Effective Provision Research Articles

The Importance of Midwifery Services in Achieving Healthy Cities: A Review Article

Introduction: WHO has developed the Healthy Cities Project, based on how a city can be a healthy city. Effective delivery of midwifery services is very important in delivering healthy services to all segments of the society. In this study, we aimed to draw attention to the importance of effective provision of midwifery services in the way of being a healthy city. Methods: Data were collected using the literature review method. The keywords "healthy city", "women-friendly city", "child-friendly city", "midwifery", "sustainable development" and "urban health" were used for the search. Turkish and English articles obtained through PubMed, GoogleAcademic were analyzed and compiled in line with the scope. The review of the subject was carried out between June and July 2022. Results: Healthy societies and cities can be achieved by protecting children from all kinds of harm from prenatal period to adulthood, providing quality birth and postpartum services to mothers and making these services accessible. In order to reach a healthy society, midwifery care provided by midwives is very important to protect and improve the health of women, families and children, and especially to reduce health inequalities in the society. In order to be a healthy city, midwifery care services must be well organized. Conclusion: The Healthy Cities Project makes significant contributions to the formulation, implementation and evaluation of health policies in the city. Each of the Sustainable Development Goals and the concept of a healthy city are interrelated. It is important for cities to organize and expand midwifery services well in order to achieve their sustainable development goals.

Impact of Humanitarian Crises on Diabetes Care in Iraq and Syria—IDF-MENA Region

This short review tried to discuss the factors that affect diabetes care during humanitarian crises after the political and military conflicts in post-2003 Iraq and post-2011 Syria. The pattern of the devastating effect of the conflicts on the suboptimal healthcare system and infrastructure is quite similar. Both countries’ long-term and continuous geopolitical instability and security concerns were barriers to applying any disaster preparedness plans. They had markedly exhausted diabetes care in these countries with similar mixed public and private healthcare systems. The influx of huge numbers of refugees with chronic diseases, especially diabetes, in the neighboring host countries created pressure on the healthcare systems. It urged some changes in the national policies with the needed help from the aid organizations to an extent. The internal displacement problem for huge nationals in their country exhausted the already exhausted healthcare facilities, with more burdens on the effective equal provision of diabetes-related medication and management tools. Still, diabetes care is not included as a vital part of the mitigation plans during crises in both countries, with the main concern the communicable rather than non-communicable diseases. Type 1 diabetes mellitus received less care during the crisis in both countries, with the insulin shortage being their major concern. The availability and affordability of diabetes medications in camp and non-camp settings were suboptimal and unsatisfactory. More active planning is needed to build a well-prepared healthcare system with diabetes care as an integral part.

Os “contratos impacto social”: uma nova modalidade de Parceria Público-Privada da nova governança pública

This article seeks to analyze the model of the “social impact bonds”, as a co-production instrument in the effective provision of state responsibilities, in harmony with the newest paradigm of the public administration, known as “new public governance”. In order to do so, this article will seek to clarify the theoretical outlines of the “new public governance” model, especially the “co-production” model, as an instrument of effectiveness in the execution of public services, in a broad sense, such as several examples observed worldwide. Knowing these guidelines for the co-production of public services is important so that this work can better identify the main legal and operational characteristics of the social impact bonds. In addition, this article will study a successful case of the implementation of a social impact bonds, promoted by the State of New York, whose object is the reduction of the high rate of criminal recurrence. This paper will also analyze an effort of its implantation by the State of São Paulo, not initiated because of the lack of legal basis for its implementation. This article will seek to demonstrate that the social impact bonds is a kind of project finance initiative, whose creation of new rules are essential in Brazil, both for the existence of successful cases, as well as for the adequacy of its adoption with the most current guidelines for efficiency in the performance of tasks reserved for Public Administration.

Assessment of the ability, perception, and readiness of nurses to manage tracheostomy-related complications in Riyadh City: a cross-sectional study

BackgroundNursing staff play a key role in the bedside management of tracheostomized patients in both intensive care units and general floors. Effective provision of postoperative care to these patients by nurses is critical. This study aimed to assess the readiness of nursing staff to manage tracheostomy-related complications in Riyadh, Saudi Arabia.MethodsThis cross-sectional study enrolled 395 nurses in Riyadh, Saudi Arabia. A self-administered questionnaire developed by the authors was distributed to nurses via an online survey. The questionnaire assessed nurses’ socio-demographic characteristics and their knowledge and practices regarding tracheostomy indications, postoperative care, and management of its complications.ResultsOf respondents, approximately 59% (232/395) had poor knowledge regarding tracheostomy-related complications and indications, 39% (154/395) had moderate knowledge, and only 2%(9/395) had good knowledge. Several factors were associated with increased knowledge, including having a higher education degree, working in a tertiary/quaternary hospital, being a government employee, caring for tracheostomized patients, and attending courses or lectures on managing tracheostomized patients.ConclusionsKnowledge level and practices regarding tracheostomy-related complications and indications among nurses remain limited. In-service continuous professional development programs for nurses working in all hospital settings are strongly recommended. Further research is warranted to elicit the major factors contributing to inadequate knowledge and practices among nurses in Riyadh.

Lessons to learn from the analysis of routine health data from Moria Refugee Camp on Lesvos, Greece.

Refugees in humanitarian settings commonly experience many health needs and barriers to access healthcare; health data from these settings are infrequently reported, preventing effective healthcare provision. This report describes health needs of refugees in Moria Camp on Lesvos, Greece-Europe's largest refugee camp. A set of routinely collected service data of 18131 consultations of 11938 patients, attending a primary care clinic in the camp over 6months in 2019-20, was analysed retrospectively, focusing on chronic health conditions. The most frequent chronic conditions were musculoskeletal pain (25.1%), mental health (15.9%), cardiac (12.7%) and endocrine conditions (8.9%). In all, 70.4% of consultations were for acute health problems, with high rates of injuries and wounds (20.8%), respiratory infections (12.5%), gastroenteritis (10.7%) and skin problems (9.7%), particularly scabies. The prevalence of acute and chronic health problems is high in this setting, with some likely attributable to the deplorable living conditions in the camp. Despite its magnitude, the interpretability of routine health data is limited. A research agenda is identified, and a framework for chronic disease management in refugee camps is proposed.

Service quality and accessibility of healthcare facilities: digital healthcare potential in Ho Chi Minh City

BackgroundEffective delivery of health services requires adequate quality in healthcare facilities and easy accessibility to health services physically or virtually. The purpose of this study was to reveal how the quality of healthcare facilities varies across the different parts of Ho Chi Minh City and how well residents (N = 9 million) can reach healthcare facilities. By demarcating the deficiently served areas of low accessibility, the study shows where urban planning and digital healthcare could improve accessibility to health services and the quality of services efficiently.MethodsThe analysis utilised geocoded information on hospitals, clinics, roads and population and the data of the quality scores of healthcare facilities. Quality scores were analysed by hot spot analysis and inverse distance weighting. Accessibility and formation of travel time-based service areas by travel time distances were calculated using road network, driving speed and population data.ResultsThe results unveiled a centripetal spatial pattern of healthcare facilities and a similar pattern in their quality. Outside the travel time of 30 min for hospitals and 15 min for clinics, the deficiently served areas have a population of 1.1 to 1.2 million. Based on the results and the evidence of digital healthcare, this paper highlights how to develop and plan spatially effective service provision. Especially, it gives grounds to discuss how cost-effective digital healthcare could be applied to improve the accessibility and quality of health services in an urban structure of extensively varying accessibility to health services.ConclusionsThe results bring up the need and the means for improving the quality of health services and their cost-efficient availability by location optimisation, road improvements and implementing digital healthcare provided by hospitals and clinics in the city. At the same, this study provides a multidisciplinary approach for planning more equal and efficient health service provision geographically.

Diabetes knowledge and related cultural safety knowledge: What do new graduate nurses know?

In New Zealand, Type 2 diabetes mellitus (T2DM) is at epidemic proportions, with poor glycaemic control contributing to more patients with diabetes presenting to inpatient settings. These patients come from diverse cultural backgrounds, so their specific socioeconomic, psychosocial and social requirements are important to understand and address for the delivery of equitable and culturally appropriate diabetes care. Nurses have a central role in providing diabetes care, but they need sufficient diabetes knowledge and cultural safety skills to provide this care effectively. New graduate nurses are educated on the management of diabetes, however, there is no current research on how this education translates to the effective provision of appropriate care for inpatients with T2DM. The purpose of this study is twofold: to measure the diabetes management and related cultural safety knowledge of hospital-based new graduate nurses and to explore their experiences with providing diabetes care. Dewey’s pragmatic paradigm underpins this mixed methods research that will be conducted with new graduate nurses in a South Auckland Hospital. An adapted version of Daly et al.’s existing published telephone questionnaire (2019) will provide quantitative data and focus group interviews, the qualitative data. Findings will highlight nurses’ diabetes knowledge and diabetes-related cultural safety knowledge, and identify gaps that affect a nurse’s ability to tailor diabetes care to the patient’s cultural needs. Nurses who are educated and can give culturally appropriate care can help reduce the number of ethnic minorities presenting with diabetes complications improving the health users’ outcomes. The study’s findings will inform organisations about diabetes education needs and influence undergraduate and post-graduate nursing diabetes training programmes.

Deaf signers and hearing aids: motivations, access, competency and service effectiveness

Objectives This study concerns culturally Deaf signers in the UK who use hearing aids and (i) explores motivations for hearing aid use (ii) identifies barriers and facilitators to accessing NHS hearing aid services, (iii) examines cultural competency of hearing aid clinics and (iv) identifies factors influencing effective adult hearing aid service provision. Design Online survey in British Sign Language and English that was informed by Deaf service users. Study sample 75 Deaf adult BSL users who wear hearing aids and use NHS hearing aid clinics. Results No specific reason emerged as outstandingly important for hearing aid use; however, assisting with lipreading (57%) and listening to music (52%) were rated as very/extremely important. Access issues reported were contacting clinics, poor communication with staff and lack of Deaf awareness. To be an effective and culturally competent hearing aid clinic for Deaf signers, a good understanding of Deaf culture and language was most rated as important (87%). Conclusion The study is the first that explores hearing aid use and experiences of accessing hearing aid clinics from Deaf signers’ perspectives. Enhancements to clinical practice are required to consider culturally Deaf people’s motivations for hearing aid use and make services more BSL-friendly.

PROBLEMS AND PROSPECTS OF STATE POLICY IN THE AREA O POPULATION EMPLOYMENT

This scientific article examines the problematic aspects in the field of employment of the population, the main directions of state policy that could contribute to lowering the unemployment rate and more effective provision of employment.

Availability and Utilization of Instructional Materials in Teaching and Learning of Biology in Senior Secondary Schools

This study investigated the availability and utilization of instructional materials in the teaching and learning of biology in senior secondary schools in Talata Mafara Town, Zamfara State. A descriptive survey research design was adopted for the study using quantitative data. The population comprised all the heads of department of biology in the senior secondary schools (six public and four private) in Talata Mafara Town. The entire population constituted the sample of the study due to its small size. A validated questionnaire with reliability index of 0.63 obtained using Cronbach’s alpha was used as instrument for data collection. The data collected were analyzed using frequency counts and percentages presented in tables and charts. Five research questions guided the study. The findings of the study revealed that some of the required instructional materials are fairly available but are not regularly use by biology teachers. Biology laboratories and instructional materials relating to multimedia are lacking in most of the schools in Talata Mafara Town. Lack of fund for procurement and large class size coupled with lack of in-service training for serving biology teachers were major factors identified to inhibit effective provision and utilization of instructional materials respectively. Based on these findings, the study recommended among others that biology teachers in Talata Mafara Town should make effort in utilizing available instructional materials. Zamfara Sate Government should build biology laboratories and make provision for instructional materials especially multimedia related in all senior secondary schools in Talata Mafara. Professional development of biology teachers should be encouraged and sponsored by government and other relevant stake holders.

Management of Pediatric Voice Disorders: Perceived Knowledge, Confidence, Attitude and Practice Patterns Among School-based Speech-language Pathologists in Hong Kong

This survey evaluated the levels of self-perceived knowledge, confidence, attitude and practice patterns of school-based speech-language pathologists (SLPs) in Hong Kong regarding their management of pediatric voice disorders. SLPs with experience working in school settings in Hong Kong were invited to complete an anonymous online survey. The survey ascertained SLPs' perception of their knowledge, confidence, attitude and practice patterns regarding their management of pediatric voice disorders. It also explored the barriers and facilitators to effective service provision for children with voice problems in schools. A total of 85 responses were received, of which 56 respondents with complete responses were selected for analysis. Results showed that respondents in general did not consider themselves having sufficient knowledge on pediatric voice. They did not feel fully confident in managing pediatric voice cases. Even though they exhibited a positive attitude and agreed that pediatric voice management was important, discrepancies were noted between their attitude and practice. Barriers that hinder practice include the lack of professional guidelines, insufficient time and resource as well as difficulties to conduct comprehensive voice assessments with children. The study findings urge the needs of enhancing school-based SLPs' perceived knowledge and competence in managing pediatric voice disorders. The study also identifies strategic directions to improve service provision for children with voice disorders in schools.

Investigating health service availability and readiness for antenatal testing and treatment for HIV and syphilis in Papua New Guinea

BackgroundPapua New Guinea (PNG) has one of the highest burdens of HIV and syphilis in pregnancy in the Asia-Pacific region. Timely and effective diagnosis can alleviate the burden of HIV and syphilis and improve maternal and newborn health. Supply-side factors related to implementation and scale up remain problematic, yet few studies have considered their impact on antenatal testing and treatment for HIV and syphilis. This study explores health service availability and readiness for antenatal HIV and/or syphilis testing and treatment in PNG.MethodsUsing data from two sources, we demonstrate health service availability and readiness. Service availability is measured at a province level as the average of three indicators: infrastructure, workforce, and antenatal clinic utilization. The readiness score comprises 28 equally weighted indicators across four domains; and is estimated for 73 health facilities. Bivariate and multivariate robust linear regressions explore associations between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis.ResultsMost provinces had fewer than one health facility per 10 000 population. On average, health worker density was 11 health workers per 10 000 population per province, and approximately 22% of pregnant women attended four or more antenatal clinics. Most health facilities had a composite readiness score between 51% and 75%, with urban health facilities faring better than rural ones. The multivariate regression analysis, when controlling for managing authority, catchment population, the number of clinicians employed, health facility type and residence (urban/rural) indicated a weak positive relationship between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis.ConclusionThis study adds to the limited evidence base for the Asia-Pacific region. There is a need to improve antenatal testing and treatment coverage for HIV and syphilis and reduce healthcare inequalities faced by rural and urban communities. Shortages of skilled health workers, tests, and medicines impede the provision of quality antenatal care. Improving service availability and health facility readiness are key to ensuring the effective provision of antenatal care interventions.

Türkiye’de Kamu Eğitim Harcamaları ile Ekonomik Büyüme İlişkisi Üzerine Uygulamalı Bir Çalışma

Bir ülkenin gelişmişlik düzeyi o ülkenin eğitim düzeyi ile yakın ilişki içerisindedir. Eğitim ülkelerin gerek ekonomik gerekse sosyal açıdan gelişmesine katkı sunmaktadır. Günümüzde mal ve hizmet üretiminde yaşanan hızlı değişime uyum sağlama kapsamında eğitimin ve eğitime yapılacak harcamaların önemi artmaktadır. Eğitim harcamaları kısa dönemde cari nitelikli bir harcama kalemi iken uzun dönemde yatırım niteliğinde bir harcama kalemine dönüşmektedir. Bu niteliğinden dolayı eğitim harcamaları kalkınma carileri olarak adlandırılmaktadır. Eğitim, yarı kamusal mal ve hizmet olarak hem kamu kesimi hem de özel kesim tarafından sunulabilen bir hizmet özelliği taşımaktadır. Eğitim hizmeti, sunulduğunda toplumsal faydası bireysel faydasından büyük sunulmadığında ise toplumsal maliyeti bireysel maliyetinden daha yüksek olmaktadır. Bu özelliğinden dolayı eğitim hizmetinin etkin olarak sunumu kamu tarafından gerçekleştirilmektedir. Bu nedenlerden dolayı kamu tarafından yapılan eğitim harcamaları önem arz etmektedir. Bu kapsamda çalışmada Türkiye’nin 1990-2020 dönemine ait yıllık veriler kullanılarak kamu eğitim harcamaları ile ekonomik büyüme arasında uzun dönemli bir ilişkinin olup olmadığı sınır (ARDL) testi ile araştırılmıştır. Test sonucundan elde edilen bulgulara göre söz konusu iki değişken arasında uzun dönemli bir eşbütünleşme ilişkisinin olduğu ve kamu eğitim harcamalarındaki artışın ekonomik büyümeyi pozitif olarak etkilediği tespit edilmiştir. Diğer bir ifadeyle kamu eğitim harcamalarında meydana gelecek %1’lik bir artışın ekonomik büyümeyi %0,74 oranında artırdığı görülmektedir.

Characteristics of Age-Friendly Bus Information

Bus information is an important element to consider when developing and implementing age-friendly bus systems. Little is known regarding the bus information needs and preferences of older people. This study aims to illuminate characteristics of age-friendly bus information. Participant observations with stimulated recall interviews (n=40) were used to identify older peoples’ (age 60 and over) perspectives on bus information. The data were analyzed using qualitative content analysis. A printed information location checklist also was conducted. Categorical analysis identified that older people used a variety of information sources including printed information, telephone, Internet, bus drivers, word of mouth, and experience. Positive and negative characteristics of each source were identified. Older people also required a range of levels of information complexity. Popular locations for sourcing printed information included post offices, news agents, tourist information centers, and libraries. Transport providers and policy makers should consider the needs and preferences of older people when providing bus information. Effective information provision requires a range of media, covering a broad spectrum of information complexity and through a variety of locations.

Innovative Public-Private Partnership Models for Road Pricing/BRT Initiatives

This article presents alternative concepts for serving commuter travel demand in major metropolitan areas with a system of priced expressways integrated with Bus Rapid Transit (BRT), and presents potential new models for setting up public-private partnerships (PPP) to finance, implement, and operate the system. These new models may make possible the self-financing of new BRT services and facilitate efficient provision of multimodal transportation services. The PPP model for expressway operation uses shadow tolls to compensate private partners, while at the same time charging motorists market-based tolls to ensure free-flowing traffic conditions and to provide a fast, reliable running way for BRT. Revenues from tolls charged to users may be used to pay contractual obligations to private partners for highway operations, toll collection, and BRT services. To encourage efficient and effective provision of transit, high-occupancy vehicle (HOV, and park-and-ride/pool services, private partners may be compensated for provision of transit services and HOV promotion using shadow fee payments based on the number of commuters served.

“We are better and happier if we are inclusive.” Therapist perspectives on the importance of LGB cultural competence in a mental health setting

AbstractLesbian, gay and bisexual people are more likely than their heterosexual counterparts to report dissatisfaction after accessing a counselling or psychological service. Greater dissatisfaction may result from therapists who focus on psychopathology without considering cultural context. Research has demonstrated therapists' cultural competence (attitudes, knowledge and skills) may influence effective service provision to LGB people. Counsellors and psychologists (N = 10) were interviewed to determine the sources of information influencing the cultural competence and LGB cultural competence practices used by therapists in their clinical practice. Three themes were developed from semistructured interviews: (1) the importance of multiple sources of cultural competence; (2) applying cultural competence improves the therapeutic process; and (3) ensuring visual cues of affirmation are affirming, not pathologising. Theme 1 highlighted that initial professional training, cultural competence training and lived experience could be triangulated to assist therapists in improving their cultural competence. Theme 2 highlighted that cultural competence improves the therapeutic process by ensuring therapists can demonstrate affirming attitudes, knowledge about LGB people and culturally affirming skills to work effectively with LGB clients. The final theme explored the need for therapists to create an inclusive space for LGB clients. Recommendations for improving clinical practices and tools to enhance cultural competence are discussed.

Exploring lessons from Covid-19 for the role of the voluntary sector in integrated care systems.

Integrated care systems (ICS) in England are partnerships between different health and social care organisations, to co-ordinate care and therefore provide more effective health and social care provision. The objective of this article is to explore the role of the 'Voluntary, Community and Social Enterprise' (VCSE) sector in integrated care systems. In particular, the paper aims to examine recent experiences of the voluntary sector in responding to the Covid-19 pandemic, and the lessons that can be learnt for integrated care provision. The article focuses on the case of Oxfordshire (UK), using a mixed methods approach that included a series of semi-structured interviews with key informants in health and the VCSE sector as well as online surveys of GPs and organisations in the VCSE sector. These were complemented by two contrasting geographical case studies of community responses to Covid-19 (one urban, one rural). Data were collected between April and June 2021. Interviewees were recruited through professional and community networks and snowball sampling, with a total of 30 semi-structured interviews being completed. Survey participants were recruited through sector-specific networks and the research arm of doctors.net.uk, with a total of 57 survey respondents in all. The research demonstrated the critical role of social prescribing link workers and locality officers in forging connections between the health and VCSE sectors at the hyper-local level, particularly in the urban case study. In the rural case study, the potential role of the Parish Council in bringing the two sectors together was highlighted, to support community health and well-being through stronger integrated working between the two sectors. The article concludes that enhanced connections between health and the VCSE sector will strengthen the outcomes of ICS.

A survey of orthodontic clear aligner practices among orthodontists

The purpose of this cross-sectional study was to survey orthodontic clear aligner therapy (CAT) practices among orthodontists in Australia. A pilot-tested electronic questionnaire was distributed to 434 full members of the Australian Society of Orthodontists. Questions were related to demographics, use and choice of aligners, digital treatment planning, patient selection, treatment protocols, refinements/finishing, retention, and patient-reported aligner issues. Factors regarding the decision not to provide CAT were also surveyed. The response rate was 54.6%. Most orthodontists (93.13%) provided CAT, which made up 24.17% of their annual orthodontic caseload. The median percentage of initial digital treatment plans (DTP) approved without changes was 0, with 4-6 changes reported by 24.14%. Orthodontists reported a mean of 2.02 ± 1.76 refinements per patient. Orthodontists were least comfortable treating patients with bilateral crossbite (71.28%) and deep overbite (62.56%). DTP challenges regarding tooth attachments and tooth positions and issues regarding patient compliance with CAT wear protocols were commonly reported. More than 1 CAT system was used by most (63.92%), with in-house systems used by 21.63%. Orthodontists rarely or never (63.68%) performed premolar extraction treatment with CAT. Adjunctive interproximal reduction was reportedly mostly carried out to relieve crowding and reduce open gingival embrasures. The view that fixed appliances provide better outcomes was a major influence (71.43%) on the decision for those who did not provide any CAT. CAT practices among orthodontists varied. Further research is required to investigate the challenges in effective CAT provision highlighted in this survey.

Professional Development: Perception among School Librarians

ABSTRACTThe roles of school librarians as well as the needs of library users have been changing. To keep up with the changes, school librarians have been required to engage in professional development which enables them to acquire the necessary knowledge and skills for the effective provision of services and programs to their clients. School districts formulate policies that provide guidelines on the professional development requirements and activities for school librarians but there have been concerns on the effectiveness and approach of professional development as outlined in the policies. Using Ball's policy cycle theoretical framework, the study analyzed professional development policies within schools and interviewed school librarians to understand their perception of professional development. Findings from the study will enable librarians and administrators within the school and districts to understand the current state of professional development and may also suggest effective and innovative strategies in professional development for school librarians.

Between Care and Control: Examining Surveillance Practices in Harm Reduction.

As harm reduction programs and services proliferate, people who use drugs (PWUD) are increasingly subjected to surveillance through the collection of their personal information, systematic observation, and other means. The data generated from these practices are frequently repurposed across various institutional sites for clinical, evaluative, epidemiological, and administrative uses. Rationales provided for increased surveillance include the more effective provision of care, service optimization, risk stratification, and efficiency in resource allocation. With this in mind, our reflective essay draws on empirical analysis of work within harm reduction services and movements to reflect critically on the impacts and implications of surveillance expansion. While we argue that many surveillance practices are not inherently problematic or harmful, the unchecked expansion of surveillance under a banner of health and harm reduction may contribute to decreased uptake of services, rationing and conditionalities tied to service access, the potential deepening of health disparities amongst some PWUD, and an overlay of health and criminal-legal systems. In this context, surveillance relies on the enlistment of a range of therapeutic actors and reflects the permeable boundary between care and control. We thus call for a broader critical dialogue within harm reduction on the problems and potential impacts posed by surveillance in service settings, the end to data sharing of health information with law enforcement and other criminal legal actors, and deference to the stated need among PWUD for meaningful anonymity when accessing harm reduction and health services.