Suchergebnisse

Abstract Background Most Ministries of Health across Africa invest substantial resources in some form of health management information system (HMIS) to coordinate the routine acquisition and compilation of monthly treatment and attendance records from health facilities nationwide. Despite the expense of these systems, poor data coverage means they are rarely, if ever, used to generate reliable evidence for decision makers. One critical weakness across Africa is the current lack of capacity to effectively monitor patterns of service use through time so that the impacts of changes in policy or service delivery can be evaluated. Here, we present a new approach that, for the first time, allows national changes in health service use during a time of major health policy change to be tracked reliably using imperfect data from a national HMIS. Methods Monthly attendance records were obtained from the Kenyan HMIS for 1 271 government-run and 402 faith-based outpatient facilities nationwide between 1996 and 2004. A space-time geostatistical model was used to compensate for the large proportion of missing records caused by non-reporting health facilities, allowing robust estimation of monthly and annual use of services by outpatients during this period. Results We were able to reconstruct robust time series of mean levels of outpatient utilisation of health facilities at the national level and for all six major provinces in Kenya. These plots revealed reliably for the first time a period of steady nationwide decline in the use of health facilities in Kenya between 1996 and 2002, followed by a dramatic increase from 2003. This pattern was consistent across different causes of attendance and was observed independently in each province. Conclusion The methodological approach presented can compensate for missing records in health information systems to provide robust estimates of national patterns of outpatient service use. This represents the first such use of HMIS data and contributes to the resurrection of these hugely expensive but underused systems as national monitoring tools. Applying this approach to Kenya has yielded output with immediate potential to enhance the capacity of decision makers in monitoring nationwide patterns of service use and assessing the impact of changes in health policy and service delivery.

BACKGROUND: Most Ministries of Health across Africa invest substantial resources in some form of health management information system (HMIS) to coordinate the routine acquisition and compilation of monthly treatment and attendance records from health facilities nationwide. Despite the expense of these systems, poor data coverage means they are rarely, if ever, used to generate reliable evidence for decision makers. One critical weakness across Africa is the current lack of capacity to effectively monitor patterns of service use through time so that the impacts of changes in policy or service delivery can be evaluated. Here, we present a new approach that, for the first time, allows national changes in health service use during a time of major health policy change to be tracked reliably using imperfect data from a national HMIS. METHODS: Monthly attendance records were obtained from the Kenyan HMIS for 1 271 government-run and 402 faith-based outpatient facilities nationwide between 1996 and 2004. A space-time geostatistical model was used to compensate for the large proportion of missing records caused by non-reporting health facilities, allowing robust estimation of monthly and annual use of services by outpatients during this period. RESULTS: We were able to reconstruct robust time series of mean levels of outpatient utilisation of health facilities at the national level and for all six major provinces in Kenya. These plots revealed reliably for the first time a period of steady nationwide decline in the use of health facilities in Kenya between 1996 and 2002, followed by a dramatic increase from 2003. This pattern was consistent across different causes of attendance and was observed independently in each province. CONCLUSION: The methodological approach presented can compensate for missing records in health information systems to provide robust estimates of national patterns of outpatient service use. This represents the first such use of HMIS data and contributes to the resurrection of these hugely expensive but underused systems as national monitoring tools. Applying this approach to Kenya has yielded output with immediate potential to enhance the capacity of decision makers in monitoring nationwide patterns of service use and assessing the impact of changes in health policy and service delivery.

The article is devoted to the phenomenon of the "monument war" in the North Caucasus in the context of Russian nation-building. The authors analyze the historical dynamics of the commemoration in the North Caucasus, depending on its historical stages and political actors. Further, the article examines the causes of the actual 'war of monuments' in the North Caucasus and formulates its essence. At the same time, the question is raised about the assessment of the position of the authorities regarding this "war" in terms of the policy of "non-decision-making" (according to P. Bachrach and M. S. Baratz). In conclusion, the authors interpret the memorial conflicts in the North Caucasus as a request for a modern (in the spirit of E. Renan) concept of the Russian nation.

AbstractDisparities in socioeconomic status (SES) may affect individuals' risk preferences, which have important developmental consequences across the lifespan. Yet, previous research has shown inconsistent associations between SES and risky decision‐making, and little is known about how this link develops from a young age. The current research is among the first to examine how SES influences preschoolers' risky decisions in both gain and loss frames. Across two studies, children aged 5 to 6 years (total N = 309, 154 boys) were asked to choose between certain and risky options. The risky option was more advantageous, equal to, or less advantageous than the certain option. Study 1 revealed that in the loss frame, high‐SES children (n = 84, 44 boys) chose more risky options and were more sensitive to the expected value compared to low‐SES children (n = 78, 42 boys), especially when the risk was more advantageous. However, this SES difference was not significant in the gain frame. Supporting the potential causal link between SES and risky decision‐making, Study 2 further found that experimentally increasing low‐SES children's (n = 68, 30 boys) status by providing additional resources increased their risk‐seeking behavior in the loss frame. Overall, our findings suggest an interaction between environmental cues (gain vs. loss) and early life circumstances (SES) in shaping children's risk preferences.Research Highlights
This research is among the first to examine how school backgrounds and experimentally manipulated SES influence preschoolers' risk preferences in gain and loss frames.
Children were more risk‐seeking for losses than for gains; this framing effect was stronger in higher‐SES than lower‐SES children.
Lower‐SES children exhibited fewer risk‐seeking behaviors and decreased sensitivity to the expected value of options for losses, but not for gains.
A temporary boost in SES increased children's risk‐seeking behavior, but not sensitivity to expected values.

'Es besteht kein Zweifel daran, dass Medien eine überragende Bedeutung für moderne Gesellschaften haben und dies in ganz unterschiedlichen Bereichen: Sie sind ein wichtiger Wirtschaftsfaktor, sie spielen bei der Freizeitgestaltung der Menschen eine herausragende Rolle und sie sind - nicht zuletzt - auch für den politischen Prozess von zentraler Bedeutung. Den Medien werden zahlreiche Wirkungen auf die Gesellschaft und die einzelnen Menschen zugeschrieben. So einfach und plausibel viele dieser Wirkungsvermutungen sind, so schwierig und aufwendig ist es, empirische Belege für diese Wirkungen zu gewinnen. Im vorliegenden Beitrag soll der Frage nachgegangen werden, ob und gegebenenfalls wie durch die Verknüpfung von Inhaltsanalyse- und Befragungsdaten auf Personenebene Medienwirkungen nachgewiesen werden können. Um diese Frage zu beantworten, werden zunächst die zahlreichen Entscheidungen diskutiert, die im Laufe des Forschungsprozesses bei der Verknüpfung der Daten getroffen werden müssen. Am Ende des Beitrags wird dann anhand des Beispiels 'Wirtschaftsberichterstattung und Wirtschaftsbewertung' empirisch gezeigt, welchen Einfluss einige dieser Entscheidungen auf die Analyseergebnisse haben. Die dabei ermittelten empirischen Befunde zeigen, dass sich die unterschiedlichen Operationalisierungen zum Teil deutlich auf die Ergebnisse auswirken. Insgesamt sprechen die Ergebnisse jedoch dafür, dass tatsächlich ein Zusammenhang zwischen der Darstellung der wirtschaftliche Lage in den Medien und der Beurteilung durch die Rezipienten besteht.' (Autorenreferat)

CITIZEN PARTICIPATION PROGRAMS SPONSORED BY GOVERNMENT AGENCIES CAN SERVE MANY PURPOSES. WHILE PARTICIPATING CITIZENS OFTEN SEE THESE PROGRAMS AS CONTRIBUTING TO INCREASED INFLUENCE IN GOVERNMENT POLICY-MAKING, MEMBERS OF THE SPONSORING AGENCIES ARE MORE LIKELY TO SEE THEM AS A MEANS TO IMPROVE AGENCY EFFECTIVENESS. FROM THE AGENCY PERSPECTIVE, PERHAPS THE MOST IMPORTANT PURPOSE OF THESE PROGRAMS IS TO PROVIDE A PROCESS THAT WILL PERMIT THE DEVELOPMENT OF IMPLEMENTABLE POLICIES; THE ASSUMPTION BEING THAT IF INDIVIDUALS BELIEVE THEY HAVE HAD A SAY IN A FAIR AND OPEN PROCESS OF POLICY DEVELOPMENT THEN THEY WILL BE WILLING TO ACCEPT THE OUTCOME OF THAT PROCESS, EVEN IF IT IS NOT THEIR PREFERRED OUTCOME (ROSENBAUM 1980: 4-5). THAT AGENCY OFFICIALS DO HOLD THESE VIEWS IS BORNE OUT BY A STUDY OF CANADIAN PARTICIPATION PROGRAMS WHICH CONCLUDES THAT "FOR MOST AGENCY REPRESENTATIVES, PARTICIPATION WAS SEEN AS A MEANS TO DEVELOP PROGRAMS WHICH WOULD HAVE BROAD PUBLIC ACCEPTANCE, TO ENHANCE THE EFFICIENT PERFORMANCE OF AGENCY RESPONSIBILITIES, AND TO IMPROVE THE AGENCY'S IMAGE" (SEWELL AND PHILLIPS 1979: 352). LIKEWISE, A STUDY OF ARMY CORPS OF ENGINEERS' PARTICIPATION PROGRAMS FOUND THAT THESE PROGRAMS WERE INSTITUTED BECAUSE THE CORPS "ASSUMED THAT A WELL-INTENTIONED, POSITIVE, OPEN-PLANNING PROCESS WOULD RESULT DIRECTLY IN THE PARTICIPANTS' GREATER SATISFACTION WITH THE AGENCY; THAT THIS WOULD IN TURN FOSTER GREATER CONGRUENCE ON GOALS BETWEEN THE INDIVIDUAL PARTICIPANTS AND THE PY: 1984

Currently, it is important to develop strategic frameworks to support the selection of sustainable resource recovery solutions. This study applies a new framework for planning, implementation, and assessment of resource recovery strategies for a full-scale wastewater treatment plant (WWTP) in São Paulo megacity. The framework comprises several steps based on case study-specific data and information from current literature. Data were collected from various sources: a survey with a wastewater treatment utility, national and regional databases, and review of local regulations and international literature. Treatment configuration, wastewater and by-products composition, potential demand (for water, energy, and phosphorus), stakeholder identification, and local legislation were thoroughly discussed regarding decision-making on resource recovery. Scenario analysis was used to explore suitable nutrient and energy recovery measures based on indicators. Biogas recovery and sewage sludge composting showed more favorable conditions due to similar experiences in the area and robust legislation. The proposed framework is a simplified tool, and its application can support managers to get information on resource recovery and how to plan such initiatives in easier ways to facilitate wiser decision-making, and better operation and management. The results on framework use and refinement can guide potential applications in other contexts and stimulate public policy formulation and further research.

Decision analysis-a systematic approach to solving complex problems-offers tools and frameworks to support decision making that are increasingly being applied to environmental challenges. Alternatives analysis is a method used in regulation and product design to identify, compare, and evaluate the safety and viability of potential substitutes for hazardous chemicals.Assess whether decision science may assist the alternatives analysis decision maker in comparing alternatives across a range of metrics.A workshop was convened that included representatives from government, academia, business, and civil society and included experts in toxicology, decision science, alternatives assessment, engineering, and law and policy. Participants were divided into two groups and prompted with targeted questions. Throughout the workshop, the groups periodically came together in plenary sessions to reflect on other groups' findings.We conclude the further incorporation of decision science into alternatives analysis would advance the ability of companies and regulators to select alternatives to harmful ingredients, and would also advance the science of decision analysis.We advance four recommendations: (1) engaging the systematic development and evaluation of decision approaches and tools; (2) using case studies to advance the integration of decision analysis into alternatives analysis; (3) supporting transdisciplinary research; and (4) supporting education and outreach efforts.