Access to care for the poor living with chronic disease in India : an analysis of selected national health policies

Cette recherche sur les barrières à l’accès pour les pauvres atteints de maladies chroniques en Inde a trois objectifs : 1) évaluer si les buts, les objectifs, les instruments et la population visée, tels qu'ils sont formulés dans les politiques nationales actuelles de santé en Inde, permettent de répondre aux principales barrières à l’accès pour les pauvres atteints de maladies chroniques; 2) évaluer les types de leviers et les instruments identifiés par les politiques nationales de santé en Inde pour éliminer ces barrières à l’accès; 3) et évaluer si ces politiques se sont améliorées avec le temps à l’égard de l’offre de soins à la population pour les maladies chroniques et plus spécifiquement chez les pauvres. En utilisant le Framework Approach de Ritchie et Spencer (1993), une analyse qualitative de contenu a été complétée avec des politiques nationales de santé indiennes. Pour commencer, un cadre conceptuel sur les barrières à l’accès aux soins pour les pauvres atteints de maladies chroniques en Inde a été créé à partir d’une revue de la littérature scientifique. Par la suite, les politiques ont été échantillonnées en Inde en 2009. Un cadre thématique et un index ont été générés afin de construire les outils d’analyse et codifier le contenu. Finalement, les analyses ont été effectuées en utilisant cet index, en plus de chartes, de maps, d'une grille de questions et d'études de cas. L’analyse a tété effectuée en comparant les barrières à l’accès qui avaient été originalement identifiées dans le cadre thématique avec celles identifiées par l’analyse de contenu de chaque politique. Cette recherche met en évidence que les politiques nationales de santé indiennes s’attaquent à un certain nombre de barrières à l’accès pour les pauvres, notamment en ce qui a trait à l’amélioration des services de santé dans le secteur public, l’amélioration des connaissances de la population et l’augmentation de certaines interventions sur les maladies chroniques. D’un autre côté, les barrières à l’accès reliées aux coûts du traitement des maladies chroniques, le fait que les soins de santé primaires ne soient pas abordables pour beaucoup d’individus et la capacité des gens de payer sont, parmi les barrières à l'accès identifiées dans le cadre thématique, celles qui ont reçu le moins d’attention. De plus, lorsque l’on observe le temps de formulation de chaque politique, il semble que les efforts pour augmenter les interventions et l’offre de soins pour les maladies chroniques physiques soient plus récents. De plus, les pauvres ne sont pas ciblés par les actions reliées aux maladies chroniques. Le risque de les marginaliser davantage est important avec la transition économique, démographique et épidémiologique qui transforme actuellement le pays et la demande des services de santé.

Living and fishing in a marine protected area : balancing traditional fisheries with conservation in Karimunjawa National Park, Indonesia

Cette recherche a porté sur quelques enjeux importants liés à la gestion des aires marines protégées (AMP) en Indonésie en examinant comment celles-ci sont en mesure d'adapter leurs politiques afin de mieux répondre à l'évolution des conditions socioéconomiques et écologiques, quels ont été les impacts socioéconomiques de ces aires, et quelles sont les préoccupations environnementales des acteurs locaux dont les moyens de subsistance dépendent des ressources règlementées. Le «livelihoods framework » a servi de guide pour notre analyse des changements socioéconomiques dans la région, tandis que la notion d’« environmentality » d’Agrawal a fourni les bases théoriques pour l'examen de la formation de sujets environnementaux au parc national de Karimunjawa. Cette étude a montré que les changements de politique apportés au plan de la gestion du parc sont un pas dans la bonne direction, mais que les objectifs importants liés sa cogestion n'ont jamais été entièrement réalisés dans la pratique. Les résultats montrent également que d'importants changements socioéconomiques surviennent dans le parc, de nombreux pêcheurs se tournent vers des moyens de subsistance alternatifs, afin de compenser la baisse des prises de poissons. Enfin, cette étude a révélé que d'importants changements positifs dans les préoccupations environnementales sont survenus depuis la modification du zonage du parc, mais que ceux-ci ne se sont pas entièrement traduits en conformité avec les règles et règlements de l'AMP.

Marine yeast Candida MCCF 101 as feed supplement in aquaculture: nutritional quality, optimization of large scale production and evaluation of its protective effect on Koi carp from Aeromonas infection

Marine yeast have been regarded as safe and showing a beneficial impact on biotechnological process. It provides better nutritional and dietary values indicating their potential application as feed supplements in aquaculture. Brown et al. (1996) evaluated all the marine yeasts characterised with high protein content, carbohydrate, good amino acid composition and high levels of saturated fats. However, there is paucity of information on marine yeasts as feed supplements and no feed formulation has been found either in literature or in market supplemented with them. This statement supported by Zhenming et al. (2006) reported still a lack of feed composed of single cell protein (SCP) from marine yeasts with high content of protein and other nutrients. Recent research has shown that marine yeasts also have highly potential uses in food, feed, medical and biofuel industries as well as marine biotechnology (Chi et al., 2009; 2010). Sajeevan et al. (2006; 2009a) and Sarlin and Philip (2011) demonstrates that the marine yeasts Candida sake served as a high quality, inexpensive nutrient source and it had proven immunostimulatory properties for cultured shrimps. This strain has been made part of the culture collection of National Centre for Aquatic Animal Health, Cochin University of Science and Technology as Candida MCCF 101. Over the years marine yeasts have been gaining increased attention in animal feed industry due to their nutritional value and immune boosting property.Therefore, the present study was undertaken, and focused on the nutritional quality, optimization of large scale production and evaluation of its protective effect on Koi carp from Aeromonas infection

Comparación de indicador “demanda no atendida” en urgencias, antes y después del especialista en emergencias

El presente estudio evalúa si hay cambios importantes en el indicador DNA, sin pretender demostrar causalidad, durante dos años antes y tres años después de la participación del EE, mediante un análisis comparativo pareado entre grupos con recolección retrospectiva. Durante el desarrollo de la formación de la primera cohorte de residentes del programa de especialización en Medicina de Emergencias en Bogotá, el hospital base del posgrado contrató un especialista en emergencias graduado en Medellín del Instituto de Ciencias de la Salud (CES), como Jefe del SU, lo que fue visto como una oportunidad única para notar los cambios posteriores a su participación, si bien el estudio no se diseñó para evaluar causalidad directa, pues los múltiples factores que intervendrían y el riesgo de modificación del factor a estudiar eran muy altos como para proponerse un análisis multivariado prospectivo.

Evaluación de tecnologías sanitarias aplicada a la selección de un módulo de proteína para uso hospitalario

Introducción: La evaluación de tecnologías en salud aplicadas a la selección de un módulo de proteína para uso hospitalario, tiene como finalidad servir de apoyo en la elección de productos costo efectivos y seguros, con el fin de favorecer la toma de decisiones a los diferentes agentes que participan en la elección de alternativas terapéuticas, recomendadas en pacientes con necesidades elevadas de proteínas, como es el caso de la presente investigación. Objetivo: Aplicar un método matemático - multicriterio que permita evaluar los módulos de proteína disponibles en el mercado para la terapia nutricional institucional. Métodos: Se establecieron dos fases, una revisión de la literatura para establecer y priorizar los criterios de evaluación técnica de las diferentes ofertas de módulos de proteína, y dos se realizó una aplicación de un modelo matemático con el fin de considerar el modulo proteico para uso dentro de las instituciones hospitalarias, el cual consistió en la asignación de un valor a cada una de las variables mediante una escala diferencial semántica establecida, que permitieron calcular el peso porcentual de cada una de las variables, cuya sumatoria arrojo la calificación porcentual de cada alternativa. Resultados: Respecto a la búsqueda de criterios de evaluación técnica para las diferentes ofertas de módulos de proteína, en la literatura se identificaron las siguientes variables para evaluación, la naturaleza o equivalencia, condiciones de administración y uso, seguridad, y eficacia. La naturaleza se evaluó mediante la calificación del cómputo químico de aminoácidos corregido por digestibilidad proteica (PDCAAS) con un peso en la evaluación del 39.05%, en referencia a las condiciones de administración y uso se tuvo en cuenta factores incluidos en los sistemas de distribución por dosis unitaria con un peso del 27.61%, la eficacia fue definida por la tasa de eficiencia proteica (PER) la cual impacta el 19.53% de la calificación y finalmente, el criterio de seguridad con un 13.81% referente al empaque y etiquetado. Conclusiones: Al realizar la evaluación de cuatro alternativas de módulos de proteína, ofertadas por las diferentes casas farmacéuticas, la mayor puntuación correspondiente a las alternativas con una calificación superior al 90%, la obtuvieron dos alternativas de módulos de proteína para uso hospitalario, las cuales contienen proteínas del suero (“Whey”) y aminoácidos en combinaciones.

National and sub-national assessments of soil organic carbon stocks and changes: The GEFSOC modelling system

Soil organic carbon (SOC) plays a vital role in ecosystem function, determining soil fertility, water holding capacity and susceptibility to land degradation. In addition, SOC is related to atmospheric CO, levels with soils having the potential for C release or sequestration, depending on land use, land management and climate. The United Nations Convention on Climate Change and its Kyoto Protocol, and other United Nations Conventions to Combat Desertification and on Biodiversity all recognize the importance of SOC and point to the need for quantification of SOC stocks and changes. An understanding of SOC stocks and changes at the national and regional scale is necessary to further our understanding of the global C cycle, to assess the responses of terrestrial ecosystems to climate change and to aid policy makers in making land use/management decisions. Several studies have considered SOC stocks at the plot scale, but these are site specific and of limited value in making inferences about larger areas. Some studies have used empirical methods to estimate SOC stocks and changes at the regional scale, but such studies are limited in their ability to project future changes, and most have been carried out using temperate data sets. The computational method outlined by the Intergovernmental Panel on Climate Change (IPCC) has been used to estimate SOC stock changes at the regional scale in several studies, including a recent study considering five contrasting eco regions. This 'one step' approach fails to account for the dynamic manner in which SOC changes are likely to occur following changes in land use and land management. A dynamic modelling approach allows estimates to be made in a manner that accounts for the underlying processes leading to SOC change. Ecosystem models, designed for site scale applications can be linked to spatial databases, giving spatially explicit results that allow geographic areas of change in SOC stocks to be identified. Some studies have used variations on this approach to estimate SOC stock changes at the sub-national and national scale for areas of the USA and Europe and at the watershed scale for areas of Mexico and Cuba. However, a need remained for a national and regional scale, spatially explicit system that is generically applicable and can be applied to as wide a range of soil types, climates and land uses as possible. The Global Environment Facility Soil Organic Carbon (GEFSOC) Modelling System was developed in response to this need. The GEFSOC system allows estimates of SOC stocks and changes to be made for diverse conditions, providing essential information for countries wishing to take part in an emerging C market, and bringing us closer to an understanding of the future role of soils in the global C cycle. (C) 2007 Elsevier B.V. All rights reserved.

Hillslope scale surface runoff, sediment, and nutrient losses associated with tramline wheelings

Research on arable sandy loam and silty clay loam soils on 4° slopes in England has shown that tramlines (i.e. the unseeded wheeling areas used to facilitate spraying operations in cereal crops) can represent the most important pathway for phosphorus and sediment loss from moderately sloping fields. Detailed monitoring over the October–March period in winters 2005–2006 and 2006–2007 included event-based sampling of surface runoff, suspended and particulate sediment, and dissolved and particulate phosphorus from hillslope segments (each ∼300–800 m2) established in a randomized block design with four replicates of each treatment at each of two sites on lighter and heavier soils. Experimental treatments assessed losses from the cropped area without tramlines, and from the uncropped tramline area, and were compared to losses from tramlines which had been disrupted once in the autumn with a shallow tine. On the lighter soil, the effects of removal or shallow incorporation of straw residues was also determined. Research on both sandy and silty clay loam soils across two winters showed that tramline wheelings represented the dominant pathway for surface runoff and transport of sediment, phosphorus and nitrogen from cereal crops on moderate slopes. Results indicated 5·5–15·8% of rainfall lost as runoff, and losses of 0·8–2·9 kg TP ha−1 and 0·3–4·8 t ha−1 sediment in tramline treatments, compared to only 0·2–1·7% rainfall lost as runoff, and losses of 0·0–0·2 kg TP ha−1 and 0·003–0·3 t ha−1 sediment from treatments without tramlines or those where tramlines had been disrupted. The novel shallow disruption of tramline wheelings using a tine once following the autumn spray operation consistently and dramatically reduced (p < 0·001) surface runoff and loads of sediment, total nitrogen and total phosphorus to levels similar to those measured in cropped areas between tramlines. Results suggest that options for managing tramline wheelings warrant further refinement and evaluation with a view to incorporating them into spatially-targeted farm-level management planning using national or catchment-based agri-environment policy instruments aimed at reducing diffuse pollution from land to surface water systems. Copyright © 2010 John Wiley & Sons, Ltd.

Integrating nitrogen fluxes at the European scale

Executive summary Nature of the problem • Environmental problems related to nitrogen concern all economic sectors and impact all media: atmosphere, pedosphere, hydrosphere and anthroposphere. • Therefore, the integration of fluxes allows an overall coverage of problems related to reactive nitrogen (Nr) in the environment, which is not accessible from sectoral approaches or by focusing on specific media. Approaches • This chapter presents a set of high resolution maps showing key elements of the N flux budget across Europe, including N2 and Nr fluxes. • Comparative nitrogen budgets are also presented for a range of European countries, highlighting the most efficient strategies for mitigating Nr problems at a national scale. A new European Nitrogen Budget (EU-27) is presented on the basis of state-of-the-art Europe-wide models and databases focusing on different segments of Europe’s society. Key findings • From c. 18 Tg Nr yr −1 input to agriculture in the EU-27, only about 7 Tg Nr yr− 1 find their way to the consumer or are further processed by industry. • Some 3.7 Tg Nr yr−1 is released by the burning of fossil fuels in the EU-27, whereby the contribution of the industry and energy sectors is equal to that of the transport sector. More than 8 Tg Nr yr−1 are disposed of to the hydrosphere, while the EU-27 is a net exporter of reactive nitrogen through atmospheric transport of c. 2.3 Tg Nr yr−1. • The largest single sink for Nr appears to be denitrifi cation to N2 in European coastal shelf regions (potentially as large as the input of mineral fertilizer, about 11 Tg N yr–1 for the EU-27); however, this sink is also the most uncertain, because of the uncertainty of Nr import from the open ocean. Major uncertainties • National nitrogen budgets are diffi cult to compile using a large range of data sources and are currently available only for a limited number of countries. • Modelling approaches have been used to fill in the data gaps in some of these budgets, but it became obvious during this study that further research is needed in order to collect necessary data and make national nitrogen budgets inter-comparable across Europe. • In some countries, due to inconsistent or contradictory information coming from different data sources, closure of the nitrogen budget was not possible. Recommendations • The large variety of problems associated with the excess of Nr in the European environment,including adverse impacts, requires an integrated nitrogen management approach that would allow for creation and closure of N budgets within European environments. • Development of nitrogen budgets nationwide, their assessment and management could become an effective tool to prioritize measures and prevent unwanted side effects.

History education in comprehensive schools: using school level data to interpret national patterns

This paper reports the findings from two large scale national on-line surveys carried out in 2009 and 2010, which explored the state of history teaching in English secondary schools. Large variation in provision was identified within comprehensive schools in response to national policy decisions and initiatives. Using the data from the surveys and school level data that is publicly available, this study examines situated factors, particularly the nature of the school intake, the numbers of pupils with special educational needs and the socio-economic status of the area surrounding the school, and the impact these have on the provision of history education. The findings show that there is a growing divide between those students that have access to the ‘powerful knowledge’, provided by subjects like history, and those that do not.

The socioeconomics of food crop production and climate change vulnerability: a global scale quantitative analysis of how grain crops are sensitive to drought

Many studies warn that climate change may undermine global food security. Much work on this topic focuses on modelling crop-weather interactions but these models do not generally account for the ways in which socio-economic factors influence how harvests are affected by weather. To address this gap, this paper uses a quantitative harvest vulnerability index based on annual soil moisture and grain production data as the dependent variables in a Linear Mixed Effects model with national scale socio-economic data as independent variables for the period 1990-2005. Results show that rice, wheat and maize production in middle income countries were especially vulnerable to droughts. By contrast, harvests in countries with higher investments in agriculture (e.g higher amounts of fertilizer use) were less vulnerable to drought. In terms of differences between the world's major grain crops, factors that made rice and wheat crops vulnerable to drought were quite consistent, whilst those of maize crops varied considerably depending on the type of region. This is likely due to the fact that maize is produced under very different conditions worldwide. One recommendation for reducing drought vulnerability risks is coordinated development and adaptation policies, including institutional support that enables farmers to take proactive action.

Scale sensitivity of drivers of environmental change across Europe

The development of effective environmental management plans and policies requires a sound understanding of the driving forces involved in shaping and altering the structure and function of ecosystems. However, driving forces, especially anthropogenic ones, are defined and operate at multiple administrative levels, which do not always match ecological scales. This paper presents an innovative methodology of analysing drivers of change by developing a typology of scale sensitivity of drivers that classifies and describes the way they operate across multiple administrative levels. Scale sensitivity varies considerably among drivers, which can be classified into five broad categories depending on the response of ‘evenness’ and ‘intensity change’ when moving across administrative levels. Indirect drivers tend to show low scale sensitivity, whereas direct drivers show high scale sensitivity, as they operate in a non-linear way across the administrative scale. Thus policies addressing direct drivers of change, in particular, need to take scale into consideration during their formulation. Moreover, such policies must have a strong spatial focus, which can be achieved either by encouraging local–regional policy making or by introducing high flexibility in (inter)national policies to accommodate increased differentiation at lower administrative levels. High quality data is available for several drivers, however, the availability of consistent data at all levels for non-anthropogenic drivers is a major constraint to mapping and assessing their scale sensitivity. This lack of data may hinder effective policy making for environmental management, since it restricts the ability to fully account for scale sensitivity of natural drivers in policy design.

Scale sensitivity of drivers of environmental change across Europe

The development of effective environmental management plans and policies requires a sound understanding of the driving forces involved in shaping and altering the structure and function of ecosystems. However, driving forces, especially anthropogenic ones, are defined and operate at multiple administrative levels, which do not always match ecological scales. This paper presents an innovative methodology of analysing drivers of change by developing a typology of scale sensitivity of drivers that classifies and describes the way they operate across multiple administrative levels. Scale sensitivity varies considerably among drivers, which can be classified into five broad categories depending on the response of ‘evenness’ and ‘intensity change’ when moving across administrative levels. Indirect drivers tend to show low scale sensitivity, whereas direct drivers show high scale sensitivity, as they operate in a non-linear way across the administrative scale. Thus policies addressing direct drivers of change, in particular, need to take scale into consideration during their formulation. Moreover, such policies must have a strong spatial focus, which can be achieved either by encouraging local–regional policy making or by introducing high flexibility in (inter)national policies to accommodate increased differentiation at lower administrative levels. High quality data is available for several drivers, however, the availability of consistent data at all levels for non-anthropogenic drivers is a major constraint to mapping and assessing their scale sensitivity. This lack of data may hinder effective policy making for environmental management, since it restricts the ability to fully account for scale sensitivity of natural drivers in policy design.

Local-scale urban meteorological parameterization scheme (LUMPS): longwave radiation parameterization and seasonality-related developments

Recent developments to the Local-scale Urban Meteorological Parameterization Scheme (LUMPS), a simple model able to simulate the urban energy balance, are presented. The major development is the coupling of LUMPS to the Net All-Wave Radiation Parameterization (NARP). Other enhancements include that the model now accounts for the changing availability of water at the surface, seasonal variations of active vegetation, and the anthropogenic heat flux, while maintaining the need for only commonly available meteorological observations and basic surface characteristics. The incoming component of the longwave radiation (L↓) in NARP is improved through a simple relation derived using cloud cover observations from a ceilometer collected in central London, England. The new L↓ formulation is evaluated with two independent multiyear datasets (Łódź, Poland, and Baltimore, Maryland) and compared with alternatives that include the original NARP and a simpler one using the National Climatic Data Center cloud observation database as input. The performance for the surface energy balance fluxes is assessed using a 2-yr dataset (Łódź). Results have an overall RMSE < 34 W m−2 for all surface energy balance fluxes over the 2-yr period when

The STEP scale: a measure of short-term export performance improvement

This article is a direct response to a recent observation in the literature that managers appear to be short-term oriented in their assessment of the performance of an export venture (Madsen 1998). On the basis of a cross-national survey of exporting firms, the authors present a three-dimensional scale for assessing managerial judgment of short-term export performance (i.e., the STEP scale). The three dimensions are (1) satisfaction with short-term performance improvement, (2) short-term exporting intensity improvement, and (3) expected short-term performance improvement. The scale presents evidence of reliability as well as convergent, discriminant, and nomological validity, and it reveals factorial similarity and factorial equivalence across both samples. The authors outline managerial and public policy implications that stem from the scale and identify avenues for further export marketing research.