Suchergebnisse

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). ; Australian efforts to address food insecurity are delivered by a charitable food system (CFS) which fails to meet demand. The scope and nature of the CFS is unknown. This study audits the organisational capacity of the CFS within the 10.9 square kilometres of inner-city Perth, Western Australia. A desktop analysis of services and 12 face-to-face interviews with representatives from CFS organisations was conducted. All CFS organisations were not-for–profit and guided by humanitarian or faith-based values. The CFS comprised three indirect services (IS) sourcing, banking and/or distributing food to 15 direct services (DS) providing food to recipients. DS offered 30 different food services at 34 locations feeding over 5670 people/week via 16 models including mobile and seated meals, food parcels, supermarket vouchers, and food pantries. Volunteer to paid staff ratios were 33:1 (DS) and 19:1 (IS). System-wide, food was mainly donated and most funding was philanthropic. Only three organisations received government funds. No organisation had a nutrition policy. The organisational capacity of the CFS was precarious due to unreliable, insufficient and inappropriate financial, human and food resources and structures. System-wide reforms are needed to ensure adequate and appropriate food relief for Australians experiencing food insecurity. ; This work was funded by Healthway, the Western Australian Health Promotion Foundation, who funded Curtin University to undertake this Special Research Initiative entitled "Charitable Food Services and the Needs of Homeless and Disadvantaged People" (Grant number 24266). We wish to acknowledge the partner organisations (The Salvation Army, United Care West, Noongar Patrol Services, Australian Red Cross, Foodbank, Western Australian Council of Social Services WACOSS—Emergency Relief Forum, Vincentcare, Perth City Council) who formed the research advisory group.

Il saggio tratta dell'utopia della bicicletta e di come le città, in continua evoluzione, abbiano esigenze sempre nuove soprattutto legate alla qualità della vita dei cittadini. Lo studio mira a promuovere il vero valore della mobilità sostenibile e i benefici collettivi che essa può portare. I benefici collettivi non hanno solo effetti sulla salute, ma anche effetti sull'economia delle famiglie, con una riduzione dei costi dedicati alla macchina, sulla politica economica come la riduzione della dipendenza energetica e il risparmio di risorse non rinnovabili. La bicicletta è vista come lo strumento per innescare una rivoluzione urbana, è un fatto sociale, è un'opportunità per un'esperienza senza precedenti: la bicicletta consente di rivalutare le distanze e percorrere tratte impossibili da effettuare con il trasporto pubblico limitato ad itinerari fissi. Per sognare una città adatta alle biciclette, è essenziale una pianificazione completa e tempestiva. Indispensabile è anche seguire l'esempio di molte realtà urbane virtuose che già promuovono la mobilità e le pratiche sostenibili. ; The essay talks about the bicycle's utopia and how ever-changing cities have ever-new needs, linked to the quality of life of citizens. The study aims to promote the true value of sustainable mobility and the collective benefits it can bring. The collective benefits have not only effects on health, but also effects on the economy of families with a reduction in costs dedicated to the car, on economic policy such as the reduction of energy dependence and the saving of non-renewable resources. The bicycle is seen as the tool to trigger an urban revolution, it is a social fact, it is an opportunity for an unprecedented experience: it allows reevaluating distances and following impossible routes for public transport following fixed itineraries. To dream of a bicycle-friendly city, comprehensive and timely planning is essential, as well as following the example of many virtuous urban realities that already promote mobility and sustainable practices.

Hepatitis C virus (HCV) infection is the most commonly reported bloodborne infection in the United States, causing substantial morbidity and mortality and costing billions of dollars annually. To update the estimated HCV prevalence among all adults aged ≥18 years in the United States, we analyzed 2013-2016 data from the National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of HCV in the noninstitutionalized civilian population, and used a combination of literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for four additional populations: incarcerated people, unsheltered homeless people, active-duty military personnel, and nursing home residents. We estimated that during 2013-2016, 1.7% (95% CI 1.4-2.0%) of all adults in the United States, approximately 4.1 (3.4-4.9) million persons, were HCV antibody-positive (indicating past or current infection), and 1.0% (95% CI 0.8-1.1%) of all adults, approximately 2.4 (2.0-2.8) million persons, were HCV RNA-positive (indicating current infection). This includes 3.7 million noninstitutionalized civilian adults in the United States with HCV antibodies and 2.1 million with HCV RNA, and an estimated 0.38 million HCV antibody-positive persons and 0.25 million HCV RNA-positive persons not part of the 2013-2016 NHANES sampling frame. CONCLUSION: Over 2 million people in the United States had current HCV infection during 2013-2016. Compared to past estimates based on similar methodology, HCV antibody prevalence may have increased while RNA prevalence may have decreased, likely reflecting the combination of the opioid crisis, curative treatment for HCV infection, and mortality among the HCV-infected population. Efforts on multiple fronts are needed to combat the evolving HCV epidemic, including increasing capacity for and access to HCV testing, linkage-to-care, and cure.

Objective Regardless of the acceptance of users, information and communication systems can be considered as a health intervention designed to improve the care delivered to patients. This study aimed to determine the adoption and use of the extended Technology Acceptance Model (TAM2) by the users of hospital information system (HIS) in paraclinical departments including laboratory, radiology, and nutrition and to investigate the key factors of adoption and use of these systems. Materials and Methods A standard questionnaire was used to collect the data from nearly 253 users of these systems in paraclinical departments of eight university hospitals in two different cities of Iran. A total of 202 questionnaires including valid responses were used in this study (105 in Urmia and 97 in Khorramabad). The data were processed using LISREL and SPSS software and statistical analysis technique was based on the structural equation modeling (SEM). Results It was found that the original TAM constructs had a significant impact on the staffs' behavioral intention to adopt HIS in paraclinical departments. The results of this study indicated that cognitive instrumental processes (job relevance, output quality, result demonstrability, and perceived ease of use), except for result demonstrability, were significant predictors of intention to use, whereas the result revealed no significant relationship between social influence processes (subjective norm, voluntariness, and image) and the users' behavioral intention to use the system. Conclusion The results confirmed that several factors in the TAM2 that were important in previous studies were not significant in paraclinical departments and in government-owned hospitals. The users' behavior factors are essential for successful usage of the system and should be considered. It provides valuable information for hospital system providers and policy makers in understanding the adoption challenges as well as practical guidance for the successful implementation of information systems in ...

BACKGROUND: The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA. OBJECTIVE: To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: Forty-two VA primary care physicians who prescribed opioids to 15 or more Veterans in 2015. We sampled physicians from two states with PDMPs (Massachusetts and Illinois) and one without prescriber access to a PDMP at the time of the interviews (Pennsylvania). APPROACH: From February to August 2016, we conducted semi-structured telephone interviews that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use. KEY RESULTS: VA physicians broadly supported use of PDMPs or desired access to one, while exhibiting varying patterns of PDMP use dictated by state laws and their clinical judgment. Physicians noted administrative burdens and incomplete or unavailable prescribing data as key barriers to PDMP use. To facilitate use, physicians endorsed (1) linking PDMPs with the VA electronic health record, (2) using templated notes to document PDMP use, and (3) delegating routine PDMP queries to ancillary staff. CONCLUSIONS: Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-018-4374-1) contains ...

Il carcinoma della mammella è la neoplasia con incidenza più elevata nel sesso femminile. Il Parlamento Europeo ha dichiarato prioritario nella politica sanitaria degli Stati membri la lotta al carcinoma della mammella ed aveva invitato tutti gli Stati membri a organizzare entro il 2016 una rete di "Breast Units", ovvero centri di senologia che devono attenersi ad un programma codificato di controllo di qualità, cioè rispondere a una serie di indicatori conformi alle Linee Guida Europee. Scopo del progetto di ricerca è stato valutare gli outcomes degli indicatori definiti mandatori dalle linee guida europee presso la Breast Unit del Policlinico di Sant'Orsola di Bologna diretto dal Prof. Taffurelli negli anni 2014/2016. Delle pazienti sono state anche valutati aspetti estetici e funzionali ed il follow-up ad oggi. Avere strumenti ed indicatori validati, riproducibili e misurabili consente, in centri certificati e dedicati alla patologia mammaria di migliorarsi qualora tali obiettivi non fossero raggiunti, garantendo i più elevati standard di cura alle pazienti affette da patologia mammaria. ; Breast cancer is the cancer with the highest incidence in females. The European Parliament has indicated breast cancer a priority in the health policy of European member States and invited them to organize a network of "Breast Units". It had to be effective from 2016. Breast units have to follow a codified program of quality control, responding to a set of indicators that comply with the European Guidelines. The aim of the research project was to evaluate the outcomes of the indicators defined "mandatory" by the EUSOMA at the Breast Unit of Policlinico di Sant' Orsola in Bologna directed by Prof. Taffurelli in the years 2014/2016. Also patient's aesthetic results, functional aspects and follow-up were analyzed. Having validated, reproducible and measurable tools and indicators allows, in breast centers, to improve if these objectives are not achieved, guaranteeing the highest standards of care for patients suffering from breast pathology

Publisher's version (útgefin grein) ; Background The global Choosing Wisely campaign has identified the following psychotropic prescribing as low-value (harmful or wasteful): (1) benzodiazepine use in the elderly, (2) antipsychotic use in dementia and (3) prescribing two or more antipsychotics concurrently. We aimed to quantify the extent of these prescribing practices in the Australian population. Methods We applied indicators to dispensing claims of a 10% random sample of Australian Pharmaceutical Benefits Scheme beneficiaries to quantify annual rates of each low-value practice from 2013 to 2016. We also assessed patient factors and direct medicine costs (extrapolated to the entire Australian population) associated with each practice in 2016. Results We observed little change in the rates of the three practices between 2013 and 2016. In 2016, 15.3% of people aged ≥65 years were prescribed a benzodiazepine, 0.5% were prescribed antipsychotics in the context of dementia and 0.2% of people aged ≥18 years received two or more antipsychotics concurrently. The likelihood of elderly people receiving benzodiazepines or antipsychotics in the context of dementia increased with age and the likelihood of receiving all three practices increased with comorbidity burden. In 2016, direct medicine costs to the government of all three practices combined, extrapolated to national figures, were > $21 million AUD. Conclusions Our indicators suggest that the frequency of these three practices has not changed appreciably in recent years and that they incur significant costs. Worryingly, people with the greatest risk of harm from these prescribing practices are often the most likely to receive them. ; This research was supported by the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Medicines and Ageing (CREMA), a Project Grant for measuring low-value care for targeted policy action and JB received funding support from an NHMRC Postgraduate award. These funding bodies played no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript. ; Peer Reviewed

Abstract: This article looks at the power actors and the political elites, who always have a position, strategic and nominations in the course of the nation's history, which often have the power to direct and designing the history of the nation. The emergence of a modernist discourse on Nahdlatul Ulama (NU) is very concerning. NU regarded as a political organization has no significant role to play down organizing political change and the substitution of elite political power actors directly. Because the domain of thinking than often become conservative, countrified, superstitious, think old-fashioned, opportunistic chameleon, inconsistent, corrupt, cultured syncretic and other. Internally, NU as experienced a 'stagnation of thought'. At the same time, it has not yet found a vision regarding the role and contribution of NU to Indonesia in the global context. Nu as an organization that has abundant millennial generations, certainly has a very strategic role in the effort to create a golden Indonesia 2045. Efforts are needed to explore things in the tradition that can support transformation. NU must be able to concentrate itself on taking care of people's problems in the social, community, education, health, empowerment, economic, religious, politics, and so on, which may be more fundamental for the Indonesian people. Abstrak: Artikel ini membahas aktor-aktor kekuasaan dan elit politik, yang selalu memiliki posisi, strategis, dan nominasi dalam perjalanan sejarah bangsa, yang sering memiliki kekuatan untuk mengarahkan dan merancang sejarah bangsa. Munculnya wacana modernis mengenai Nahdlatul Ulama (NU) sagatlah miris. NU dianggap sebagai organisasi politik tidak mempunyai peran yang signifikan untuk turut mengatur perubahan politik dan pergantian aktor-aktor kekuasaan dan elit-elit politik secara langsung. Hal ini dikarenakan ranah berfikir yang sering menjadi konservatif, kampungan, percaya takhyul, berfikir kuno, oportunis, berwatak bunglon dan plin-plan, korup, berbudaya sinkretis, dan lainnya. Secara ...

Cross-national differences in adolescent life satisfaction in Europe and North America are consistent, but remain poorly understood. While previous studies have predominantly focused on the explanatory role of economic factors, such as national wealth and income equality, they revealed weak associations, at most. This study examines whether societal gender equality can explain the observed cross-national variability in adolescent life satisfaction. Based on the assumption that gender equality fosters a supportive social context, for example within families through a more equal involvement of fathers and mothers in child care tasks, adolescent life satisfaction was expected to be higher in more gender-equal countries. To test this hypothesis, national-level data of gender equality (i.e., women's share in political participation, decision making power, economic participation and command over resources) were linked to data from 175,470 adolescents aged 11–16 years old (Mage = 13.6, SD = 1.64, 52% girls) from 34 European and North American countries involved in the 2009/10 Health Behaviour in School-aged Children (HBSC) study. Results of linear multilevel regression analyses indicate that adolescents in countries with relatively high levels of gender equality report higher life satisfaction than their peers in countries with lower levels of gender equality. The association between gender equality and adolescent life satisfaction remained significant after controlling for national wealth and income equality. It was equally strong for boys and girls. Moreover, the association between gender equality and life satisfaction was explained by social support in the family, peer and school context. This analysis suggests that gender equality fosters social support among members of a society, which in turn contributes to adolescent life satisfaction. Thus, promoting gender equality is likely to benefit all members of a society; not just by giving equal rights to women and girls, but also by fostering a supportive social climate for all.

BACKGROUND: Understanding how policies lead to changes in health systems and in practice helps policymakers and researchers to intervene more successfully. Yet identifying all the possible changes that occur as a result of a new policy is challenging not only methodologically and logistically, as limited resources are available to conduct indefinite evaluations, but also theoretically, as a complete mapping and attribution of post-hoc changes requires a full understanding of the mechanisms underpinning all change. One option is to identify possible changes across a number of policy impact domains. METHODS: Using a Policy Impact Framework, we brought together data from media, documents and interviews to identify changes to midwifery policy, practice and provision, following the launch of a new global policy initiative, the State of the World's Midwifery (SoWMy 2014) report published in 2014. We used these identified impacts to develop a map of the mechanisms underpinning these changes. RESULTS: SoWMy 2014 contributed to a number of changes at national levels, including increased status of midwifery within national governments, improved curricula and training opportunities for midwives, and improved provision of and access to midwifery-led care. These contributions were attributed to SoWMy 2014 via mechanisms such as stakeholder interaction and acquisition of government support, holding national and international dissemination and training events, and a perceived global momentum around supporting midwifery provision. Policy initiatives of this kind can lead to changes in national and international policy dialogue and practice. We identify factors and mechanisms that are likely to increase the scope and scale of these changes, at contextual, national and global levels. CONCLUSIONS: Identifying changes following a policy using a policy impact framework can help researchers and policymakers understand why policies have the effect they do. This is important information for those wishing to increase the effectiveness of future policies and interventions.

David E Jamison,1,2 Steven P Cohen1–6 1Department of Anesthesiology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA; 2Department of Anesthesiology, Uniformed Services University of Health Sciences (USUHS), Bethesda, MD, USA; 3Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; 4Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; 5Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA; 6Department of Physical Medicine and Rehabilitation, USUHS, Bethesda, MD, USA Background: The use of radiofrequency ablation (RFA) procedures to treat chronic knee pain has surged in the past decade, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness. Methods: A comprehensive literature review was performed on anatomy, selection criteria, technical parameters, results of clinical studies, and complications. Databases searched included MEDLINE and Google Scholar, with all types of clinical and preclinical studies considered. Results: We identified nine relevant clinical trials, which included 592 patients, evaluating knee RFA for osteoarthritis and persistent postsurgical pain. These included one randomized, placebo-controlled trial, one randomized controlled trial evaluating RFA as add-on therapy, four comparative-effectiveness studies, two randomized trials comparing different techniques and treatment paradigms, and one non-randomized, controlled trial. The results of these studies demonstrate significant benefit for both reduction and functional improvement lasting between 3 and 12 months, with questionable utility for prognostic blocks. There was considerable variation in the described neuroanatomy, neural targets, radiofrequency technique, and selection criteria. Conclusion: RFA of the knee appears to be a viable and effective treatment option, providing significant benefit to well-selected patients lasting at least 3 months. More research is needed to better identify neural targets, refine selection criteria to include the use of prognostic blocks, optimize treatment parameters, and better elucidate relative effectiveness compared to other treatments. Keywords: Knee pain, osteoarthritis, radiofrequency, ablation, denervation, genicular nerve

El mercurio es un elemento altamente tóxico, es volátil a temperatura ambiente y debido a su elevada presión de vapor con respecto a la de los metales, a 20ºC éste se libera continuamente al ambiente en forma natural y también debido a las actividades antrópicas que favorecen su presencia en el ecosistema. De esta manera el mercurio llega al suelo, aire y agua. La preocupación de organismos internacionales y gubernamentales por cuidar la salud de la población, llevó a incluir al mercurio, como uno de los parámetros con mayor restricción en los límites máximos permisibles (LMP) para el agua potable, así, en México actualmente el LMP es 0.001 mg/L y su tendencia es a disminuirlo. Esta circunstancia ha llevado a la optimización de las técnicas analíticas que lo cuantifiquen. En este trabajo se muestran los resultados de dos técnicas analíticas por vapor frío: con borohidruro de sodio y el método 1SO12846:212, cuyos alcances son de µg/L. ; Mercury is a highly toxic element, it is volatile at room temperature and due to its high vapor pressure, at 20 C, it is released continuously to the environment in a natural way and also due to the anthropogenic activities that favor its presence in the ecosystem. In this way the mercury reaches the ground, air and water. The concern for international and governmental organizations to take care of the health of the population, led to the inclusion ofmercury, as one ofthe parameters with the greatest restriction in the maximum permissible limits (LMP) for drinking water, thus, in Mexico, currently the LMP is 0.001 mg / L and its tendency is to decrease it. This circumstance has led to the optimization of the analytical techniques that quantify it, in this work the results of two cold vapor analytical techniques are shown: with sodium borohydride and the method 1SO12846: 212, whose scope is µg /L.

Background In many countries, access to general health and eye care is related to an individual's socioeconomic status (SES). We aimed to examine the prevalence of oculo-visual disorders in children in Istanbul Turkey, drawn from schools at SES extremes but geographically nearby. Methods Three school-based vision screenings (presenting distance visual acuity, cover test, eye assessment history, colour vision, gross stereopsis and non-cycloplegic autorefraction) were conducted on 81% of a potential 1014 primary-school children aged 4–10 years from two private (high SES) schools and a nearby government (low SES) school in central Istanbul. Prevalence of refractive errors and school-based differences were analysed using parametric statistics (ANOVA). The remaining oculo-visual aspects were compared using non-parametric tests. Results Of the 823 children with mean age 6.7 ± 2.2 years, approximately 10% were referred for a full eye examination (8.2% and 16.3% of private/government schools respectively). Vision had not been previously examined in nearly 22% of private school children and 65% of government school children. Of all children, 94.5% were able to accurately identify the 6/9.5 [LogMAR 0.2] line of letters/shapes with each eye and 86.6% the 6/6 line [LogMAR 0], while 7.9% presented wearing spectacles, 3.8% had impaired colour vision, 1.5% had grossly impaired stereo-vision, 1.5% exhibited strabismus, 1.8% were suspected to have amblyopia and 0.5% had reduced acuity of likely organic origin. Of the 804 without strabismus, amblyopia or organic conditions, 6.0% were myopic ≤−0.50DS, 0.6% hyperopic ≥ + 2.00DS, 7.7% astigmatic ≥1.00 DC and 6.2% anisometropic ≥1.00DS. Conclusions The results highlight the need for general vision screenings for all children prior to school entry given the varied and different pattern of visual problems associated with lifestyle differences in two populations raised in the same urban locale but drawn from different socioeconomic backgrounds.

AbstractIntroductionSouth Africa faces epidemics of HIV and non‐communicable diseases (NCDs). The aim of this study was to characterize the prevalence of non‐communicable disease risk factors and depression, stratified by HIV status, in a community with a high burden of HIV.MethodsWe conducted a home‐based HIV counselling and testing study in KwaZulu‐Natal, South Africa between November 2011 and June 2012. Contiguous households were approached and all adults ≥18 years old were offered an HIV test. During follow‐up visits in January 2015, screening for HIV, depression, obesity, blood glucose, cholesterol and blood pressure were conducted using point‐of‐care tests.ResultsOf the 570 participants located and screened; 69% were female and 33% were HIV‐positive. NCD risk factor prevalence was high in this sample; 71% were overweight (body mass index (BMI) 25 to 29.9 kg/m2) or obese (BMI≥30 kg/m2), 4% had hyperglycaemia (plasma glucose >11.0 mmol/l/200 mg/dl), 33% had hypertension (HTN, >140/90 mmHg), 20% had hyperlipidaemia (low density cholesterol >5.2 mmol/l/193.6 mg/dl) and 12% had major depressive symptoms (nine item Patient Health Questionnaire ≥10). Of the 570 participants, 87% had one or more of HIV, hyperglycaemia, HTN, hyperlipidaemia and/or depression. Over half (56%) had two or more. Older age and female gender were significantly associated with the prevalence of both HIV infection and NCD risk factors. Around 80% of both HIV‐positive and negative persons had one of the measured risk factors (i.e. obesity, hyperglycaemia, hyperlipidaemia, HTN), or depression.ConclusionsIn a community‐based sample of adults in KwaZulu‐Natal, South Africa, the prevalence of both HIV infection and NCD risk factors were high. This study is among the first to quantify the substantial burden of NCD risk factors and depression in this non‐clinic based population.

Background: Persons with serious mental illnesses (SMI) can lead productive lives, and the majority want to work. Mental health providers can play an important role in helping their clients gain and maintain employment. Aims: The Provider Survey was developed to shed additional light on providers' views toward employment and recovery, and the utilization of Individual Placement and Support (IPS) supported employment (SE) services for people with SMI. Methods: A total of 1,306 providers of the State of Connecticut participated in the survey. Four main questions were addressed in the survey: what do providers do, what do they view as most important regarding employment, what are their views when it comes to what promotes recovery and what barriers do providers face in attempting to refer their clients to IPS services. Results: Referring clients to additional supports was rated as the most important aspect of what providers do; encouragement was rated as the most important component to enable clients in gaining and maintaining employment; agency, belonging and medical care were rated as most important in promoting recovery; and expectations that clients would be discriminated against at work was the most important barrier to referring clients for SE. Also, employment and finances were seen as the least important factors in promoting the recovery of people with SMI. Conclusion: This survey suggests that one reason that more clients may not be referred to IPS programs is that clinicians do not view employment or financial self-sufficiency as important factors in recovery, further compounding the historical view that these persons are unable to, and uninterested in, working. Such findings call for a provider education and training campaign to highlight the fact that most persons with SMI – like most persons in general – do want to work and, with supports, most are capable of doing so.