compatible with the trust doctrine's federal common law principles. Finally, this Comment proposes that a broader interpretation of judicially enforceable trust obligations inherent in statutes like the IHCIA would be more faithful to original common law principles, align with human rights and indigenous peoples' rights principles under international law, and initiate long overdue restorative justice for American Indians.

BACKGROUND: Health-care workers (HCWs) are among the highest risk groups for COVID-19 infection. The vaccine is found to be vital for HCWs, their household contacts, and their patients to protect against COVID-19 infection and maintain the safety of health systems. The actual willingness to pay for COVID-19 vaccination and associated factors remain uncertain among health-care workers in Ethiopia. Therefore, studying health-care workers' willingness to pay (WTP) for COVID-19 vaccination helps to have an insight on valuation of the vaccine. METHODS: Institution-based cross-sectional study was conducted among 403 randomly selected health-care workers working in health facilities in eastern Ethiopia from February 3 to March 20, 2021. Pretested structured questionnaire was used to collect data. Binary logistic regression analysis was fitted to test the associations between outcome and explanatory variables. A p-value of 7000 ETB, AOR = 1.22; 95% CI: 1.11, 2.51), affordability (AOR = 1.99; 95% CI: 1.18, 3.35), fear of side effects (AOR = 3.75; 95% CI: 2.13, 6.60), support vaccinations (AOR = 2.97; 95% CI: 1.65, 5.35), the likelihood of getting COVID-19 infection (AOR = 2.11; 95% CI: 1.26, 3.52) were independent determinants of WTP for a COVID-19 vaccine. CONCLUSION: Health-care workers' willingness to pay for COVID-19 vaccination was found to be low. Detailed health education and training about COVID-19 vaccines are required regarding their side effects, and efficacy to make an informed decision to enhance the willingness to pay for the vaccine. Moreover, the government should consider providing COVID vaccines free of charge for low-income groups and at an affordable price for those who could pay.

Despite substantial legislation, access to healthcare remains a threatened right. The poorest patients face complex administrative procedures, stigmatization from the administration and caregivers. Social inequalities in health have profound consequences. PASS (Health Care Access Permanence) welcome people without social or partial coverage and/or in precarious situations. Their mission is to promote the return to common law. Many studies show insertion between 60 and 65% in the wake of PASS care. The objective was to evaluate the percentage of patients leaving the Henri MONDOR hospital's dedicated medical PASS, once acquired rights, continuing their follow up with a single-handed general practitioner. Secondarily, we investigate in the various factors that can influence this insertion. The inclusion criteria were the absence of open social security rights at the first consultation, at least one social consultation and one medical consultation. The included patients were contacted by phone at 3 months. The primary outcome was a consultation with a general practitioner within 3 months. 138 patients were included in our study between April 2017 and October 2017: 114 patients were analyzed and 24 lost to follow-up. Among the analyzed patients, 78% had consulted a general practitioner. The mastery of the French language was significantly more represented in this population. Consequently, to this result, we plan to map the general practitioners speaking a language other than French in Ile-de-France and to identify the places to learn French for this population. ; Malgré une législation importante, l'accès aux soins reste un droit menacé. Les patients les plus démunis font face à des démarches administratives complexes, à une stigmatisation de la part de l'administration et de soignants. Les inégalités sociales de santé ont pourtant de lourdes conséquences. Les PASS accueillent des personnes sans couverture sociale ou partielle et/ou en situation de précarité. Elles ont pour mission de favoriser le retour au droit commun. De nombreux travaux montrent une insertion entre 60 à 65% dans les suites d'une prise en charge en PASS. L'objectif était d'évaluer le pourcentage de patients quittant la PASS médicale dédiée de l'hôpital Henri MONDOR, une fois des droits acquis poursuivant leur parcours auprès d'un omnipraticien en ville. Secondairement, nous ont intéressés les différents facteurs pouvant influencer cette insertion. Les critères d'inclusion étaient l'absence de droits à la sécurité sociale ouverts lors de la première consultation, bénéficier d'au moins une consultation sociale et une consultation médicale. Les patients inclus étaient contactés par téléphone à 3 mois. Le critère de jugement principal était la réalisation d'une consultation avec un omnipraticien dans les 3 mois. 138 patients étaient inclus dans notre étude entre avril 2017 et octobre 2017 : 114 patients analysés et 24 perdus de vue. Parmi les patients analysés, 78% avaient consultés un omnipraticien. Le caractère francophone était statistiquement plus représenté dans cette population. Nous envisageons donc de cartographier les médecins généralistes maîtrisant une autre langue que le français en Ile-de-France et de répertorier les lieux permettant d'apprendre le Français.

Despite substantial legislation, access to healthcare remains a threatened right. The poorest patients face complex administrative procedures, stigmatization from the administration and caregivers. Social inequalities in health have profound consequences. PASS (Health Care Access Permanence) welcome people without social or partial coverage and/or in precarious situations. Their mission is to promote the return to common law. Many studies show insertion between 60 and 65% in the wake of PASS care. The objective was to evaluate the percentage of patients leaving the Henri MONDOR hospital's dedicated medical PASS, once acquired rights, continuing their follow up with a single-handed general practitioner. Secondarily, we investigate in the various factors that can influence this insertion. The inclusion criteria were the absence of open social security rights at the first consultation, at least one social consultation and one medical consultation. The included patients were contacted by phone at 3 months. The primary outcome was a consultation with a general practitioner within 3 months. 138 patients were included in our study between April 2017 and October 2017: 114 patients were analyzed and 24 lost to follow-up. Among the analyzed patients, 78% had consulted a general practitioner. The mastery of the French language was significantly more represented in this population. Consequently, to this result, we plan to map the general practitioners speaking a language other than French in Ile-de-France and to identify the places to learn French for this population. ; Malgré une législation importante, l'accès aux soins reste un droit menacé. Les patients les plus démunis font face à des démarches administratives complexes, à une stigmatisation de la part de l'administration et de soignants. Les inégalités sociales de santé ont pourtant de lourdes conséquences. Les PASS accueillent des personnes sans couverture sociale ou partielle et/ou en situation de précarité. Elles ont pour mission de favoriser le retour au droit commun. De nombreux travaux montrent une insertion entre 60 à 65% dans les suites d'une prise en charge en PASS. L'objectif était d'évaluer le pourcentage de patients quittant la PASS médicale dédiée de l'hôpital Henri MONDOR, une fois des droits acquis poursuivant leur parcours auprès d'un omnipraticien en ville. Secondairement, nous ont intéressés les différents facteurs pouvant influencer cette insertion. Les critères d'inclusion étaient l'absence de droits à la sécurité sociale ouverts lors de la première consultation, bénéficier d'au moins une consultation sociale et une consultation médicale. Les patients inclus étaient contactés par téléphone à 3 mois. Le critère de jugement principal était la réalisation d'une consultation avec un omnipraticien dans les 3 mois. 138 patients étaient inclus dans notre étude entre avril 2017 et octobre 2017 : 114 patients analysés et 24 perdus de vue. Parmi les patients analysés, 78% avaient consultés un omnipraticien. Le caractère francophone était statistiquement plus représenté dans cette population. Nous envisageons donc de cartographier les médecins généralistes maîtrisant une autre langue que le français en Ile-de-France et de répertorier les lieux permettant d'apprendre le Français.

The dominant rhetoric in the health care policy debate about cost has assumed an inherent tension between access and quality on the one hand, and cost effectiveness on the other; but an emerging discourse has challenged this narrative by presenting a more nuanced relationship between access, quality, and cost. This is reflected in the discourse surrounding health literacy, which is viewed as an important tool for achieving all three goals. Health literacy refers to one's ability to obtain, understand and use health information to make appropriate health decisions. Research shows that improving patients' health literacy can help overcome access barriers and empower patients to be better health care partners, which should lead to better health outcomes. Promoting health literacy can also reduce expenditures for unnecessary or inappropriate treatment. This explains why, as a policy matter, improving health literacy is an objective that has been embraced by almost every sector of the health care system. As a legal matter, however, the role of health literacy in ensuring quality and access is not as prominent. Although the health literacy movement is relatively young, it has roots in longstanding bioethical principles of patient autonomy, beneficence, and justice as well as the corresponding legal principles of informed consent, the right to quality care, and antidiscrimination. Assumptions and concerns about health literacy seem to do important, yet subtle work in these legal doctrines - influencing conclusions about patient understanding in informed consent cases, animating decisions about patient responsibility in malpractice cases, and underlying regulatory guidance concerning the quality of language assistance services that are necessary for meaningful access to care. Nonetheless, health literacy is not explicitly treated as a legally relevant factor in these doctrines. Moreover, there is no coherent legal framework for incorporating health literacy research that challenges traditional assumptions about patient comprehension and decision-making, and that emphasizes the need for providers to improve communication and take affirmative steps to assess patient understanding. The absence of a clear and robust consideration of health literacy in these doctrines undermines core access and quality aims, and it means that such laws are of limited efficacy in promoting health literacy. Returning to the theme that the health literacy problem reflects a complementary view of access, quality and cost, it is likely that the cost implications of this problem (and not concerns about quality and access) will motivate the kind of health literacy reform that may ultimately strengthen existing quality and access standards. One recent example of this can be seen in reforms linked to government, insurer and provider attempts to reduce costly medication errors.

Background: Nepal has one of the highest rates of maternal mortality in the South Asia region, partly due to the underutilization of maternal health services and the high number of adolescent pregnancies. This study explores married Nepali adolescent girls' healthcare-seeking behaviour throughout their pregnancies, during their delivery and postpartum. Methods: We conducted a prospective qualitative study in Banke district, Nepal. In-depth interviews were conducted with 27 married adolescent girls before and after delivery. In addition, a focus group discussion was conducted with community health works and key-informant interviews were conducted with family members of adolescent girls, representatives from the government and health care providers. We applied the Social-Ecological Model (SEM) as a framework to guide thematic content analysis and presentation of our qualitative data. Results: Several factors in the SEM influenced maternal health care-seeking behaviour of adolescents. At the individual level, girls' perceptions, their lack of knowledge about maternal and reproductive health, certain traditional practices, their sole dependency on their husbands and mothers-in-laws and their low decision-making autonomy towards their own health care negatively influenced their utilization of skilled maternal health services. Mothers-in-law and other family members played a critical role in either encouraging or discouraging the use of skilled maternal health services. At the health systems level, lack of adolescent-friendly maternal health services, difficulties in accessing quality maternal health services, and the fixed operating hours of public health facilities restricted their ability to obtain services. The existence of the Safe Motherhood Programme, knowledge sharing platforms such as "women's groups" and the active role of Female Community Health Volunteers (FCHVs) positively influenced utilization of skilled maternal health services among these girls. Conclusion: Influences on married adolescent girls' use of skilled maternal health services in Banke District, Nepal were multi-factoral. Ensuring easy access and availability of adolescent-friendly maternal health services are important to encourage adolescent girls to use skilled maternal health services. Moreover, interventions are needed to improve adolescent girls' knowledge of maternal health, keep them in school, involve family members (mainly mothers-in-law) in health interventions, as well as overcome negative traditional beliefs within the community that discourage care-seeking for skilled maternal health services.