Years Of Services Research Articles

Recognition of Prior Learning Implementation in Library and Information Science Schools in South Africa: A Literature Review

This article reviews the literature on trends and practices of recognition of prior learning (RPL) in Africa and internationally with specific reference to some of the key elements of the RPL system, including; purpose; assessment methods; quality assurance; and legislative and regulatory frameworks. In addition, a theoretical foundation of RPL is discussed underpinned by the experiential learning theory principles with a brief description of other learning theories related to RPL. The article also discusses the trends and practices of RPL in African countries with an established RPL system. The key finding of the literature review was that there are different conceptions of RPL globally but which all have a similar purpose, that is, economic benefit. Africa has a different take on RPL. A portfolio of evidence is the most commonly used method of assessment both internationally and in Africa with an increased use of e-portfolios internationally. A variety of quality assurance methods are used which differ from country to country but are similar to the Council for Adult and Experiential Learning (CAEL) quality standards which have been in use for many decades in the United States (US) since the inception of RPL. There are discrepancies in terms of legislative and regulatory frameworks. Some countries in Africa and internationally have no formal legislative and regulatory frameworks for RPL despite providing RPL services for years or decades. South Africa and Mauritius boast standardised and regulated RPL systems as do other developed countries such as New Zealand.

Burden of Hepatitis B Viral Infection among Workers in a Tertiary Health Institution in Southwestern Nigeria

Background: Health care workers (HCWs) are particularly at risk of hepatitis B virus (HBV) infections due to contact with infectious material like contaminated blood and body fluids or contact with HBV contaminated fomites. HBV vaccine is efficient in preventing infection though 5% - 10% of individuals are non-responders. HBV vaccine was introduced into Nigerian childhood immunization services in year 2004. However, routine vaccination of HCWs is often not implemented due to cost in resource limited settings like ours. Therapeutic options are also not affordable and available options do not guarantee complete cure. This study aimed at determining the burden of HBV infection among HCWs in Ekiti State University Teaching Hospital (EKSUTH), Ado Ekiti, Nigeria, in order to institute prompt treatment as a way of curbing HBV spread and disease progression. Materials and Method: This cross-sectional study was conducted between October and December, 2016. Staff from various cadres in EKSUTH, who accepted to participate, was recruited into the study. Following informed consent, 5 mls of blood collected from each participant was screened for HBV markers using HBV serologic combo test kit. Demography and Information on risk factors were collected with questionnaire. Results: A total of 965 participants, of which 323 (33.5%) were males and 642 (66.5%) were females, were recruited. Majority (72.6%) were married. History of unprotected sexual contact and multiple sexual partners was found in 62.3% and 54% of participants, respectively. In this study, 43 (4.5%) were HBsAg positive, out of which 40 (93%) had HBV infection (HBcAb positive). Prevalence of HBV infection was significantly higher among males than females (p value 0.004). Majority (60.5%) of infected individuals were 30 to 49 years of age. All infected participants had no previous vaccination, but no serologic evidence of previous vaccination was seen among vaccinated individuals. Conclusion and Recommendation: We concluded that Hepatitis B virus infection is still high among HCWs and significantly higher among males than females. Vaccinated individuals were found to be HBsAg negative, but had no detectable protective immunoglobulin against HBV. We recommend pre-employment screening and free vaccination of all staff in our health institutions, post vaccination immunization status assessment and provision of standard and affordable treatment for infected individual in order to achieve vision 2030 of HBV eradication.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.

The Collaborative Payer Provider Model Enhances Primary Care, Producing Triple Aim Plus One Outcomes: A Cohort Study.

Rising health care costs are threatening the fiscal solvency of patients, employers, payers, and governments. The Collaborative Payer Provider Model (CPPM) addresses this challenge by reinventing the role of the payer into a full-service collaborative ally of the physician. From 2010 through 2014, a Medicare Advantage plan prospectively deployed the CPPM, averaging 30,561 members with costs that were 73.6% of fee-for-service (FFS) Medicare (p < 0.001). The health plan was not part of an integrated delivery system. After allocating $80 per member per month (PMPM) for primary care costs, the health plan had medical cost ratios averaging 75.1% before surplus distribution. Member benefits were the best in the market. The health plan was rated 4.5 Stars by the Centers for Medicare and Medicaid Services for years 1–4, and 5 Stars in study year 5 for quality, patient experience, access to care, and care process metrics. Primary care and specialist satisfaction were significantly better than national benchmarks. Savings resulted from shifts in spending from inpatient to outpatient settings, and from specialists to primary care physicians when appropriate. The CPPM is a scalable model that enables a win-win-win system for patients, providers, and payers.

Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UK

SummaryBackgroundEvidence regarding the association between service contact and subsequent mental health in adolescents is scarce, and previous findings are mixed. We aimed to longitudinally assess the extent to which depressive symptoms in adolescents change after contact with mental health services.MethodsAs part of a longitudinal cohort study, between April 28, 2005, and March 17, 2010, we recruited 1238 14-year-old adolescents and their primary caregivers from 18 secondary schools in Cambridgeshire, UK. Participants underwent follow-up assessment at months 18 and 36. Trained researchers assessed the adolescents for current mental disorder using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL). Caregivers and adolescents reported contact with mental health services in the year before baseline. Adolescents self-reported depressive symptoms (Mood and Feelings Questionnaire [MFQ]) at each timepoint. We assessed change in MFQ sum scores from baseline contact with mental health services using multilevel mixed-effects regression adjusted for sociodemographic, environmental, individual, and mental health confounders, with multiple imputation of missing data. We used propensity score weighting to balance confounders between treatment (users of mental health services) and control (non-users of mental health services) groups. We implemented an MFQ clinical cutoff following the results of receiver operating characteristic analysis.Findings14-year-old adolescents who had contact with mental health services in the past year had a greater decrease in depressive symptoms than those without contact (adjusted coefficient −1·68, 95% CI −3·22 to −0·14; p=0·033). By age 17 years, the odds of reporting clinical depression were more than seven times higher in individuals without contact than in service users who had been similarly depressed at baseline (adjusted odds ratio 7·38, 1·73–31·50; p=0·0069).InterpretationOur findings show that contact with mental health services at age 14 years by adolescents with a mental disorder reduced the likelihood of depression by age 17 years. This finding supports the improvement of access to adolescent mental health services.FundingWellcome Trust, National Institute for Health Research.

Evaluating the Efficacy of the "Support for Life" Program for People with Dementia and Their Families and Carers' to Enable Them to Live Well: A Protocol for a Cluster Stepped Wedge Randomized Controlled Trial.

Assistance provided to support people living with dementia and carers is highly valued by them. However, current support systems in Australia are disjointed, inaccessible to all, poorly coordinated, and focus on dysfunction rather than ability. Support workers for people with dementia are in short supply, and there is little consistency in their roles. To address this large service gap and unmet need, we have developed an evidence-based optimized model of holistic support for people with dementia and their carers and families. This article describes the "Support for Life" model intervention. A stepped wedge cluster randomized controlled trial will be conducted over 3 years across three Australian states. One hundred participants with dementia and/or their carers/family members will be randomly selected from community health center client lists in each state to receive either the dementia "Support for Life" intervention (Group A) or routine care (Group B). Group A participants will have access to the intervention from year 1. Group B participants will continue to receive usual care and will not be denied information on dementia or dementia services in year 1. In year 2, Group B participants will have access to the intervention. A highly trained expert dementia support worker will provide the "Support for Life" intervention, which is a flexible, individually tailored, holistic support that is relationship-centered, focused on enablement as opposed to dysfunction, and facilitate participants' continued engagement in their community and the workforce. Additionally, dementia education, information resources, advocacy, and practical support to navigate and access dementia services and health care will be provided. The mode of support will include face to face, telephone, and internet interaction on an "as needed basis" for 12 months. The primary hypothesis is that the intervention will improve the quality of life of people with dementia and the health and well-being of carers/family through facilitating the continuation and enhancement of regular daily activities. Secondary hypotheses will examine other health and service usage outcomes. The outputs will also include a health economic analysis to investigate the costs (and savings) of any associated reduction in unnecessary health services use and delay in accessing permanent residential aged care. Australian and New Zealand Clinical Trials Registry: ACTRN12616000927426p.

Pediatric cardiothoracic program in Malaysia: a study based on the outcome of the program.

Vulnerable communities in Malaysia have been facing issues of accessibility and availability for pediatric cardiac services for years due to long waiting times, high costs and a lack of pediatric cardiothoracic surgeons. To ease this situation, the government has allocated a certain amount of funds, introduced through the Pediatric Cardiothoracic Program (PCP), in which the patients are transported to the Narayana Health Institute of Cardiac Science (NH) in India to receive a heart operation following an eligibility check at MediAssist4U Sdn Bhd in Selangor, Malaysia, a facility appointed by the NH. This study aimed to determine the demographic incidence of congenital heart diseases of patients in this program and to evaluate the outcome of the program in association with post-operative mortality rate and the beneficial factors of the program. In this study, 241 patients who participated in this program from August 2008 to September 2012 were reviewed. Fisher's exact tests were applied to calculate p-values of categorical data. Out of 241, 11 patients were rejected because of their poor health condition for flight transportation to India, leaving 230 patients for analysis. The majority of patients were 1 to 4 years of age (57.8%), Malays (61.7%), from families of monthly household income less than RM 1,500 (86.5%) and with primary school-educated parents (86.5%). Patients could apply from any government hospital in Malaysia, but 34.8% of the patients were from the state of Johor. The region (Peninsular Malaysia and East Malaysia) of patients seeking pediatric cardiac services was significantly associated with race (p<0.001), low household income (p<0.001) and low education background of parents (p=0.004). The associations between the age group and diagnosis group (p=0.010) and between duration of hospitalization and outcome of medical management (p=0.013) were significant. Post-operative mortality rate was 1.7% (95% confidence interval, 0.5-4.4). In conclusion, the patients and the government were considered to have benefited from the PCP.

Trends and characteristics of short-term and frequent representations to emergency departments: A population-based study from New South Wales, Australia.

The objective of this study is to describe the trends and characteristics of short-term and frequent representations to EDs in New South Wales, Australia. This was a retrospective analysis of a linked population-based registry of ED representations in New South Wales, conducted as part of the Demand for Emergency Services in Years 2010-2014 project. Trend analysis of unplanned representations to ED within 3 days of discharge from ED, readmission to an in-patient unit within 30 days of index in-patient admission from ED and demographic data and trends for frequent and very frequent ED presenters is discussed. A total of 10 798 797 ED presentations were identified from 4 188 283 individual patients. Within 1 year, 48.9% of ED presentations had a previous presentation, and 4.9% had represented within 3 days of a previous presentation. The readmission rate within 30 days was 2.8%, the proportion of frequent (representing 5212 [0.1%] individual patients) and very frequent representations (representing 1186 [0.03%] individual patients) were 1.7% and 1.0%, respectively. The overall rate of representations within 3 days has decreased from 5.1% in 2010 to 4.7% in 2014 (P < 0.001). The rate of readmissions within 30 days has increased from 2.4% in 2010 to 3.1% in 2014 (P < 0.001). In this population-based study, short-term representations were highest in the infant patient population, in-patient readmission rates were highest in the elderly and very frequent representations to ED were characterised by middle-aged patients with mental health or drug and alcohol related presentations.

Trajectories of psychological distress after prison release: implications for mental health service need in ex-prisoners.

Understanding individual-level changes in mental health status after prison release is crucial to providing targeted and effective mental health care to ex-prisoners. We aimed to describe trajectories of psychological distress following prison discharge and compare these trajectories with mental health service use in the community. The Kessler Psychological Distress Scale (K10) was administered to 1216 sentenced adult prisoners in Queensland, Australia, before prison release and approximately 1, 3 and 6 months after release. We used group-based trajectory modeling to identify K10 trajectories after release. Contact with community mental health services in the year following release was assessed via data linkage. We identified five trajectory groups, representing consistently low (51.1% of the cohort), consistently moderate (29.8%), high increasing (11.6%), high declining (5.5%) and consistently very high (1.9%) psychological distress. Mood disorder, anxiety disorder, history of self-harm and risky drug use were risk factors for the high increasing, very high and high declining trajectory groups. Women were over-represented in the high increasing and high declining groups, but men were at higher risk of very high psychological distress. Within the high increasing and very high groups, 25% of participants accessed community mental health services in the first year post-release, for a median of 4.4 contact hours. For the majority of prisoners with high to very high psychological distress, distress persists after release. However, contact with mental health services in the community appears low. Further research is required to understand barriers to mental health service access among ex-prisoners.

Changes in Low-Value Services in Year 1 of the Medicare Pioneer Accountable Care Organization Program.

Wasteful practices are widespread in the US health care system. It is unclear if payment models intended to improve health care efficiency, such as the Medicare accountable care organization (ACO) programs, discourage the provision of low-value services. To assess whether the first year of the Medicare Pioneer ACO program was associated with a reduction in use of low-value services. In a difference-in-differences analysis, we compared use of low-value services between Medicare fee-for-service beneficiaries attributed to health care provider groups that entered the Pioneer program (ACO group) and beneficiaries attributed to other health care providers (control group) before (2009-2011) vs after (2012) Pioneer ACO contracts began. Data analysis was conducted from December 1, 2014, to June 27, 2015. Comparisons were adjusted for beneficiaries' sociodemographic and clinical characteristics as well as for geography. We decomposed estimates according to service characteristics (clinical category, price, and sensitivity to patient preferences) and compared estimates between subgroups of ACOs with higher vs lower baseline use of low-value services. Use of, and spending on, 31 services in instances that provide minimal clinical benefit, measured as annual service counts per 100 beneficiaries and price-standardized annual service spending per 100 beneficiaries. During the precontract period, trends in the use of low-value services were similar for the ACO and control groups. The first year of ACO contracts was associated with a differential reduction (95% CI) of 0.8 low-value services per 100 beneficiaries for the ACO group (-1.2 to -0.4; P < .001), corresponding to a 1.9% differential reduction in service quantity (-2.9% to -0.9%) and a 4.5% differential reduction in spending on low-value services (-7.5% to -1.4%; P = .004). Differential reductions were similar for services less sensitive vs more sensitive to patient preferences and for higher- vs lower-priced services. The ACOs with higher than their markets' mean baseline levels of low-value service use experienced greater service reductions (-1.2 services per 100 beneficiaries; -1.7 to -0.7; P < .001) than did ACOs with use below the mean (-0.2 services per 100 beneficiaries, -0.6 to -0.2; P = .41; P = .003 for test of difference between subgroups). During its first year, the Pioneer ACO program was associated with modest reductions in low-value services, with greater reductions for organizations providing more low-value care. Accountable care organization-like risk contracts may be able to discourage use of low-value services even without specifying services to target.

Catching up with time: Tips, tricks, and best practices for library renovations

July/August 2015 362 Academic libraries built before the wave of digital and broadband technology rolled in are now required to provide today’s users with advanced technologies and facilities. As a result, libraries are renovating their existing facilities, as well as creating new spaces. Benjamin S. Rosenthal Library (BRL), l o c a t ed on the campus o f Q u e e n s College of the City University of New York, opened i t s d o o r s d u r i n g t h e spring semester of 1988. At the time, t he awa rd winning, sixstory library was “suited to high tech services for years to come.” At its opening, the state-of-the-art facility was lauded for its “advanced technology” and “services of dial-up access . . . to library’s databases.” Nearly 25 years later, the technological advances in formats and access have left the library vastly outdated, unable to meet the current needs for more computer work stations, wireless access, and more comfortable study and lounge areas. In 2008, BRL formed the Rosenthal Improvement Committee to initiate plans to improve the library through a multiphase plan. As our experience may soon be your experience, an overview of the process, and lessons learned, may help you and your institution.

PWE-401 Nurse-led audit of post-operative morbidity following colorectal resection: making the most of existing resources

Introduction: Colorectal and stoma care nurses have been auditing their specialist services for years, but have contributed less frequently to colorectal surgical service-wide audit measuring clinical outcomes relating to surgical as well as nursing care. Nurse-led follow-up provides the ideal platform to measure key indicators of quality care and identify areas for both service improvement and future research activity. Method: A nurse-led follow-up clinic at 30 days following patient discharge was used to audit 142 consecutive patients undergoing elective (n= 98) or emergency (n=44) colorectal resection over a three month period. Audit data were recorded at two time-points, discharge from hospital and at clinic, with audit templates developed using validated tools designed to measure general post-operative morbidity (Grocott et al, 2007; Dindo et al, 2004) and modified to include a focus on colorectal surgery-specific complications. Audit templates were tested during two clinics prior to full data collection to ensure they included all required variables. Results: A wide range of anticipated and unanticipated findings were identified relating to both inpatient and early post- discharge morbidity. Findings were presented to the whole colorectal team, including upper GI and colorectal surgeons and their teams, specialist nurses, theatre-based and ward-based nursing staff. Areas of clinical practice identified by the audit as requiring improvement were identified and discussed, with immediate changes to surgical practice agreed by the whole team. Nurse-led follow-up for all colorectal patients was established as a potential goal for future service improvement. Conclusion: This nurse-led audit enabled the whole colorectal team to scrutinise their clinical practice by comprehensively examining patient outcomes at two time-points following colorectal resection. Nurse-led follow-up using an auditable documentation template facilitates the recognition and reporting of a wide range of post-operative complications and provides valuable support for patients, particularly those who do not have routine access to specialist nursing services.

A five-year randomized parallel and blinded clinical trial of an extended specialized early intervention vs. regular care in the early phase of psychotic disorders: study protocol

BackgroundSpecialized Early Intervention services (SEI) for first episode psychosis are shown to be effective for the treatment of positive and negative symptoms, medication adherence, rates of relapse, substance abuse disorders, functional outcome and quality of life at two-year treatment follow up. However, it is also reported that these benefits are not maintained when SEI is not sustained. The objective of this trial is to test the efficacy of a 3-year extension of a SEI service (following 2 years of SEI prior to randomization) for the maintenance and consolidation of therapeutic gains as compared to regular care in the community.MethodsFollowing an initial 2 years of SEI, patients are randomized to receive either 3-years of continued SEI or regular care. SEI provided at three sites within the McGill network of SEI services, using a model of treatment comprised of: modified assertive case management; psycho education for families; multiple family intervention; cognitive behavioural therapy; and substance abuse treatment and monitoring. Blinded research assistants conduct ongoing evaluation of the outcome variables every three months. The primary outcome measure is remission status measured both as the proportion of patients in complete remission and the mean length of remission achieved following randomization during the additional three years of follow up. Based on preliminary data, it is determined that a total of 212 patients are needed to achieve adequate statistical power. Intent to treat with the last observation carried forward will be the primary method of statistical analysis.DiscussionThe “critical period” hypothesis posits that there is a five year window during which the effects of the nascent psychotic illness can be countered and the impact of the disorder on symptomatic and functional outcomes can be offset through active and sustained treatment. Providing SEI throughout this critical period may solidify the benefits of treatment such that gains may be more sustainable over time as compared to intervention delivered for a shorter period. Findings from this study will have implications for service provision in first episode psychosis.Trial registrationISRCTN11889976

An epidemiologic study of occupational stress factors in Mumbai police personnel.

Introduction:Occupational stress is common to each and every organization at various levels of hierarchy. The police organization is no exception to this. Rather policing is widely recognized as more stressful than any other occupation, nature of work, irregular duty hours, and many more factors, which can trigger stress. The present study was done to highlight some of these stressful factors in Mumbai police.Materials and Methods:Simple as well as systematic random sampling technique was adopted to get equal representation from each zone as well as region from Mumbai police. Occupational stress index (OSI) questionnaire was prepared, pilot tested, and validated for screening stress.Result:We screened 276 policemen for occupational stress. Seventy-three percent of them were in the 30–50 years age group, and most of them (49%) studied up to H.S.C. Ninety-one percent were married and 56% had reported duty hours 12–16 h/day. Seventy-one percent were addicted to any of the substance. After screening we found 73% moderately stressed, whereas 18% highly stressed policemen. Sociodemographic factors which were age group (50–58 years), duration of service in years (>25 years), duration of duty hours (>16 h/day), addiction habits, and number of monthly holidays (no holiday). We found role ambiguity, under participation, role overload, strenuous working condition, and unprofitability as predominant scales in OSI. So prevention as well as management of stress in policemen is the necessity of the current situation. This stress can be managed at organizational level by adopting right techniques, whereas at individual level by habituating right behavior and attitude.

A randomised controlled trial to explore insight into psychosis; effects of a psycho-education programme on insight in a forensic population

A psycho-education programme for people with psychosis has been delivered across forensic services for years. A multi-site randomised controlled trial was carried out over a three and a half year period, to review the effectiveness of the programme. A range of psychometric instruments were used to measure the following: insight; knowledge of psychosis; general mental health, including depression, quality of life, and social behaviour. Results from (n = 81) indicate a significant improvement in knowledge and empathy. An improvement was also noted in the measures of insight, mental health, and quality of life, although they did not reach significance. In conclusion, psycho-education has a place in forensic clinical practice. It is recommended that psycho-education programmes are used across the forensic network as part of a package of care, to improve the patient experience and reduce the likelihood of re-offending.

Financial impact of an oncology medical home on participating providers.

e17581 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer care clinical pathway in the United States in August 2008. Due to early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of patient care. The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services. This would allow physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. We analyzed the financial impact of the medical home program on participating physicians 1 year after implementation. Methods: Intravenous drug codes plus the evaluation and management codes for patient visits and chemotherapy administration were used in the analysis. We analyzed amounts paid to participating practices for chemotherapy, supportive care treatments, and nondrug services for year +1 to the amounts paid for the same services for year -1. We also analyzed the medical home fee schedule for year +1 when compared to the first-generation fee schedule applied to program year +1 utilization. This was calculated by repricing year +1 claims to the first-generation fee schedule and comparing that cost to what was actually paid under the medical home fee schedule. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. Average amounts paid to physicians were 4.7% higher for year +1 compared to the prior year. The average cost difference for year +1 based on the medical home fee schedule versus the first-generation fee schedule was -5.7%. If physicians had chosen not to join the medical home program their revenues would have increased by 11%. Conclusions: Drug cost inflation was a significant contribution to savings in this model and directly impacts the observed lower average reimbursement to medical home participants versus their pathway program peers. Providers are likely to seek remedies for continued participation.

Indicators of ecosystem service potential at European scales: Mapping marginal changes and trade-offs

This study develops an approach to mapping indicators of the potential of ecosystems to supply ecosystem services, and the impact of changes in land cover and use upon them. The study focuses on the EU-25 plus Switzerland and Norway, and develops the methodology proposed by Kienast et al. (2009), which uses expert-and literature-driven modelling methods. The methods are explored in relation to mapping and assessing four of the ecosystem services: “Crop-based production”; “Wildlife products”; “Habitat diversity”; and “Recreation”. The potential to deliver services is assumed to be influenced by (a) land-use, (b) net primary production, and (c) bioclimatic and landscape properties such as mountainous terrain, adjacency to coastal and wetland ecosystems, as well as adjacency to landscape and nature protection zones.The novel aspect of this work is an analysis of whether the historical and the projected land use changes for the periods 1990–2000, 2000–2006, and 2000–2030 are likely to be supportive or degenerative in the capacity of ecosystems to deliver ecosystem services; we refer to these as ‘marginal’ or incremental changes. The latter are assessed by using land account data for 1990–2000 and 2000–2006 (LEAC, EEA, 2006) and EURURALIS 2.0 land use scenarios for 2000–2030. The results are reported at three spatial reporting units, i.e. (1) the NUTS-X regions, (2) the bioclimatic regions, and (3) the dominant landscape types. All mapped output has been compared with independently generated continent-wide assessments (maps of ecosystem services or environmental parameters/indicators), which revealed that the straightforward binary links work satisfactorily and generate plausible geographical patterns. This conclusion mainly holds for provisioning services. At the continental scale, the selected input parameters are thus valid proxies which can be used to assess the medium-term potential of landscapes to provide ecosystem services.For a subset of NUTS-x regions for which change trajectories for 1990–2000, 2000–2006 and 2000–2030 are available, trade-offs between the four services have been analyzed using cluster analyses. The latter allowed us to simultaneously analyze the state of the four services in year 2000 and the individual trajectories of each service over three time periods. As a result we obtained seven regions with distinct trade-off patterns. To our knowledge this is one of the first continental-wide analyses where land use trajectories are taken into account to construct an indicator to estimate the balance between a set or bundle of ecosystem services. The relationship between the outputs of this work and the development of rapid assessment and accounting frameworks is discussed.

The global financial crisis and the right to a decent job

The United Nations, and, before it the International Labour Organization, have consistently emphasised the right to employment with dignity and security. With the onset of the global crisis in the financial sector, this right is more important than ever. But paying lip service to the importance of the right is not enough. This article sets out the policies necessary to restore full employment as quickly as possible. It argues that it is possible to do this while still providing all employed with a ‘decent’ job, and that the counter argument depends more on ideology than empirical evidence. The article concludes that the country whose economy has the most influence on the rest of the world, the United States, and our own country are both currently implementing appropriate policies. In a longer-run context, the rhetoric of the Commonwealth government is not so helpful. It argues that, unlike other sectors in the economy, governments should not normally borrow to invest in assets that will produce a flow of services for years; moreover, if they do so they should repay the loan as soon as circumstances permit. This focus is likely to cut short the fall in unemployment before Australia reaches full employment.

Palliative care for patients with hematological malignancies—a case series

Palliative care for patients with hematological malignancies—a case series

Mental Health Service Use Among Suicidal Adolescents: Findings From a U.S. National Community Survey

This study assessed patterns of mental health service use among adolescents who had attempted suicide and examined factors associated with their service use at individual, family, and community levels. Bivariate and multiple logistic regression analyses were conducted with data from 877 adolescents aged 12-17 who had attempted suicide in the past 12 months and who participated in the 2000 National Household Survey on Drug Abuse. Of the 877 adolescents, less than half (45%) reported that they had used mental health services in the past 12 months. Adolescents from racial-ethnic minority groups were less likely than whites to receive inpatient or outpatient mental health treatment, even when the analyses controlled for other demographic, individual, and family and community characteristics. Poor self-perceived health and living in a single-parent family were associated with use of inpatient services. Female gender, higher family income, participation in extracurricular activities, and the presence of symptoms of anxiety or disruptive disorders were associated with use of outpatient services. Use of school-based mental health services was associated only with participation in extracurricular activities. The mental health service needs of suicidal adolescents, especially those from ethnic minority groups and lower-income families, too frequently remain unmet. Larger racial-ethnic disparities were found in use of inpatient and outpatient mental health services than in use of school-based services. Mental health services offered within school settings can reach suicidal adolescents who need services but may experience barriers to standard types of care.