Guatemala's health poses early challenge for Morales

2016 ◽  
Keyword(s):  
Medical Students ◽  
Health Service ◽  
Healthcare System ◽  
Zika Virus ◽  
Large Scale ◽  
Content Type ◽  
Additional Pressure

Subject Guatemala's struggling health service. Significance Repeated protests have taken place in Guatemala since late 2015, calling for greater investment in the struggling healthcare system. Recently elected President Jimmy Morales will come under pressure to allocate more funds to the system but Guatemala's precarious fiscal situation will prevent the large-scale investment that is required for major improvements. Impacts The healthcare system will come under additional pressure in the coming months as a result of the Zika virus, which emerged in late 2015. Protests (comprising largely doctors, medical students, patients and their families) could escalate if the issue remains unaddressed. Morales may prioritise his anti-corruption campaign, which could be expanded to address irregularities in the healthcare system.

Health service system in transition

2016 ◽  
Vol 21 (4) ◽  
pp. 204-221 ◽  
Author(s):  
Chhavi Sodhi ◽  
Pushpendra Singh
Keyword(s):  
Health Service ◽  
Healthcare System ◽  
Service Sector ◽  
Service System ◽  
Healthcare Sector ◽  
Indian Health Service ◽  
Content Type ◽  
Indian Health ◽  
The People ◽  
Health Service System

Purpose The purpose of this paper is to present a historical overview of the health service sector in India. The development in the healthcare sector from the late eighteenth century into current times is examined from the prism of the role played by British and US healthcare systems in influencing change in the Indian setup. Design/methodology/approach Online databases searched were PubMed and JSTOR, using the search terms, “Indian health service system in transition”, “British influence on the Indian healthcare setup” and “American neo-liberal influence on Indian healthcare sector”. The authors then examined titles and abstracts of selected articles for short-listing relevant articles. Reference lists of selected articles were examined for further locating related studies. While this constituted the secondary literature for the current paper, reports by governmental and non-governmental organisation reports on the Indian health service system too were utilised as primary data sources. Findings Influenced by the British and later by the American healthcare system, the Indian healthcare network has undergone numerous changes. In the present era, the Indian healthcare system is increasingly veering towards the American model of healthcare delivery. Health is increasingly being conceived of as a commodity to be traded in the market, with the state’s role curtailed towards provisioning for and facilitating access of the weakest sections of the society through a means-tested insurance system. This has happened without adequate checks and balances on the private sector to ensure that the needs of the people accessing the system are adequately met. Social implications By tracing the development of the health service sector in India and the motives that guide such change, the paper depicts how the thrust of the system has altered from one providing universal healthcare services to the people, irrespective of their ability to pay, at the time of independence to commercialisation in present times. With the marketisation of healthcare, the focus has shifted from serving people to profiting from the provisioning of healthcare. Originality/value The paper throws light on the underlying inadequacies of the Indian healthcare setup and the need for more active participation by the government in this sector in the future if it aims to make healthcare more equitably accessible to its vast population.

Appreciative enquiry peer review improving quality of services

2019 ◽  
Vol 32 (5) ◽  
pp. 857-866
Author(s):  
Frank R. Burbach ◽  
Sarah K. Amani
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Peer Review ◽  
Large Scale ◽  
Service Development ◽  
Service Improvement ◽  
Content Type ◽  
Early Intervention In Psychosis ◽  
Health Service Improvement

Purpose Mental health service improvement initiatives often involve the setting of targets and monitoring of performance. The purpose of this paper is to describe the application of appreciative enquiry (AE), a radically different but complementary approach to quality assurance and improvement, to specialist mental health services across a health region. Design/methodology/approach This case study describes a regional quality improvement (QI) project involving 12 early intervention in psychosis (EIP) services in South West England. In total, 40 people were trained in AE interviewing skills and in non-reciprocal peer review visits 59 interviews were conducted involving 103 interviewees including service users, carers, clinicians, managers and commissioners. Immediate verbal feedback was provided and main themes summarised in individual reports to host teams using the following headings: team values, strengths, dreams and development plans. A thematic analysis was conducted on team reports and a project report produced which summarised the stages and results of this regional initiative. Findings All participants rated the experience as positive; it enhanced staff motivation and led to service development and improvement. Research limitations/implications The experiences of these 12 EIP teams may not necessarily be generalisable to other services/regions but this positive approach to service improvement could be widely applied. Practical implications AE is applicable in large-scale QI initiatives. Originality/value To the authors knowledge this is the first time that AE has been applied to large-scale mental health service improvement and innovation.

The adoption of technology orientation in healthcare delivery

2010 ◽  
Vol 4 (4) ◽  
pp. 355-374 ◽  
Author(s):  
Olivia F. Lee ◽  
Matthew L. Meuter
Keyword(s):  
Healthcare System ◽  
Large Scale ◽  
Driving Forces ◽  
Healthcare Delivery ◽  
Future Research ◽  
Extensive Literature ◽  
Patient Centered ◽  
Content Type ◽  
Research Activities ◽  
Technology Orientation

PurposeThe purpose of this paper is to explore the role of technology through the study of electronic health record system in delivering patient‐centered services. The goal is to identify the antecedents and consequences of adopting a technology orientation (TECHOR) approach in a large‐scale hospital and healthcare system.Design/methodology/approachA grounded approach is used whereby extensive literature review and field studies were conducted over a two‐year period. The three major field research activities included observation on hospital premises, semi‐structured interviews, and focus group discussions with hospital employees from a large‐scale hospital and healthcare system.FindingsThe findings reveal that TECHOR is institutionalized as a result of its demonstrated effectiveness in delivering patient‐centered services with improved cost effectiveness, efficiency, safety, and quality control.Research limitations/implicationsEmpirical testing of the presented framework is an important future research direction to validate the current qualitative investigation.Practical implicationsBy understanding the driving forces and consequences of TECHOR, healthcare managers can better understand and manage their technology initiatives. Such effort will help healthcare organizations to create new services in meeting evolving demands and establishing long‐lasting competitive advantage.Originality/valueThis paper fulfills a research gap by presenting a firm‐level construct crucial to successful planning and implementation of technology‐enabled health services.

scholarly journals Educating a health service workforce about dementia: a qualitative study

2016 ◽  
Vol 17 (2) ◽  
pp. 119-130 ◽  
Author(s):  
Lesley Baillie ◽  
Eileen Sills ◽  
Nicola Thomas
Keyword(s):  
Health Service ◽  
Qualitative Study ◽  
Focus Groups ◽  
Large Scale ◽  
Longitudinal Design ◽  
Phase 1 ◽  
Organisational Culture ◽  
Long Term Effects ◽  
Content Type ◽  
Support Person

Purpose – People who are living with dementia are core health service users, but there are ongoing concerns about the quality of their care and the need for improved education of healthcare staff. The purpose of this paper is to report a qualitative study that investigated staff perspectives on an ethnodrama (“Barbara’s Story”) which was used to educate an entire health service workforce and promote a person-centred approach to care. Design/methodology/approach – The study used a qualitative, longitudinal design with focus groups held with clinical (nurses, allied health professionals, medical) and non-clinical staff. In Phase 1 there were ten focus groups (n=67 participants) and one individual interview. In Phase 2 there were 16 focus groups (n=77 participants) and three individual interviews. Findings – Barbara’s Story raised awareness of dementia, engaged staff emotionally and prompted empathetic responses and improved interactions. The project’s senior leadership, whole organisation and mandatory approach were well-supported, with a perceived impact on organisational culture. The project helped to embed practice developments and initiatives to support person-centred care. Barbara’s Story is now well-integrated into the organisation’s practices, supporting its sustainability in use. Originality/value – Whilst there are increasing resources for educating about dementia, there are fewer evaluations, particularly for large-scale educational initiatives, and a lack of focus on long-term effects. The study findings indicate that education about dementia can be delivered to a whole workforce in a sustainable manner, to prompt empathy, raise awareness, support person-centred care and impact on individual behaviour and organisational culture.

Financial distress determinants among SMEs: empirical evidence from Sweden

2020 ◽  
Vol 47 (3) ◽  
pp. 547-560 ◽  
Author(s):  
Darush Yazdanfar ◽  
Peter Öhman
Keyword(s):  
Financial Crisis ◽  
Financial Distress ◽  
Large Scale ◽  
Global Financial Crisis ◽  
Binary Logistic Regression ◽  
Data Availability ◽  
Cross Sectional ◽  
Data Set ◽  
Content Type ◽  
The Global Financial Crisis

PurposeThe purpose of this study is to empirically investigate determinants of financial distress among small and medium-sized enterprises (SMEs) during the global financial crisis and post-crisis periods.Design/methodology/approachSeveral statistical methods, including multiple binary logistic regression, were used to analyse a longitudinal cross-sectional panel data set of 3,865 Swedish SMEs operating in five industries over the 2008–2015 period.FindingsThe results suggest that financial distress is influenced by macroeconomic conditions (i.e. the global financial crisis) and, in particular, by various firm-specific characteristics (i.e. performance, financial leverage and financial distress in previous year). However, firm size and industry affiliation have no significant relationship with financial distress.Research limitationsDue to data availability, this study is limited to a sample of Swedish SMEs in five industries covering eight years. Further research could examine the generalizability of these findings by investigating other firms operating in other industries and other countries.Originality/valueThis study is the first to examine determinants of financial distress among SMEs operating in Sweden using data from a large-scale longitudinal cross-sectional database.

An Internet-based health gateway device for interactive communication and automatic data uploading: Clinical efficacy for type 2 diabetes in a multi-centre trial

2016 ◽  
Vol 23 (6) ◽  
pp. 595-604 ◽  
Author(s):  
Jae Hyoung Cho ◽  
Hun-Sung Kim ◽  
Seung Hyun Yoo ◽  
Chang Hee Jung ◽  
Woo Je Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Healthcare System ◽  
Glucose Control ◽  
Large Scale ◽  
Diabetes Management ◽  
Intervention Group ◽  
Diabetes Control ◽  
Control Group ◽  
Anthropometric Parameters ◽  
Automatic Data

Introduction The aim of this study was to improve the quality of diabetes control and evaluate the efficacy of an Internet-based integrated healthcare system for diabetes management and safety. Methods We conducted a large-scale, multi-centre, randomized clinical trial involving 484 patients. Patients in the intervention group ( n = 244) were treated with the Internet-based system for six months, while the control group ( n = 240) received the usual outpatient management over the same period. HbA1c, blood chemistries, anthropometric parameters, and adverse events were assessed at the beginning of the study, after three months, and the end of the study. Results There were no initial significant differences between the groups with respect to demographics and clinical parameters. Upon six-month follow-up, HbA1c levels were significantly decreased from 7.86 ± 0.69% to 7.55 ± 0.86% within the intervention group ( p < 0.001) compared to 7.81 ± 0.66% to 7.70 ± 0.88% within the control group. Postprandial glucose reduction was predominant. A subgroup with baseline HbA1c higher than 8% and good compliance achieved a reduction of HbA1c by 0.8 ± 1.05%. Glucose control and waist circumference reduction were more effective in females and subjects older than 40 years of age. There were no adverse events associated with the intervention. Discussion This e-healthcare system was effective for glucose control and body composition improvement without associated adverse events in a multi-centre trial. This system may be effective in improving diabetes control in the general population.

The dialectics of authoring expansive learning: tracing the long tail of a Change Laboratory

2016 ◽  
Vol 28 (4) ◽  
pp. 245-262 ◽  
Author(s):  
Annalisa Sannino ◽  
Yrjö Engeström ◽  
Johanna Lahikainen
Keyword(s):  
Large Scale ◽  
Scale Transformation ◽  
Dialectical Tensions ◽  
Content Type ◽  
Organization Model ◽  
Expansive Learning ◽  
Conceptual Argument ◽  
University Library ◽  
Dialectical Process ◽  
Cultural Historical Activity

Purpose The paper aims to examine organizational authoring understood as a longitudinal, material and dialectical process of transformation efforts. The following questions are asked: To which extent can a Change Laboratory intervention help practitioners author their own learning? Are the authored outcomes of a Change Laboratory intervention futile if a workplace subsequently undergoes large-scale organizational transformations? Does the expansive learning authored in a Change Laboratory intervention survive large-scale organizational transformations, and if so, why does it survive and how? Design/methodology/approach The paper develops a conceptual argument based on cultural–historical activity theory. The conceptual argument is grounded in the examination of a case of eight years of change efforts in a university library, including a Change Laboratory (CL) intervention. Follow-up interview data are used to discuss and illuminate our argument in relation to the three research questions. Findings The idea of knotworking constructed in the CL process became a “germ cell” that generates novel solutions in the library activity. A large-scale transformation from the local organization model developed in the CL process to the organization model of the entire university library was not experienced as a loss. The dialectical tension between the local and global models became a source of movement driven by the emerging expansive object. Practitioners are modeling their own collective future competences, expanding them both in socio-spatial scope and interactive depth. Originality/value The article offers an expanded view of authorship, calling attention to material changes and practical change actions. The dialectical tensions identified serve as heuristic guidelines for future studies and interventions.

scholarly journals Low seroprevalence rates of Zika virus in Kuala Lumpur, Malaysia

2019 ◽  
Vol 113 (11) ◽  
pp. 678-684 ◽  
Author(s):  
I-Ching Sam ◽  
Magelda Montoya ◽  
Chong Long Chua ◽  
Yoke Fun Chan ◽  
Andrew Pastor ◽  
...  
Keyword(s):  
Zika Virus ◽  
Large Scale ◽  
Binding Assay ◽  
Seroprevalence Rate ◽  
Protective Effects ◽  
Kuala Lumpur ◽  
Serum Samples ◽  
Denv Serotypes ◽  
Population Immunity ◽  
Low Incidence

Abstract Background Zika virus (ZIKV) is believed to be endemic in Southeast Asia. However, there have been few Zika cases reported to date in Malaysia, which could be due to high pre-existing levels of population immunity. Methods To determine Zika virus (ZIKV) seroprevalence in Kuala Lumpur, Malaysia, 1085 serum samples from 2012, 2014–2015 and 2017 were screened for anti-ZIKV antibodies using a ZIKV NS1 blockade-of-binding assay. Reactive samples were confirmed using neutralization assays against ZIKV and the four dengue virus (DENV) serotypes. A sample was possible ZIKV seropositive with a ZIKV 50% neutralization (NT50) titre ≥20. A sample was probable ZIKV seropositive if, in addition, all DENV NT50 titres were &lt;20 or the ZIKV NT50 titre was &gt;4-fold greater than the highest DENV NT50 titre. Results We found low rates of possible ZIKV seropositivity (3.3% [95% confidence interval {CI} 2.4 to 4.6]) and probable ZIKV seropositivity (0.6% [95% CI 0.3 to 1.4]). Possible ZIKV seropositivity was independently associated with increasing age (odds ratio [OR] 1.04 [95% CI 1.02 to 1.06], p&lt;0.0001) and male gender (OR 3.5 [95% CI 1.5 to 8.6], p=0.005). Conclusions The low ZIKV seroprevalence rate, a proxy for population immunity, does not explain the low incidence of Zika in dengue-hyperendemic Kuala Lumpur. Other factors, such as the possible protective effects of pre-existing flavivirus antibodies or reduced transmission by local mosquito vectors, should be explored. Kuala Lumpur is at high risk of a large-scale Zika epidemic.

Dynamic output feedback control for nonlinear large-scale interconnected systems

2020 ◽  
Vol 39 (4) ◽  
pp. 801-821
Author(s):  
Ezzeddine Touti ◽  
Ali Sghaier Tlili ◽  
Muhannad Almutiry
Keyword(s):  
Decentralized Control ◽  
Output Feedback ◽  
Large Scale ◽  
Optimization Problem ◽  
Lyapunov Theory ◽  
Interconnected Systems ◽  
Dynamic Output Feedback ◽  
Content Type ◽  
Dynamic Output ◽  
Control Scheme

Purpose This paper aims to focus on the design of a decentralized observation and control method for a class of large-scale systems characterized by nonlinear interconnected functions that are assumed to be uncertain but quadratically bounded. Design/methodology/approach Sufficient conditions, under which the designed control scheme can achieve the asymptotic stabilization of the augmented system, are developed within the Lyapunov theory in the framework of linear matrix inequalities (LMIs). Findings The derived LMIs are formulated under the form of an optimization problem whose resolution allows the concurrent computation of the decentralized control and observation gains and the maximization of the nonlinearity coverage tolerated by the system without becoming unstable. The reliable performances of the designed control scheme, compared to a distinguished decentralized guaranteed cost control strategy issued from the literature, are demonstrated by numerical simulations on an extensive application of a three-generator infinite bus power system. Originality/value The developed optimization problem subject to LMI constraints is efficiently solved by a one-step procedure to analyze the asymptotic stability and to synthesize all the control and observation parameters. Therefore, such a procedure enables to cope with the conservatism and suboptimal solutions procreated by optimization problems based on iterative algorithms with multi-step procedures usually used in the problem of dynamic output feedback decentralized control of nonlinear interconnected systems.

scholarly journals Large-Scale Synonymous Substitutions in Cucumber Mosaic Virus RNA 3 Facilitate Amino Acid Mutations in the Coat Protein

2018 ◽  
Vol 92 (22) ◽  
Author(s):  
Tomofumi Mochizuki ◽  
Rie Ohara ◽  
Marilyn J. Roossinck
Keyword(s):  
Amino Acid ◽  
Secondary Structure ◽  
Viral Genome ◽  
Large Scale ◽  
Viral Rna ◽  
Wild Type ◽  
Competitive Fitness ◽  
Content Type ◽  
Synonymous Substitutions ◽  
Cp Gene

ABSTRACTThe effect of large-scale synonymous substitutions in a small icosahedral, single-stranded RNA viral genome on virulence, viral titer, and protein evolution were analyzed. The coat protein (CP) gene of the Fny stain of cucumber mosaic virus (CMV) was modified. We created four CP mutants in which all the codons of nine amino acids in the 5′ or 3′ half of the CP gene were replaced by either the most frequently or the least frequently used synonymous codons in monocot plants. When the dicot host (Nicotiana benthamiana) was inoculated with these four CP mutants, viral RNA titers in uninoculated symptomatic leaves decreased, while all mutants eventually showed mosaic symptoms similar to those for the wild type. The codon adaptation index of these four CP mutants against dicot genes was similar to those of the wild-type CP gene, indicating that the reduction of viral RNA titer was due to deleterious changes of the secondary structure of RNAs 3 and 4. When two 5′ mutants were serially passaged inN. benthamiana, viral RNA titers were rapidly restored but competitive fitness remained decreased. Although no nucleic acid changes were observed in the passaged wild-type CMV, one to three amino acid changes were observed in the synonymously mutated CP of each passaged virus, which were involved in recovery of viral RNA titer of 5′ mutants. Thus, we demonstrated that deleterious effects of the large-scale synonymous substitutions in the RNA viral genome facilitated the rapid amino acid mutation(s) in the CP to restore the viral RNA titer.IMPORTANCERecently, it has been known that synonymous substitutions in RNA virus genes affect viral pathogenicity and competitive fitness by alteration of global or local RNA secondary structure of the viral genome. We confirmed that large-scale synonymous substitutions in the CP gene of CMV resulted in decreased viral RNA titer. Importantly, when viral evolution was stimulated by serial-passage inoculation, viral RNA titer was rapidly restored, concurrent with a few amino acid changes in the CP. This novel finding indicates that the deleterious effects of large-scale nucleic acid mutations on viral RNA secondary structure are readily tolerated by structural changes in the CP, demonstrating a novel part of the adaptive evolution of an RNA viral genome. In addition, our experimental system for serial inoculation of large-scale synonymous mutants could uncover a role for new amino acid residues in the viral protein that have not been observed in the wild-type virus strains.

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