[One] food access to population that don’t have access. Two is the grower incomes. That we are allowing family farmers to be livable wages [sic]. We have focused on minority growers and those that have not had access to markets like our Amish grow- ers and low- income growers for our markets not large production farms that are already doing pretty well. (August 6, 3015) Findings from Region 5 highlight how the county public health department was particularly important in providing stable, dedicated funding as well as technical support to move food systems change forward in Region 5. Choose Health is particularly illustrative of the role of the health department in food systems planning in this con- text. Beginning as a six-month pilot project funded by Hunger-Free Minnesota, the program is cur- rently sustained by additional funding from hospi- tals and healthcare practitioners in the region. According to interviewees, establishment of such a partnership was challenging at the beginning since the Choose Health program did not focus on hunger relief as much as it did on food security, and they perceived the R5DC merely as an eco- nomic development entity. However, all partners in the program eventually moved beyond their more conventional practices in order to make the Choose Health program work. One way that the health agencies, especially hospitals, were able to financially support the program was through the federal tax code changes of 2014. The new tax codes allowed nonprofit hospitals to purchase local foods and pay for community supported agricul- ture (CSA) memberships as a remediation for obesity or mental health. One interviewee men- tioned that this mechanism enabled a sustainable funding source for the program and brought support from the health care system:
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Method switching was 40.4 %, and switching from im- plant was 29.8 % and the rest, 10.6 %, switched from IUCD. This is relatively low compared to reports from other stud- ies. For example, in Egypt method switching from IUCD and Norplant to another method was 45.9 % . Similar study from 14 developing countries showed that there were high rates of switching in Peru (70.5 %) and Morocco (69.8 %). In Vietnam, two-thirds of women who had an IUCD reported to switch to other methods (n = 306/434) . In contrast to our findings, method switching is low in Bolivia (16.7 %) and Kazakhstan (25.2 %). Reports of USAID in 2007, indicated that high method switching can be Table 2 Fertility characteristics of re-visit clients to family planning
Input from experts in disaster- related pediatric research, such as pediatricians, psychologists, public health planners, bioethicists, and federal subject matter experts, is critical to developing this agenda. Ideally, these experts would meet regularly before a PHE to develop prepositioned generic, yet customizable, research agendas that incorporate the perspectives of parents, educators, and child care professionals. Postevent refining of the generic research agenda is imperative. As an example of this strategy, the Institute of Medicine convened a meeting of stakeholders to review existing knowledge regarding Ebola virus disease and set research priorities related to environmental transmission and personal protective equipment (report available at http:// www. nap. edu/ catalog/ 19004/ research- priorities- to- inform- public- health- and- medical- practice- for- ebola- virus- disease).
Elmira Produce Auction: This is an example of a private-sector initiative that required some new ways of thinking for the land use planners who reviewed its application. In 2003, a group of Old Order Mennonite farmers asked for a rural building permit to establish a produce auction where farm- ers could sell wholesale quantities of their produce cooperatively. The internal rules of the auction’s operators permitted only growers within a 47 mile (75 km) radius of the town of Elmira to sell their products at the auction. This limit was intended to support local farm incomes by encouraging diversi- fication into higher value crops such as seasonal fruit and produce. Sellers range from hobby gar- deners to large produce operations. Some farmers use the auction to offload surplus crops, while oth- ers see it as a reliable sales outlet for their products. Public Health and Planning staff were excited by the prospect of establishing one of the missing links in the local food system: a one-stop place for urban retailers to access locally grown food. The establishment of this commercially related land use, however, normally would not have been permitted in an agricultural zone under a strict
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The majority of documents reviewed contained at least one suggestion for potential adaptation that may be undertaken in relation to changing infectious-disease dynamics with climate change (Table 5). However, the specificity of the proposed adaptations varied substantially between plans. Some only broadly outlined public health principles for adaptation: for example, current recommendations in Switzerland’s adaptation plan  largely focus upon the importance of multidisciplinarity in tackling climate change-related health risks, sharing of data and information across sectors and the integration of “new risks” in current public health strategies. The adaptation plan does not, however, describe any detailed objectives that must be attained to support the realization of these principles. Specifically, it does not mention how professionals within different scientific disciplines, or governmental bodies, ought to be cooperating to optimize knowledge sharing. Interestingly, the document doesn’t explicitly name infectious agents or diseases which may become an emerging or amplified threat in relation to climate change (though it mentions threats brought forth by the propagation of certain vectors), and does not detail current gaps in public health strategies to address such risks. A broad assessment of potential future infectious disease risks in relation to climate change is available in another national-level risk assessment . In contrast, other plans, such as that proposed by the Australian government , go considerably further in planning development and identify the ministries, organizations and stakeholders which are to carry out and evaluate the proposed strategies; all of these aspects are of key importance in creating readiness for adaptation [35,109].
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Early discontinuation among older women may be attrib- utable to reaching menopause, but the finding that women in farming/manual occupations were more likely to discontinue IUD use has implications for FP campaigns. Women who work as farmers or in manual occupations may represent potential target groups for FP campaigns to improve IUD continuation. Although we do not have data on the rural/ urban status of women, it is likely that women who work as farmers live in rural areas, and it is known that women living in rural areas are more likely to access public health services than women living in urban areas. 14 DHS data show
clinics to private doctors because they thought these providers could give them better care for their family planning needs. Several other P4HB ® participants, however, switched providers because the health clinics did not accept their health plan. One participant, “Dena,” 30, Atlanta, had to switch from a public health clinic to a private OBGYN to get her birth control, because the clinic did not accept her CMO (Peach State) and made her pay for her contraception. Since switching to the private provider, she had not experienced any problems. Another P4HB ® enrollee experienced a similar situation, when her local health clinic stopped accepting Well Care. This enrollee, “Candice,” 23, Atlanta, initially received her birth control through a community-based primary care center. However, when this center stopped accepting her health plan, she switched to a nearby federally qualified health center that accepted all Medicaid health plans. A third P4HB ® enrollee, “Yasmine,” 30, Atlanta, needs fibroid surgery (myomectomy), but can’t find a doctor to perform the procedure. “A lot of them are saying that they don’t take Medicaid as well anymore because I have to get like a myomectomy because I have fibroids. So, I’ve been having a really hard time trying to find a doctor that actually does the surgery. “
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Participants in this study referred to tacit knowledge both at an individual and collective level. Other researchers have identified this additional layer of knowledge that is held collectively by health care teams [30-32]. These researchers also highlight the important element of time for accumulating shared understand- ings. Furthermore, in terms of teams, the findings from this pilot study suggest that a much wider range of sta- keholders should be involved in a public health-based KT process. Community partners (school principals, tea- chers, students, community committees, police, etc) are involved in the public health planning process. While these stakeholders bring a wealth of tacit knowledge to public health practice, the involvement of these stake- holders in KT strategies has received limited attention. The community-based participatory research body of work provides an excellent starting point for working with community members, and readers are directed to Lencucha et al.  and Kothari and Armstrong  for detailed discussions about the relationship between this research approach and KT. Strategies that recognize and support the use of tacit knowledge, such as communities of practice or networks, may be important components of a comprehensive approach to KT. These strategies would support the perspective that tacit knowledge is conveyed through personal interactions and the con- struction of a shared understanding. It is difficult to determine from our study whether traditional group planning meetings are more in keeping with explicit knowledge sharing or whether they also function to sup- port tacit knowledge, i.e., dialogue and shared understandings.
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The Chinese PHC sectors have long faced the challenge of inadequate LHWs . Thus, capacity building for the PHC sectors has attracted a great deal of attention from the Chinese government with vigorous support in human resources, funding and equipment to improve the capacity of PHC sectors since 2009. Substantial pro- gress has been achieved in the number of LHWs; for example, LHWs in PHC sectors have increased from 3, 282,000 in 2010 to 3,683,000 in 2016 . However, PHC sectors still lack adequately qualified LHWs to pro- vide BPHS for residents across China [32–37]. This is more noticeable in western China, where socio-economic development lags behind that of central and eastern China [22, 38, 39]. The current study also demonstrated that PHC sectors lack LHWs for BPHS in southwest China. Even worse is that many LHWs often undertake more than one BPHS programme. It has been reported that the main reasons for the shortage of LHWs are the heavy workload, poor working conditions, low income, and lack of social security for BPHS delivery in Guizhou province . Furthermore, medical students from universities pre- fer to stay in large hospitals rather than the PHC sectors in rural communities . This study also revealed that the PHC sectors in the study sites were almost unable to attract medical students who had graduated from univer- sity and retain existing LHWs due to low incomes and limited self-development, harsh working conditions and heavy workloads. Critically, the shortage of LHWs must be addressed through policy, planning and the imple- mentation of innovative strategies. The Chinese central government has already gradually increased substantial financial support for regions with financial difficulties
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Background: Service franchising is a business model that involves building a network of outlets (franchisees) that are locally owned, but act in coordinated manner with the guidance of a central headquarters (franchisor). The franchisor maintains quality standards, provides managerial training, conducts centralized purchasing and promotes a common brand. Research indicates that franchising private reproductive health and family planning (RHFP) services in developing countries improves quality and utilization. However, there is very little evidence that franchising improves RHFP services delivered through community-based public health clinics. This study evaluates behavioral outcomes associated with a new approach - the Government Social Franchise (GSF) model - developed to improve RHFP service quality and capacity in Vietnam’s commune health stations (CHSs). Methods: The project involved networking and branding 36 commune health station (CHS) clinics in two central provinces of Da Nang and Khanh Hoa, Vietnam. A quasi-experimental design with 36 control CHSs assessed GSF model effects on client use as measured by: 1) clinic-reported client volume; 2) the proportion of self-reported RHFP service users at participating CHS clinics over the total sample of respondents; and 3) self- reported RHFP service use frequency. Monthly clinic records were analyzed. In addition, household surveys of 1,181 CHS users and potential users were conducted prior to launch and then 6 and 12 months after implementing the GSF network. Regression analyses controlled for baseline differences between intervention and control groups.
encompassing society and space, and conceptualizes the role of place and geography in health, well-being and disease; this is a holistic perspective evolved from the more biomedical approach seen in medical geography (Dyck, 1999; Kearns & Moon, 2002; Meade & Erickson, 2000; Mayer, 2000). Concerns about social and spatial polarization especially with inequities and poverty prompted research that explores the causes and implications of health variations, including issues related to poverty, health care access and public health (Dummer, 2008; Kearns & Moon, 2002). While the focus of medical geography tends to be more aligned with epidemiologic inquiries using traditional positivist approaches, health geography is concerned with broader social issues and well-being. In the development of health geography, the concept of place has been significant to the understanding of health as it relates to spatial location as well as how it relates to peoples’ experiences of their environments and health (Kearns, 1993; Tuan, 1974; Eyles, 1985). The study of health inequalities and the consequences of spatial and social marginalization on health are among the important developments in health geography, as is the use of various models and theories to understand these
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Hypertension is a chief communal health issue in Pakistan. Distinguishing geographical variations in hypertension is vital to reinforce the health of adult Pakistanis no matter where they live. Aim of this study to know risk factors of hypertension among rural and urban population. The study could help the policymakers to have a baseline data for planning to prevent hypertension and also public health personnel to make further studies and research and give awareness of reasons of high blood pressure to metropolitan and rural populations according to their requirements and circumstances.
The hypotheses supported by this study start from the assumption that the Brazilian university has not yet fully fulfilled its "urgent mission", particularly with regard to communication with society, sharing with society the scientific production generated on its bench. At the time of Kunsch's study, Brazil had 84 universities, 29 of which participated in the survey. Today there are more than 200 universities in the country, between public and private institutions. It was not intended to repeat the study of this researcher, but it was proposed to study a segment of the graduate program, the Graduate Programs in Public Health. The process of Brazilian university reform, initiated in the late 1960s and early 1970s, favored graduate studies as the source of national research and consequently generating scientific knowledge. With the encouragement and need to develop a national science, there is an exponential growth in the number of graduate programs and courses in Brazil. The numbers of graduate programs increase each year. The option to work with the graduate programs in Public Health in Brazil is due to the fact that the knowledge production of these programs is related to the planning and implementation of policies that aim to reach the enlarged society and that, therefore, to these programs to develop communication policies capable of sensitizing, mobilizing and integrating citizens with the specific objectives of the public policies proposed by them.
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Fourth, a list of specific educational objectives, through questioning potential trainees, can be obtained, which might reflect grass-root needs, thus ultimately insuring high public health relevance to the program . Fifth, the pilot program, based on the needs assessment allowed to experiment various educational approaches, such as interactive lectures, question-answer debates, case- studies, e-learning, community project planning, educa- tional approaches most participants had not been familiar with, being more used to formal lectures, yet approaches that have been reported as highly effective in terms of reaching specific educational objectives and setting the stage for life-long learning . The pilot project showed that these approaches, though difficult at times due to logistic problems (access to Internet, computer configura- tion issues), to deadlines imposed by training staff, to self- discipline of students, were appreciated by students and even seemed to act as a motivating factor.
non-government providers is not confined to Bangladesh [25,35-38] and there is ongoing debate about the role of the private sector in health care in developing countries [39,40]. The very high use of unqualified practitioners of Western medicine is striking in Bangladesh. However, the BMA rejected all ideas of providing training or regu- lation of the non-medically qualified practitioners. This negative view from the body representing the medical profession in 2003 is relevant for initiatives to train and certify unqualified practitioners to help solve the problem of medical staffing in Bangladesh . There are reports of successfully training village doctors in Bangladesh to diagnose and supervise treatment of tuberculosis . The government engages around 70,000 non-medically qualified health workers of different types, with training, ranging from 40 days to six months, provided in the pub- lic and private sectors. Private institutions providing such training need to involve qualified doctors as a condition for accreditation by the government Health Directorate.
This paper reports on a community-based initiative to enable the voice of frail older people to inform research and service development within the National Health Ser- vice (NHS) in England. A frail older adult in this paper refers to a person over 75, with some mobility issues and a wide range of health conditions and care needs. Patient and Public Involvement and Engagement (PPIE) in health and social care can be for the purpose of planning research and to understand the priorities of service users and here, both approaches were used . The goal was to understand patient experience to generate research that improved services and produced better patient out- comes . Involvement and engagement of a wide var- iety of older people was sought in a large provincial city in England, across a range of community settings. Group and individual meetings were arranged via key con- tacts and links with representative community leaders to access affluent and non-affluent areas as well as people from Black, Asian Minority Ethnic (BAME) Communities.
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Although this study shows that half of the Countdown countries for which data are available have seen an in- crease in SHP density and 60% in SHP numbers since 2004, most remain affected by critical needs-based short- ages. This situation has hindered the achievement of the MDGs , and the fact that so many countries have fewer than the 44.5 SHPs per 10 000 population needed to deliver on the health-related SDGs will negatively affect progress towards these goals. The demand for high, sustained and equitable coverage with proven life-saving interventions will continue to rise especially in sub-Saharan Africa, a challenge compounded by its significant population growth. In many countries, the required scale-up of SHPs may be unrealistic given the resources available and the present capacity of production of qualified health workers.
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Over the course of two-and-one-half years, within an undergraduate Arts for Elementary Education Majors: Visual Art course that I taught at a university two hours south of Chicago, I engaged teacher candidates (TCs) in a built environment community lesson for the elementary classroom. The project took place over two one-hour and fifty-minute class periods each semester and was meant to be an exercise that could be adapted by elementary educators to any public school environment. Although the project could have been expanded to include community interviews (La Porte, 2011), photo collages, personal maps, and journals (Powell, 2008), design analyses of local buildings and public amenities (Vande Zande, 2010), an exploration of ecological architecture (Muller, 2014), and a critical ecological review of the environment (Graham, 2007), the course time frame and structure at that time did not allow for this expansion. One hundred seventy-eight TCs—164 females and 14 males—participated in the project for the two years and a summer before I instigated a change. Sixty-four additional TCs, 59 females and five males, participated in the revised project. The TCs somewhat reflected the university’s demographics: about 84% were under the age of 25; 93% were white, and only one student was not a U.S. national (University Quick Facts, 2014).
After identifying the appropriate data-gathering method, the next step that needs to be considered is the design of the instrument. In order for the researcher to gain a clear insight into the research aims, developing a new instrument is considered more appropriate than using previously designed instruments for a number of reasons. First, developing a new instrument will allow the researcher to link main and specific objectives of the study with certain questions or groups of questions developed specifically to serve the purpose of the study. Burns and Grove (1997) state that designing an instrument is a protracted and sometimes difficult process but the overall aim is that the final questions will be clearly linked to the research questions and will elicit accurate information that help achieve the goals of the research. Second, the present study investigates the strategic planning formation process from a variety of angles; the extent to which the process is practised (formality); the process output ‘strategic plan document’ quality and the internal and external barriers to the planning process. All are integral components of the research study and require the development of a specific set of questions for each of them. Third, designing a new instrument gives the researcher the flexibility to include different types of questions and to use the proper scales accordingly. Different types of scales were used while designing the instrument based on the type of enquiry needed.
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The strength points of this study included random allocation of the subjects, allocation concealment, large sample size for detecting a clinical promotion of knowledge and also evaluation of the knowledge before and after the intervention. The limitations of the cur- rent study included using available samples from women referred to selected centers. We tried to lessen this limitation through random selection of the health care centers and posts from different geographical regions of Tabriz as well as selection of all eligible clients re- ferred to health care centers for any reason (e.g., diabetes screening and etc.). Subjects in this study were women with educational lev- el of at least intermediate school and its re- sults my not be generalized to individuals with lower education.