Problems with accessibility to health services by persons with disabilities in Sao Paulo, Brazil

Purpose. To describe the occurrence of self-reported problems of accessibility to health services used by persons with disabilities in terms of social and health services variables. Methods. We performed a cross-sectional household survey designed to assess problems with accessibility to health services faced by persons with disabilities. We interviewed 333 persons in Sao Paulo city, in 2007. Variables related to the presence of accessibility problems, disabilities, gender, age, family head income, ethnicity, use of health services and others were analysed using frequencies, percentages, chi(2)-test, ANOVA and Poisson regression models. Results. 15.92% of the interviewed persons reported problems with accessibility to health services. Persons having multiple (prevalence ratios; PR = 2.91) or mobility disability (PR = 6.46) had more problems with accessibility than persons with hearing disability. Persons younger than 78 years old had more problems with accessibility; those who needed help to go to the health service (PR = 3.01) also. Conclusions. Persons with multiple or mobility disability, younger than 78 years, and those who needed help of others to go to the health service were more likely to have problems with accessibility to health services. This information could be one of the first steps to the management and/or planning of appropriate health services for persons with disabilities.

Improving data perturbation testing techniques for Web services

The widespread use of service-oriented architectures (SOAs) and Web services in commercial software requires the adoption of development techniques to ensure the quality of Web services. Testing techniques and tools concern quality and play a critical role in accomplishing quality of SOA based systems. Existing techniques and tools for traditional systems are not appropriate to these new systems, making the development of Web services testing techniques and tools required. This article presents new testing techniques to automatically generate a set of test cases and data for Web services. The techniques presented here explore data perturbation of Web services messages upon data types, integrity and consistency. To support these techniques, a tool (GenAutoWS) was developed and applied to real problems. (C) 2010 Elsevier Inc. All rights reserved.

Enhancing the distribution of Swedish tourism services on international markets : Possible export-ready criteria requisitioned by European tour operators

This paper identifies subjects which are relevant for Swedish suppliers of tourism services beforeapproaching foreign markets. Most suppliers are micro, small or medium sized companies anduse intermediaries, such as tour operators, for internationalization. The research considers theopinion of British and German tour operators, which require some criteria beforehand in orderto simplify both the initialization and the development of cooperation. Destination marketingorganizations (DMOs) are hereby the go-betweens since they not only represent small-scalesuppliers on international markets, but also initiate first encounters between suppliers and touroperators. Suppliers need to provide DMOs with accurate information in order to ensure thebest possible representation. After initializing collaboration, business relationships are sought todevelop in order to facilitate long-term cooperation. Proper preparation forms therefore the basefor strengthening the competitiveness of Swedish tourism prior approaching internationalmarkets. The enhancement of distributing Swedish tourism services on foreign markets appearedto be a profitable way to enable further growth, which is strongly limited on the domestic market.Increasing the export share therefore secures and further facilitates tourism’s valuablecontributions to the Swedish economy.

The effects of Kanban in software development teams : a study of the implementation at Sandvik

In software development organizations there is sometimes a need for change. In order to meet continuously increasing demands from their customers, Sandvik IT Services- SITS, at Sandvik in Sweden, required improving the way they worked with software development. Due to issues like a lot of work in progress and lot of simultaneous tasks for individuals in the teams that caused stress, it was almost impossible to address the question of working with improvements. In order to enable the improvement process Kanban was introduced in the software development teams. Kanban for software development is a change method created by David J. Anderson. The purpose of this thesis is twofold. One part is to assess what effects Kanban has had on the software development teams. The other part is to make a documentation of the Kanban implementation process at SITS. The documentation has been made on the basis of both company internal resources and observations of the Kanban implementation process. The effects of Kanban have been researched with an interview survey to the teams that have gone through the Kick start of the Kanban process. The result of the thesis is also twofold. One part of the result is an extensive documentation of the implementation process of Kanban at SITS. The other part is an assessment of the effects that Kanban has had at SITS. The major effects have been that the teams are experiencing less stress, more focus on quality and better customer collaboration. It is also evident is that it takes time for some effects to evolve when implementing Kanban

Building a Learning Architecture : e-Learning and e-Services

With the rapid advancement of the webtechnology, more and more educationalresources, including software applications forteaching/learning methods, are available acrossthe web, which enables learners to access thelearning materials and use various ways oflearning at any time and any place. Moreover,various web-based teaching/learning approacheshave been developed during the last decade toenhance the capability of both educators andlearners. Particularly, researchers from bothcomputer science and education are workingtogether, collaboratively focusing ondevelopment of pedagogically enablingtechnologies which are believed to improve theinfrastructure of education systems andprocesses, including curriculum developmentmodels, teaching/learning methods, managementof educational resources, systematic organizationof communication and dissemination ofknowledge and skills required by and adapted tousers. Despite of its fast development, however,there are still great gaps between learningintentions, organization of supporting resources,management of educational structures,knowledge points to be learned and interknowledgepoint relationships such as prerequisites,assessment of learning outcomes, andtechnical and pedagogic approaches. Moreconcretely, the issues have been widelyaddressed in literature include a) availability andusefulness of resources, b) smooth integration ofvarious resources and their presentation, c)learners’ requirements and supposed learningoutcomes, d) automation of learning process interms of its schedule and interaction, and e)customization of the resources and agilemanagement of the learning services for deliveryas well as necessary human interferences.Considering these problems and bearing in mindthe advanced web technology of which weshould make full use, in this report we willaddress the following two aspects of systematicarchitecture of learning/teaching systems: 1)learning objects – a semantic description andorganization of learning resources using the webservice models and methods, and 2) learningservices discovery and learning goals match foreducational coordination and learning serviceplanning.

Modeling and illustrating requirement prioritization in public e-service development from a value-based perspective

A major problem in e-service development is the prioritization of the requirements of different stakeholders. The main stakeholders are governments and their citizens, all of whom have different and sometimes conflicting requirements. In this paper, the prioritization problem is addressed by combining a value-based approach with an illustration technique. This paper examines the following research question: How can multiple stakeholder requirements be illustrated from a value-based perspective in order to be prioritizable? We used an e-service development case taken from a Swedish municipality to elaborate on our approach. Our contributions are: 1) a model of the relevant domains for requirement prioritization for government, citizens, technology, finances and laws and regulations; and 2) a requirement fulfillment analysis tool (RFA) that consists of a requirement-goal-value matrix (RGV), and a calculation and illustration module (CIM). The model reduces cognitive load, helps developers to focus on value fulfillment in e-service development and supports them in the formulation of requirements. It also offers an input to public policy makers, should they aim to target values in the design of e-services.

Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Transparent Fault Tolerance for Web Services based Architectures

Service-based architectures enable the development of new classes of Grid and distributed applications. One of the main capabilities provided by such systems is the dynamic and flexible integration of services, according to which services are allowed to be a part of more than one distributed system and simultaneously serve different applications. This increased flexibility in system composition makes it difficult to address classical distributed system issues such as fault-tolerance. While it is relatively easy to make an individual service fault-tolerant, improving fault-tolerance of services collaborating in multiple application scenarios is a challenging task. In this paper, we look at the issue of developing fault-tolerant service-based distributed systems, and propose an infrastructure to implement fault tolerance capabilities transparent to services.

The Adequacy of Health Care Services for the Elderly in China

This study examines the adequacy of health care services for the elderly in China, specifically focusing on the influence of location, method of payment, living situation, and financial status. The study finds that rural residents, respondents living alone and respondents unable to meet all of their daily costs have a lower probability of reporting the availability of adequate health care. It also investigates the reasons why elderly respondents do not visit the hospital when it is necessary, concluding that financial and distance constraints are main deterrents. Finally, changes in the reported adequacy of health care over time are taken into consideration, and are found to follow a likely pattern given the history of the health care system in China. This is an important investigation given the historical background of health care in China, the current cost problems facing residents, and, consequently, the policy changes that will need to be implemented by the Chinese government in the near future.

Wetlands and Development in Maine

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