Health networks : an innovation in the territorial offer of medical cares in France

The variety of changes in the modes of producing have led us to re-discover the active and structuring part played by territories in the present economic dynamics, particularly the new reticular organizations - including within the public service, and especially in the health sector. The latter has recently developed some changes that have allowed to go beyond the existing territorial divisions. The main change may be seen in the substitution of a more clinical medicine for an offer of more and more technical medical cares, in the context of a necessary health cost control, and also a development of an equitable access to the care services. Consequently, new innovative organizations have been set up which have raised more and more various forms of partnership between the care providers, between these providers and other actors such as the territorial communities and the associative sector. These forms of partnerships initiate territorial links which coincide less and less with the institutional boundaries - notably urban boundaries - so as to play a significant part in the dynamics of recombining in urban spaces. This is particularly the case of cancer treatments in the Rhône-Alpes region, which have been partly organized according to this new reticular mode, built on a pivot-institution : the Lyons Léon Bérard Centre. Especially through the cancer network in Rhône-Alpes (ONCORA), this centre sets relationships between various actors of health in the ambulatory and hospital sectors - either with a public or private status - located in about twenty towns of the Rhône-Alpes region and its periphery. In this specific case, the urban network is structuring cancerology in the framework of medical disciplines, situating it at the crossing of the organ specialities (vertical specialities) and, while giving it its disciplinary legibility, contributes to contributes to re-combining the territories through the urban centres concerned, from the Lyons city to the medium-sized towns. In this paper, we propose to analyse the changing of medical and territorial trajectories, while considering a sample of patients set up at two different dates, one before the foundation of the network, the other afterwards ; then, we will study and evaluate, in terms of economic efficiency and social justice, the effects of this innovative network - ONCORA - in the regional offer of care.

Genetic complexity of the human hsp 60 gene

Hsp 60 is a chaperonin protein, homologous to GroEL of Escherichia coli and highly conserved across species. Immune response induced by the hsp 60 equivalent of numerous microorganisms elicits in animals and man a dominantcross-reactive T lymphocyte response. Hsp 60 has been strongly implicated as an example of molecular mimicry in the pathogenicity of autoimmune diseases and, more recently, in T cell-mediated protection. Curiously, in spite of this interest, the gene encoding HSP 60 has not yet been cloned. Sequencing of numerous PCR-derived HSP 60 clones, obtained following amplification of genomic DNA revealed multiple distinct but highly related sequences. These were all different from the sequence encoding the expressed protein and all had interrupted reading frames. PCR amplification from mRNA, however, yielded only the sequence expected for the expressed hsp 60 protein. This apparent paradox was resolved by cloning and sequencing HSP 60-specific genomic clones: the majority of these clones corresponded to intronless genes having the characteristics of retro-pseudogenes and were flanked by unrelated DNA sequences. In addition, several genomic clones were isolated that corresponded to a unique functional HSP 60 gene. This gene is composed of multiple exons, some very short. The transcription start site was identified and 750 bp of 5' flanking sequence were determined. The human HSP 60 gene is induced by heat. We conclude that hsp 60 is encoded by a single highly fragmented gene, that co-exists with multiple HSP 60 retro-pseudogenes, normally not expresse

Quality of Neonatal Health Care: Learning From Health Workers’ Experiences in Critical Care in Kilimanjaro Region, Northeast Tanzania

Neonatal deaths are generally attributed to suboptimal standards of health care. Health care worker motivation and adherence to existing guidelines are rarely studied. To assess the performance of health workers for neonatal health care in the hospitals of Kilimanjaro region. A descriptive study using a semi-structured interview for health care workers at a tertiary referral hospital and peripheral health facilities (regional referral, district hospitals and health centres).was used. Health Care Workers (HCW) were asked to recall a scenario of a critically ill neonate admitted in the wards and the treatment that was provided. The WHO Emergency Triage Assessment and Treatment (ETAT) guidelines were used as a standard reference for knowledge of critical care. Birth asphyxia was the most recalled health problem requiring critical care, reported by 27.5% of 120 HCW at both peripheral hospitals and by 46.4% of 28 health workers in tertiary referral centres. Half of the HCW commented on their own performance (47.5%, n=140). HCW presented with low to moderate levels of knowledge for critical care were at 92%. Supplementary training was associated with a higher levels of knowledge of neonatal critical care (p value = 0.05). HCW in peripheral hospital had lower levels of knowledge (only 44.7% at peripheral hospitals had sufficient ratings compared to 82.1% at the referral centre). [Pearson χ2 (2) = 12.10, p value = 0.002]. Guided Practical-Competence Diagnostic Specific neonatal health care training is highly needed in the peripheral facilities of rural Kilimanjaro region

Willingness To Donate Blood During the Summer

Introduction. Each year donation rates fall in the summer months straining blood banks’ capacities to meet local demands. In hopes of identifying factors to increase summer donations, our study investigated donor reported barriers which influence summer donations habits.Methods. An anonymous 16 question survey investigating various donation factors was administered across multiple American Red Cross (ARC) donation centers in Vermont. Questions addressed donor demographics, frequency of blood donation, preference in appointment making modalities including smartphone app use, summer travel habits, willingness to donate during vacation, and factors that deter donors from donating on vacation.Results. A total of 292 surveys were received. Survey respondents across multiple demographic groups cited similar barriers to summer donation, namely “Too busy” (27.5 %) and “Traveling is a time for me to relax.” (30.6 %). Of the respondents who travel in the summer, very few reported donating while traveling (3.4 %). Summer donation rates between summertime travelers (36.5 %) and non-travelers (36.4 %) were essentially equivalent. The most preferred methods of scheduling appointments were via ARC website (45.6 %) and phone (28.4%). Willingness to use the ARC app was highest among respondents ages of 18 to 34 (45-55%) and lowest among ages 55 and older (13-15%). Of respondents with no prior knowledge of summer seasonal shortages (22 %), 2/3rds indicated newfound motivation to donate.Conclusion. Regardless of travel, increasing awareness of summer shortages may increase summer donations. Use of donor websites and smartphone apps may be instrumented as part of recruitment efforts.https://scholarworks.uvm.edu/comphp_gallery/1239/thumbnail.jp