Availability Of Such Services Research Articles

“I only seek treatment when I am ill”: experiences of hypertension and diabetes care among adults living with HIV in urban Tanzania

BackgroundFor adults living with HIV (ALHIV) and comorbidities, access to comprehensive healthcare services is crucial to achieving optimal health outcomes. This study aims to describe lived experiences, challenges, and coping strategies for accessing care for hypertension and/or diabetes (HTN/DM) in HIV care and treatment clinics (CTCs) and other healthcare settings.MethodologyWe conducted a qualitative study that employed a phenomenological approach between January and April 2022 using a semi-structured interview guide in six HIV CTCs in Dar es Salaam, Tanzania. We purposively recruited 33 ALHIV with HTN (n = 16), DM (n = 10), and both (n = 7). Thematic content analysis was guided by the 5As framework of access to care.FindingsThe majority of the participants were females, between the ages of 54–73, and were recruited from regional referral hospitals. HIV CTCs at regional referral hospitals had more consistent provision of HTN screening services compared to those from district hospitals and health centers. Participants sought HTN/DM care at non-CTC health facilities due to the limited availability of such services at HIV CTCs. However, healthcare delivery for these conditions was perceived as unaccommodating and poorly coordinated. The need to attend multiple clinic appointments for the management of HTN/DM in addition to HIV care was perceived as frustrating, time-consuming, and financially burdensome. High costs of care and transportation, limited understanding of comorbidities, and the perceived complexity of HTN/DM care contributed to HTN/DM treatment discontinuity. As a means of coping, participants frequently monitored their own HTN/DM symptoms at home and utilized community pharmacies and dispensaries near their residences to check blood pressure and sugar levels and obtain medications. Participants expressed a preference for non-pharmaceutical approaches to comorbidity management such as lifestyle modification (preferred by young participants) and herbal therapies (preferred by older participants) because of concerns about side effects and perceived ineffectiveness of HTN/DM medications. Participants also preferred integrated care and focused patient education on multimorbidity management at HIV CTCs.ConclusionOur findings highlight significant barriers to accessing HTN/DM care among ALHIV, mostly related to affordability, availability, and accessibility. Integration of NCD care into HIV CTCs, could greatly improve ALHIV health access and outcomes and align with patient preference.

ИЗУЧЕНИЕ АСПЕКТОВ ПОТРЕБИТЕЛЬСКОЙ УДОВЛЕТВОРЁННОСТИ КАЧЕСТВОМ ОНЛАЙН-СЕРВИСОВ ЗАКАЗА ТОВАРОВ АПТЕЧНОГО АССОРТИМЕНТА

The current level of development of pharmaceutical care allows consumers to buy pharmacy products remotely. Online services that provide this service (Internet pharmacies) have gained popularity both abroad and in Russia. In order to fully analyze the quality of their activities and identify opportunities for development, it is necessary to assess the consumers' perception of such services. The objective of the study was to assess customer satisfaction and loyalty of online pharmacy ordering services, as well as the availability of such services for different socio-demographic groups. The main method of the study was a questionnaire survey conducted among 424 residents of Moscow and the Moscow region, which allowed us to assess their expectations and real perceptions in the context of a number of aspects of using online pharmacies with the subsequent identification of factors that reduce the satisfaction of respondents. The following quality criteria were evaluated: interface usability, design aesthetics, order fulfillment aspects, availability and completeness of product information, and availability of pharmaceutical counseling. In addition, the Net Promoter Score and the Customer Effort Score were measured. According to most of the proposed quality criteria, the satisfaction of residents of Moscow and the Moscow region with online services for ordering pharmacy products is high. Negative values of quality coefficients for two items require paying attention to the aspects of order fulfillment, as well as the presence of remote pharmaceutical counseling services in online pharmacies. In addition, it was found that less than half (33.7%) of respondents trust information about medicines on the websites of pharmacy product ordering services.

Beyond Access: Can a School Health Initiative Facilitate Healthcare Services Utilisation for School-Going Children?

Accessing quality healthcare services is critical to addressing the different health challenges confronting school-going children, especially those in low-resource communities. However, the evidence of access to services is utilisation and not the mere availability of such services. This study explored caregivers' descriptions of the factors influencing the access and utilisation of quality healthcare services for school-going children and their perceptions of the services provided through the integrated school health programme in South Africa. Qualitative interviews were conducted with 17 caregivers of school-going children in three low-resource communities of KwaZulu-Natal province. The data was analysed using thematic analysis, and the themes were clustered using components of the Aday and Andersen framework for access. Despite the efforts to expand the coverage and range of services provided through the Integrated School Health Programme (ISHP), we identified various factors that undermine the overall aim of the ISHP. Financial constraints, distance to health facilities, poor communication and information dissemination systems, low literacy levels, healthcare workers' negative attitudes, and long waiting periods at the referral sites constitute barriers to service utilisation. Specific attention should be paid to improving the communication system between the school-health team and the caregivers, providing support for transportation, improving the attitude of the clinic staff, and providing follow-up services for children referred for further screening and treatment.

Releasing Placentas to Families: A Unified Recommendation From the Perinatal Committee of the Society for Pediatric Pathology

As perinatal pathologists, we acknowledge that some families would like to take their placenta home with them from the hospital for various sociocultural and/or religious beliefs and practices (eg, special burial, and, not uncommonly, consumption by encapsulation and/or other means of direct ingestion or placentophagy).1–5 Despite the increasing popularity of this practice, most states in the United States lack clear guidelines for release of the placenta from hospitals.1,3,5 We respect that the placenta is the property of the family, but feel it is important to offer our insights into the matter, based on our collective experiences and currently available literature.1–5 This is a proposed consensus guideline constructed by a panel of experts on placental pathology, which aims to (1) guide our colleagues who might be navigating through such requests for the first time and (2) educate on the potential health risks and hospital liabilities that the process may entail.The group's recommendations are as follows:Recommendation 1: An institution-tailored policy should, at the minimum, involve representatives from the obstetrics department, the pathology department, infection control, risk management, and the legal department.1 A suggested outline for forming this group is depicted in Figure 1.Recommendation 2: The obstetric provider should inform the patient and family that taking the placenta home will prevent gross and microscopic assessment of the placenta by the pathology department and thus the potential diagnosis of clinically significant diseases, including those contributing to recurrent adverse pregnancy outcomes.3Recommendation 3: Further, it is the obstetric provider's responsibility to determine if placental pathologic evaluation is indicated, and to assess the safety risks of releasing the placenta, based on the clinical history (eg, meconium-stained placentas, clinical chorioamnionitis, known maternal viral infections such as HIV and hepatitis B and C among others, and placentas of heavy smokers/substance abusers, which may be deemed unsafe for release)4; to discuss with the family the importance and potential value of placental pathologic examination; and, following this discussion, to come to a shared decision with the family as to the final placental disposition.Recommendation 4: Placentas requested for release must not be delivered to the pathology department but must be retained with the mother or in the labor and delivery ward pending discharge from the hospital. Moreover, placentas released to the family must be wrapped in sturdy leak-proof opaque containers, placed in biohazard bags, and kept refrigerated while awaiting transport.3Recommendation 5: A signed waiver of responsibility/specimen release form must be obtained from the family (preferably the mother), which informs the family of the potential biohazardous nature of the placenta and its care in transport and releases the hospital from liabilities that may occur if the placenta carries any infectious disease, which may induce cross-contamination, or if toxic substances cause illness to the recipient.1,3Recommendation 6: Placental consumption is strongly discouraged based on the lack of empirical data confirming benefits of such practice,1–5 as well as reports of adverse outcomes, including maternal-to-fetal transfer of infectious agents causing life-threatening neonatal sepsis2 and potential accumulation of toxic substances in the placenta.3Recommendation 7: Patient and family must be informed by the obstetric provider that examining the placenta in the pathology laboratory may result in the inability to release the placenta owing to potential contamination in the laboratory. In fact, many institutions do not permit the release of placenta following examination. However, there are institutions that have the capabilities to examine and sample placenta in a quasi-sterile/clean fashion that is subsequently deemed suitable for release post processing; availability of such services must be confirmed and arranged with the pathology department ahead of time. Nevertheless, in our collective opinion, it is safer not to release placentas following pathologic examination (whether in fresh or formalin-fixed state). In case the pathology department (or the hospital) would like to have the option to release the placenta post pathologic evaluation, the risks to the recipient must be outlined in the waiver. Additionally, certain hospital liabilities may arise from releasing placentas that are later found to carry infectious diseases by pathologic examination.An example of a placenta disposition flowchart (Figure 2) is provided as an overview, which may be used as a quick reference or may be modified depending on an individual institution's policy.While this matter is deeply personal, some aspects of it—particularly relating to placentophagy, which inevitably requires involvement of medical practitioners for hospital-based deliveries—invite potential risks and liabilities that must be taken into consideration by medical providers and administrators.This manuscript was also reviewed by the Star Legacy Foundation.

Impact of community-based health insurance on health services utilisation among vulnerable households in Amhara region, Ethiopia

BackgroundEthiopia piloted community-based health insurance in 2011, and as of 2019, the programme was operating in 770 districts nationwide, covering approximately 7 million households. Enrolment in participating districts reached 50%, holding promise to achieve the goal of Universal Health Coverage in the country. Despite the government’s efforts to expand community-based health insurance to all districts, evidence is lacking on how enrolment in the programme nudges health seeking behaviour among the most vulnerable rural households. This study aims to examine the effect of community-based health insurance enrolment among the most vulnerable and extremely poor households participating in Ethiopia’s Productive Safety Net Programme on the utilisation of healthcare services in the Amhara region.MethodsData for this study came from Amhara pilot integrated safety net programme baseline survey in Ethiopia and were collected between December 2018 and February 2019 from 5,398 households. We used propensity score matching method to estimate the impacts of enrolment in community-based health insurance on outpatient, maternal, and child preventive and curative healthcare services utilisation.ResultsResults show that membership in community-based health insurance increases the probabilities of visiting health facilities for curative care in the past month by 8.2 percentage points (95% CI 5.3 to 11.1), seeking care from a health professional by 8.4 percentage points (95% CI 5.5 to 11.3), and visiting a health facility to seek any medical assistance for illness and check-ups in the past 12 months by 13.9 percentage points (95% CI 10.5 to 17.4). Insurance also increases the annual household per capita health facility visits by 0.84 (95% CI 0.64 to 1.04). However, we find no significant effects of community-based health insurance membership on utilisation of maternal and child healthcare services.ConclusionsFindings that community-based health insurance increased outpatient services utilisation implies that it could also contribute towards universal health coverage and health equity in rural and informal sectors. The absence of significant effects on maternal and child healthcare services may be due to the free availability of such services for everyone at the public health facilities, regardless of insurance membership. Outpatient services use among insured households is still not universal, and understanding of the barriers to use, including supply-side constraints, will help improve universal health coverage.

Mental and Physical Well Being in Prisoners

Global health attention is necessary to improve the prison population mental and physical health because limited public health ramifications and inmates’ psychological effects impose many strains on community preventive measures and prison rehabilitation. Though some prisoners are younger than the general population, the jail population often has the worse health. Many have considerable mental and physical health needs as a result of social and economic poverty. Since many prisoners have histories of tobacco use and alcohol or drugs, many of these risk patterns result in addictions that are tied to unhealthy lifestyles. Prior contact with mental health, substance use or medical services typically was very limited or absent due to lack of access to treatment, diminished resources, barriers for the uninsured and underserved, financial stability to afford care, stigma, or reluctance to focus on self-care. There are certain mental health disorders and infectious diseases that are prevalent in prisoners and should be addressed. Many prisoners have serious, debilitating mental and physical conditions that go untreated or undiagnosed while they are incarcerated. Prior to being incarcerated, If crime and incarceration are to be decreased and rehabilitative efforts are increased to deter re-incarceration, preventive measures are necessary that include community mental and medical services accessibility and affordability while availability of such services are provided in prison and coordination of care of evidence-based therapy and infection-control strategies are highly recommended before the inmate returns to the community. This review covers most common mental and physical health issues and their management for inmates because few research has explored how having a mental health disorder compound with a physical ailment affects an inmate’s behavior while advocating for human rights-informed strategies for the treatment of people in the criminal justice system.

Digitalization of the administrative services in various fields of activity

The aim of the article was to analyze the state of the digital transformation of administrative services in various fields of activity. The main methodological tools were statistical, graphical, comparative analysis, and observation methods. The research found that national governments are taking a large number of initiatives related to digital public services. The DESI Index has shown itself to good advantage in the EU. It ranks Member States according to their digital performance and analyses their progress in providing e-government services. The AuroraAI programed developed in Finland will contribute to the improvement of electronic administrative services, smooth daily life, business, safe and ethical approach. The Finnish web portal My Kanta provides a wide range of applications that can be of benefit to citizens, healthcare professionals and organizations, government bodies. In Ukraine, the smooth functioning of the Diia web portal promotes the spread of digital skills, the inclusion of citizens in relation to receiving digital administrative services during the period of hostilities. Global geopolitical transformations have focused the efforts of states on strengthening intersectoral cooperation of public authorities in the digitalization of administrative services. The availability of such services for the elderly remains unresolved. The adaptation of the positive practices of the government of Finland in Ukraine will become a vector for further research and thorough studies during the post-war reconstruction of the state. Particular attention will be paid to the issue of availability of the services under research.

The Availability of Sexual and Gender Minority (SGM) Specific Substance Use Services

Background: In 2007, Cochran, Peavy, and Robohm conducted a study of treatment programs that indicated that they provided specialized services for gay and lesbian clients; however, phone calls to these agencies revealed that over 90% of these agencies actually did not provide services that were discernibly different from the agencies’ general services. Objectives: Given the progress and development since 2007 regarding awareness of SGM (sexual and gender minority) rights and an increased understanding of the impact of health disparities on SGM individuals, the current study aimed to gain a renewed understanding of the state of SGM-specific substance treatment using a similar methodology. Results: agencies reporting that they provide SGMTitle specific services since 2007, fewer than 1 in 5 agencies who indicated offering SGM-specific treatment on the National Survey of Substance Abuse Treatment Services (N-SSAT S) survey actually provided such services (17.4%) in 2021. Conclusions/Importance: The current study reinforces the already observed need for specialized substance treatment services for the SGM population. Despite having hundreds more SGM-specific substance treatment services in existence today compared to 2007, our findings point to a strong need to address the discrepancies between self-reported and existing availabilities of SGM-specific services in substance treatment. Actions that can potentially close this gap might be two-fold: standardizing the definition of and criteria for SGM-specific services and increasing funding and resources that could expand the availability of such services, particularly in rural regions.

Study protocol to assess de-implementation of the initial provider encounter for diagnosis and treatment of obstructive sleep apnea: the DREAM (Direct Referral for Apnea Monitoring) Project

BackgroundObstructive sleep apnea (OSA) is a very common and serious health condition which is highly prevalent among U.S. military Veterans. Because the demand for sleep medicine services often overwhelms the availability of such services, it is necessary to streamline diagnosis and treatment protocols. The goals of this study are to, (1) assess the efficacy of de-implementing the initial provider encounter for diagnosis and treatment of OSA; (2) determine the negative predictive value (NPV) of home sleep apnea testing (HSAT); (3) develop HSAT usage recommendations for various at-risk patient populations.MethodsThis is a large, pragmatic study that will take place in 3 VA sleep medicine programs: San Francisco, CA; Portland, OR; and Pittsburgh, PA. All Veterans referred for new sleep apnea evaluations at these sites will be included in this four-year study. Outcomes will include time from referral for OSA to sleep testing and treatment; positive airway pressure (PAP) treatment adherence measures; patient-reported clinical outcomes and measures of satisfaction; determination of the NPV of HSAT; HSAT usage recommendations for at-risk patient populations.DiscussionThe DREAM (Direct Referral for Apnea Monitoring) Project will inform sleep medicine providers and clinical organizations regarding strategies to streamline diagnosis and treatment protocols for OSA. Results of this study should have significant impact on clinical practices and professional guidelines.Trial registration The majority of this project is an observational study of clinical procedures. Therefore, clinical trial registration is not required.

The Impact of Linguistic Concordance and the Active Offer of French Language Services on Patient Satisfaction

Communication is essential to providing quality primary care. Linguistic concordance between patients and physicians has been linked to improved health outcomes and greater patient satisfaction. Although Canadian Francophones often struggle to access linguistics concordant health services, the concept of the active offer of French Language Services (FLS) has emerged as a means of ensuring the availability of such services and improving the francophone patient experience. However, the impact of language concordance and the active offer of FLS on patient satisfaction among Ontario Francophones remain largely unknown. Patient satisfaction surveys were collected as part of a continuing education program targeted at family physicians in Northeastern Ontario. Participating physicians distributed patient surveys consisting of select patient satisfaction questions from the Physicians Achievement Review (PAR) and select questions from the Active Offer of French Language Services in Minority Context Measure. Valid surveys were received from 235 patients. Just under half of these (44%) identified as Francophones, 62.6% had a French-speaking family physician; however, only 17.2% reported regularly speaking in French with their family physician. As hypothesized, there was a consistent tendency for Francophones who experience stronger linguistic concordance with their family physician to report higher satisfaction scores. Francophones who regularly speak French with their family physicians were more satisfied ( = 4.63) than those who rarely/never speak French ( = 4.29, F(1; 83) = 4.852; p < 0.05). There was also a statistically significant interaction between the patients' language of preference and the service language. Francophones who prefer French and regularly speak it with their family physician (linguistic concordance; adj= 4.82) were significantly more satisfied than those who prefer French yet rarely/never speak it (linguistic discordance; adj= 4.06, F(1; 75) = 11.950; p < 0.001). Furthermore, a positive correlation between patient satisfaction and the active offer was observed in Francophones (r = 0.49, p<0.001). The present findings provide evidence of the impact of linguistically adapted health care services on the satisfaction of Ontario Francophones and suggest that patient satisfaction may be improved through the active offer of FLS. A larger and more diverse sample is required to confirm these findings.

Profile of ocular conditions from school eye screening in Southern India.

Purpose:To profile the presentation of ocular conditions among school children aged 6 to 17 years from the south Indian state of Tamil Nadu.Methods:The study was conducted as part of a school eye health program in Kanchipuram district, Tamil Nadu that aimed to address the refractive needs of children (6–17 years) between July 2016 and June 2019. The study followed a three-phase protocol, which included visual acuity test, modified clinical test, color vision test, binocular vision assessment, objective and subjective refraction, dispensing spectacles, posterior segment evaluation using direct ophthalmoscopy, and referral to the base hospital. The demographics, clinical details, and ocular conditions (classified under 16 categories) were analyzed. Profiling and association of ocular conditions among different locations, types of schools, class grades, and gender were presented.Results:Data of 2,45,565 children were analyzed from 1,047 schools, of which 4,816 (1.96%) children were identified with ocular conditions other than refractive errors. The common reasons for referral were high myopia 901 (0.37%), strabismus 819 (0.33%), and amblyopia 691 (0.28%). Retinal problems (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.22–2.22, P = 0.001) and strabismus (OR: 1.41, 95% CI: 1.21–1.65, P < 0.001) were the conditions prevalent in the rural location. Cataract and related conditions (OR: 5.73, 95% CI: 4.10–8.01, P < 0.001) and retinal problems (OR: 4.76, 95% CI: 3.37–6.72, P < 0.001) were common in children studying in public schools. Of the 16 categories, 13 conditions were seen among primary school children. Vernal keratoconjunctivitis (OR: 3.64 95% CI: 2.12–6.23 P < 0.001) was common among males.Conclusion:The study profiled ocular conditions among school children. Most ocular conditions warrant prolonged care and specialty eye care services. Ensuring the availability of such services and follow-up after school eye screening would safeguard the visual development of these children.

Continual usage intention of platform-based governance services: A study from an emerging economy

Several emerging economies have embarked on a path of digitization to provide lean governance through platform-based applications. Platforms and ecosystems can play vital roles in the proliferation of technologies, which can facilitate a digital transformation of society aimed at equitable and efficient service delivery to citizens. Despite being innovative, citizen-centric, and citizen-inclusive, such platforms has been observed to be rare in emerging economies. Our study assesses the factors that lead to the intention to continue to use these platforms, with the objective of establishing a revised approach to better governance through these platform-based services. A conceptual framework is proposed, based on an integration of various models, and tested using primary data from citizens subscribing to platform-based government services. The results indicate that a continuous availability of such services has better predictive power for the continual-use intention. A unique contribution of the study worth highlighting is the significance of the factor, “sovereign structural assurance,” a pre-requisite for strengthening the degree of control. Based on this study's findings, it is recommended that platforms should invest in controls for structural assurance. These interventions can serve as contrivances that create a sustainable model for such services. A successful convergence of the factors would accelerate the government services by transforming the public service landscape.

Integrating mindfulness in fitness classes: self-compassion and mental health outcomes in a pilot study featuring longitudinal mediational analysis

ABSTRACT Mental health concerns are becoming increasingly commonplace in society, and demand for services consistently outweighs the availability of such services. In light of this discrepancy and other barriers associated with pursuing mental health services, it is important to explore innovative, cost-effective avenues to increase accessibility of programs that promote mental health and build psychological resilience. This research examines the longitudinal effect of such a program, that combines two burgeoning fields of research in mental health: self-compassion and physical activity. In this naturalistic study, we explored how participation in a physical fitness program integrating mindfulness affected levels of self-compassion and perceived mental health in a sample of 39 women in Toronto, Canada. Mindfulness levels were also measured to determine whether mindfulness mediates the relationship between physical activity and self-compassion. Participants attending fitness classes over two months completed self-report questionnaires. Analyses involved multilevel modeling. Self-compassion was found to increase over time as a function of fitness class attendance, but this relationship was not mediated by mindfulness. We discuss other possible explanatory mechanisms in the relationship between exercise and self-compassion, and findings of perceived mental health, with implications for using fitness classes incorporating mindfulness as a mental health promotion strategy.

Ecosystem Services Provisioning, Urban Growth and the Rural–Urban Interface: A Case Study from China

The rural-urban (peri-urban) interface zones are important places that generate demands for ecosystem goods and services (EG &amp; S). Urban regions face transitions in land use that affect ecosystem services (EG &amp; S) and thus human wellbeing. Especially in urban areas with high population densities (as in most of China) and high demand for EG &amp; S, the future availability of such services must be considered in order to promote effective and sustainable decision making and prevent further ecosystem degradation. The challenge for local government planners and land managers is to find tools that allow relevant data to be collected and analyzed. Ideally, such tools should be able to give a rapid assessment, and not involve large teams of highly trained personnel or incur high costs. The paper reports on the development and trial of such a tool. The paper has three main parts. First, we present a brief overview of the current and developing situation in China, in relation to urbanization, population shifts and the creation of peri-urban areas (PUAs). Next, we build on insights from the literature and from discussions with village heads and county- and prefecture-level officials to develop an understanding of their needs for tools to help planning and land management within the constraints of the national policy. Lastly, a “template” was derived from our multi-method approach that provided a new technical tool for the rapid assessment of the value of EG &amp; S in each of five land use categories. The tool embodies a way to address trade-offs between environmental, social and economic values in the transition zone between rural and urban areas. The tool was trialed in QinBei District in Guangxi Autonomous Region in south China and judged to be useful and adaptable to other rural–urban regions.

Enabling Fog Complex Security Services in Mobile Cloud Environments

The security infrastructure in modern mobile cloud relays on a set of atomic security services like key distribution, and authentication services which are mostly deployed at the fog. A mobile node may provide a simple or an atomic security service. Complex security services are obtained by coordinating several atomic services at different nodes. In mobile fog environments, the availability of such services for the mobile nodes at the edge straggles challenging nature of the environment and then service availability is deeply affected. Complex security requirements require available several atomic services at the edge and fog levels. So, increasing atomic service availability is vital and enhances security features between the fog and the edge. In this work a proactive complex security service replication protocol for increasing availability of fog security services is proposed. The protocol is able to manage proactively replicas whenever they are requested. It is aware of the distributed resources at the edge nodes. Using an extensive simulation analysis, the protocol performance shows a better achieved availability and reasonable response time for complex security services in different configurations.

Assessment and prioritization of cultural ecosystem services in the Sahara-Sahelian region.

Desert environments remain largely neglected by the society and their potential to provide benefits to people remain understudied. Hotspots of cultural ecosystem services have been identified in some deserts; yet, knowing which countries need to strengthen efforts to satisfy people's demand for those services is timely needed. Here, we show the performance of countries within the Earth's largest warm region - the Sahara-Sahel - in managing cultural ecosystem services. Using the most-advanced decision-support tools and updated databases on biodiversity features and constrains to ecosystem services and on socioeconomic indicators, we identified national priorities for cultural services management. We also identified countries that are missing opportunities for local sustainable development. About 34% of Sahara-Sahel is prioritized for cultural ecosystem services, particularly in the main mountains and waterbodies of the region and along the Western and Eastern coastal limits. Algeria, Egypt, Libya, Morocco, Senegal, and Tunisia are performing better in managing their cultural services given the availability of such services in their territories. Burkina Faso, Cameroon, Chad, Egypt, Libya, Mali, Niger, Nigeria, Sudan, and South Sudan need to urgently improve their ease of mobility, governance, safety, socioeconomic and health systems to foster ecosystem services demand. Cameroon, Eritrea, and Senegal are receiving far less tourists than what their ecosystems can handle and need to improve their local conditions for better marketing international tourists able to economically contribute to sustainable development through ecotourism programs. The approach developed here serves as a framework for conserving the last world wild ecosystems and is replicable to other contexts where regional planning for ecosystem management is compulsory.

Social prescription for those living with dementia; does MedTech have a role to play?

Ageing is the major risk factor for dementia and nearly every country has seen its life expectancy rise from the beginning of the 21st century. Remaining socially connected has positive health and social implications and may be even more significant for marginalized group of people like those living with dementia. If appropriately used, social prescriptions can help deliver value-based social engagement and primary care by maximising the utilisation of resources and addressing social determinants of health, decreasing dependency on the biomedical model and thus providing a way for health care systems to deal with social determinants of health. More frequently, however, those seeking access to these programmes do not tend to do so simply due to lack of understanding and knowledge of the availability of such services. So, provision of social activities involves more than developing a program and hoping people will attend, and considering the particular situations of those living with dementia as marginalised group of people, and taking into account that there is no treatment for dementia, societies need to move toward social prescription, integrating appropriate MedTech support- targeting on those living with dementia- into such programs.

Possibilities to Support Heterogeneous Mobile Services in Vehicle Communication Networks

Research on the provision of heterogeneous services in the field of intelligent transport is of great interest in the rapidly changing infrastructure of road transport. In particular, the availability of such services has increased through the use of wireless technologies and communication tools. The current development of Information Communication Technologies (ICT) and the integration of intelligent transport platforms and service systems make it possible to significantly improve road safety and reduce the likelihood of road accidents. However, the delivery of mobile-smart services requires the development of a rather sophisticated infrastructure to support multicast services. The purpose of this scientific article is to analyze the data transmission capabilities for heterogeneous services while ensuring road safety. The paper deals with the tasks of evaluating the possibilities of integrating such mobile services into the infrastructure of motor vehicles. Measuring bandwidth by enabling multicast services on the base of Ad-hoc wireless networks becomes an important task. The demonstrated results illustrate the capabilities of wireless networks by simulating these services in a transport service generating environment. The paper demonstrates that high-quality heterogeneous services require new wireless network interaction protocols, such as a session initiation protocol (SIP), GPRS functionality, routing protocols, and channel access to provide a large number of supportive service components.

Exploring mental health needs and services among affected population in a cyclone affected area in costal Bangladesh: a qualitative case study

BackgroundBangladesh, one of the most densely populated countries in the world has been ranked 9th on the Climate Risk Index for 2017: the 10 most affected countries & 7th on the Long-Term Climate Risk Index: the 10 countries most affected from 1998 to 2017. Every year it is afflicted with various climatic disasters including floods, hurricanes and cyclones. Apart from the obvious devastation of lives and property, there is a huge increase in clinical diseases when these disasters occur. Mental health of affected persons after these disasters is a topic that is often neglected by local and national level.MethodsA qualitative case study was conducted on perceived need on mental health support & availability of such services in a cyclone affected area in rural Bangladesh. Ten (10) key informant interviews (KIIs) with different stakeholders and ten (10) in-depth interviews (IDIs) with affected people were taken.FindingsWe found that cyclones had numerous psychosocial impacts on the population including acute stress disorder, sleep disorder, post-traumatic stress disorders (PTSDs), generalized anxiety disorders, suicidal ideation and depression. The survivors had specific needs for receiving support. Children, elderly and women were perceived to be more vulnerable. The government and NGOs had no specific action plans and initiatives to address these issues and support the mental health of affected population. There was a visible gap in finding effective ways to provide affected people with the required mental health & psycho-social services (MHPSS).ConclusionResilient, responsive and self-sustaining health systems for this vulnerable population are required. Implementation of effective mental health programs and strong mental health policies remain a challenge in Bangladesh where there is a cultural fatalistic acceptance of mental health issues.

Inequalities in Spatial Accessibility of Childcare: The Role of Non-profit Providers

AbstractEqual access to childcare services is a key concern of childcare policy. This article analyses social inequalities in the availability of such services. We explore how observed disparities are related to the socio-economic status of neighbourhoods and investigate how different provider types contribute to such differences. To do so, we use data on all childcare centres in the city of Vienna, Austria, on the spatial distribution of children aged under six and on three measures of neighbourhood status, over a period of eight years. We find that spatial accessibility is highest in neighbourhoods with the highest socio-economic status, that such inequality has increased over time and that both effects can be attributed to the role of non-profits. The results indicate that the policy change undertaken in Vienna towards increased communitarisation – that is, a shift towards non-profit provision – has undermined the universal character of the city’s childcare system.