Search results for: regional health care

Authors: Anne Prip, Kirsten Alling Møller, Dorte Lisbet Nielsen, Mary Jarden, Marie-Helene Olsen, Anne Kjaergaard Danielsen

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Background: The development in cancer care has shifted towards shorter hospital stays and more outpatient treatment. Today, cancer care and treatment predominantly takes place in outpatient settings where encounters between patients and health care professionals are often brief. This development will probably continue internationally as the global cancer burden seems to be growing significantly. Furthermore, the number of patients who require ambulatory treatments such as chemotherapy is increasing. Focusing on the encounters between health care professionals and patients during oncology treatment has thus become increasingly important due to a growing trend in outpatient cancer management. Objective: The aim of the systematic review was to summarize the literature from the perspective of the patient, on experiences of and the need for communication and relationships with the health care professional during chemotherapy treatment in an outpatient setting. Method: The review was designed and carried out according to the PRISMA guidelines and PICO framework. The systematic search was conducted in Medline, CINAHL, The Cochrane Library and Joanna Briggs Institute Evidence Based Practice Database. Results: In all, 1174 studies were identified by literature search. After duplicates were removed, the remaining studies (n = 1053) were screened for inclusion. Nine studies were included; qualitative (n = 5) and quantitative (n = 4) as they met the inclusions criteria. The review identified that communication and relationships between health care professionals and patients were important for the patients’ ability to cope with cancer and also had an impact on patients’ satisfaction with care in the outpatient clinic. Furthermore, the review showed that hope and positivity was a need and strategy for patients with cancer and was facilitated by health care professionals. Finally, it revealed that outpatient clinic visits framed and influenced communication and relationships. Conclusions: This review identified the significance of communication and the relationships between patients and health care professionals in the outpatient setting as it supports patients’ ability to cope with cancer. The review showed the need for health care professionals to pay attention to the relational aspects of communication in an outpatient clinic as encounters are often brief. Furthermore, the review helps to specify which elements of the communication are central in the patient-health care professional interaction from the patients' perspective. Finally, it shows a need for more research to investigate which type of interaction and intervention would be the most effective in supporting patients’ coping during chemotherapy in an outpatient clinic.

Keywords: ambulatory chemotherapy, communication, health care professional-patient relation, nurse-patient relation, outpatient care, systematic review

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Authors: S. Kurian, S. Satpathy, S. K. Gupta, S. Arya, D. K. Sharma

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Advances in the use of health care technology have resulted in increased adverse events (AEs) related to the use of medical devices. The study focused on the existing reporting systems. This study was conducted in a tertiary care public sector hospital. Devices included Syringe infusion pumps, Cardiac monitors, Pulse oximeters, Ventilators and Defibrillators. A total of 211 respondents were recruited. Interviews were held with 30 key informants. Medical records were scrutinized. Relevant statistical tests were used. Resident doctors reported maximum frequency of AEs, followed by nurses; and least by consultants. A significant association was found between the cadre of health care personnel and awareness that the patients and bystanders have a risk of sustaining AE. Awareness regarding reporting of AEs was low, and it was generally done verbally. Other critical findings are discussed in the light of the barriers to reporting, reasons for non-compliance, recording system, and so on.

Keywords: adverse events, health care technology, medical devices, public sector hospital, reporting systems

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Authors: Andriana E. Tran, Anna Chur-Hansen

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Sexual health is an important aspect of overall wellbeing. This study aimed to explore the sexual health experiences of men aged 50 years and over from the perspective of health care professional participants who were specializing in sexual health care and who consulted with older men. A total of ten interviews were conducted. Eleven themes were identified regarding men’s experiences with sexual health care as reported by participants. 1) Biologically focused: older male clients focus largely on the biological aspect of their sexual health without consideration of other factors which might affect their functioning. 2) Psychological concerns: there is an interaction between mental and sexual health but older male clients do not necessarily see this. 3) Medicalization of sexual functioning: advances in medicine that aid with erectile difficulties which consequently mean that older men tend to favor a medical solution to their sexual concerns. 4) Masculine identity: sexual health concerns are linked to older male clients’ sense of masculinity. 5) Penile functionality: most concerns that older male clients have center on their penile functionality. 6) Relationships: many male clients seek sexual help as they believe it improves relationships. Conversely, having supportive partners may mean older male clients focus less on the physicality of sex. 7) Grief and loss: men experience grief and loss – the loss of their sexual functioning, grief from loss of a long-term partner, and loss of intimacy and privacy when moving from independent living to residential care. 8) Social stigma: older male clients experience stigma around aging sexuality and sex in general. 9) Help-seeking behavior: older male clients will usually seek mechanistic solution for biological sexual concerns, such as medication used for penile dysfunction. 10) Dismissed by health care professionals: many older male clients seek specialist sexual health care without the knowledge of their doctors as they feel dismissed due to lack of expertise, lack of time, and the doctor’s personal attitudes and characteristics. Finally, 11) Lack of resources: there is a distinct lack of resources and training to understand sexuality for healthy older men. These findings may inform future research, professional training, public health campaigns and policies for sexual health in older men.

Keywords: ageing, biopsychosocial model, men's health, sexual health

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Authors: Sengul Celik, Alper Ketenci

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In Turkish Constitution about health care in Article 56, it is said that: everyone has the right to live in a healthy and balanced environment. It is the duty of the state and citizens to improve the environment, protect environmental health, and prevent environmental pollution. The state ensures that everyone lives their lives in physical and mental health; it organizes the planning and service of health institutions from a single source in order to realize cooperation by increasing savings and efficiency in human and substance power. The state fulfills this task by utilizing and supervising health and social institutions in the public and private sectors. General health insurance can be established by law for the widespread delivery of health services. To have health care is one of the basic rights of patients. After the coupe attempt in July 2016, the Government of Turkey has announced a state of emergency and issued lots of emergency decrees. By these emergency decrees, lots of people were dismissed from their jobs and lost their some basic social rights. The violations occur in social life. One of the most common observations is the discrimination by government in health care system. This study aims to put forward the violation of human rights in health care system in Turkey due to their discriminated position by an emergency decree. The study is a case study that is based on nine interviews with the people or relatives of people who lost their jobs by an emergency decree in Turkey. In this study, no personally identifiable information was obtained for the safety of individuals. Also no distinctive questions regarding the identity of individuals were asked. The interviews are obtained through internet call applications. The data were analyzed through the requirements of regular health care system in Turkey. The interviews expose that the people or the relatives of people lost their right to have regular health care. They have to pay extra amount both in clinical services and in medication treatment. The patient right to quality medical care without prejudice is violated. It was assessed that the people who are involved in emergency decree and their relatives are discriminated by government and deprived of regular medical care and supervision. Although international legal arrangements and legal responsibilities of the state have been put forward by Article 56, they are violated in practice. To prevent these kinds of violations, some measures should be taken against the deprivation in health care system especially towards the discriminated people by an emergency decree.

Keywords: emergency decree in Turkey, health care, discriminated people, patients rights

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Authors: Luís Farinha, João J. Ferreira

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Nowadays innovation represents a challenge crucial to remaining globally competitive. This study seeks to develop a conceptual model aimed at measuring the dynamic interactions of the triple/quadruple helix, balancing innovation and entrepreneurship initiatives as pillars of regional competitiveness – the Regional Helix Scoreboard (RHS). To this aim, different strands of literature are identified according to their focus on specific regional competitiveness governance mechanisms. We put forward an overview of the state-of-the-art of research and is duly assessed in order to develop and propose a framework of analysis that enables an integrated approach in the context of collaborative dynamics. We conclude by presenting the RHS for the study of regional competitiveness dynamics, which integrates and associates different backgrounds and identifies a number of key performance indicators for research challenges.

Keywords: entrepreneurship, KPIs, innovation, performance measurement, regional competitiveness, regional helix scoreboard

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Authors: T. Turan, Ç. Erdoğan

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As far as is known, general nursing care practices do not include specific evidence-based practices related to oral care in children. This study aimed to evaluate the evidence based nursing practice for oral care in children. This article is planned as a review article by searching the literature in this field. According to all age groups and the oral care in various specific situations located evidence in the literature were examined. It has been determined that the methods and frequency used in oral care practices performed by nurses in clinics differ from one hospital to another. In addition, it is seen that different solutions are used in basic oral care, oral care practices to prevent ventilator-associated pneumonia and evidence-based practice in mucositis management in children. As a result, a standard should be established in oral care practices for children and education for children is recommended.

Keywords: evidence-based practice, oral care, nursing, children

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Authors: Tewelde Gebreslassie Gebreanenia, Frie Ayalew Yimam, Seada Hussen Adem

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Patient safety and quality of care are essential goals of health care delivery, but they are often compromised by human errors, system failures, or resource constraints. In a variety of healthcare contexts, artificial intelligence (AI), a quickly developing field, can provide fresh approaches to enhancing patient safety and treatment quality. Artificial Intelligence (AI) has the potential to decrease errors and enhance patient outcomes by carrying out tasks that would typically require human intelligence. These tasks include the detection and prevention of adverse events, monitoring and warning patients and clinicians about changes in vital signs, symptoms, or risks, offering individualized and evidence-based recommendations for diagnosis, treatment, or prevention, and assessing and enhancing the effectiveness of health care systems and services. This study examines the state-of-the-art and potential future applications of AI-based technologies for enhancing patient safety and care quality, as well as the opportunities and problems they present for patients, policymakers, researchers, and healthcare providers. In order to ensure the safe, efficient, and responsible application of AI in healthcare, the paper also addresses the ethical, legal, social, and technical challenges that must be addressed and regulated.

Keywords: artificial intelligence, health care, human intelligence, patient safty, quality of care

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Authors: Seongho Han, Dongkwan Kim

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The focus of regional innovation policies is shifting from a central government to local governments. The central government demands that regions enforce autonomous and responsible regional innovation policies and that regional governments seek for innovation policies fit for regional characteristics. However, the central government and local governments have not arrived yet at a conclusion on what innovation policies are appropriate for regional circumstances. In particular, even if each local government is trying to find regional innovation strategies that are based on the needs of a region, its innovation strategies turn out to be similar with those of other regions. This leads to a consequence that is inefficient not only at a national level, but also at a regional level. Existing researches on regional innovation types point out that there are remarkable differences in the types or characteristics of innovation among the regions of a nation. In addition they imply that there would be no expected innovation output in cases in which policies are enforced with ignoring such differences. This means that it is undesirable to enforce regional innovation policies under a single standard. This research, given this problem, aims to find out the characteristics and differences in innovation types among the regions in Korea and suggests appropriate policy implications by classifying such characteristics and differences. This research, given these objectives, classified regions in consideration of the various indicators that comprise the innovation suggested by existing related researches and illustrated policies based on such characteristics and differences. This research used recent data, mainly from 2012, and as a methodology, clustering analysis based on multiple factor analysis was applied. Supplementary researches on dynamically analyzing stability in regional innovation types, establishing systematic indicators based on the regional innovation theory, and developing additional indicators are necessary in the future.

Keywords: regional innovation policy, regional innovation type, region-based innovation, multiple factor analysis, clustering analysis

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Authors: Hazel S. Cometa-Lamberte

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This paper presents the residential care workers reflections in working with children who were under protective custody and placed in a residential care facility for children. Key informant interviews and focus group discussion were employed in this study to analyze the views of residential care workers on the programs and services and case management system in residential care for children. Results suggest that working in a residential care facility for children needs the interplay of both the worker’s personal and professional values, knowledge and skills in working with children. Analyzing the residential care workers experiences in handling children in residential care facilities is vital for the improvement of the policies, programs and services, the repertoire of techniques and facilitate the creation of a new social work practice framework/model in child protection specifically in residential care facilities.

Keywords: child protection, residential care, residential care workers, social workers

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Authors: Ge Zhan

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Mobile health (mHealth) concerns the use of mobile technologies to deliver health care and improve wellness. In this paper, we ask the question of what are the drivers of positive consumer attitude toward mHealth programs. Answers to this question are important to consumer health, but existing marketing and health care service literature does not provide sufficient empirical conclusions on the use of mobile technologies for consumer health. This study aims to fill the knowledge gap by investigating mHealth use and consumer attitude. A content analysis was conducted with sample mHealth programs and online consumer reviews in Hong Kong, UK, US, and India. The research findings will contribute to marketing and health services literature.

Keywords: mobile health, consumer attitude, content analysis, online marketing

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Authors: Ivan N. Gallegos, Merle Dawn Comidoy, Mira Sol Cabal, Paul Martin Acol, Arnie Polistico

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Barangay Health Workers (BHWs) are the lead health advocates who provide basic health care services at the grass-roots level. Hence, adequate skills and training are needed to deliver these services effectively. The study aimed at identifying the communication needs of Barangay health workers situated at the dumpsite of Davao City, Philippines, gravitating towards designing a communication plan tailor-fitted to their needs. It employed a qualitative research design, particularly an in-depth interview of the health workers. Several communication problems were identified, including the lack of participation of BHWs in the Barangay development plan, the lack of a continuous skills enhancement program, ineffective communication strategies resulting in insufficient knowledge of proper personal hygiene, and the inactive participation of community members in health services. Based on these communication problems, the following activities and training were suggested: capacitating BHWs on writing proposals and plans; basic communication skills training; educational seminars for parents; and a sanitation campaign.

Keywords: communication planning, health care services, Barangay health workers, communication strategies

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Authors: Sehrish Ather

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Introduction: To improve organizational achievements through the production of new knowledge, health policy and system research is the basic requirement. An aging population is always the source of the increased burden of chronic diseases, disabilities, mental illnesses, and other co-morbidities; therefore the provision of quality health care services to every group of the population should be achieved by making strong policy and system research for the betterment of health care system. Unfortunately, the whole world is lacking policies and system research for providing health care to their elderly population. Materials and Methods: A literature review of published studies on aging diseases was done, ranging from the year 2011-2018. Geriatric, population, health policy, system, and research were the key terms used for the search. Databases searched were Google Scholar, PubMed, Science Direct, Ovid, and Research Gate. Grey literature was searched from various websites, including IHME, Library of the University of Lahore, World Health Organization (Ageing and Life Course), and Personal communication with Neuro-physicians. After careful reviewing published and un-published information, it was decided to carry on with commentary. Results and discussion: Most of the published studies have highlighted the need to advocate the funders of health policy and stakeholders of healthcare system research, and it was detected as a major issue, research on policy and healthcare system to provide health care to 'geriatric population' was found as highly neglected area. Conclusion: It is concluded that physicians are more involved with the policy and system research regarding any type of diseases, but scientists and researchers of basic and social science are less likely to be involved in methods used for health policy and system research due to lack of funding and resources. Therefore ageing diseases should be considered as a priority, and comprehensive policy and system research should be initiated for diseases of the geriatric population.

Keywords: geriatric population, health care system, health policy, system research

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Authors: Sandra Soca Lozano, Teresa Isabel Lozano Pérez, Germain Weber

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Cancer is a chronic disease of high prevalence in children and adolescents. Medical care in Cuba is carried out by a multidisciplinary team and family is the mediator between this team and the patient. Around this disease, there are interwoven many stereotypes and taboos by its relation to death. In this research report, we describe the work paradigm of psychological care to patients suffering from these diseases in the University Pediatric Hospital Juan Manuel Márquez of Havana, Cuba. We present the psychosocial factors that must be taken into account to provide comprehensive care and ensuring the quality of life of patients and their families. We also present the factors related to the health team and the management of information done with the patient. This is a descriptive proposal from the working experience accumulated in the named institution and in the review of the literature. As a result of this report we make a proposal of teamwork and the aspects in which psychological intervention should be continue performing in terms of increasing the quality of the care made by the health team. We conclude that it is necessary to continue improving the information management of children and adolescents with theses health problems and took into account their right to autonomy.

Keywords: comprehensive care, management of information, psychosocial factors, right to autonomy

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Authors: Nasim Hashemi, Abbas Sheikhtaheri

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Telemedicine is the use of telecommunication and information technologies to provide health care services that would often not be consistently available in distant rural communities to people at these remote areas. Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Thus, teleophthalmology can overcome geographical barriers and improve quality, access, and affordability of eye health care services. Since teleophthalmology has been widespread applied in recent years, the aim of this study was to determine the different applications of teleophthalmology in the world. To this end, three bibliographic databases (Medline, ScienceDirect, Scopus) were comprehensively searched with these keywords: eye care, eye health care, primary eye care, diagnosis, detection, and screening of different eye diseases in conjunction with telemedicine, telehealth, teleophthalmology, e-services, and information technology. All types of papers were included in the study with no time restriction. We conducted the search strategies until 2015. Finally 70 articles were surveyed. We classified the results based on the’type of eye problems covered’ and ‘the type of telemedicine services’. Based on the review, from the ‘perspective of health care levels’, there are three level for eye health care as primary, secondary and tertiary eye care. From the ‘perspective of eye care services’, the main application of teleophthalmology in primary eye care was related to the diagnosis of different eye diseases such as diabetic retinopathy, macular edema, strabismus and aged related macular degeneration. The main application of teleophthalmology in secondary and tertiary eye care was related to the screening of eye problems i.e. diabetic retinopathy, astigmatism, glaucoma screening. Teleconsultation between health care providers and ophthalmologists and also education and training sessions for patients were other types of teleophthalmology in world. Real time, store–forward and hybrid methods were the main forms of the communication from the perspective of ‘teleophthalmology mode’ which is used based on IT infrastructure between sending and receiving centers. In aspect of specialists, early detection of serious aged-related ophthalmic disease in population, screening of eye disease processes, consultation in an emergency cases and comprehensive eye examination were the most important benefits of teleophthalmology. Cost-effectiveness of teleophthalmology projects resulted from reducing transportation and accommodation cost, access to affordable eye care services and receiving specialist opinions were also the main advantages of teleophthalmology for patients. Teleophthalmology brings valuable secondary and tertiary care to remote areas. So, applying teleophthalmology for detection, treatment and screening purposes and expanding its use in new applications such as eye surgery will be a key tool to promote public health and integrating eye care to primary health care.

Keywords: applications, telehealth, telemedicine, teleophthalmology

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Authors: Nditsheni Ramakuela, Sonto Maputle, Base Khoza, Augustine Tugli

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Inadequate health literacy can cause difficulties in understanding and compliance to treatment plan. With diabetic condition, self-care activities include behaviours of following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care. Patients with poor health literacy have difficulty interpreting medication warning labels, following directions on a prescription label and identifying their medications. Difficulties in understanding and performing self-care and health-related activities may ultimately lead to poor health outcomes. The study explored and described factors affecting health literacy and self-care to diabetic regimen by female patients at selected hospital in Limpopo Province of South Africa. Qualitative and explorative research design was used. Female patients who were admitted and diagnosed with diabetes in female medical ward constituted the study population. Non-probability, purposive sampling was used to select 20 female patients diagnosed with diabetes, who were above 18 years and admitted during April–November 2014. An in-depth face-to-face, unstructured interview was used to collect data. Data were analysed using open coding method. Measures to ensure trustworthiness and ethical considerations were adhered to. Findings revealed factors affecting health literacy for diabetic self-care activities amongst patients were; patient, family, disease and facility related. Proposed recommendations were; to strengthen diabetes education and patient-provider partnership. This is important and must be transferred to strengthen self-care activities to fully benefit the patient.

Keywords: compliance, diabetes mellitus, diabetic regimen, health literacy, self activities

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Authors: Eduard Fosch-Villaronga

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This paper pioneers Care Robot Impact Assessment (CRIA), a methodology used to identify, analyze, mitigate and eliminate the risks posed by the insertion of non-medical personal care robots (PCR) in medical care facilities. Its precedent instruments (Privacy and Surveillance Impact Assessment (PIA and SIA)) fall behind in coping with robots. Indeed, personal care robots change dramatically how care is delivered. The paper presents a specific risk-sector methodology, identifies which robots are under its scope and presents some of the challenges introduced by these robots.

Keywords: ethics, impact assessment, law, personal care robots

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Authors: Ruttana Phetsitong, Patama Vapattanawong, Malee Sunpuwan, Marc Voelker

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The majority of care for older people at home in Thai society falls upon caregivers resulting in caregiver’s mental health problem. Beyond individual characteristics, household factors might have a profound effect on the caregiver’s mental health. But reliable data capturing this at the household level have been limited to date. The objectives of the present study were to explore the levels of Thai caregiver’s mental health and to investigate the factors affecting the mental health at household level. Data were obtained from the 2011 National Survey of Thai Older Persons conducted by the National Statistical Office of Thailand. Caregiver’s mental health was measured by using the 15- items-short version of the Thai Mental Health Indicator (TMHI-15) developed by the Department of Mental Health, the Ministry of Public Health. Multivariate logistic regression models were used to explore the impact of potential factors on caregiver’s mental health. The THMI-15 produced an overall average caregiver mental health score of 30.9 out of 45 (SD 5.3). The score can be categorized into good (34.02-45), fair (27.01-34), and poor (0-27). Duration of care for older people, household wealth, and functional dependency of the older people significantly predicted total caregiver’s mental health. Household economic factor was key in predicting better mental health. Compared to those poorest households, the adjusted effect of the fifth quintile household wealth was high (OR=2.34; 95%CI=1.47-3.73). The findings of this study provide a fuller picture to a better understanding of the level and factors that cause the mental health of Thai caregivers. Health care providers and policymakers should consider these factors when designing interventions aimed at alleviating caregiver’s psychological burden when provided care for older people at home.

Keywords: caregiver’s mental health, household, older people, Thailand

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Authors: Gudakesh Yadav

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Uttar Pradesh is one of the poorest performing states of India in terms of child health. Using data from the three round of NFHS and two rounds of DLHS, this paper attempts to examine tempo-spatial change in child health and care practices in Uttar Pradesh and its regions. Rate-ratio, CI, multivariate, and decomposition analysis has been used for the study. Findings demonstrate that child health care practices have improved over the time in all regions of the state. However; western and southern region registered the lowest progress in child immunization. Nevertheless, there is no decline in prevalence of diarrhea and ARI over the period, and it remains critically high in the western and southern region. These regions also poorly performed in giving ORS, diarrhoea and ARI treatment. Public health services are least preferred for diarrhoea and ARI treatment. Results from decomposition analysis reveal that rural area, mother’s illiteracy and wealth contributed highest to the low utilization of the child health care practices consistently over the period of time. The study calls for targeted intervention for vulnerable children to accelerate child health care service utilization. Poor performing regions should be targeted and routinely monitored on poor child health indicators.

Keywords: Acute Respiratory Infection (ARI), decomposition, diarrhea, inequality, immunization

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Authors: Issa M. Hweidi, Saba W. Al-Ibraheem

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This study aimed to assess the increased hospital length of stay and healthcare costs associated with SSIs among ventriculoperitoneal shunting surgery patients in Jordan. This study adopted a retrospective and nested 1:1 matched case-control design. A non-probability convenient sample of 48 VP shunt patients was recruited for the purpose of the study. The targeted groups of the study basically used to cross-match the variables investigated to minimize the risk of confounding. Information was extracted from the text of patients' electronic health records. As compared to the non-SSI group, the SSI group had an extra mean healthcare cost of $13,696.53 (p=0.001) and longer hospital length of stay (22.64 mean additional days). Furthermore, Acinetobacter baumannii and Klebsiella pneumonia were identified as being the most predominant causative agents of SSIs. The results of this study may provide baseline data for national and regional benchmarking to evaluate the quality of care provided to likewise patients. Adherence to infection control strategies and protocols considering new surveillance methods of SSIs is encouraged.

Keywords: ventriculoperitoneal shunt, health care cost, length of stay, neurosurgery, surgical site infections

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Authors: Patcharaporn Sakulpong, Wiriya Phokhwang

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Background: Banpunrug (Love Sharing House) established in 2013 provides a community-based palliative care for patients with cancer from 7 provinces in southern Thailand. These patients come to receive outpatient chemotherapy and radiotherapy at Suratthani Cancer Hospital. They are poor and uneducated; they need an accommodation during their 30-45 day course of therapy. Methods: A community-participatory action research (PAR) was employed to establish a model of palliative care for patients with cancer. The participants included health care providers, community, and patients and families. The PAR process includes problem identification and need assessment, community and team establishment, field survey, organization founding, model of care planning, action and inquiry (PDCA), outcome evaluation, and model distribution. Results: The model of care at Banpunrug involves the concepts of HHHS model, in that Banpunrug is a Home for patients; patients live in a house comfortable like in a Hotel resource; the patients are given care and living facilities similarly to those in a Hospital; the house is a School for patients to learn how to take care themselves, how to live well with cancer, and most importantly how to prepare themselves for a good death. The house is also a humanized care school for health care providers. Banpunrug’s philosophy of care is based on friendship therapy, social and spiritual support, community partnership, patient-family centeredness, Live & Love sharing house, and holistic and humanized care. With this philosophy, the house is managed as a home of the patients and everyone involved; everything is costless for all eligible patients and their family members; all facilities and living expense are donated from benevolent people, friends, and community. Everyone, including patients and family, has a sense of belonging to the house and there is no authority between health care providers and the patients in the house. The house is situated in a temple and a community and supported by many local nonprofit organizations and healthcare facilities such as a health promotion hospital at sub-disctrict level and Suratthani Cancer Hospital. Village health volunteers and multi-professional health care volunteers have contributed not only appropriate care, but also knowledge and experience to develop a distinguishing HHHS community-based palliative care model for patients with cancer. Since its opening the house has been a home for more than 400 patients and 300 family members. It is also a model for many national and international healthcare organizations and providers, who come to visit and learn about palliative care in and by community. Conclusions: The success of this palliative care model comes from community involvement, multi-professional volunteers and distributions, and concepts of HHHS model. Banpunrug promotes a consistent care across the cancer trajectory independent of prognosis in order to strengthen a full integration of palliative

Keywords: community-based palliative care, model, participatory action research, patients with cancer

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Authors: Ruoyu Mao

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Exploring the relationship between urban green development and regional integration level is of great significance for realising regional high quality and sustainable development. Based on the Tapio decoupling model and the theoretical framework of urban green development and regional integration, this paper builds an analysis system, makes a quantitative analysis of urban green development and regional integration level in a certain period, and discusses the relationship between the two. It also takes China's Yangtze River Delta urban agglomeration as an example to study the degree of decoupling, the type of decoupling, and the trend of the evolution of the spatio-temporal pattern of decoupling between the level of urban green development and the level of regional integration in the period of 2014-2021, with the aim of providing a useful reference for the future development of the region.

Keywords: regional integration, urban green development, Tapio decoupling model, Yangtze River Delta urban agglomeration

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Authors: Gayathri Nagarajan, L. D. Dhinesh Babu

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Health care is one of the prominent industries that generate voluminous data thereby finding the need of machine learning techniques with big data solutions for efficient processing and prediction. Missing data, incomplete data, real time streaming data, sensitive data, privacy, heterogeneity are few of the common challenges to be addressed for efficient processing and mining of health care data. In comparison with other applications, accuracy and fast processing are of higher importance for health care applications as they are related to the human life directly. Though there are many machine learning techniques and big data solutions used for efficient processing and prediction in health care data, different techniques and different frameworks are proved to be effective for different applications largely depending on the characteristics of the datasets. In this paper, we present a framework that uses ensemble machine learning technique gradient boosted trees for data classification in health care big data. The framework is built on Spark platform which is fast in comparison with other traditional frameworks. Unlike other works that focus on a single technique, our work presents a comparison of six different machine learning techniques along with gradient boosted trees on datasets of different characteristics. Five benchmark health care datasets are considered for experimentation, and the results of different machine learning techniques are discussed in comparison with gradient boosted trees. The metric chosen for comparison is misclassification error rate and the run time of the algorithms. The goal of this paper is to i) Compare the performance of gradient boosted trees with other machine learning techniques in Spark platform specifically for health care big data and ii) Discuss the results from the experiments conducted on datasets of different characteristics thereby drawing inference and conclusion. The experimental results show that the accuracy is largely dependent on the characteristics of the datasets for other machine learning techniques whereas gradient boosting trees yields reasonably stable results in terms of accuracy without largely depending on the dataset characteristics.

Keywords: big data analytics, ensemble machine learning, gradient boosted trees, Spark platform

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Authors: Karina Guimaraes, Lilian Santos

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This study has the purpose of planning and instituting monitoring actions as a way of knowing the scenario of assistance to the patient with stoma, treated in the public health network in Brazil, from January to November of the year 2016, from the elaboration of a technical document containing the survey of the number of procedures offered and the value of the ostomy services, accredited in the Unified Health System-SUS. The purpose of this document is to improve the quality of these services in the efficient management of available financial resources, making it indispensable for the creation of strategies for the implementation and implementation of care services for people with stomata as a strategic tool in the promotion, prevention, qualification and efficiency in health care.

Keywords: health economic, management, ostomy, unified health system

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Authors: Pascal Gliesche, Kathrin Seibert, Christian Kowalski, Dominik Domhoff, Max Pfingsthorn, Karin Wolf-Ostermann, Andreas Hein

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Robotic assistance in nursing care is an increasingly important area of research and development. Facing a shortage of labor and an increasing number of people in need of care, the German Nursing Care Innovation Center (Pflegeinnovationszentrum, PIZ) aims to address these challenges from the side of technology. Little is known about nurses experiences with existing robotic assistance systems. Especially nurses perspectives on starting points for the development of robotic solutions, that target recurring burdensome tasks in everyday nursing care, are of interest. This paper presents findings focusing on robotics resulting from an explanatory mixed-methods study on nurses experiences with and their expectations for innovative technologies in nursing care in stationary and ambulant care facilities and hospitals in Germany. Based on the findings, eight scenarios for robotic assistance are identified based on the real needs of practitioners. An initial system addressing a single use-case is described to show perspectives for the use of robots in nursing care.

Keywords: robotics and automation, engineering management, engineering in medicine and biology, medical services, public health-care

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Authors: Jin Hun Choi, So Hyun Ahn, Seong Keun Wang, Ik-Seung Chee, Jung Lan Kim, Sun Woo Lee

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Objectives: The purpose of the study is to investigate the effects of day hospital care in hospitalized schizophrenic patients in terms of treatment adherence and treatment outcomes. Methods: Among schizophrenic patients hospitalized between 2011 and 2012, 23 day hospital care patient and 40 control subjects were included in the study. All candidates underwent Beck Cognitive Insight Scale, Drug Attitude Inventory, World Health Organization Quality of Life Assessment and Psychological Well-Being Scale when their symptoms were stabilized during hospitalization, and after being discharged, 23 patients received day hospital care for two months and then changed to out-patient care while 40 patients received out-patient care immediately after discharge. At the point of two months of out-patient care, the treatment adherence of the two groups was evaluated; tracking observation was performed until February, 2013, and survival rates were compared between the two groups. Results: Treatment adherence was higher in the day hospital care group than in the control group. Kaplan-Meier survival analysis showed a higher survival rate for the day hospital care group compared to the control group. Levels of cognitive insight and quality of life were higher after day hospital care than before day hospital care in the day hospital care group. Conclusions: Through the study, it was confirmed that when hospitalized schizophrenic patients received continuous day hospital care after being discharged, they received further out-patient care more faithfully. The study is considered to aid in the understanding regarding schizophrenic patients’ treatment adherence issues and improvement of treatment outcomes.

Keywords: schizophrenia, day hospital care, adherence, outcomes

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Authors: C. Sridawruang

Abstract:

Young people today has sexual activities differing from those of earlier generations, in that teenagers are likely to have multiple partners, and are frequently in short-term relationships or with partners that are not well known to them. The proportion of teenage mothers in Thailand has increased. Young people were not specifically addressed during the overall very successful HIV-prevention campaigns. Because of this missed opportunity, they are still unaware of the risk of unsafe sexual behavior. Aims: To describe the reproductive health care services in perspectives of rural Thai teenagers Methods: This survey was one part of a mixed method approach taken using survey and focus groups with 439 teenagers aged 12-18 years in 5 villages, Udon Thani, Thailand. The standard questionnaire survey had been used for collecting data. The numeric data was checked and analyzed by using descriptive statistics. Results: Most teenager respondents stated that they do not know where sexual reproductive health services provided for them. Most teenagers felt difficult to access and talk with health staff about sexual related issues. They stated that discussing, or consulting with health providers might not be safe. Teenagers might lose opportunities to access and get advice from health care services. The mean knowledge score of contraception and condom reproductive was 6.34 from a total score 11. Most teenagers especially girls expressed a need for counseling services and reported a need for telephone services. Conclusions: The need of appropriate information focusing on sexual relationships and contraception should be designed to help young people make wise decisions and there should be set health care services for Thai teenagers to make sure that teenagers could access easily. Health care providers need to be trained to improve their knowledge, attitudes and skills in reproductive health care practices for Thai teenagers.

Keywords: youth friendly health services, rural, Thai, teenagers

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Authors: Jeetendra Yadav, Geetha Menon, Anita Pal, Rajkumar Verma

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Even after encouraging maternal and child wellness programs at worldwide level, lower-middle income nations are not reached the goal set by the UN yet. This study quantified the contribution of socioeconomic determinants of inequality to the utilization of Antenatal Care in South Asian Countries. This study used data from Demographic Health Survey (DHS) of the selected countries were used, and Oaxaca decomposing were applied for socioeconomic inequalities in utilization of antenatal care. Finding from the multivariate analysis shows that mother’s age at the time of birth, birth order and interval, mother’s education, mass media exposure and economic status were significant determinants of the utilization of antenatal care services in South Asian countries. Considering, concentration index curve, the line of equity was greatest in Pakistan which followed by India and Nepal.

Keywords: antenatal care, decomposition, inequalities, South Asian countries

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Authors: Hyunsik Park

Abstract:

Objective: To provide information of charged nursing care facility for helping to establish geriatric health care policy, and to figure out which factors would be the main determinants for the choice of it. Method: 46 males and 53 females, and the same number of their caregivers admitted into the charged nursing care facility were recruited for intensive interview including personal information, disease information, and economic, familial, marital and emotional statuses. This is a cross-sectional study and we analyzed the data qualitatively. Results: Patients had 3.2 diseases and a hospitalization for 2.3 years on average. They were consists of 46 singles (46.9%), 8 unmarried (8.2%), 5 divorced (5.1%) and 32 married (32.7%). More than two third (70.1%) were supported by their eldest son or daughter. Mostly, the family caregivers decided to admit into the facilities by the doctor’s recommendation (68.4%). When they made a choice for a facility, most of them (42.9%) considered environmental and sanitary conditions. According to their expectation for management in nursing care facility, most caregivers (59.2%) wanted simple-staying for the duration, but most patients (61.3%) expected to be home after taking comprehensive rehabilitation. Three-quarter of the caregivers would agree to use nursing care facilities in the future, if they would be the same situation. Conclusion: Life style and environment are rapidly changing. In the near future, we need lots of the charged nursing care facilities for the old, thus this study can be the good reference for the preparing upcoming aged and super-aged society.

Keywords: nursing care facility, aged society, qualitative analysis, health

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Authors: J. Dutton, L. Knight

Abstract:

Achieving quality and respectful maternal health care is part of the global agenda to improve reproductive health and achieve universal reproductive rights. Barriers to quality of care in South African maternal health facilities exist at both systemic and individual levels. Addition to this, the normalization of gender violence within South Africa has a large impact on people seeking health care as well as those who provide care within health facilities. The hierarchical environment of South Africa’s public health system penalizes both patients and providers who battle to assume any assessable power. This paper explores how systemic and individual level barriers to quality of care affect the midwifery profession within South African maternal health services and create, at times, an environment of enmity rather than care. This paper analyzes and discusses the data collected from in-depth, semi-structured interviews with nurses and midwives at three maternal health facilities in South Africa. This study has taken a holistic approach to understand the realities of nurses and midwives in order to explore the ways in which experience informs their practice and treatment of pregnant women. Through collecting and analyzing narratives, linkages between nurses and midwives day-to-day and historical experiences and disrespectful care have been made. Findings from this study show that barriers to quality of care take form in complex and interrelated ways. The physical structure of the health facility, human resource shortages, and the current model of maternal health care, which often lacks a person-centered approach, is entangled within personal beliefs and attitudes of what it means to be a midwife to create an environment that is often not conducive to a positive birthing experience. This entanglement sits within a society of high rates of violence, inequality, and poverty. Having teased out the nuances of each of these barriers and the multiple ways they reinforce each other, the findings of this paper demonstrate that birth, and the work of a midwife, are situated in a mode of discipline and punishment within this context. For analytical purposes, this paper has broken down the individual barriers to quality care and discusses the current and historical significance before returning to the interrelated forms in which barriers to quality maternal health care manifest. In conclusion this paper questions the role of agency in the ability to subvert systemic barriers to quality care and ideas around shifting attitudes and beliefs of and about midwives. International and local policies and guidelines have a role to play in realizing such shifts, however, as this paper suggests, when policy does not speak to the local context there is the risk of it contributing to frustrations and impeding the path to quality and respectful maternal health care.

Keywords: disrespect and abuse in childbirth, midwifery, South African maternal health care, quality of care

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Authors: Doriane Micaela Andeme Bikoro, Samuel Fosso Wamba, Jean Robert Kala Kamdjoug

Abstract:

Currently one of the leading fields in the market of technological innovation is digital health. In developed countries, this booming innovation is experiencing an exponential speed. We understand that in developed countries, e-health could also revolutionize the practice of medicine and therefore fill the many failures observed in medical care. Everything leads to believe that future technology is oriented towards the medical sector. The aim of this work is to explore at the same time the technological resources and the potential of health care based on new technologies; it is a case study in a rural area of Southern Cameroon. Among other things, we will make a census of the shortcomings and problems encountered, and we will propose various appropriate solutions. The work methodology used here is essentially qualitative. We used two qualitative data collection techniques, direct observation, and interviews. In fact, we spent two weeks in the field observing and conducting some semi-directive interviews with some of those responsible for these health structures. This study was conducted in three health facilities in the south of the country; including two health centers and a rural hospital. Many technological failures have been identified in the day-to-day management of these health facilities and especially in the administration of health care to patients. We note major problems such as the digital divide, the lack of qualified personnel, the state of isolation of this area. This is why various proposals are made to improve the health sector in Cameroon both technologically and medically.

Keywords: Cameroon, capacities, census, digital health, qualitative method, rural area

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