Curative Sector Research Articles

Validation of Sinhala and Tamil translations of the motherisk: Pregnancy unique quantification of emesis (PUQE) scoring system

Aims: Nausea and vomiting in pregnancy (NVP), where there are no other underlying causes, is one of the most common symptoms in the early part of the pregnancy. It is responsible for up to 80% of pregnant population. By using PUQE score system, it is very convenient to categorize pregnant women with nausea and vomiting come to outpatient department (OPD) or general practice into those who can manage in community setting or those who need inpatient treatments. Objectives: Validation of PUQE instrument to assess NVP and hyperemesis gravidarum (HG) women in Sri Lanka. Methods: Descriptive cross-sectional study conducted among 160 pregnant women presented to the Gynecology Unit of Teaching Hospital Anuradhapura (ATH) during three months duration. Translated self-administered PUQE questionnaire was applied to the patients with signs and symptoms with emesis in pregnancy. All study participants were undergoing clinical judgment as a confirmation test. Diagnostic test accuracy methods were used to assess criterion validity of the experimental tool. Data were analyzed by using SPSS statistical software version 25.0. Results: Study population has a mean age of 27.96 (SD 5.31). Majority of study participants were Sinhalese and according to the parity majority were primigravida pregnancies. Majority of study participants were diagnosed as NVP Stage II (N=134:53.8%) by the PUQE scoring system. According to the clinical judgment Stage II of NVP was diagnosed among 127 (79.4%) study participants. Mean score of the PUQE scale was 9.08 (SD=2.35). Reliability assessment of the PUQE scoring system was reported as an excellent level (Cronbach alpha=0.804). Five types of management strategies were detected among study participants. Significantly high percentage of study participants were given first line antiemetics and oral rehydration solutions. Calculated sensitivity of the PUQE scoring system to diagnose Stage I of NVP was 69.56% and specificity was 96.35%. Calculated sensitivity of the PUQE scoring system to diagnose Stage II of NVP was 100% and specificity was 78.78%. All pregnant women who were clinically detected as Stage II NVP patients were detected as Stage II NVP patients by the PUQE scoring system also. None of the false positives and false negatives regarding Stage II of NVP detected by the PUQE scoring system. Conclusion: First line antiemetics and oral rehydration solutions are usually used for treating pregnancy-related nausea and vomiting. Stage II NVP conditions were detected with a higher prevalence when NVP status was diagnosed clinically and with PUQE scoring system. Specificity of PUQE scoring system appeared higher while detecting NVP Stage I and for NVP Stage II, sensitivity of PUQE scoring system appeared high. For Stage III NVP, clinical judgments and PUQE scoring system values were completely compatible. Management strategies used for treating pregnancy-related hyperemesis status should be further studied. Conducting these studies at different study settings may help to achieve more successful results. Pregnancy unique quantification of emesis tool can be used to diagnose NVP status more descriptively. Also, this PUQE tool is a valid tool which can be effectively used for patient management. Application of PUQE scoring system should be published by planning and implementing staff awareness programs for both curative sector and public health sector.

Prevention Platform

A brand new prevention platform calls for decisive investment in prevention.
 It is unique because the platform acts across policy domains, as well as policy levels and language borders.
 The platform aims to promote health for all, contributing to more quality of life and healthy life years. We aim at a transformation from curative care (curative) to ensuring that people are born healthy and stay healthy (preventive).
 This fits seamlessly with the goal of integrated care: enabling people to maintain or regain their independence and improve their quality of life. Prevention and self-care are as essential to achieving this goal as the coordination of health and social care services. 
 With prevention support, people should be able to make informed decisions about their care and well-being; develop skills and knowledge to self-manage their long-term conditions; remain active in their communities and not become socially isolated.
 Prevention, especially primary prevention, is the basis of the new, integrated health and well-being policies we are pursuing. This requires many initiators from the health and welfare sector, as well as schools, businesses, social services, sports clubs to pull on the same sea.
 Driven by the Health in All Policies idea, the prevention platform groups together everyone - institutions and individuals - who want to give priority to prevention, to join forces to this end (to 'unbundle').
 The prevention platform focuses on the question of how to make prevention structurally permeate all sections of society. 
 Structural attention and a long-term strategy for prevention are the message here.
 Major investments in better prevention and health promotion within a strengthened primary care system as well as in an integrated social, welfare and healthcare concept: from ""taking care of sick people" to "making sure people are born healthy and stay healthy".
 We are working on a Community. There is a common concern to work preventively, health and wellness-wise, from very different, missions and experiences. There is no common language around prevention. By working together, talking together and setting concrete goals, prevention will have richer content.
 
 First achievement of the platform during the corona crisis was the call to the GEMS "Create a healthier living environment and make a healthy lifestyle a basic rule".
 The great interest in the platform compelled us to draft a charter.
 Round table discussions were organised across Flanders for the charter's signatories. This gets the conversation going across domains and levels.
 The charter has so far been signed by 820 organisations, academics or citizens.
 Major organisations such as VVSG, Domus Medica, Zorgnet Icuro, VRP, VAD, ... put their backs into it. 
 At the launch conference of the platform, ministers from the federal and Flemish levels were present together.
 The Prevention Platform is taken up as an important stakeholder in various consultative forums, as an independent advocacy platform, striving for transformation.
 The platform aims for an Interfederal plan for Belgium: Bringing together the prevention & health promotion sector (regional level) and the curative sector (national level) to work together on government-wide policies for Health for All.

Initial response to SARS-CoV-2 (COVID-19) outbreak in Sri Lanka; views of public health specialists through an International Health Regulations lens.

The COVID-19 pandemic affected Sri Lanka despite having developed an International Health Regulations (IHR) steering committee in 2016 and a national action plan for health security following the Joint External Evaluation in 2018. Many steps were taken to improve the disaster management skills of healthcare workers even before the COVID-19 outbreak. We interviewed seven public health specialists to obtain their views on the country's response to the pandemic. A thematic analysis was conducted, leading to the emergence of three major themes and seven subthemes. The major themes included health security preparedness; COVID-19 management; and effects of COVID-19. The subthemes were; preparedness prior to pandemic and gaps in the preparedness (under health security preparedness); dual burden for the curative sector, strategies to reduce transmission and barriers to managing COVID-19 (under COVID-19 management) and negative and positive effects of COVID-19 (under effects of COVID-19). When COVID-19 reached Sri Lanka, healthcare workers, border control authorities and those involved with infectious disease control were overwhelmed by the magnitude of the pandemic. Healthcare workers' hesitation to work amidst the pandemic due to fear of infection and possible transmission of infection to their families was a major issue; the demand for personal protective equipment by health workers when stocks were low was also a contributory factor. Lockdowns with curfew and quarantine at government regulated centers were implemented as necessary. Perceptions of the public including permitting healthcare workers to perform field public health services, logistical barriers and lack of human resources were a few of the barriers that were expressed. Some persons did not declare their symptoms, fearing that they would have to be quarantined. The pandemic severely affected the economy and Sri Lanka relied on donations and loans to overcome the situation. Pandemic also brought about innovative methods to maintain and upgrade health service provision. Individuals with non-communicable diseases received their regular medications through the post which reduced their risk of being infected by visiting hospitals. Improvement of laboratory services and quarantine services, a reduction of acute respiratory infections and diarrhoeal diseases, improved intersectoral coordination and public philanthropic response were other positive effects.

Incidence management system of the healthcare institutions for disaster management in Sri Lanka

BackgroundIncident management systems and disaster planning processes facilitate maximal use of available resources. Evaluation of the Incident Command System (ICS) is one of the top five key areas of research priority in the field of surge. The study was aimed at assessing the disaster preparedness and ICS of the public healthcare institutions for the disaster management in a disaster-prone district of Sri Lanka.MethodsA descriptive cross-sectional study was conducted among all public sector healthcare institutions (n = 74), including curative-healthcare institutions (n = 46) which have inward-care facilities for patient care and preventive healthcare institutions (n = 28) in Kurunegala district, Sri Lanka from May–September 2019 using a validated interviewer administered questionnaire which was based on ‘CO-S-TR Model’ for ICS assessment including ‘Clear need for increased capacity (≤25%), Basic level (26 – 50%), Moderate level (51 – 75%) and High level (>75%)’.ResultsFocal points for disaster management were nominated by the majority of the curative sector (n = 33; 76.7%) and preventive sector (n = 19; 73.1%) healthcare institutions. A written disaster preparedness and response plans were available in 72% (n= 31) curative sector and 76% (n= 19) preventive sector institutions. The higher proportion of the curative sector institutions had moderate level capacity in the area of providing treatment, and basic level capacities were in the areas of ‘staff mobilization, coordination of activities, supplying of special needs, triage of cases and transportation’. There is a clear need for improvement in the areas of communication commanding, management of controlling the incidence and tracking of the cases in the curative sector. The majority of the preventive sector institutions had moderate level capacity in commanding, control, coordination and tracking of cases. The basic level capacity in the areas of staff mobilization, stuff management and triage of cases. There is a clear need for improvement in the areas of communication in preventive sector. Of the public sector healthcare institutions, the higher proportion of the preventive sector (n = 20; 76.9%) and curative sector (n = 29; 67.4%) had basic level overall surge capacity of ICS for disaster management.ConclusionCoordination, communication, commanding, management of controlling the incidence and tracking of cases following outbreaks need to be improved and capacity development programmes could implement to develop the preparedness for future disasters.

Cost of Managing COVID 19 Patients in a Tertiary Care Hospital in Sri Lanka

<strong>Introduction: </strong>COVID-19 is caused by Severe Acute Respiratory Syndrome coronavirus 2 and it spread throughout the world and turned into a severe global pandemic in 2020. The severity of the COVID-19 is wide, ranging from asymptomatic to severe illness that requires mechanical ventilation. Although the curative sector response of Sri Lanka was somewhat different from other countries, it was remarkably effective in preventing community spread. <strong> </strong> <strong>Objective: </strong>To assess the average cost of treating Covid 19 patients at Covid Treatment Centre (CTC) in District General Hospital (DGH) Hambantota. <strong> </strong> <strong>Methodology: </strong>This retrospective costing study was conducted in CTC at DGH, Hambantota in December 2020. The step-down costing method was used in this study. Key informant interviews with the accountant, deputy director, and staff of CTC, reviewing expenditure records of the accountant’s office, visiting and taking measurements of the floor area, reviewing relevant literature were used to gather data in this costing study. <strong> </strong> <strong>Results: </strong>The average cost of treating a Covid 19 patient per day at CTC, DGH Hambantota was Rs 2317.60. The total cost of treating a Covid 19 Patient at DGH Hambantota for 10 days was Rs 23176.00. The cost of treating Covid patients at CTC, DGHH was exceptionally low when compared to other countries. <strong> </strong> <strong>Discussion and conclusion: </strong>Treating Covid 19 patients is an economic burden to any health system. Treatment cost was extremely low at DGH, Hambantota and only about 23000 rupees was spent for one patient for 10 days. Drug cost was comparatively low and transport cost was relatively high.

Pain management in the rehabilitative setting

In rehabilitation medicine, differentiated concepts of interdisciplinary multimodal pain management have existed for years, or even decades. What does orthopedic pain management include? How do these treatment measures carried out in the curative and rehabilitative setting differ? In addition to the content of rehabilitative pain management, further established models such as IMST (interdisciplinary multimodal pain therapy) are discussed. The duration and intensity of the rehabilitation treatment differ from the models offered in topical medicine or in the curative sector. The treatment is also based on different questions or goals. In addition to the actual treatment, the aspect of complaint validation and socio-medical assessment is also typical for the rehabilitation sector. Orthopedic rehabilitation through pain management provisos is part of atiered and diversified system of treatment methods and models; Aleap in quality was again achieved in the past few years through the introduction of behavioral medicine-oriented rehabilitation (VMO).

Connected care for endocarditis and heart failure patients: ahospital-at-home programme.

BackgroundHealthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively)AimIn a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction.ResultsWe tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record.ConclusionThe current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

Building the hospital event-based surveillance system in Viet Nam: a qualitative study to identify potential facilitators and barriers for event reporting.

IntroductionHospitals are a key source of information for the early identification of emerging disease outbreaks and acute public health events for risk assessment, decision-making and public health response. The objective of this study was to identify potential facilitators and barriers for event reporting from the curative sector to the preventive medicine sector in Viet Nam.MethodsIn 2016, we conducted 18 semi-structured, in-depth interviews, as well as nine focus group discussions, with representatives from the curative and preventive medicine sectors in four provinces. We transcribed the interviews and focus group discussions and used thematic analysis to identify the factors that appeared to affect public health event reporting.ResultsWe identified five major themes. First, the lack of a legal framework to guide reporting meant hospital staff relied on internal procedures that varied from hospital to hospital, which sometimes delayed reporting. Second, participants stated the importance of an enabling environment, such as leadership support and having focal points for reporting, to facilitate reporting. Third, participants described the potential benefits of reporting, such as support provided during outbreaks and information received about local outbreaks. Fourth, some challenges prohibited timely reporting such as not perceiving reporting to be the task of the curative sector and hesitancy to report without laboratory confirmation. Finally, limited resources and specialist capacities in remote areas hindered timely detection and reporting of unusual events.DiscussionThis study identified potential opportunities to promote the detection and reporting of unusual events from health-care workers to the public health sector, and thus to improve the overall health security system in Viet Nam.The influenza virus is a respiratory pathogen that is transmitted through respiratory droplets.1 During seasonal influenza epidemics, high attack rates cause a significant public health burden.2 The infection is usually self-limited in young adults but can lead to severe infections in people in high-risk groups, including elderly people (> 65 years old), pregnant women, children aged 6–59 months and adults with chronic illnesses.3

Enhancing hospital event-based surveillance system – Findings from a pilot study, Vietnam, 2017-2018

ABSTRACT In our inter-connected world, health-care professionals are the first line of defence to identify emerging diseases and public health events for rapid response. In Vietnam, event-based surveillance (EBS), critical for the early detection of emerging disease outbreaks and acute public health events, has been limited to media-based EBS until recently. In 2017–2018, the Ministry of Health of Vietnam, in collaboration with the World Health Organisation and the US Centres for Disease Control and Prevention, designed, implemented, and evaluated a hospital EBS demonstration pilot in six hospitals in two provinces in Vietnam. After the 9-month implementation period, we conducted a logbook review, eight interviews, and six focus group discussions with hospital and preventive medicine staff, and conducted thematic and descriptive analysis. During the implementation period, 11 signals were reported and confirmed as true events. Of the 11 signals, majority (N = 8, 72.7%) were detected in ICU, followed by the outpatient department (N = 2, 18.2%). The most common signal were clusters of food poisoning (N = 4, 36.4%). All (100%) signals were reported, risk-assessed, and responded to within 24 hours of signal detection. The hospital and preventive medicine staff reported that one of the main benefits of the pilot was their improved mutual relationship. This pilot formalised hospital event-based surveillance through a legal framework, standard operating procedures, a formal feedback mechanism to hospitals to facilitate a two-way conversation, and providing additional training and continued sensitisation. Most importantly, it fostered a trusting relationship between the curative medicine and public health sectors, marking an important step towards advancing the national event-based surveillance system in Vietnam.

Capitalizing on specialists' services in rural family health unit: Interventional study.

The objectives of the study were to explore legal and regulatory environment for the policy of specialists' visits to unit and assess the impact of gynecology specialist's visits on utilization pattern of gynecological services and clients' satisfaction. Settings The study settings were Ministry of Health/Headquarters, Giza Health Directorate, El-Badrashin Health District and Hospital, and Met-Rahinah Unit. Study design The study includes qualitative research (in-depth interviews with policymakers at all Ministry of Health levels and focus group discussions with service providers) and quantitative research (interventional operation research using separate sample pretest (n = 210) and posttest (n = 209) and family-planning service statistics). Analysis of specialist outreach services indicated integration absence between preventive and curative sectors. Capitalizing on the policy of specialists' outreach visits to the unit could support clients' access quality services and reduce referral to get specialist services in hospitals. There is a 6-month intervention of scheduled visits of a female gynecologist to a rural health unit. The intervention led to 12% increase in efficiency and utilization of services compared with the previous 6 months. Clients' satisfaction increased from 27% to 73% after the intervention (.001, OR = 7.5, CI = 4.9-11.6). Scheduled specialists' visits increase services' efficiency and clients' satisfaction.

Ebola Preparedness in the Netherlands: The Need for Coordination Between the Public Health and the Curative Sector.

Context:During the Ebola outbreak in West Africa in 2014-2015, close cooperation between the curative sector and the public health sector in the Netherlands was necessary for timely identification, referral, and investigation of patients with suspected Ebola virus disease (EVD).Objective:In this study, we evaluated experiences in preparedness among stakeholders of both curative and public health sectors to formulate recommendations for optimizing preparedness protocols. Timeliness of referred patients with suspected EVD was used as indicator for preparedness.Design:In focus group sessions and semistructured interviews, experiences of curative and public health stakeholders about the regional and national process of preparedness and response were listed. Timeliness recordings of all referred patients with suspected EVD (13) were collected from first date of illness until arrival in the referral academic hospital.Results:Ebola preparedness was considered extensive compared with the risk of an actual patient, however necessary. Regional coordination varied between regions. More standardization of regional preparation and operational guidelines was requested, as well as nationally standardized contingency criteria, and the National Centre for Infectious Disease Control was expected to coordinate the development of these guidelines. For the timeliness of referred patients with suspected EVD, the median delay between first date of illness until triage was 2.0 days (range: 0-10 days), and between triage and arrival in the referral hospital, it was 5.0 hours (range: 2-7.5 hours). In none of these patients Ebola infection was confirmed.Conclusions:Coordination between the public health sector and the curative sector needs improvement to reduce delay in patient management in emerging infectious diseases. Standardization of preparedness and response practices, through guidelines for institutional preparedness and blueprints for regional and national coordination, is necessary, as preparedness for emerging infectious diseases needs a multidisciplinary approach overarching both the public health sector and the curative sector. In the Netherlands a national platform for preparedness is established, in which both the curative sector and public health sector participate, in order to implement the outcomes of this study.

Ebola preparedness: the need for co-ordination overarching the public health and curative sector

Ebola preparedness: the need for co-ordination overarching the public health and curative sector

First World Healthcare by Third World Provider: Position of Bangladesh

Despite being a third world country, Bangladesh has a huge prospect of providing modern, advanced healthcare in cheap rates. It has started that journey by building new health infrastructures, strengthening primary health care, increasing outputs of doctors, nurses and paramedics, developing a strong health information system and encouraging public-private partnerships. With increasing GDP, health status of people has also been improved as evidenced by achieving targets of the health related indicators in Millennium Development Goals. In spite of having lower per capita health expenditure than neighboring countries, Bangladeshi people have achieved higher life expectancy at birth with progressively strengthened health system. This country is developing resources at a fast pace to attract the medical tourists challenging other Asian countries popular for medical tourism. Bangladesh needs to make curative sector stronger to earn massive sum of foreign currency and emerge as a country of medical tourism in near future.

Advancing the application of systems thinking in health: why cure crowds out prevention.

IntroductionThis paper presents a system dynamics computer simulation model to illustrate unintended consequences of apparently rational allocations to curative and preventive services.MethodsA modeled population is subject to only two diseases. Disease A is a curable disease that can be shortened by curative care. Disease B is an instantly fatal but preventable disease. Curative care workers are financed by public spending and private fees to cure disease A. Non-personal, preventive services are delivered by public health workers supported solely by public spending to prevent disease B. Each type of worker tries to tilt the balance of government spending towards their interests. Their influence on the government is proportional to their accumulated revenue.ResultsThe model demonstrates effects on lost disability-adjusted life years and costs over the course of several epidemics of each disease. Policy interventions are tested including: i) an outside donor rationally donates extra money to each type of disease precisely in proportion to the size of epidemics of each disease; ii) lobbying is eliminated; iii) fees for personal health services are eliminated; iv) the government continually rebalances the funding for prevention by ring-fencing it to protect it from lobbying.The model exhibits a “spend more get less” equilibrium in which higher revenue by the curative sector is used to influence government allocations away from prevention towards cure. Spending more on curing disease A leads paradoxically to a higher overall disease burden of unprevented cases of disease B. This paradoxical behavior of the model can be stopped by eliminating lobbying, eliminating fees for curative services, and ring-fencing public health funding.ConclusionsWe have created an artificial system as a laboratory to gain insights about the trade-offs between curative and preventive health allocations, and the effect of indicative policy interventions. The underlying dynamics of this artificial system resemble features of modern health systems where a self-perpetuating industry has grown up around disease-specific curative programs like HIV/AIDS or malaria. The model shows how the growth of curative care services can crowd both fiscal and policy space for the practice of population level prevention work, requiring dramatic interventions to overcome these trends.

The need for an Institute of Hospital Management.

The monitoring mechanism of activities of the government preventive health sector is better than that of the curative sector, although much more money is spent on the latter. Recent initiatives for monitoring the curative sector should be strengthened by establishment of an institute of hospital management. The need for such an institute has been recognised for about 15 years. This need has been further emphasised by recent studies and discussions.

Development of Radiology in Nepal: Gearing Up for Mountainous Challenges

INTRODUCTION Nepal is a poor county with a population of 30 million. Its annual per capita income is about $540. More than 25% of the population lives below the poverty line, earning less than $1 per day [1,2]. More than 90% of the poor population lives in rural areas and the rest in urban areas. Only 41.4% of rural households have access to nearby health institutions within a short walking distance [3]. The government has declared primary health care to be a fundamental right of every citizen of Nepal, but the infrastructure of the nation’s health care system is still poor, with inadequate utilization and delivery of facilities. Annual per capita health expenditures are about $29. Total expenditures on health care account for 5.5% of the government’s budget. The curative sector is funded by 49% of the health budget [4,5]. Radiology in Nepal, including the diagnostic and radiotherapy sectors, is funded inadequately compared with other curative sectors. Therefore, radiologic service is poor, with limited resources, which are located in limited private and government hospitals in the capital and major cities. Major differences exist between urban and rural areas in access to radiologic and other health care facilities [6-8]. Private-sector investment, which amounts to about 25%, is beginning to improve service quality by increasing the availability of advanced facilities [5]. However, inequity still exists because these expensive medical facilities are affordable only to wealthy people. The poor citizens of Nepal remain

Use of glucometer and fasting blood glucose as screening tools for diabetes mellitus type 2 and glycated haemoglobin as clinical reference in rural community primary care settings of a middle income country

BackgroundThailand is considered to be a middle income country, and to control and prevent type 2 diabetes mellitus (T2DM) is one of the main concerns of the Thai Ministry of Public Health (MoPH). Screening for T2DM and care for T2DM patients has been integrated into the primary health care system, especially in rural areas. The intention of this investigation is to link public health research at the academic level with the local health authorities of a district of a north-eastern province of the country.MethodsEpidemiological methods were applied to validate the screening tools fasting capillary blood glucose (CBG), measured by glucometer and venous blood for the determination of plasma glucose (VPG), used for screening for T2DM among asymptomatic villagers. For assessing the validity of these two methods glycated haemoglobin (HbA1c) values were determined and used as the ‘clinical reference’.ResultsAll together 669 villagers were investigated. Determinations of CBG and VPG resulted in suspected T2DM cases, with 7.3% when assessed by CBG and 6.4% by VPG using a cutoff point of 7 mmol/L (126 mg/dl). Taking HbA1c determinations with a cutoff point of 7% into account, the proportion of T2DM suspected participants increased to 10.4%. By estimating sensitivity, specificity and the positive predictive value of CBG and VPG against the ‘clinical reference’ of HbA1c, sensitivity below 50% for both screening methods has been observed. The positive predictive value was determined to be 58.5% for CBG and 56.8% for VPG. The specificity of the two screening tests was over 96%.ConclusionsThe low sensitivity indicates that using fasting CBG or VPG as a screening tool in the field results in a high proportion of diseased individuals remaining undetected. The equally low positive predictive values (below 60%) indicate a high working load for the curative sector in investigating suspected T2DM cases to determine whether they are truly diseased or false positive cases according to the screening method. Further implications of the results and the controversial discussion related to the use of HbA1c as clinical evidence for suffering from T2DM are also discussed.

EClinics Integration Techniques to Clincal Information Systems moving into a National Network

Patients in rural areas in developing countries have less access to specialised consultations within their hometown. They are required to incur a great cost, time and effort to reach a Health Institute that provides specialised health care. Yet, it is discovered that through the utilisation of comparatively cheaper Information and Communication Technology advances, it is possible to provide better health services for developing regions. The healthcare delivery setting in rural parts of Sri Lanka today exposes limited access to highly specialised consultancies. It is stated that 35 per cent of the medical specialists in the curative sector are concentrated in the Colombo district. A pilot project funded by the Information and Communication Technology Agency of Sri Lanka (ICTA) was initiated connecting the Marawila Base Hospital and Dankotuwa Peripheral hospital which is situated around 33 miles away from Colombo in the North-Western province of Sri Lanka. The hospitals are connected through a web-based Electronic Medical Record (EMR) system along with a video-conferencing component through which a patient from his/her village peripheral hospital can consult a Specialist in the city/urban area to receive treatment with the assistance of a doctor in an eClinic. After the successful implementation of this concept, a research is being carried out by the authors focusing on eClinics integration and role based access level security implementation to the Clinical Information Systems. The pilot project involves one-to-one connection. However, when going for a wider network in order to replicate the solution throughout the island, several integration techniques must be considered. This includes patient-to-eClinic, patient-to-consultant and hospital-to-eClinic connections. Also in the wider network with many eclinics integrated, access rights must be enforced to users using role based access level security model. This paper describes the architecture, methodology, features and security model of the eClinics Integration module in Clinical Information Systems.

Challenges in physician supply planning: the case of Belgium

IntroductionPlanning human resources for health (HRH) is a complex process for policy-makers and, as a result, many countries worldwide swing from surplus to shortage. In-depth case studies can help appraising the challenges encountered and the solutions implemented. This paper has two objectives: to identify the key challenges in HRH planning in Belgium and to formulate recommendations for an effective HRH planning, on the basis of the Belgian case study and lessons drawn from an international benchmarking.Case descriptionIn Belgium, a numerus clausus set up in 1997 and effective in 2004, aims to limit the total number of physicians working in the curative sector. The assumption of a positive relationship between physician densities and health care utilization was a major argument in favor of medical supply restrictions. This new regulation did not improve recurrent challenges such as specialty imbalances, with uncovered needs particularly among general practitioners, and geographical maldistribution. New difficulties also emerged. In particular, limiting national training of HRH turned out to be ineffective within the open European workforce market. The lack of integration of policies affecting HRH was noteworthy. We described in the paper what strategies were developed to address those challenges in Belgium and in neighboring countries.Discussion and evaluationPlanning the medical workforce involves determining the numbers, mix, and distribution of health providers that will be required at some identified future point in time. To succeed in their task, health policy planners have to take a broader perspective on the healthcare system. Focusing on numbers is too restrictive and adopting innovative policies learned from benchmarking without integration and coordination is unfruitful. Evolving towards a strategic planning is essential to control the effects of the complex factors impacting on human resources. This evolution requires an effective monitoring of all key factors affecting supply and demand, a dynamic approach, and a system-level perspective, considering all healthcare professionals, and integrating manpower planning with workforce development.ConclusionTo engage in an evidence-based action, policy-makers need a global manpower picture, from their own country and abroad, as well as reliable and comparable manpower databases allowing proper analysis and planning of the workforce.

Public health education in Europe and the Nordic Countries: Status and perspectives

The challenges that public health education has to meet are represented in two systems – the population’s health, and artificial systems aimed at improving population health, both from a longitudinal perspective – history, present state, and future development. Population health varies considerably across European countries, as do living conditions, healthcare and social security systems, and environmental systems. In terms of disease burden, the major ‘‘old rascals’’ are still cardiovascular disease and cancer, with the addition of traffic injuries, musculoskeletal diseases, mental disorders, and suicide. Although still active on the scene, many classic infectious diseases no longer seem to pose major problems as concerns life expectancy and burden of disease. Moreover, new infectious population threats have emerged, including still more or less hidden HIV and AIDS spread. Major persistent population health determinants are related to poor living conditions in general, and they show considerable social inequality; poor social adjustment of immigrant and other population groups outside the national or local mainstream culture; violence and other health-damaging behaviour such as smoking, excess alcohol consumption and substance abuse, and unprotected sexual intercourse; stressful workplace environment and pollution of the physical environment. The list could easily be extended. Even if there are heavy contrasts between European regions in terms of both health and health determinants, the nature of the components of the overall picture seems rather similar. This also applies to the Nordic countries. The structure, resources and functioning of the health systems also vary considerably between countries and between regions, and the health systems have been subject to reform in many European countries, with the aim of catching up with population needs, expectations and demands; with scarce resources, underproduction and emigration of health staff; with firmly established old traditions and institutional inertia; with poorly developed sectors of health science, including public health science and, thus, with a burden of inherited practices in health promotion, disease prevention, cure, healthcare and social care and rehabilitation, unsupported or poorly supported by rational scientific evidence. Also in the affluent Nordic countries with their developed welfare systems, public health systems are relatively weak as compared to the curative sectors in terms of programmes, organizational structures, professional staffing, and other resources. Population demands for curative interventions keep increasing, creating problems such as overuse of pharmaceuticals and waiting lists even for simple services, e.g. visits to general practitioners and hernia surgery. In public health, interactions between practice, research and training seem very far from being developed to a degree that could make them comparable to parallel interactions in the curative sector. Also in the Nordic countries, investment in research on health promotion and disease prevention is very much smaller than investment in curative interventions and curative science – in spite of the fact that the major health determinants are those mentioned above, and that much more evidence for