Availability Of Material Resources Research Articles

Fortalezas y debilidades del programa para la detección y el control del cáncer cervicouterino. Evaluación cualitativa en San Luis Potosí, México

ObjectiveTo identify, from the perspective of the health staff, the strengths and weaknesses of the program for the detection and control of cervical cancer through a qualitative assessment implemented in three health centers in the city of San Luis Potosi, Mexico, from August 2008 to November 2009. MethodsA qualitative evaluation was performed. Nine providers participated in the study. The providers were selected by purposeful sampling using a voluntary participation criterion. Initially, information on the characteristics and the context in which the program operates was obtained from the health centers. Later, 18 semi-structured interviews were conducted with nine informants to probe their perspective. A directed content analysis was used. ResultsThe strengths reported by staff were the fact that the program is free of charge, the availability of material resources, and the strategies that helped encourage the recruitment of women and their access to screening. The main weaknesses consisted of limitations in human resources and physical infrastructure, inefficient organization of activities, the staff's poor technical training, limited promotion of activities, and limitations in monitoring women with positive results. ConclusionsThis study reveals the need for increased human resources, changes in regulations and reorganization of the program's actions in some health centers to ensure the quality of the service, meet women's needs, and promote coverage in all the program's actions.

Identifying sources of strength: resilience from the perspective of older people receiving long-term community care

This study seeks to explore the sources of strength giving rise to resilience among older people. Twenty-nine in-depth interviews were conducted with older people who receive long-term community care. The interviews were subjected to a thematic content analysis. The findings suggest that the main sources of strength identified among older people were constituted on three domains of analysis; the individual-, interactional and contextual domain. The individual domain refers to the qualities within older people and comprises of three sub-domains, namely beliefs about one’s competence, efforts to exert control and the capacity to analyse and understand ones situation. Within these subdomains a variety of sources of strength were found like pride about ones personality, acceptance and openness about ones vulnerability, the anticipation on future losses, mastery by practising skills, the acceptance of help and support, having a balanced vision on life, not adapting the role of a victim and carpe-diem. The interactional domain is defined as the way older people cooperate and interact with others to achieve their personal goals. Sources of strength on this domain were empowering (in)formal relationships and the power of giving. Lastly, the contextual domain refers to a broader political-societal level and includes sources of strength like the accessibility of care, the availability of material resources and social policy. The three domains were found to be inherently linked to each other. The results can be used for the development of positive, proactive interventions aimed at helping older people build on the positive aspects of their lives.

Welche Wohlfahrtspolitik fördert die Gesundheit? Der ungeklärte Zusammenhang von ökonomischer und gesundheitlicher Ungleichheit

In all highly developed countries, the overall health status of the population has significantly improved within the past 30 years. The most important reason for this is the increase in economic prosperity. Economic wealth, however, today is much more unequally distributed than it was 3 decades ago. Countries with relatively small disparities in the availability of material resources between socioeconomic groups, such as the Scandinavian countries, have better health outcomes on the population level. Health inequalities, however, have also reached a higher level than 30 years ago. As of today, we do not have convincing explanations for the interrelation of economic and health inequality. This paper gives an overview of existing research on a comparative basis. The research results are ambivalent. They show the puzzling result that the Scandinavian countries with their highly distributive welfare policy manage to achieve the comparatively highest level of economic, but not health, equity. Based on these results, we develop proposals for future research approaches. A central assumption is that in rich societies no longer only material, but more and more immaterial determinants are crucial for the formation of health inequality. The promotion of "salutogenic" self-management capabilities in socially disadvantaged groups is considered to be the central element in effective intervention strategies.

Skilled attendance: the key challenges to progress in achieving MDG-5 in north central Nigeria.

The importance of skilled attendance at delivery, as reflected in the MDG 5, is being promoted in developing countries to address the high maternal/perinatal morbidity and mortality. Evaluation of personnel skills and availability of material resources are central to elimination of barriers to delivery of basic Emergency Obstetric Care (EOC) to the community. We designed a semi-structured, interviewee-administered questionnaire for 54 certified Nurse-Midwives working in Primary Health Care (PHC) clinics in Nasarawa State, central Nigeria, and examined their knowledge and competencies in the five major areas responsible for maternal mortality in sub-Saharan Africa, including power supply, referral linkages and motivation to work. Majority 51 (94.4%) of PHCs neither used the Partograph nor performed manual vacuum aspiration. Referral systems and feedback mechanisms were practically non-existent, 38 (70.4%) of facilities were >5 km from the nearest referral centre, with 14 (29.5%) connected to the national grid. Majority (68.5%) of respondents would want to work abroad. The quality of skilled attendance is low and basic EOC facilities are lacking, a situation further threatened by potential emigration to greener pastures. Governments and development partners need to address facility and skilled manpower shortages in developing countries to make a modest attempt at meeting the MDG on maternal health.

Socio-economic inequalities in physical activity practice among Italian children and adolescents: a cross-sectional study

AimThe aim of the study was to evaluate whether socio-economic inequalities in the practice of physical activity existed among children and adolescents, using different indicators of socio-economic status (SES).Subjects and methodsData were derived from the Italian National Health Interview Survey carried out in 2004–2005, which examined a large random sample of the Italian population using both an interviewer-administered and a self-compiled questionnaire. This study was based on a sample of 15,216 individuals aged 6–17 years. The practice of physical activity was measured on the basis of questions regarding frequency and intensity of activity during leisure time over the past 12 months. Parents’ educational and occupational level, as well as family’s availability of material resource, were used as indicators of SES. Multivariable logistic regression analyses were performed to estimate the contribution of each SES indicator to the practice of physical activity, adjusting for potential confounding factors. The results of the regression models are expressed as odds ratio (OR) with 95% confidence intervals (95% CI).ResultsAbout 64% of children and adolescents in the sample declared that they participated in moderate or vigorous physical activity at least once a week. After adjustment for gender, age, parental attitudes towards physical activity and geographical area, the practice of physical activity increased with higher parental educational and occupational level and greater availability of material resources. Children and adolescents whose parents held a middle or high educational title were 80% more likely to practice moderate or vigorous physical activity than subjects whose parents had a lower level of education (OR = 1.80, 95% CI: 1.40–2.33), while subjects with unemployed parents had an odds of practicing moderate or vigorous physical activity 0.43 times that of those children whose parents belonged to the top job occupation category (administrative/professionals). Socio-economic differences were about the same when the practice of vigorous physical activity only was considered instead of that of moderate or vigorous physical activity.ConclusionInterventions that promote the practice of physical activity, and especially those aimed at the wider physical and social environment, are strongly needed to contrast socio-economic differences in physical activity among children and adolescents.

Higienização das mãos: o ensino e a prática entre graduandos na área da saúde

This study was undertaken with students during their last year/semester of health sector studies at Higher Education Institutions (HEI), in Goiás State/2005. It aimed to verify the understanding of these students about hands washing (HW), identify the contribution of the HEI to the students’ education on this theme, identify factors that favor the practice of HW, and verify the availability of material resources for HW at Health Assistance Establishments (HAE) used as practice scenarios. After observing ethical aspects, the data was obtained through a previously-evaluated questionnaire, and processed using Epi Info software (CDC, 2004), when the chi-square test was applied. 777 students took part (68.0%) in the study, belonging to the following courses: Biomedicine, Nursing, Pharmacy, physiotherapy, phonoaudiology, Medicine, Dentistry and Occupational Therapy. There was a noticeable difference between the understanding on HW and actual practice. Although we evidenced that HEIs have approached this subject during the educational process, this was not enough to modify the practice

Survey of the Pharmaceutical Care Situation of the HIV Patient in Spain

ObjectiveTo understand the Pharmaceutical Care (PC) given to HIV+ patients in Spain. MethodIn the year 2004, a survey on PC provided to HIV+ patients was conducted among pharmacists. The survey, with 33 questions, aimed to determine the material and human resources used in this area, as well as specific aspects of PC, and finally the pharmacist's opinion. The survey was distributed through the SEFH (Spanish Society of Hospital Pharmacists) webpage and at HIV conferences. ResultsData was collected from 68 hospitals, most of them public. The most important strengths included the availability of material resources, extensive consulting hours, and the intervention of the pharmacist at key moments (treatment initiation, changes in treatment, and changes at the request of the patient). Verbal information was provided in most hospitals, accompanied by written information in 68% of cases. Although 81% of hospitals monitored compliance, less than half did it in a systematic manner, with the most widely used method being the dispensing records. Dispensing data was recorded, and to a lesser extent, the patients’ drug treatment histories were available. Differences were seen among the hospitals depending on their size. The pharmacist considered that the PC was acceptable, but that there was room for improvement, and considered the measures available insufficient, highlighting the need for specific personnel and training. ConclusionsThe PC situation of HIV patients is of a good standard, but there is still a lot to be done to achieve acceptable, quality PC. Resumen.

Response: On economic growth, business fluctuations, and health progress

Demographic research on preindustrial societies has documented links between harvest yields, grain prices, real wages, and changes in mortality, but mortality hikes as a result of agricultural failures or grain price inflation become more muted as the level of development increases. 1–5 During the early industrialization period in the 19th century, decades of rapid economic growth coincided with stagnating or even increasing mortality in the United States and Britain. 6,7 During the Second World War, deaths from coronary disease declined in Norway and other German-occupied countries as fats and calories were drastically cut in the diet. Then, in 1945, pre-war levels returned both in diet and coronary deaths. 8 It also appears that the blockage of Confederate cotton exports at the start of the US civil war and the subsequent work stoppage improved both adult and infant health in the textile districts of England. Adults were no longer exposed to exhausting work and fumes in the factories, and infants could be breastfed by their mothers, who no longer gave them the Godfried’s cordial, a ‘baby syrup’ made with opiates. 9 Though opiate syrups sold as medicines have been considered a major contributor to deaths of children,3 years old in 19th century England, 10 the health hazards of the early industrialization period have been generally attributed to overcrowding and lack of sanitary conditions in cities, as well as working conditions that packed workers (including children), animals, fumes, and water in mines and factories for working days of 12 and even more hours. 7,11,12 These examples of health declines during periods of prosperity and health improvements during periods of economic hardship show how the relationship between affluence and health is not a univocal one. 13 Two recent major pandemics—nicotine addiction and obesity—are unequivocally associated with increased purchasing power of multitudes who consume marketed commodities that are harmful to health. Most researchers studying the secular decline of mortality would accept ‘some kind’ of link between demographic transition—in which death rates drop because of the decline in infectious disease mortality—and various factors associated with social and economic advancement in the past two centuries, including increasing levels of education; the abolition of slavery; significant reductions in discrimination by gender, ethnic, or religious issues; rising availability ofmaterial resources; urbanization; and improvement in physical infrastructure. But there is no consensus on which particular aspect is the major cause of the mortality decline. 14–21 Early in the 20th century, the secular drop in mortality was attributed to advances in medical technology, improvements in the standard of life or in urban sanitation, and, even, to changes in the virulence of germs. But Dubos questioned these ideas 8,22 andMcKeown 17,18

State Subsidies, International Diffusion, and Transnational Civil Society: The Case of Frankfurt-Oder and Słubice

This article details the manner in which the German state and the European Union (EU) have affected incentives at the state and local levels in their attempts to encourage transnational civil society in both Frankfurt-Oder and SÂubice. While elites on both sides of the Oder have initiated some civil society organization, incentives stemming from the German state and the EU have served as the more important influence on the density and configuration of associations in these two cities. In this article, the author argues that despite deleterious legacies stemming from the Leninist period, the availability of material resources coupled with the commitment of local elites accounts for the existence of the tenuous yet influential civil society sphere examined in the case study. This article further contends that EU efforts throughout the 1990s to foster the structures of civil society have met with successes that will prove consequential to the long-run institutionalization of EU reforms.

Early life transitions of Canadian youth: effects of family transformation and community characteristics

This paper looks at the impact of family transformation and community characteristics on the timing and sequences of early life transitions of Canadians born in 1971-75. Using event history techniques of analysis, the effects on school completion, start of regular work, and home-leaving are examined using a data set that merged the 1995 General Social Survey of the Family with data derived from the enumeration areas of the 1996 Census. The results show that family disruption impacts negatively on the transition to adulthood. And, mother=s work status and community-level characteristics indicative of availability of material resources and opportunities have significant effect on the timing of transition to adulthood mainly through longer period of education.

To Work or Not to Work: Is That the Right Question?

This paper applies thematic analysis to survey data obtained from a sample of AFDC recipients to investigate the complexities of single-parent decision-making in low-income households. A basic needs budget is developed to determine the adequacy of women's wages to provide for children's minimal material needs. In surveys, parents indicate their primary goal is the well-being of the children, determined by the adequacy of several types of resources, which we categorize into four groups: 1) material resources, 2) caring resources, 3) community resources, and 4) the macro-level environment. Using this framework, we develop a schematic model of single-parent decision-making, incorporating the assumption that children's level of need and well-being are determined not only by the cost and availability of material resources but also by psychological factors such as gender conflicts, neighborhood safety, as well as parents' time and social networks that provide caring labor.

Mortality and living conditions: relative mortality levels and their relation to the physical quality of life in urban populations.

The general inverse association between mortality and the availability of material resources has been well established in large populations. Using data for Israeli urban locations, we show that indirectly standardized mortality ratios (SMR) are well able to capture this relationship in small populations for which reliable age specific mortality data are not available; and that they are inversely related to the standard of living, as measured by a variety of census based indicators. It is thus suggested that SMRs offer a ready indicator of living standards in populations for which more specific indicators may not be readily accessible.

The front line health worker: selection, training, and performance.

Iranian villagers with basic literacy were recruited, selected, trained, and deployed as Village Health Workers (VHWs) to rural areas of Iran. VHW clinical visit records and activities logs were analyzed to determine levels and nature of effort achieved in the field. Within six months of deployment, the number of patient visits to VHW treatment services constituted 53% of the target population. Within ten months of deployment, the number of family planning acceptors rose from 8% to 21% of the population at risk. Improvements to water supplies have been effected in 50% of target villages. Sanitary improvements have been made to 35% of the houses and 88% of toilets in those villages. Demographic characteristics, class rank, and place of residence of VHWs appear unassociated with village differences in levels of achievement. However, availability of material resources and actual time spent by VHWs on the job may be factors influencing the differences in outcome between villages.