Suchergebnisse

Aim To develop pragmatic recommendations for Central and Eastern European (CEE) policymakers about transferability assessment of integrated care models established in higher income European Union (EU) countries. Methods Draft recommendations were developed based on Horizon 2020-funded SELFIE project deliverables related to 17 promising integrated care models for multimorbid patients throughout Europe, as well as on an online survey among CEE stakeholders on the relevance of implementation barriers. Draft recommendations were discussed at the SELFIE transferability workshop and finalized together with 22 experts from 12 CEE countries. Results Thirteen transferability recommendations are provided in three areas. Feasibility of local implementation covers the identification and prioritization of implementation barriers and proposals for potential solutions. Performance measurement of potentially transferable models focuses on the selection of models with proven benefits and assurance of performance monitoring. Transferability of financing methods for integrated care explores the relevance of financing methodologies and planning of adequate initial and long-term financing. Conclusions Implementation of international integrated care models cannot be recommended without evidence on its local feasibility or scientifically sound and locally relevant performance assessment in the country of origin. However, if the original financing method is not transferable to the target region, development of a locally relevant alternative financing method can be considered.

The concept of biorefinery expands the possibilities to extract value from organic matter in form of either bespoke crops or organic waste. The viability of biorefinery schemes depends on the recovery of higher-value chemicals with potential for a wide distribution and an untapped marketability. The feasibility of biorefining organic waste is enhanced by the fact that the biorefinery will typically receive a waste management fee for accepting organic waste. The development and implementation of waste biorefinery concepts can open up a wide array of possibilities to shift waste management towards higher sustainability. However, barriers encompassing environmental, technical, economic, logistic, social and legislative aspects need to be overcome. For instance, waste biorefineries are likely to be complex systems due to the variability, heterogeneity and low purity of waste materials as opposed to dedicated biomasses. This article discusses the drivers that can make the biorefinery concept applicable to waste management and the possibilities for its development to full scale. Technological, strategic and market constraints affect the successful implementations of these systems. Fluctuations in waste characteristics, the level of contamination in the organic waste fraction, the proximity of the organic waste resource, the markets for the biorefinery products, the potential for integration with other industrial processes and disposal of final residues are all critical aspects requiring detailed analysis. Furthermore, interventions from policy makers are necessary to foster sustainable bio-based solutions for waste management.

Plastic pollution is considered one of today's major environmental problems. Current land-based monitoring programs typically rely on beach litter data and seldom include plastic pollution further inland. We initiated a citizen science project known as the Mass Experiment inviting schools throughout The Danish Realm (Denmark, Greenland and the Faeroe Islands) to collect litter samples of and document plastic pollution in 8 different nature types. In total approximately 57,000 students (6-19 years) collected 374,082 plastic items in 94 out of 98 Danish municipalities over three weeks during fall 2019. The Mass Experiment was the first scientific survey of plastic litter to cover an entire country. Here we show how citizen science, conducted by students, can be used to fill important knowledge gaps in plastic pollution research, increase public awareness, establish large scale clean-up activities and subsequently provide information to political decision-makers aiming for a more sustainable future.

PURPOSE To improve cancer outcomes for Aboriginal and Torres Strait Islander people through the development and national endorsement of the first population-specific optimal care pathway (OCP) to guide the delivery of high-quality, culturally appropriate, and evidence-based cancer care. METHODS An iterative methodology was undertaken over a 2-year period, and more than 70 organizations and individuals from diverse cultural, geographic, and sectorial backgrounds provided input. Cancer Australia reviewed experiences of care and the evidence base and undertook national public consultation with the indigenous health sector and community, health professionals, and professional colleges. Critical to the OCP development was the leadership of Aboriginal and Torres Strait Islander health experts and consumers. RESULTS The OCP received unanimous endorsement by all federal, state, and territory health ministers. Key elements of the OCP include attention to the cultural appropriateness of the health care environment; improvement in cross-cultural communication; relationship building with local community; optimization of health literacy; recognition of men's and women's business; and the need to use culturally appropriate resources. The OCP can be used as a tool for health services and health professionals to identify gaps in current cancer services and to inform quality improvement initiatives across all aspects of the care pathway. CONCLUSION The development of the OCP identified a number of areas that require prioritization. Ensuring culturally safe and accessible health services is essential to support early presentation and diagnosis. Multidisciplinary treatment planning and patient-centered care are required for all Aboriginal and Torres Strait Islander people, irrespective of location. Health planners and governments acknowledge the imperative for change and have expressed strong commitment to work with indigenous Australians to improve the accessibility, cultural appropriateness, and quality of cancer care.

Plastic pollution is considered one of today's major environmental problems. Current land-based monitoring programs typically rely on beach litter data and seldom include plastic pollution further inland. We initiated a citizen science project known as the Mass Experiment inviting schools throughout The Danish Realm (Denmark, Greenland and the Faeroe Islands) to collect litter samples of and document plastic pollution in 8 different nature types. In total approximately 57,000 students (6–19 years) collected 374,082 plastic items in 94 out of 98 Danish municipalities over three weeks during fall 2019. The Mass Experiment was the first scientific survey of plastic litter to cover an entire country. Here we show how citizen science, conducted by students, can be used to fill important knowledge gaps in plastic pollution research, increase public awareness, establish large scale clean-up activities and subsequently provide information to political decision-makers aiming for a more sustainable future.

When globalization hit Europe from the early 1980s onwards, it first and foremost took the shape of sharply increased East-Asian and American competition. The two sectors to be hit hardest were the automobile industry and consumer electronics. Pehr G. Gyllenhammar of Swedish car maker Volvo and Wisse Dekker of the Dutch electronics giant Philips, joined forces for the sake of a rescue operation for their beleaguered companies. By founding the Round Table of European Industrialists (RTE), they launched the first pan-European non-governmental driving force for the sake of overcoming the continent's economic fragmentation. True, since the Summer of 1968, the economies of the member-states of the European Economic Community (EEC) were formally united in the EEC's Customs Union. A plethora of Non-Tariff Barriers to trade (NTBs), however, had made free cross border trade in Europe a farce. The success of RTE's campaign for the establishment of the EU internal market was the result of its effective cooperation with other NGOs, notably the Action Committee for Europe (ACE), comprising senior men of state, and with the Kangaroo group, uniting members of the European Parliament, as well as the ascendance of a new European Commission under the presidency of Jacques Delors. By establishing a pro-Single Market network of networks, RTE and its coalition allies managed to set the agenda, in convincingly proposing policy options for overcoming market fragmentation and promoting arguments for institutional change in a way that would steer Europe's national preferences formation and intergovernmental discourse towards making the Single Market its first and foremost priority.

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.

Nearly 40% of the refugees arriving in Germany suffer from psychological traumatization. After initial accommodation in reception centers, German legislation requires that all refugees undergo a medical visual examination (MVE) to screen for infectious diseases. This examination is, in part, conducted by volunteering medical doctors. The present study aimed to analyze volunteering medical doctors' motivation for performing MVE, their connected experiences, and their psychological strain in a reception center. In this context, the emergence of secondary traumatic stress, vicarious traumatization, and the need for psychological support were explored. Semistandardized interviews were conducted with 18 medical doctors after they had performed MVE. Interview recordings were transcribed and subsequently underwent qualitative thematic analysis. Finally, thematic clusters were identified. The analysis revealed 512 relevant single codes, from which three main categories were derived. These ranged from private motives for volunteering to perform MVEs in a reception center setting, to thoughts and feelings after performing the examination, and the need for psychosocial support. After having performed MVE, some of the doctors displayed cognitive alterations, which can be an indication of vicarious traumatization. Most participants felt motivated to reflect on their personal beliefs and their moral concepts.

The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the 'digital transformation'. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important.

Most alternatives assessments (AAs) published to date are largely hazard‐based rankings, thereby ignoring potential differences in human and/or ecosystem exposures; as such, they may not represent a fully informed consideration of the advantages and disadvantages of possible alternatives. Building on the 2014 US National Academy of Sciences recommendations to improve AA decisions by including comparative exposure assessment into AAs, the Health and Environmental Sciences Institute's (HESI) Sustainable Chemical Alternatives Technical Committee, which comprises scientists from academia, industry, government, and nonprofit organizations, developed a qualitative comparative exposure approach. Conducting such a comparison can screen for alternatives that are expected to have a higher or different routes of human or environmental exposure potential, which together with consideration of the hazard assessment, could trigger a higher tiered, more quantitative exposure assessment on the alternatives being considered, minimizing the likelihood of regrettable substitution. This article outlines an approach for including chemical ingredient‐ and product‐related exposure information in a qualitative comparison, including ingredient and product‐related parameters. A classification approach was developed for ingredient and product parameters to support comparisons between alternatives as well as a methodology to address exposure parameter relevance and data quality. The ingredient parameters include a range of physicochemical properties that can impact routes and magnitude of exposure, whereas the product parameters include aspects such as product‐specific exposure pathways, use information, accessibility, and disposal. Two case studies are used to demonstrate the application of the methodology. Key learnings and future research needs are summarized.

Breastfeeding practices are critical for child health and growth. This paper investigates demographic factors, socioeconomic status, and information sources that affect breastfeeding practices in Sindh Province, Pakistan. A secondary analysis was performed of data on 10,028 women with a birth in the preceding two years who had participated in the 2013-14 Maternal and Child Health Program Indicator Survey. Multiple logistic regressions were used to test the association between breastfeeding status (ever breastfed and still breastfeeding) and age, number of living children, residence, education, wealth, information sources about breastfeeding, assistance during delivery, and place of delivery. Of the 9955 women included in the analysis, 97.9% had breastfed and 83.9% were still breastfeeding at the time of the survey. Being in the second, third, or fourth wealth quintiles and receiving breastfeeding information from relatives and friends were associated with ever breastfeeding. Women who were 35 years or older, living in a town/small city, higher maternal education, middle wealth quintile, and receiving breastfeeding information from the media were associated with still breastfeeding. The findings suggest the need to develop interventions considering maternal socioeconomic status and peer counseling interventions. Mass media campaigns to promote breastfeeding practices should be accompanied by governmental restrictions on the marketing of infant formula.

Humanitarian organizations are increasingly interested in using seasonal forecasts to prepare for and mitigate the impacts of potential disasters before they begin. El Niño teleconnections increase the predictability of flooding and drought events in Southern and Eastern Africa, providing humanitarian stakeholders with advanced warning of potential weather events. This study draws on evidence from key-informant interviews with humanitarian organizations and government officials in five African countries (Zambia, Somalia, Kenya, Ethiopia, and Malawi) to better understand how national, regional, and international humanitarian organizations respond to climate and weather warnings. We find that organizations looked to data from past El Niño events to develop contingency plans and gradually implement response activities but that few organizations attempt to monitor and evaluate their activities or use forecasts to help people capture additional benefits. Although they would like greater specificity and higher forecast skill, humanitarians largely trust international forecasts. Access to intermediaries, contextualized data, and flexible funding, and well-established social protection mechanisms facilitate action. Based on these results we recommend that future efforts focus on developing capacities and complementary, localized, information that will help actors translate the forecasts into action. Future research is also needed to understand whether action leads to desired impacts.

Introduction Autistic people may have different educational needs that need to be met to allow them to develop their full potential. Education and disability policies remain within the competence of EU Member States, with current educational standards and provisions for autistic people implemented locally. This scoping review aims to map EU and national special education policies with the goal of scoping the level of fulfilment of the right to education of autistic people. Methods Four EU countries (United Kingdom, France, Poland and Spain) were included in this scoping review study. Governmental policies in the field of education, special education needs and disability law were included. Path dependency framework was used for data analysis; a net of inter-dependencies between international, EU and national policies was created. Results and discussion Each country created policies where the right to free education without discrimination is provided. Poland does not have an autism specific strategy, whereas the United Kingdom, France and Spain have policies specifically designed for autistic individuals. Within the United Kingdom, all countries created different autism plans, nevertheless all aim to reach the same goal-inclusive education for autistic children that leads to the development of their full potential. Conclusion Policy-making across Europe in the field of education has been changing through the years in favour of autistic people. Today their rights are noticed and considered, but there is still room for improvement. Results showed that approaches and policies vastly differ between countries, more Member States should be analysed in a similar manner to gain a broader and clearer view with a special focus on disability rights in Central and Eastern Europe.

Objective To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff. Methods Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed-methods design. This included seven in-depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2-week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation. Results The MWH at Attat Hospital has become a well-established intervention for high-risk pregnant women (1987-2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142-832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy-related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby. Conclusions Facilitators for MWH utilisation according to users and staff ...

This chapter analyses the major trends in Rotterdam's migration history in three periods: the early-modern period (1600–1800), the era in which the Working Class Port City was created (1850–1940), and the post-war period until the 1980s. Rotterdam's pre-industrial history convincingly reveals a multi-ethnic and religious diverse society. Small foreign minorities could have a significant influence on Rotterdam's cultural, political and economic development. Even strong national identities did not restrict a strong sense of local attachment. The port city of the nineteenth century was less diverse, considering the smaller number of foreign migrants that settled in the city. The migration narrative of the port city in this period is inexorably linked to that of the working city. This narrative became highly popular in the post-war reconstruction period. The offspring of Rotterdam's nineteenth century rural-urban migrants had rebuilt the city after the fatal German bombardment in May 1940 and had been responsible for its successful post-war industrial port development. The arrival of non-Western migrants in the 1960s and 1970s challenged Rotterdam's nineteenth century popularised migration narrative. Policy-makers have suggested that this post-war migration process is fundamentally different from older migration patterns. In general, we tend to be too pessimistic about the post war integration and too optimistic about patterns of integration in the past, particularly during the nineteenth century. Notwithstanding the fact that by then the large majority of the migrants were Dutch, marginalisation and exclusion took place on a larger scale than realised. Our long-term perspective hopes to contribute to link earlier migration narratives to Rotterdam's recent superdiversity.