What is access to radiation therapy? A conceptual framework and review of influencing factors

2016 ◽  
Vol 40 (1) ◽  
pp. 11 ◽  
Author(s):  
Puma Sundaresan ◽  
Martin R. Stockler ◽  
Christopher G. Milross

Objectives Optimal radiation therapy (RT) utilisation rates (RURs) have been defined for various cancer indications through extensive work in Australia and overseas. These benchmarks remain unrealised. The gap between optimal RUR and actual RUR has been attributed to inadequacies in ‘RT access’. We aimed to develop a conceptual framework for the consideration of ‘RT access’ by examining the literature for existing constructs and translating it to the context of RT services. We further aimed to use this framework to identify and examine factors influencing ‘RT access’. Methods Existing models of health care access were reviewed and used to develop a multi-dimensional conceptual framework for ‘RT access’. A review of the literature was then conducted to identify factors reported to affect RT access and utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE, 1946 to October 2014 and PsycINFOvia OvidSP,1806 to October 2014. Results The framework developed demonstrates that ‘RT access’ encompasses opportunity for RT as well as the translation of this opportunity to RT utilisation. Opportunity for RT includes availability, affordability, adequacy (quality) and acceptability of RT services. Several factors at the consumer, referrer and RT service levels affect the translation of this opportunity for RT to actual RT utilisation. Conclusion ‘Access’ is a term that is widely used in the context of health service related research, planning and political discussions. It is a multi-faceted concept with many descriptions. We propose a conceptual framework for the consideration of ‘RT access’ so that factors affecting RT access and utilisation may be identified and examined. Understanding these factors, and quantifying them where possible, will allow objective evaluation of their impact on RT utilisation and guide implementation of strategies to modify their effects. What is known about the topic? It is well documented that the use of RT in Australia is well below evidence-based benchmarks. The shortfall in the use of RT has been attributed to problems with access to treatment services. Although considerable attention has been directed (rightly) towards addressing infrastructure needs, access to RT is more than just supply of services. There is currently no specific framework for RT access to comprehensively consider and examine other factors influencing the use of RT. The existing international literature addresses some of the influencing factors. However, there is a need for a detailed review of all actual and potential influencers of RT utilisation. What does this paper add? This paper presents a conceptual framework for the specific consideration of access to RT. A detailed review of various factors affecting access and utilisation of RT has been performed using the aforementioned conceptual framework. To our knowledge this is the first such review and hence we are confident that it adds to the existing international literature on this subject. What are the implications for practitioners? The topic of improving consumers’ access to RT is of relevance locally, in Australia, as well as internationally. We feel that the RT access framework proposed herein will be of interest and use to those involved in health services research, delivery and policy, especially those involved with the planning and delivering of cancer services. In addition to compiling evidence on the subject, the review of factors influencing RT utilisation highlights and proposes areas for future translational and implementation research in the areas of health services and treatment-related decision making.

2014 ◽  
Vol 522-524 ◽  
pp. 797-805 ◽  
Author(s):  
Ying Zhu ◽  
Miao Zhang ◽  
Zhe Han ◽  
Su Ping Feng

In order to know about the variation of PAHs, PCBs and OCPs of sludge in landfill, discover the factors influencing the contents of PAHs, PCBs, OCPs and provide the scientific basis for the agriculture reuse of aged-sludge, the variation of PAHs, PCBs, OCPs contents and influencing factors in sludge landfill were studied in this paper. PAHs concentration of different landfill periods rang from 6.645 to 10.008 mg·kg-1 and show an increasing tendency with the increase of landfill duration. PAHs are mainly composed of more than four benzene-based compounds, and less than three benzene rings compounds contents of PAHs are relatively low. PCBs concentrations rang from 15.655 to 25.569 μg·kg-1 and present a decreasing trend with the landfill time, which far less than the standard of 0.2 mg·kg-1. PCBs at the beginning of the landfill are mainly composed of the 3-Cl and 5-Cl compounds. In the late of the landfill, 2-Cl compounds increase significantly. The range of OCPs concentration is 1.78~2.37 μg·kg-1. The main factors affecting the PAHs, PCBs and OCPs contents are microbial degradation and transformation. Analysis of the pollutants sources indicate that PAHs in sludge are mainly derived from the waste water of refinery, coking plant, gasworks, smelt plant and pitch plant. Chemical industry, timber process and electricity industry are the main sources of PCBs and OCPs in sludge.


Author(s):  
Dede Ansyari Guci ◽  
Puspa Liza Ghazali ◽  
Nik Hazimi Mohd Foziah ◽  
Juliana Arifin

Just a little part of SMEs are fruitful in accomplishing remarkable execution and maintainable development, The writing shows that there is as yet a hole for powerful approaches to expand the size of that division. This paper expects to contribute in filling the hole by distinguishing factors influencing SME execution and, subsequently, their turn of events; and to build up a reasonable system clarifying their connections. The writing uncovers that despite the fact that there is positive connection between government support, training, digital marketing, financial capital and SMEs performance, the relationship is as yet uncertain; proposing that there are mediating develops between the five builds. Field perceptions and writing surveys propose a second-request develops serving directing parts between government support, training, digital marketing, financial capital and SMEs performance that may explain the relationship, i.e., risk control. Albeit the connections among the six builds have been broadly concentrated in the surviving writing, this paper is one of only a handful few endeavors, assuming any, in researching the six develops in an extensive structure as a reason for additional examinations. On the off chance that exactly upheld, the proposed system may give a powerful option in helping business people and SMEs players to build up their venture all the more viably.


2022 ◽  
Vol 8 (1) ◽  
pp. 48
Author(s):  
Meleq Hoxhaj ◽  
Kamolli Erjus

The aim of this paper is to analyse factors affecting tax evasion of businesses in Albania. Business tax evasion is a phenomenon that has to do with people trying not to pay the level of taxes they owe, as such it is understood to be as old a phenomenon as taxation. Factors affecting tax evasion vary from country to country, although they can be grouped into economic, psychological and social factors. Nowadays tax evasion has become an increasingly worrying phenomenon so it is important to analyse the factors that make people have an unethical attitude towards taxes, in order to identify the policies needed to mitigate this phenomenon. In our paper we initially made a description of this phenomenon and the main influencing factors. Following the data collected through a questionnaire in some businesses in Albania we have made an analysis to find the relationship between the tendency for business evasion and demographic factors such as age and gender of the person as well as factors such as the period of operation of the firm in the market, the size of the firm and the perception of the level of fines. The results show that young people, men, new firms in the market, large firms and when the perception of the level of fines is low there is a greater tendency for evasion.


Author(s):  
Tran Minh Hieu ◽  
Nguyen Duong Ngoc Mai Chi

This study applied SERVQUAL scale of Parasuraman et al to measure factors affecting customer satisfaction on service quality at Vietnam Technological and Commercial Joint Stock Bank - An Giang Branch (Techcombank An Giang). The study was conducted to survey 207 customers who have been using the service at Techcombank An Giang. The survey results were analyzed by the Cronbach's Alpha reliability test method, then used Exploratory factor analysis (EFA) to verify and evaluate the scale of service quality. The results of the regression analysis show that customer's satisfaction about service quality at Techcombank An Giang includes four factors: The factor with the highest level is the Empathy with Beta = 0.253, the second of factor is the Responsibility with Beta = 0.248, ranked third in the influence level is the Tangible with Beta = 0.235, and the lowest impact level is the Reliability with Beta = 0.144. The research also uses statistical methods to describe and test the differences of demographic factors with customer's satisfactionon service quality.The analysis results show that there is no difference between customer's satisfaction on service quality and factors such as gender, age, income, number of transaction banks, regular transaction banks, and time to use the service at Techcombank An Giang. Through the research results, the author would like to propose some ideas to improve the quality of services, thereby attracting new customers and importantly, keeping traditional customers because the development orientation of Techcombank is to take care of old customers to cross sell other products of the bank. The Stud results offer a basis for the branch to identify the factors influencing customer satisfaction on their service quality, thereby having an appropriate strategy to improve customer satisfaction.


2015 ◽  
Vol 4 (1and2) ◽  
Author(s):  
Gyanvati

This paper analyses the factors affecting for utilization of maternal healthcare services. Following is the section wise description of the paper. Firstly, the paper looks into socio-economic background of women. Secondly, the paper focuses on usage of maternal healthcare services by women. Thirdly, the paper also traces the factors affecting for usage of maternal healthcare services. Lastly, the paper concludes and suggests by emphasizing the significance of proper utilization of maternal healthcare services that it leads to better health of mother and their newborn child.


2018 ◽  
Vol 52 ◽  
pp. 77 ◽  
Author(s):  
María Beatriz Duarte-Gómez ◽  
Silvia Magali Cuadra-Hernández ◽  
Myriam Ruiz-Rodríguez ◽  
Armando Arredondo ◽  
Jesús David Cortés-GilI

OBJECTIVE: To analyze the impacts of the care to the population displaced by violence on the health system and the challenges that this entails. METHODS: This is a narrative review of the national and international literature in PubMed, SciELO, WHO/PAHO, and Bireme. Inclusion criteria were date of publication ( from 2000), relation with the subject, and language (Spanish or English). We found 292 documents, of which 91 met the inclusion criteria. RESULTS: The main challenges are the intersectoral, participatory, and integral approach (with emphasis on mental health and sexual and reproductive health), ensured accessibility to health services, the need for a reliable registration and information system of the population displaced by violence and its characteristics, and the addressing of the biopsychosocial problems of the different groups, especially women, persons with disabilities or infectious diseases, adolescents, children, ethnic minorities, older adults and the lesbian, gay, bisexual, transsexual, and intersexual population. CONCLUSIONS: The lack of political will to accept and see the internal displacement by violence and its importance as a humanitarian and public health problem is an obstacle to the adequate and timely care of the population displaced by violence in Mexico.


2021 ◽  
pp. 021849232110100
Author(s):  
Neetika Katiyar ◽  
Sandeep Negi ◽  
Sunder Lal Negi ◽  
Goverdhan Dutt Puri ◽  
Shyam Kumar Singh Thingnam

Background Pulmonary complications after cardiac surgery are very common and lead to an increased incidence of post-operative morbidity and mortality. Several factors, either modifiable or non-modifiable, may contribute to the associated unfavorable consequences related to pulmonary function. This study was aimed to investigate the degree of alteration and factors influencing pulmonary function (forced expiratory volume in one second (FEV1) and forced vital capacity), on third, fifth, and seventh post-operative days following cardiac surgery. Methods This study was executed in 71 patients who underwent on-pump cardiac surgery. Pulmonary function was assessed before surgery and on the third, fifth, and seventh post-operative days. Data including surgical details, information about risk factors, and assessment of pulmonary function were obtained. Results The FEV1 and forced vital capacity were significantly impaired on post-operative days 3, 5, and 7 compared to pre-operative values. The reduction in FEV1 was 41%, 29%, and 16% and in forced vital capacity was 42%, 29%, and 19% consecutively on post-operative days 3, 5, and 7. Multivariate analysis was done to detect the factors influencing post-operative FEV1 and forced vital capacity. Discussion This study observed a significant impairment in FEV1 and forced vital capacity, which did not completely recover by the seventh post-operative day. Different factors affecting post-operative FEV1 and forced vital capacity were pre-operative FEV1, age ≥60, less body surface area, lower pre-operative chest expansion at the axillary level, and having more duration of cardiopulmonary bypass during surgery. Presence of these factors enhances the chance of developing post-operative pulmonary complications.


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