On administrative borders and accessibility to public services: : The case of hospitals in Sweden.

An administrative border might hinder the optimal allocation of a given set of resources by restricting the flow of goods, services, and people. In this paper we address the question: Do administrative borders lead to poor accessibility to public service such as hospitals? In answering the question, we have examined the case of Sweden and its regional borders. We have used detailed data on the Swedish road network, its hospitals, and its geo-coded population. We have assessed the population’s spatial accessibility to Swedish hospitals by computing the inhabitants’ distance to the nearest hospital. We have also elaborated several scenarios ranging from strongly confining regional borders to no confinements of borders and recomputed the accessibility. Our findings imply that administrative borders are only marginally worsening the accessibility.

Residential planning, driver mobility and CO2 emission

The literature on residences and citizens’ transports has focused on either reforming traffic managing in response to residential relocation or post-evaluation of urban planning policies or the evolution of the urban spatial form. In a city there are hotspots that attract the citizens and most of the transportation in the city arises as the citizens’ movement between their residence and the hotspots. Little scholarly attention has been devoted to the possibility to minimize citizens’ transportation in the city by the urban planning of residential areas. In this paper we propose a method to evaluate the environmental impact (in terms of CO2-emissions) of urban plans of residential areas. The method is illustrated in a Swedish case of a midsize city which is presently preoccupied with urban planning of new residential areas in response to substantial population growth due to immigration. The residential plans aims to increase the compactness and residential density in the current center and sub centers leads to less CO2 emissions compare to urban expansion to the edge of the city. The plans of concentrated apartment buildings are more effective in meeting residential needs and mitigating CO2 emissions than dispersed single-family houses.

Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

An analysis of the aspects attracting medical tourists : a case study in Seoul, South Korea

Many countries recognized the potential of medicaltourism as an alternative source of economic growth. Especially after theeconomic crisis many Asian countries joined medical tourism in hopes to escapethe severe financial difficulty. However, yet only few countries have managedto become a famous medical tourism destination. With growing number ofcompetitors, newly joined countries of medical tourism, face the difficulty inintroducing them self as attractive medical tourism destination. South Koreaas a new medical tourism destination, should consider what to offer to themedical tourists to attract them. The aim of the thesis was to investigate aspects influencing the participationof medical tourists to discover how South Korea could develop anattractive medical tourism destination. After examining the casestudy and results from the text analysis, researcher reached to the conclusionthat quality, cost and accessibility to treatment are the major reasons toparticipate in medical tourism. Also in the fierce competition, it is importantto develop differentiated offers from other destinations. Therefore, Koreashould concentrate on specialized treatments and ICT system to become anattractive medical tourism destination.

The most severe parkinsonian patients are most improved with duodenal levodopa infusion

Objectives:To find variables correlated to improvement with intraduodenal levodopa/carbidopa infusion (Duodopa) in order to identify potential candidates for this treatment. Two clinical studies comparing Duodopa with oral treatments in patients with advanced Parkinson’s disease have shown significant improvement in percent on-time on a global treatment response scale (TRS) based on hourly and half-hourly clinical ratings and in median UPDRS scores.Methods:Data from study 1 comparing infusion with Sinemet CR (12 patients, Nyholm et al, Clin Neuropharmacol 2003; 26(3): 156-163) and study 2 comparing infusion with individually optimised conventional combination therapies (18 patients, Nyholm et al, Neurology, in press) were used. Measures of severity were defined as total UPDRS score and scores for sections II and III, percent functional on-time and mean squared error of ratings on the TRS and as mean of diary questions about mobility and satisfaction (only study 2). Absolute improvement was defined as difference in severity, and relative improvement was defined as percent absolute improvement/severity on oral treatment. Pearson correlation coefficients between measures of improvement and other variables were calculated.Results:Correlations (r2>0.28, p<0.05) between severity during oral treatment and absolute improvement on infusion were found for: Total UPDRS, UPDRS III and TRS ratings (studies 1 and 2) and for diary question 1 (mobility) and UPDRS II (study 2). Correlation to relative improvement was found for total UPDRS (study 2, r2=0.47). Figure 1 illustrates absolute improvement in total UPDRS vs. total UPDRS during oral treatment (study 2).Conclusion:Correlating different measures of severity and improvement revealed that patients with more severe symptoms were most improved and that the relation between severity and improvement was linear within the studied groups. The result, which was reproducible between two clinical studies, could be useful when deciding candidates for the treatment.