A Case Study of Health Tourism in the Jeju Province, South Korea

The United States Census Bureau (2006) reported that in 2005 more than 46 million Americans lacked health insurance, and that by 2019 national spending for health care would exceed $4.5 trillion (Centers for Medicare & Medicaid Services, 2010). Because those numbers are expected to increase, health tourists are seeking better opportunities for low-cost, high-quality treatment in other countries, plus the added benefit of experiencing foreign cultures. Health tourism is a rapidly growing market in both advanced and developing countries. The purpose of this study was to develop an applicable model of health tourism, the Jeju-Style Health Tourism Model, for Jeju Special Self-Governing Province, in the Republic of Korea (South Korea) and to provide other cities and countries with its implications. This study employed a focus group, indepth interviews, and content analysis to discover important factors in developing the model. The results suggested that four major sources must be executed together to maximize the benefits of health tourism development. On a foundation of natural resources, knowledge-based resources were most important (54.5%), followed by artificial resources (25.7%), and expenses-based resources (19.8%).

Health reforms in Latin America: processes and results

Two types of health reforms in Latin America are analysed: one based on insurance and service commodification and the one referred to the unified public systems of progressive governments. Health insurance with explicit service packages has not fulfilled their purposes of universal coverage, equal access to necessary health services and improvement of health conditions but has opened health as a field of profit making for insurance companies and private health providers. The national health services as a state obligation have developed territorialized health services and widened substantially timely access to the majority of the population. The adoption of an integrated and wide social policy has an impact on population well fare. It faces some problems derived from the old health systems and the power of the insurance and medical complex.

VALIDATION STUDY OF HEALTH BELIEFS SCALE

Introduction: The Health Belief Scale is a questionnaire used to assess a wide range of beliefs related to health. The objective of this study was to undertake construction and culturally adapt the Health Belief Scale (HBS) to the Portuguese language and to test its reliability and validity. Methods: This new version was obtained with forward/backward translations, consensus panels and a pre-test, having been inspired by some of the items from “Canada’s Health Promotion Survey” and the “European Health and Behaviour Survey”, with the inclusion of new items about food-related beliefs. The Portuguese version of Health Belief Scale and a form for the characteristics of the participants were applied to 849 Portuguese adolescents. Results: Reliability was good with a Cronbach’s alpha coeficient of 0.867, and an intraclass correlation coeficient (ICC) of 0.95. Corrected item-total coeficients ranged from 0.301 to 0.620 and weighted kappa coeficients ranged from 0.72 to 0.93 for the total scale items. We obtained a scale composed of 13 items divided into ive factors (smoking and alcohol belief, food belief, sexual belief, physical and sporting belief, and social belief), which explain 57.97% of the total variance. Conclusions: The scale exhibited suitable psychometric properties, in terms of internal consistency, reproducibility and construct validity. It can be used in various areas of research.

O modelo de atenção a saúde bucal no Médio e Baixo Xingu: parcerias, processos e perspectivas

Este artigo tem por objetivo apresentar as ações desenvolvidas na construção do modelo de atenção em saúde no Distrito Especial Indígena - Xingu (DSEI-Xingu), mais especificamente, na área de saúde bucal, com a efetiva parceria entre a Universidade Federal do Estado de São Paulo (UNIFESP), Faculdade de Odontologia de Ribeirão Preto - Universidade de São Paulo (FORP-USP) e a Colgate®, que permitiu a construção social da práxis em saúde no Médio e Baixo Xingu. Ao longo da história, o DSEI "Espaço Social" é onde as comunidades se constituem e, por meio do processo social de produção, cria acessos diferenciados aos bens de consumo, além de formar a base para a organização dos serviços de atenção à saúde dos povos indígenas. Para o DSEI-Xingu, são pontos básicos o estabelecimento de parcerias institucionais e a participação efetiva dos povos indígenas na gestão da saúde em seu território. Estruturado no planejamento baseado em problemas sentidos pela população, utiliza-se da construção coletiva de redes explicativas, apontando soluções em vários planos com abordagem intersetorial. É através da observação dos indicadores de saúde que se torna perceptível a assimilação das comunidades indígenas com o recente modelo de atenção básica à saúde bucal, uma vez que constantemente está sendo adaptado à cultura, à tradição e às singularidades desses povos indígenas.

COOP/WONCA Charts as a Screen for Mental Disorders in Primary Care

PURPOSE most people with mental disorders receive treatment in primary care. The charts developed by the Dartmouth Primary Care Cooperative Research Network (COOP) and the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA) have not yet been evaluated as a screen for these disorders, using a structured psychiatric interview by an expert or considering diagnoses other than depression. We evaluated the validity and feasibility of the COOP/WONCA Charts as a mental disorders screen by comparing them both with other questionnaires previously validated and with the assessment of a mental health specialist using a structured diagnostic interview. METHODS We trained community health workers and nurse assistants working in a collaborative mental health care model to administer the COOP/WONCA Charts, the 20-item Self-Reporting Questionnaire (SRQ-20), and the World Health Organization Five Well-Being Index (WHO-5) to 120 primary care patients. A psychiatrist blinded to the patients' results on these questionnaires administered the SCID, or Structured Clinical Interview for the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS The area under the receiver operating characteristic curve was at least 0.80 for single items, a 3-item combination, and the total score of the COOP/WONCA Charts, as well as for the SRQ-20 and the WHO-5, for screening both for all mental disorders and for depressive disorders. The accuracy, sensitivity, specificity, and positive and negative predictive values of these measures ranged between 0.77 and 0.92. Community health workers and nurse assistants rated the understandability, ease of use, and clinical relevance of all 3 questionnaires as satisfactory. CONCLUSIONS One-time assessment of patients with the COOP/WONCA Charts is a valid and feasible option for screening for mental disorders by primary care teams.

The effects of work control and job demands on employee adjustment and work performance

The present study examined the effects of work control and job demands on employee adjustment and work performance using a multidimensional measure of work control (assessing levels of task control, decision control and work scheduling control). It was proposed that the negative effects of job demands and employee adjustment would be moderated by high levels of task control. It was also proposed that there would be evidence of main effects of both job demands and work control (particularly task-related levels of control) on employee adjustment. To test these predictions, a study of 135 university employees holding administrative positions was undertaken. Methodological improvements over previous research included the use of both self-reported adjustment measures and supervisor ratings of work performance as outcome variables, and the assessment of the predictor and outcome measures at different points in time (self-reported adjustment was assessed at both Times 1 and 2). The results revealed some support for the proposal that the effects of job demands would be buffered by high levels of task control, but not more peripheral aspects of work control. There were also significant main effects of task control on job satisfaction.

Effects of biomass burning on nasal mucociliary clearance and mucus properties after sugarcane harvesting

Objective: Biofuel from sugarcane is widely produced in developing countries and is a clean and renewable alternative source of energy. However, sugarcane harvesting is mostly performed after biomass burning. The aim of this study was to evaluate the effects of harvesting after biomass burning on nasal mucociliary clearance and the nasal mucus properties of farm workers. Methods: Twenty seven sugarcane workers (21-45 years old) were evaluated at the end of two successive time-periods: first at the end of a 6-month harvesting period (harvesting), and then at the end of a 3-month period without harvesting (non-harvesting). Nasal mucociliary clearance was evaluated by the saccharine transit test, and mucus properties were analyzed using in vitro mucus contact angle and mucus transportability by sneeze. Arterial blood pressure, heart rate, respiratory rate, pulse oximetry, body temperature, associated illness, and exhaled carbon monoxide were registered. Results: Data are presented as mean values (95% confidence interval). The multivariate model analysis adjusted for age, body-mass index, smoking status and years of working with this agricultural practice showed that harvesting yielded prolonged saccharine transit test in 7.83 min (1.88-13.78), increased mucus contact angle in 8.68 degrees (3.18-14.17) and decreased transportability by sneeze in 32.12 mm (-44.83 to -19.42) compared with the non-harvesting period. No significant differences were detected in any of the clinical parameter at either time-period. Conclusion: Sugarcane harvesting after biomass burning negatively affects the first barrier of the respiratory system in farm workers by impairing nasal mucociliary clearance and inducing abnormal mucus properties. (C) 2011 Elsevier Inc. All rights reserved.

Fusão de hospitais em centros hospitalares : impacto no seu desempenho operacional e financeiro

Mestrado em Contabilidade e Análise Financeira

El temps del mal: l’experiència i la gestió de la cronicitat en adults

El temps del mal. L’experiència i la gestió de la cronicitat en adults. El principal objectiu d’aquesta recerca és l’estudi de l’experiència i la gestió diària de la cronicitat, entenent-la com a categoria analítica que engloba els processos de malalties i/o malestars crònics, biomèdicament diagnosticats o no, que perduren en el temps. La recerca es centra en adults entre 30 i 50 anys amb problemes crònics de salut que impliquin algun tipus de discapacitat i/o dependència (a nivell moderat), i s’ubica en l’àmbit urbà i en la comunitat autònoma de Catalunya (dins del context de l’estat Espanyol). L’estudi analitzarà la gestió individual i social de la cronicitat a través dels itineraris terapèutics i pràctiques assistencials dels processos de salut/malaltia/atenció prenent l’autoatenció com a principal categoria analítica. Per altra banda, es descriurà el rol dels serveis assistencials de la sanitat pública i dels serveis socials, per veure com es duu a terme la gestió – polítiques públiques - de la cronicitat en un país amb estat del benestar com Espanya. L’experiència de la cronicitat s’explorarà a través de les narratives de la vivència de la malaltia/malestar tan com a representació cultural – que dóna compte de les relacions, interaccions i respostes socials – i des d’una perspectiva fenomenològica que ens permet comprendre la naturalesa del patiment en l’experiència viscuda del cos malalt. Aquesta recerca espera poder fer aportacions pertinents que contribueixin des de l’antropologia però amb la intenció d’obrir un diàleg públic i interdisciplinar – professionals de la salut, experts en polítiques públiques i públic en general - a la resolució de l’actual problema de salut pública d’increment de cronicitat. El model públic d’atenció a la salut espanyol es va dissenyar per resoldre problemes de salut aguts, malgrat la major part dels usuaris actuals presentes problemes de salut crònics. L’actual crisi econòmica que amenaça aquest pilar de l’estat del benestar és, alhora, una oportunitat per replantejar-ho.

Effective continuing professional development for translating shared decision making in primary care: A study protocol.

Background: Shared decision making (SDM) is a process by which a healthcare choice is made jointly by the healthcare professional and the patient. SDM is the essential element of patient-centered care, a core concept of primary care. However, SDM is seldom translated into primary practice. Continuing professional development (CPD) is the principal means by which healthcare professionals continue to gain, improve, and broaden the knowledge and skills required for patient-centered care. Our international collaboration seeks to improve the knowledge base of CPD that targets translating SDM into the clinical practice of primary care in diverse healthcare systems. Methods: Funded by the Canadian Institutes of Health Research (CIHR), our project is to form an international, interdisciplinary research team composed of health services researchers, physicians, nurses, psychologists, dietitians, CPD decision makers and others who will study how CPD causes SDM to be practiced in primary care. We will perform an environmental scan to create an inventory of CPD programs and related activities for translating SDM into clinical practice. These programs will be critically assessed and compared according to their strengths and limitations. We will use the empirical data that results from the environmental scan and the critical appraisal to identify knowledge gaps and generate a research agenda during a two-day workshop to be held in Quebec City. We will ask CPD stakeholders to validate these knowledge gaps and the research agenda. Discussion: This project will analyse existing CPD programs and related activities for translating SDM into the practice of primary care. Because this international collaboration will develop and identify various factors influencing SDM, the project could shed new light on how SDM is implemented in primary care.

"Sóc" a la professió infermera

El propòsit de la present investigació és conèixer el model Salutogènic i la sevaaplicació en el treball diari dels professionals d’infermeria. La disciplina infermera escaracteritza pel tracte amb les persones, el seu paradigma està basat en les cures cap aaquestes. Aquest fet causa que formin part de la professió els estímuls estressants tantde l’ambient com de l’interior dels professionals i és important que aquests prenguinconsciència d’aquesta realitat i desenvolupin recursos i mecanismes que possibilitinrealitzar les cures de gran qualitat. Creiem que el model Salutogènic i el seu constructeprincipal, el Sentit de Coherència ens col·loquen en bon camí per poder aprofundir enaquest tema. (Extret de la introducció)

Kolmen hyvinvointiaseman toimintakustannusten määritys Etelä-Karjalassa

Työn tavoitteena oli tutkia, millä tavalla perusterveydenhuollon perinteisestä terveysasemamallista hyvinvointiasemamalliin siirtyminen vaikuttaa sosiaali- ja terveyspalvelujen tarjonnan kustannuksiin, mikäli vaikutus on havaittavissa. Toisaalta tavoitteena oli kartoittaa, millä keinoilla hyvinvointiasemien kustannustehokkuutta voitaisiin parantaa tulevaisuudessa ja mitä kustannushyötyjä tiiviimmällä sosiaali- ja terveystoimen yhteistyöllä on mahdollista saavuttaa. Tutkimuksessa käsiteltiin terveyden ja hyvinvoinnin edistämisen roolin merkitystä perusterveydenhuollossa, sähköistä asiointipalveluja ja terveydenhuollon ammattiryhmien välistä työnjakoa sekä edelleen, miten näillä voidaan vaikuttaa tuottavuuteen ja vaikuttavuuteen. Havaittiin, että sähköisellä asioinnilla ja työnjaolla on selkeä yhteys kustannuksiin. Työn empiirisessä osassa tarkasteltiin kolmea hyvinvointiasemamallin pilottihankkeessa mukana olevaa asemaa Lauritsalassa, Lemillä ja Ruokolahdella. Kustannusten tarkastelu keskittyi henkilöstö- ja tilakustannuksiin. Tutkittiin myös, miten sähköinen asiointi ja Eksoten alueen puhelinpalvelujen keskittäminen vaikuttaa edellä mainittuihin kustannuseriin. Tutkimuksen tuloksina havaittiin, että hyvinvointiasemamallin pilotointi ei ole tutkittavilla asemilla merkittävästi vaikuttanut kustannuksiin henkilöstön osalta; tilakustannukset olivat pienentyneet Lemillä ja Ruokolahdella. Laskelmien perusteella muodostettujen tavoitteiden mukaisesti on hyvinvointiasemilla kuitenkin pyrittävä vähintään noin 14 % tai enintään 32 % säästöön henkilöstö- ja tilakustannuksissa pilottivaiheen kustannuksiin verrattuna. Tulevaisuudessa olennaiseksi kustannusten hallinnan edellytykseksi havaittiin työnjaon muuttaminen hoitajavetoisemmaksi ja sähköisten asiointipalvelujen lisääntyvä tarjonta. Sähköisten asioinnin lisääntyvällä käytöllä on mahdollista vähentää hoitohenkilöstön tarvetta kokonaisuudessaan. Sekä sähköisen asioinnin käytön lisäämisellä että puhelinpalvelujen keskittämisellä tulevaisuudessa havaittiin olevan huomattava vaikutus henkilöstöresurssien käyttöön ja edelleen kustannustehokkuuteen.

Hälsa i vårdande gemenskap : gemenskapens betydelse för äldre

The aim of the study and research questions: The aim of this study is to illuminate how caring communion can aid in promoting health as becoming in elderly people in the context of natural caring. The target group of the study consists of elderly citizens living at home. The focus of this thesis is on the concept of communion and how caring communion can affect the inner health resources in a patient’s inner health domain, as well as how caring communion can support health as becoming and inner health resources in the elderly. The main research questions of this study are the following: 1) what does communion mean? 2) what does caring communion mean? 3) what is the connection between caring communion and health? Theoretical perspective: The theoretical perspective of this qualitative study relies on the caritative caring theory as developed by scholars of caring sciences at the Åbo Academi University’s Vasa unit. The caritas motive is based on an ethos built on a consideration of togetherness, i.e. caring communion, a place where one feels at home and where one can be the person one was meant to be. Methodology: A hermeneutic research approach based on Gadamer (1997) permeates the study. This entails that understanding and interpretation become central. The study conducted in the thesis is divided into three sub-studies. Sub-study one and two are based on ontological determination whereas the third sub-study is carried out by contextual determination. The first sub-study is conducted by etymological and semantic analysis of the concept of communion (gemenskap) based on Koort (1975) and the second sub-study by determining the basic epistemological category of the concept based on Eriksson (2010b). Sub-study three is conducted through content analysis of 18 multidisciplinary and 13 caring science articles and dissertations based on Kvale (2009). The aim in the third sub-study is to define caring communions in various contexts of meaning based on Eriksson´s model of conceptual determination (2010b). All studies are interpreted through hermeneutic interpretation where the continuous movement from a part of a whole, to the whole, to part again, leads to new understanding. Finally, the findings from all the three sub-studies are compared to the concepts of pre-understanding and the inner-health-domain model of Wärnås (2002). Results: The results of the study offer a description of the dimensions of caring communion and a model that illuminates how caring communion can further health as becoming. The fundamentals of caring communion rest on the idea of a human being’s absolute right to dignity as a base for communion. The concept of communion contains a moral, an ethical, and a spiritual component. In communion, there exists a moral and ethical responsibility and a willingness to commit oneself. The individual is part of a connection or relation and knows the aim and course for the communion. A caring connection, a caring culture, a caring atmosphere and caring listening are characteristics of caring communion. In caring communion, the elderly feel trusting and see themselves as unique, powerful, and valuable. The model demonstrates that when the elderly are able to rest in caring communion, the virtues of courage and faith become strong and desire for life awaken within the elderly and health as becoming becomes possible. Conclusions: The outcome of the study is that all communion is not necessarily caring communion. In order for communion to be caring and for the elderly to achieve health as becoming, there are certain criteria that must be met. This is especially important when designing activities for the elderly in the context of natural caring.

Favoriser la santé psychologique des professionnels de la santé en début de carrière : l'importance du soutien à l'autonomie, de la concordance des tâches et de la conscience de soi

Les études mettent en évidence des problèmes de santé psychologique chez les professionnels de la santé. Par contre, les facteurs permettant d’expliquer ces difficultés sont peu connus (p. ex., Cohen & Patten, 2005). Le but de cette thèse est d’étudier les déterminants de la santé psychologique des professionnels de la santé en se basant sur une théorie validée empiriquement. À cette fin, la théorie de l’autodétermination (Deci & Ryan, 1985, 2000) est utilisée comme cadre conceptuel et le soutien à l’autonomie (Black & Deci, 2000; Grolnick & Ryan, 1989) est proposé comme déterminant principal de la santé psychologique. Le premier article consiste en une recension des conséquences et corrélats associés au soutien à l’autonomie dans divers domaines de vie. Le deuxième article a pour objectif de tester un modèle prédictif de la santé psychologique auprès de médecins résidents. Le modèle propose que la concordance des tâches (Sheldon & Elliot, 1999) et la conscience de soi (Goldman & Kernis, 2002) sont deux sources distinctes d’autonomie qui prédisent de façon indépendante la santé psychologique. De plus, le soutien à l’autonomie de la part des superviseurs est suggéré comme étant un déterminant important de la concordance des tâches et de la conscience de soi. Au total, 333 médecins résidents de la province de Québec (Canada) ont rempli un questionnaire comportant différentes mesures. Des analyses par équations structurelles révèlent une excellente adéquation du modèle. Le troisième article examine l’influence du soutien à l’autonomie des collègues sur la satisfaction au travail ainsi que sur la santé psychologique des professionnels de la santé. Au total, 597 jeunes professionnels de la santé ont rempli un questionnaire incluant diverses mesures. Les résultats confirment que le soutien à l’autonomie perçu de la part des collègues prédit la santé psychologique et la satisfaction au travail. De plus, des régressions hiérarchiques démontrent que le soutien à l’autonomie des collègues contribue à la prédiction de la satisfaction au travail, du bien-être subjectif et des idéations suicidaires au-delà de ce qui est prédit par le soutien à l’autonomie des superviseurs. Les implications théoriques et pratiques de ces recherches sont discutées.

Pertinence de la référence en orthopédie pédiatrique des cas suspectés de scoliose idiopathique : association avec la morbidité perçue et les itinéraires de soins des patients

La scoliose idiopathique de l’adolescent (SIA) est le type de déformation musculosquelettique le plus fréquent dans la population pédiatrique, pour une prévalence d’environ 2,0%. Depuis l’arrêt des programmes scolaires de dépistage de la SIA dans les années 1980 au Canada, nous ne disposions d’aucune donnée sur l’utilisation des services de santé par les patients présentant une SIA suspectée. En l’absence de tels programmes, des changements dans les patrons d’utilisation des services spécialisés d’orthopédie pédiatrique sont anticipés. La thèse a donc pour but d’étudier la pertinence de la référence dans ces services des jeunes avec SIA suspectée. Elle est structurée autour de trois principaux objectifs. 1) Valider un instrument de mesure de la morbidité perçue (perception des symptômes) dans la clientèle d’orthopédie pédiatrique; 2) Étudier la relation entre la morbidité perçue par les profanes (le jeune et le parent) et la morbidité objectivée par les experts; 3) Caractériser les itinéraires de soins des patients avec SIA suspectée, de façon à en élaborer une taxonomie et à analyser les relations entre ceux-ci et la pertinence de la référence. En 2006-2007, une vaste enquête a été réalisée dans les cinq cliniques d’orthopédie pédiatrique du Sud-Ouest du Québec : 831 patients référés ont été recrutés. Ils furent classés selon des critères de pertinence de la référence (inappropriée, appropriée ou tardive) définis en fonction de l’amplitude de la courbe rachidienne et de la maturité squelettique à cette première visite. La morbidité perçue par les profanes a été opérationnalisée par la gravité, l’urgence, les douleurs, l’impact sur l’image de soi et la santé générale. L’ensemble des consultations médicales et paramédicales effectuées en amont de la consultation en orthopédie pédiatrique a été documenté par questionnaire auprès des familles. En s’appuyant sur le Modèle comportemental de l’utilisation des services d’Andersen, les facteurs (dits de facilitation et de capacité) individuels, relatifs aux professionnels et au système ont été considérés comme variables d’ajustement dans l’étude des relations entre la morbidité perçue ou les itinéraires de soins et la pertinence de la référence. Les principales conclusions de cette étude sont : i) Nous disposons d’instruments fidèles (alpha de Cronbach entre 0,79 et 0,86) et valides (validité de construit, concomitante et capacité discriminante) pour mesurer la perception de la morbidité dans la population adolescente francophone qui consulte en orthopédie pédiatrique; ii) Les profanes jouent un rôle important dans la suspicion de la scoliose (53% des cas) et leur perception de la morbidité est directement associée à la morbidité objectivée par les professionnels; iii) Le case-mix actuel en orthopédie est jugé non optimal en regard de la pertinence de la référence, les mécanismes actuels entraînant un nombre considérable de références inappropriées (38%) et tardives (18%) en soins spécialisés d’orthopédie pédiatrique; iv) Il existe une grande diversité de professionnels par qui sont vus les jeunes avec SIA suspectée ainsi qu’une variabilité des parcours de soins en amont de la consultation en orthopédie, et v) La continuité des soins manifestée dans les itinéraires, notamment via la source régulière de soins de l’enfant, est favorable à la diminution des références tardives (OR=0,32 [0,17-0,59]). Les retombées de cette thèse se veulent des contributions à l’avancement des connaissances et ouvrent sur des propositions d’initiatives de transfert des connaissances auprès des professionnels de la première ligne. De telles initiatives visent la sensibilisation à cette condition de santé et le soutien à la prise de décision de même qu’une meilleure coordination des demandes de consultation pour une référence appropriée et en temps opportun.