reasons such as the need to improve efficiency and performance of healthservices or shortages of physicians, among others. The most common situation is that nurses substitute for physicians in the provision of health care. Different studies have proven that nurse practitioners are proficient in providing health care. The definition of nurse practitioner is as follows: “A Nurse Practitioner/ Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice.” 27
Garrido-Cumbrera, M., Borrell, C., Palencia, L., Espelt, A., Rodriguez-Sanz, M., Pasarin, MI., Kunst, A., (2010). Social class inequalities in the utilization of health care andpreventiveservices in Spain, a country with a national health system. International Journal of HealthServices, 40(3), 525-542. doi: 10.2190/HS.40.3.h
A survey-based cross-sectional study was conducted among older adults of both sexes assigned to nine PHCUs (Primary Healthcare Units) at IMSS in Mexico City, which have a population of 131 288 individuals aged 60 and older. IMSS is a mandatory social security health system, whose beneficiaries are affiliated with a specific PHCU based on their home address. IMSS offers a comprehensive package that includes health care services as well as economic and social security benefits. Other benefits include preventive programs to encourage health promotion practices such as PA at IMSS sports facilities known as Social Security Centers. These programs are available to IMSS affiliates for a nominal fee, or for free in the case of older adults and patients with diabetes, hypertension or obesity. The study participants were selected through a simple random sampling of IMSS affiliates at nine PHCUs in Mexico City, which was obtained from a list of IMSS af- filiates in 2007. This sampling method was used to obtain a representative sample of older adults who are IMSS affiliates that included all the PHCU in the administra- tive zone. Differences in the size and sociodemographic characteristics of the population affiliated to the nine PHCUs were taken into consideration. The number of participants selected from each PHCU was proportional to the size of its total population; the participants were stratified by age and sex.
Figure 1 shows the drug spending as a percentage of goods andservices spending by house right category. By 1998, three groups that have an irregular distribution of drug spending in households were observed. The group that does not have a social security has a spending limit of 25% and a minimum expenditure of 0% it is recorded in the other groups. The average was different in the three groups, being the group that does not have a social security the largest one (4%). In 2010 it is shown by type of house right the drug spending as a percentage of goods andservices spending. Households without social security and population assigned to the ‘Seguro Popular’ spend the most. This indicates that despite the inequality in health care distribution has been reduced, it has no impact in the reduction of health inequity because access to healthservices via ‘Seguro Popular’ with a basic package of services does not guarantee that poor people do not have to spend more on the purchase of medication in comparison with people who have a higher income. See Figure 1.
Abstract This paper seeks to analyze the factors associated with the use of dental healthservices (UDHS) by adults in the city of Corrientes, Ar- gentina. A cross-sectional study was conducted. Information concerning the study variables was collected via a home survey. The sample size was established with a 95% confidence interval level (381 individuals). A simple random sampling design was used, which was complemented with a non-probability quota sampling. The data was analyzed using SPSS version 21.0 and Epidat ver- sion 3.1 softwares. Socio-economic level, dental health coverage, perception of oral health care, perception of oral health, knowledge about oral health, and oral hygiene habits were significant- ly associated with the UDHS over the last twelve months. These same factors, excluding dental health coverage and knowledge about oral health, were associated with the UDHS for routine den- tal check-ups. Measures should be implemented to increase the UDHS for prevention purposes in men and women of all socio-economic levels, par- ticularly in less-privileged individuals.
In urban settings we have never done so little physical activity as we do nowadays, in addition more people live in cities each year. From this we wonder if recoup some lost physical activity in this secular transition will improve our quality of life. Quality of life and physical activity are both multidimensional concepts. Despite this complexity there are tools that have helped operationalize, with their limitations, these concepts so they can test their interaction.
However, intermittent supply and inadequate distribution systems are major problems. Acute water scarcity is aggravated by relatively high population growth. The available water from the existing renewable sources per person per year is projected to fall from 159 centimetres in 2003 to about 90 centimetres by 2025. Water scarcity is exacerbated by pollution of water sources caused by inadequate and inefficient management of domestic wastewater, uncontrolled disposal of industrial waste, leakage from solid waste landfills and seepage from excessive use of fertilizers and pesticides. While 60% of the population has access to improved sanitation (unrealistically reported at 93% in some references), wastewater collection and treatment systems are overloaded and effluent from them does not meet national standards. Solid waste collection, which covers 75% of Jordanians and more than 90% of the population of greater Amman, seems to be satisfactory. Nevertheless, the design and operation of most of these disposal sites need improvement not to contribute to pollution.
implementación de un manual de funciones para disminuir el alto índice de rotación del personal de la empresa Healthand Global Services S.A., el primero de ellos es realizar contrataciones de nuevo personal que cumplan el perfil para cada cargo de la empresa obteniendo personal que integre la empresa por mucho tiempo. El segundo punto es generar oportunidades de crecimiento laboral para que los empleados exploten al máximo sus capacidades, tanto para los que ingresan por primera vez a la empresa como a los empleados que ya se encuentran dentro. El tercer punto es distribuir la funciones adecuadamente para que no exista recarga laboral en ciertos colaboradores. El cuarto punto es capacitar al personal de acuerdo al cargo y apegado al área del giro del negocio que la importación, y distribución de insumos médicos el quinto punto tenemos la elaboración del organigrama de la empresa el cual nos permitirá tener una mejor perspectiva de los cargos de la empresa, realizando la departamentalización de toda la organización.
Migration Law It recognizes the obligation of the Mexican State to guarantee the enjoyment of the rights and freedoms of foreigners, regardless of their migration status, together with the recognition of the rights of migrants to justice, education, andhealth, among others
Around the world, community health workers (CHW)* currently offer misoprostol for a variety of gynecological and obstetric indications, a practice endorsed by key global bodies. The WHO recommends that auxiliary nurses and nurse midwives be able to administer misoprostol to prevent and treat postpartum hemorrhage and that lay health workers be able to administer misoprostol to prevent the same. 36 A review of global misoprostol implementation found that programs allowing CHW to distribute misoprostol had the greatest coverage, suggesting that leveraging providers with comparatively low skill levels can increase crucial access to the life-saving drug. 37 Studies have clearly demonstrated the safety and efficacy of administration of misoprostol by CHW for indications such as postpartum hemorrhage 37–39 and treatment of incomplete abortion. 40 Further advantages in- clude relative ease of provider training, supply chain man- agement, and adherence to protocol.
As for the price that Cuidum offers, it is quite similar to the other placement agencies. Prices vary depending on the type of service. First, an initial amount of between 250 to 550 € will be paid depending on the geographical area where the client resides. This includes the collection of information and selection of candidates that comply with the needs, coordination and monitoring of families and drafting, signing of contract and registration of social security.
Evidence from past economic crises predicts what is likely to happen in the current economic downturn. Despite increased pressure on mental healthservices (71), government expenditure on health will be squeezed and will probably fall in real terms, contributing to worse health outcomes. Household income to pay for healthservices will drop. Insurance protection will decline. People will switch from the services that require out-of-pocket spending to less costly services: in some countries this means switching from the private to the public health care sector. In countries without comprehensive services funded by taxes or health insurance, the people who need mental healthservices the most may have less access to them because of the costs involved. Overall, the health effects of the economic downturn will be less pronounced in countries with better social safety nets (72).
The research failed to reﬂect the demographic composition of Latin America indigenous popula- tions, with severe under-representation of indigenous groups from Mexico, Central and South America. The exception of Brazil might be explained by the strong research tradition in the Brazilian society and also by the commitment of national government and research groups to their indigenous populations. The implemen- tation of special indigenous health districts all across the nation or the recent formation of the Committee on the Demography of Indigenous Peoples in the Brazilian Association for Population Studies and the Working Group on Indigenous Health in the Brazilian Association of Graduate Studies in Collective Health are examples of these efforts. 11 Lessons from the experi-
Many people contributed to the execution of this project. Without their help we would not have been able to achieve the sampling across the city, recruit participants, conduct the experimental sessions, explore archives and understand the provision of social services to the poor. We want to express our gratitude with the following organizations and people: Fundación Enséñame a Pescar; Dangely Bernal, Pilar Cuervo, Álvaro Castillo, Hernando Ramírez, Dora Alarcón, Fernando Arrázola, Consultorio Jurídico y Facultad de Derecho, Universidad de los Andes, Rocío Marín, Defensoría del Pueblo, Sandra Carolina Vargas, Facultad de Economía, Universidad de los Andes, Natalia Marín, Foro Joven, Yezid Botiva, SEI Consultores, Teresa Ortiz, Jardín Infantil Gimnasio Británico, Luz Mélida Hernández, Fundación Bella Flor, Carlos Betancourt, Secretaria de Hacienda Distrital, Germán Nova, Secretaria de Hacienda Distrital, Mauricio Castillo, Contraloría General de la República, Luis Hernando Barreto, Contraloría General de la República, Jeannette Avila, Departamento Administrativo de Bienestar Social, DABS, Students from the Universidad de los Andes who volunteered at different stages of the project: Pablo Andrés Pérez. Stybaliz Castellanos, Juan Carlos Reyes, Andrés Felipe Sarabia, Gustavo Caballero, Gloria Carolina Orjuela, Orizel Llanos, Fabián Garcia. Finally our gratitude to Hugo Ñopo and Andrea Moro who also provided valuable comments to previous drafts, and to the Inter-American Development Bank Research Department for their generous funding support.
he objective of this article is to put in economic perspective the expenditure in health within the pattern of family expenditure of the Mexican households. Information of the National Survey on Income Expenditure of Households (ENIGH) of Mexico of 2004 is analyzed on: structure of the expenditure of the households, expenditure in healthand income-expenditure elasticities in health; by quintiles of income and to the condition of insurance in health. It is revealed that the poorest households in Mexico do not rely on their structure of expenditure to support out of the pocket expenses in health, reason why an unexpected event of disease places the families at risk of impoverishment, sale of assets or indebtedness. Other results are the elasticities that were obtained by condition of insurance, quintile of income and type of expenditure; and that there are basic services in health that the Mexican population perceives as if they were luxury goods, among them the orthopedic, dental care and hospitalization. It is emphasized that the income elasticities found can serve as baseline measurement of the effectiveness of the Popular Insurance of Health just orchestrated on the modification of the pattern of family expenditure on health for the first quintiles of income.
Sample: The methodological strategy involved a convenience sample of 88 adults between the ages of 21-63 years (Table 1) (without rejection or dropout) recruited face to face in the waiting rooms of dental emergency services (selection criteria) at Family Health Centers (CESFAM, for their acronym in Spanish), strategically selected, where dental interns of Universidad de Talca complete their professional training. The following districts were included: a) Paredones, semi-rural, with a poverty rate of 33.41% by income, according to the 2013 National Socioeconomic Characterization Survey (CASEN, for its acronym in Spanish); b) Rengo, semi-rural, with 20.47% of the population living in poverty (by income), and; c) the Carlos Trupp neighborhood in the city of Talca, a vulnerable urban area, consisting of a socially emerging population. These districts are characterized by informal and sporadic sources of work, minimum income, and a population with incomplete primary and secondary education. The rural population is also associated with low income and low educational levels, so the risk of oral disease is higher. This marks a difference in the access to health care, mainly due to poor access to information, such as delayed dental visits and limited resources.
system. WHO recommends that payments from individuals for healthservices be collected as a type of prepayment, rather than at the time of service delivery (51). However, in many settings, user fees are customarily charged and can be an important bar- rier to services for poor women and adolescents. In addition, women seeking abortion may be expected to pay substantial informal fees (charges made by providers on top of the official health-system charges) which, when combined with travel expenses and opportunity costs such as time lost from paid employment, pose a barrier for many women. The barrier of high costs to women is likely to generate higher costs for the health system, by increasing the number of women who attempt to self-induce abor- tion or go to unsafe providers and, as a result, require hospitalization for serious complications (52, 53). The respect, protection, and fulfilment of human rights require that women can access legal abortion services regardless of their ability to pay. Financing mechanisms should ensure equitable access to good-quality services (54). Where user fees are charged for abortion, such fees should be matched to women’s ability to pay, and procedures should be developed for exempting the poor and adolescents from paying for services. As far as possible, abortion services should be mandated for coverage under insurance plans. Abortion should never be denied or delayed because of a woman’s inability to pay. Furthermore, all facilities should have procedures in place to ensure that informal charges are not imposed by staff.
La presente investigación ha sido elaborada con la finalidad de dar a conocer sobre el Modelo Costo - Volumen - Utilidad y su impacto en la toma de decisiones de la empresa Vitalia Health Care & Medical Services S.A.C, tomando como base temas generales sobre costos, punto de equilibrio, y toma de decisiones. El Modelo Costo - Volumen – Utilidad se convierte hoy en día en una herramienta contemporánea e importante ya que las implicaciones que tienen, tanto en el corto como en el largo plazo, son muy positivas para las empresas. De esta manera el Modelo Costo - Volumen - Utilidad se convierte en una tendencia eficaz para la planeación de resultados y la toma de decisiones. Este informe se ha desarrollado con un diseño de contrastación Descriptivo - Aplicativo, los métodos que se aplicaron fueron: método de análisis – síntesis y el método hermenéutico; y para la recolección de la información se utilizó tanto análisis documental y la observación. En el análisis documental realizado, podemos resaltar que un ordenamiento de costos, el punto de equilibrio y la aplicación del Modelo Costo - Volumen – Utilidad son tópicos valorados para el desarrollo de una buena gestión de algunos cambios y una eficaz toma de decisiones. Luego de esta investigación podemos concluir que el Modelo Costo - Volumen – Utilidad costo influye de manera positiva en la toma de decisiones de la empresa Vitalia Health Care & Medical Services S.A.C.
Mental disorders are one of the top public health challenges in the WHO European Region, affecting about 25% of the population every year. In all countries, mental health problems are much more prevalent among those who are most deprived. The WHO European Region therefore faces diverse challenges affecting both the (mental) well-being of the population and the provision and quality of care for people with mental health problems. The European Mental Health Action Plan focuses on seven interlinked objectives and proposes effective actions to strengthen mental healthand well-being. Investing in mental health is essential for the sustainability of healthand socio-economic policies in the European Region.The European Mental Health Action Plan corresponds to the four priority areas of the European policy framework for healthand well- being, Health 2020, and will contribute directly to its implementation. The Action Plan has been developed in close consultation with Member States, experts and NGOs, guided by the Standing Committee of the WHO Regional Committee for Europe. The Regional Director for Europe and the Regional Office thanks all who have contributed to this Action Plan. The resolution adopting this Action Plan can be found in annex 4.