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1.

"Girls need to behave like girls you know": the complexities of applying a gender justice goal within sexuality education in South African schools.

Ngabaza, Sisa; Shefer, Tamara; Macleod, Catriona Ida
| Idioma(s): Inglés
Sexuality education, as a component within the Life Orientation (LO) programme in South African schools, is intended to provide young people with knowledge and skills to make informed choices about their sexuality, their own health and that of others. Key to the programme are outcomes relating to power, power relations and gender. In this paper, we apply a critical gender lens to explore the ways in which the teaching of sexuality education engages with larger goals of gender justice. The paper draws from a number of ethnographic studies conducted at 12 South African schools. We focus here on the data collected from focus group discussions with learners, and semi-structured interviews with individual learners, principals and Life Orientation (LO) teachers. The paper highlights the complexities of having gender justice as a central goal of LO sexuality education. Teaching sexuality education is reported to contradict dominant community values and norms. Although some principals and school authorities support gender equity and problematize hegemonic masculinities, learners experience sexuality education as upholding normative gender roles and male power, rather than challenging it. Teachers rely heavily on cautionary messages that put more responsibility for reproductive health on female learners, and use didactic, authoritative pedagogical techniques, which do not acknowledge young people's experience nor facilitate their sexual agency. These complexities need to be foregrounded and worked with systematically if the goal of gender justice within LO is to be realised.
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2.

Ecosystem Health Assessment at County-Scale Using the Pressure-State-Response Framework on the Loess Plateau, China.

Liu, Delin; Hao, Shilong
| Idioma(s): Inglés
Assessing ecosystem health is helpful to determine reasonable eco-environmental restoration and resource management strategies. Based on a pressure-state-response (PSR) framework, a set of comprehensive indicators including natural, social and economic aspects was proposed and applied for assessing the ecosystem health of Yuanzhou County, Loess Plateau, Ningxia Province, China. The basic data used to calculate the values of the assessment indicators include Landsat TM image and socio-economic data, and remote sensing (RS) and the geographic information system (GIS) were used to process image data. The results showed that the ecosystem health conditions of most townships in Yuanzhou County were at the moderately healthy level, three townships were at the healthy level, and only two townships were at the unhelathy level; the areas (percentage) at the unhealthy, moderately healthy and healthy levels were 443.91 km² (12.66%), 2438.75 km² (69.54%) and 624.50 km² (17.81%), respectively. The results could provide useful information for local residents and the government to take measures to improve the health conditions of their township ecosystem.
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3.

The Impact of Health Literacy Status on the Comparative Validity and Sensitivity of an Interactive Multimedia Beverage Intake Questionnaire.

Hooper, Lucy P; Myers, Emily A; Zoellner, Jamie M; Davy, Brenda M; Hedrick, Valisa E
| Idioma(s): Inglés
Self-reported dietary assessment methods can be challenging to validate, and reporting errors for those with lower health literacy (HL) may be augmented. Interactive multimedia (IMM) based questionnaires could help overcome these limitations. The objectives of this investigation are to assess the comparative validity and sensitivity to change of an IMM beverage intake questionnaire (IMM-BEVQ) as compared to dietary recalls and determine the impact of HL. Adults completed three 24-h dietary recalls and the IMM-BEVQ at baseline and after a six-month intervention targeting either sugar-sweetened beverages (SSB) or physical activity. Correlations and paired-samples -tests are presented. For validity ( = 273), intake of SSB (mean difference = 10.6 fl oz) and total beverage consumption (mean difference = 16.0 fl oz) were significantly different ( ≤ 0.001) at baseline between the IMM-BEVQ and dietary recalls for all participants. However, the differences in intake were generally greater in low HL participants than in adequate HL participants. For sensitivity ( = 162), change in SSB intake (mean difference = 7.2 fl oz) was significantly different ( ≤ 0.01) between pre-/post-IMM-BEVQ and pre-/post-dietary recalls, but not total beverage intake (mean difference = 7.6 fl oz) for all participants. Changes in SSB and total beverage intake were not significantly different for those with adequate HL. The IMM-BEVQ is a valid dietary assessment tool that is as responsive to detecting changes in beverage intake as dietary recalls. However, adults with lower HL may need additional guidance when completing the IMM-BEVQ.
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6.

US Spending on Personal Health Care and Public Health, 1996-2013.

Dieleman, Joseph L; Baral, Ranju; Birger, Maxwell; Bui, Anthony L; Bulchis, Anne; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Johnson, Elizabeth K; Joseph, Jonathan; Lavado, Rouselle; Lomsadze, Liya; Reynolds, Alex; Squires, Ellen; Campbell, Madeline; DeCenso, Brendan; Dicker, Daniel; Flaxman, Abraham D; Gabert, Rose; Highfill, Tina; Naghavi, Mohsen; Nightingale, Noelle; Templin, Tara; Tobias, Martin I; Vos, Theo; Murray, Christopher J L
| Idioma(s): Inglés
Importance: US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. Objective: To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. Design and Setting: Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. Exposures: Encounter with US health care system. Main Outcomes and Measures: National spending estimates stratified by condition, age and sex group, and type of care. Results: From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%-2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]). Conclusions and Relevance: Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.
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7.

[A Case of HPN, In Which QOL Improvement Was Achieved by Combining Continuous Infusion with Once-Weekly Intermittent Infusion - Contribution of Pharmacists to Health Promotion among Home Patients Receiving Infusion Therapy].

Takeda, Namihiro; Hamana, Tomoko; Oka, Toyoka; Hirohara, Masayoshi; Kushida, Kazuki
| Idioma(s):
Patients receiving parenteral nutrition at home have the following two options: 24-h continuous or intermittent infusion. To date, for patients with impaired glucose tolerance and/or other metabolic disorders or for those with decreased cardiac/ pulmonary/renal function, it is desirable to opt for continuous infusion to minimize the variance in the body's metabolic rate as much as possible. Furthermore, it should be noted that continuous infusion evokes a stronger feeling among patients of being constrained because it restricts their everyday activities. This case witnesses collaborations among the patient's doctor, dispensary's pharmacy, and patient's family. Because ofthe use ofintermittent infusion more or less once per week in addition to continuous infusion, significant improvement in quality of life was achieved, and the patient was able to enjoy taking a short trip. To assist a home patient receiving infusion therapy, it is essential that the pharmacist be equipped with skills to manage risks associated with infusion therapy and have knowledge about insurance to cover incidents concerning infusion fluids or medical materials. It will certainly depend on the degree ofindependence ofpatients and the level ofcare their families can provide; however, should we manage to use a similar medical procedure in at least a few cases in the future, we may be able to contribute to "joie de vivre" in home patients receiving infusion therapy.
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9.

Paying for volume: British Columbia's experiment with funding hospitals based on activity.

Sutherland, Jason M; Liu, Guiping; Crump, R Trafford; Law, Michael
| Idioma(s): Inglés
INTRODUCTION: For decades, Canadian hospitals have been funded using global budgets, a lump sum for providing care irrespective of the volume or mix of patients. In 2010, British Columbia (BC) introduced a controversial, but limited, form of activity-based funding (ABF) for hospitals. This study uses a quasi-experimental design to evaluate the impact of the introduction of ABF funding in the province. METHODS: Our analysis used the population of patient-level acute hospitalization and day surgery discharge summaries from BC's acute hospitals from April 1, 2008 to March 31, 2013. Our outcome measures focused on both the intended and unintended impacts of ABF including the volume of cases, the efficiency of care, and the quality of care delivered. Our analysis used interrupted time series analysis. RESULTS: There was an increase in the volume of inpatient surgical activity associated with the implementation of ABF. The volume of medical cases dropped, and medical patients' lengths of stays increased. There were no changes in measures of quality. CONCLUSIONS: Hospitals' measurable responses to ABF policies on a number of key performance measures were mixed. Though BC's experiment with ABF was not associated with increases in hospital volumes for all types of care, the experience provides key lessons that small magnitude and short-term reforms are unlikely to change hospitals' behaviors quickly.
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10.

Industrial metal pollution in water and probabilistic assessment of human health risk.

Saha, Narottam; Rahman, M Safiur; Ahmed, Mohammad Boshir; Zhou, John L; Ngo, Huu Hao; Guo, Wenshan
| Idioma(s): Inglés
Concentration of eight heavy metals in surface and groundwater around Dhaka Export Processing Zone (DEPZ) industrial area were investigated, and the health risk posed to local children and adult residents via ingestion and dermal contact was evaluated using deterministic and probabilistic approaches. Metal concentrations (except Cu, Mn, Ni, and Zn) in Bangshi River water were above the drinking water quality guidelines, while in groundwater were less than the recommended limits. Concentration of metals in surface water decreased as a function of distance. Estimations of non-carcinogenic health risk for surface water revealed that mean hazard index (HI) values of As, Cr, Cu, and Pb for combined pathways (i.e., ingestion and dermal contact) were >1.0 for both age groups. The estimated risk mainly came from the ingestion pathway. However, the HI values for all the examined metals in groundwater were <1.0, indicating no possible human health hazard. Deterministically estimated total cancer risk (TCR) via Bangshi River water exceeded the acceptable limit of 1 × 10 for adult and children. Although, probabilistically estimated 95th percentile values of TCR exceeded the benchmark, mean TCR values were less than 1 × 10 . Simulated results showed that 20.13% and 5.43% values of TCR for surface water were >1 × 10 for adult and children, respectively. Deterministic and probabilistic estimations of cancer risk through exposure to groundwater were well below the safety limit. Overall, the population exposed to Bangshi River water remained at carcinogenic and non-carcinogenic health threat and the risk was higher for adults. Sensitivity analysis identified exposure duration (ED) and ingestion rate (IR) of water as the most relevant variables affecting the probabilistic risk estimation model outcome.
Resultados  1-10 de 9.208