Suchergebnisse

The use of pesticides has rapidly increased in Japan since the end of World War II, significantly reducing work burdens and boosting food production. In the meantime, pesticides, responsible for poisoning and environmental pollution, have for many years posed grave issues that have had to be tackled by scientists of rural medicine for a long period. The Japanese Association of Rural Medicine, founded by the late Toshikazu Wakatsuki, has grappled with those issues for many years. Above all, the association has fulfilled its social obligations, such as by bringing the toxicity of organic mercury to light in animal tests to prompt the government to prohibit its use, and by casting light on birth defects caused by defoliants aerially sprayed during the Vietnam War to urge U.S. military forces to break off herbicide warfare. As it has become possible to make less toxic pesticides available for farm work in recent years, death-inducing accidents have seldom occurred during the spraying of pesticides, and the association's activities are now at a low ebb. Now that pesticides, which after all are biologically toxic compounds, are openly used on farms, there is the need to pay constant attention to their impacts on the human body and the environment. In the future, it is necessary to epidemiologically probe into chronic impacts on the human body and contribute to the prevention of pesticide poisoning in Southeast Asia.

What is known about the topic? Avoidable adverse events are often being attributed to health workforce shortages associated with the coronavirus disease 2019 (COVID-19) pandemic and government funding cuts. What does this paper add? Health workforce shortages were predicted well before the COVID-19 pandemic. What are the implications for practitioners? Senior executives and leaders should unitedly take action to influence change in funding and models of care.

Objective: This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. Methods: This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. Results: Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. Conclusions: The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals.

Background Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates' longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists. Methods A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002–2011. The outcome of interest was primary place of graduates' practice categorised as rural for at least 50% of time since graduation ('Longer-term Rural Practice', LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2). Results Independent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37–3.20]), RCS-1 (2.85 [1.77–4.58]), RCS-2 (5.38 [3.15–9.20]), GP (3.40 [2.13–5.43]), and bonded scholarship (2.11 [1.19–3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21–0.57]). The effects of RB and RCS were additive—compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32–13.04]), RB and RCS-2 (10.36[4.89–21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner's background were apparent. Conclusions Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical ...

Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.

1.4.1 Training for Healthcare Practitioners1.4.2 Training Full-time Agriculture Health and Safety Specialists ; 1.5 Demographics of the Agricultural Workforce; 1.6 The Evolution of Production Agricultural, Workforce, and Types of Farms; 1.6.1 Family Farms; 1.6.2 Principal Operator; 1.6.3 Farm Family Members; 1.6.4 Farm Workers; 1.6.5 Indigenous Farm Workers; 1.6.6 Migrant and Seasonal Farm Workers; 1.6.7 Large Farms and Industrial-style Farms ; 1.6.8 Family Corporations; 1.7 Other Occupations Exposed to the Agricultural Environment; 1.8 General Health Status of the Agricultural Population.

Andean traditional medicines in rural settings and community exchange networks -- Traditional medicines in new contexts: old cultural practices in new venues -- Women's roles in Andean marketplaces: shopping in the Andes -- Marketing medicines in rural Bolivia: San Pedro de Condo -- Selling medicines at Condo's regional marketplaces: Huari, Challapata, and Oruro -- Bolivian traditional medicines and urban commercialization: medicine vendors in Cochabamba -- Coca, coca medicines, and the dilemma of coca in the Andes and beyond -- Natural medicine and naturopaths in Bolivia: a new twist on traditional medicine -- Traditional medicines and intellectural property rights -- The future of traditional medicines in Bolivia

FrontMatter -- Reviewers -- Contents -- 1 Introduction -- 2 Official U.S. Rural Area Classification Systems -- 3 Other Rural Area Classification Systems Used in the United States and Internationally -- 4 Changes in Society and Economy and Their Impact on Rural Area Classifications -- 5 Different Ways to Conceptualize Rural Areas in Metropolitan Society -- 6 Uses of Current Rural Classification Systems -- 7 Changes in Social Science Data and Methods -- 8 Evaluating the Reliability and Validity of Rural Area Classifications -- 9 Closing Remarks -- Bibliography

Abstract Background Numerous not-for-profit pharmacies have been created to improve access to medicines for the poor, but many have failed due to insufficient financial planning and management. These pharmacies are not well described in health services literature despite strong demand from policy makers, implementers, and researchers. Surveys reporting unaffordable medicine prices and high mark-ups have spurred efforts to reduce medicine prices, but price reduction goals are arbitrary in the absence of information on pharmacy costs, revenues, and profit structures. Health services research is needed to develop sustainable and "reasonable" medicine price goals and strategic initiatives to reach them. Methods We utilized cost accounting methods on inventory and financial information obtained from a not-for-profit rural pharmacy network in mountainous Kyrgyzstan to quantify costs, revenues, profits and medicine mark-ups during establishment and maintenance periods (October 2004-December 2007). Results Twelve pharmacies and one warehouse were established in remote Kyrgyzstan with 100%, respectively. Annual mark-ups increased dramatically each year to cover increasing recurrent costs, and by 2007, only 19% and 46% of products revealed mark-ups of 100%. 2007 medicine mark-ups varied substantially across these products, ranging from 32% to 244%. Mark-ups needed to sustain private pharmacies would be even higher in the absence of government subsidies. Conclusion Pharmacy networks can be established in hard-to-reach regions with little funding using public-private partnership, resource-sharing models. Medicine prices and mark-ups must be interpreted with consideration for regional costs of business. Mark-ups vary dramatically across medicines. Some mark-ups appear "excessive" but are likely necessary for pharmacy viability. Pharmacy financial data is available in remote settings and can be used towards determination of "reasonable" medicine price goals. Health systems researchers must document the positive and negative financial experiences of pharmacy initiatives to inform future projects and advance access to medicines goals.

Medical care in developing countries is challenging. The providers have the knowledge of best practices, but these often can not be used due to lack of funding and resources. This leaves healthcare less than subpar and full of innovations to make it work. This presentation is an overview of our experiences observing healthcare in Uganda. Topics include, in field operations, maternal fetal medicine, traditional healers, dentistry, lack of healthcare in rural villages, and the lack of medical tools and resources. Healthcare work was observed at the Kigezi Healthcare Foundation in Kabale, Uganda. KIHEFO is a non-profit non governmental organization (NGO) that provides care to many people throughout the Kabale area This organization is founded and operated by Dr. Geoffery Anguyo, an expert in HIV and public health. A main issue in Uganda was funding, KIHEFO didn't have enough money. The Public Health department would like to help this situation by hosting a coin drive and doing a tooth brush collection drive before our next trip. These two fundraisers should help improve medical situations at KIHEFO, providing medical supplies for those in need. During Christmas break, a group of 11 students and 2 Faculty members traveled to Kabale, Uganda to learn about global health. The best way to understand global health is to immerse yourself and experience global health.

Intro -- RURAL TELEMEDICINE AND HOMELESSNESS ASSESSMENTS OF SERVICES -- RURAL TELEMEDICINE AND HOMELESSNESS ASSESSMENTS OF SERVICES -- CONTENTS -- PREFACE -- Chapter 1 TELECOMMUNICATIONS: FCC'S PERFORMANCE MANAGEMENT WEAKNESSES COULD JEOPARDIZE PROPOSED REFORMS OF THE RURAL HEALTH CARE PROGRAM -- WHY GAO DID THIS STUDY -- WHAT GAO RECOMMENDS -- WHAT GAO FOUND -- ABBREVIATIONS -- BACKGROUND -- FCC HAS NOT PERFORMED THE ANALYSIS NECESSARY TO ENSURE THAT THE PRIMARY RURAL HEALTH CARE PROGRAM MEETS THE NEEDS OF RURAL HEALTH CARE PROVIDERS -- Participation in the Program, Although Increasing, Has Not Met FCC Projections and over Half of All Program Funds Are Used in Alaska -- FCC Has Not Assessed the Telecommunications Needs of Rural Health Care Providers to Guide the Evolution of the Rural Health Care Program -- FCC'S POOR PLANNING AND COMMUNICATION DURING THE DESIGN AND IMPLEMENTATION OF THE PILOT PROGRAM CAUSED DELAYS AND DIFFICULTIES -- FCC's Limited Collaboration with USAC, Federal Agencies, and Other Knowledgeable Stakeholders Affected Pilot Program Design -- Pilot Participants Have Experienced Delays and Difficulties, in Part, Because FCC Did Not Fully Establish Requirements Prior to Calling for Applications and Did Not Provide Effective Program Guidance -- Pilot Participants Have Experienced Delays and Difficulties for Many Reasons -- FCC's Call for Applications Did Not Include Needed Information about the Eligibility of Entities, Expenses, and How to Meet the Match Requirement -- FCC Introduced New Requirements after Its Call for Applications and Selection of Pilot Participants -- Program Guidance Is Not Provided in an Effective Manner -- Program Guidance Is Not Provided in an Effective Manner