Diabetes Mellitus: from epidemiology to health policy

This thesis deals with the interrelationship between epidemiology and health policy. According to Rothman, the clearest of many definitions of epidemiology that have been proposed has been attributed to Anderson, who defined epidemiology as "the science of disease occurrence". The primary task of epidemiological research is to quantify the occurrence of illness in order to evaluate hypotheses about the causation of illness and its sequelae, and to relate disease occurrence to characteristics of people and their environment

A Mathematical and Conceptual Model Regarding Social Inclusion and Social Leverage

Este artículo discute un modelo matemático conceptual integral para especificar las principales teorías conceptos y sus relaciones, con respecto a la inclusión social y el apalancamiento social. Los elementos particulares del modelo están relacionados con: (i) aspectos clave de los principios teóricos; (ii) principales vínculos entre el principal aspectos; y (iii) interrelaciones con respecto a cuestiones sociales y económicas dentro de cualquier sociedad en particular. Uno Uno de los principales objetivos de esta investigación es ir más allá de los elementos estrictamente económicos, para complementar un perspectiva más holística con aspectos sociales y políticas públicas. Este estudio es parte de una investigación más amplia. proyecto que estudia la inversión social en América Latina, particularmente enfocado en el sector salud. Más específicamente, este estudio identificará las relaciones entre variables e indicadores de inclusión social y apalancamiento social, como base para realizar estudios empíricos sobre inversiones que los países latinoamericanos hacer en servicios de salud. El modelo presentado aquí permite la identificación de elementos diferenciados. política pública, el papel de los servicios públicos destinados a ayudar especialmente a los sectores sociales más vulnerables y El apoyo de dichos servicios en relación con la competitividad, el bienestar social y la sostenibilidad de un país. bases del desarrollo humano.This article discusses a comprehensive conceptual mathematical model to specify main theoretical concepts and their relationships, regarding social inclusion and social leverage. The particular elements of the model are related to: (i) key aspects of theoretical principles; (ii) major links among principal aspects; and (iii) interrelations regarding social and economic issues within any particular society. One of the principal aims of this research is going beyond the strictly economic elements, to complement a more holistic perspective with social aspects and public policy. This study is part of a broader research project that studies social investment in Latin America, particularly focused in the health sector. More specifically, this study will identify relationships between variables and indicators of social inclusion and social leverage, as basis for carrying out empirical studies on investments that Latin American countries make in health services. The model presented here allows the identification of elements of differentiated public policy, the role of public services aimed to assist especially the most vulnerable social sectors and the support of such services in relation to a country's competitiveness, social well-being and sustainable basis of human development

Inclusión social y fundamentos de apalancamiento social: una revisión teórica

The main aim of this research is to present a theoretical review regarding the theory of social inclusion and social leverage. In this research, four fundamental and complementary approaches are taken into account: (i) the theory of growing capacities and increasing opportunities as essential aspects of Amartya Sen's theory of human development; (ii) the perspective and factors of the current process of globalization; (iii) Douglass North's neoinstitutionalist approach to social and political conditions; and (iv) foundations of the legitimacy theory from Jürgen Habermas. These considerations made possible a more comprehensive consideration that goes beyond the strictly economic elements, to complement the standpoint with other elements, including those of public policy analysis

Identifying integration and differentiation in a Hospital's logistical system:a social network analysis of a case study

Background: Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital's logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration. Methods: The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network. Results: This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents. Conclusions: This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another

Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands.

In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital

Measuring the reasons that discourage medical students from working in rural areas

The sharply uneven distribution of human resources for health care across urban and rural areas has been a long-standing concern globally. The present study aims to develop and validate an instrument measuring the factors deterring final year students of Bachelor of Medicine and Bachelor of Surgery (MBBS) in 3 northern states of India, from working in rural areas. The medical student's de-motivation to work in rural India (MSDRI) scale was developed using extensive literature review followed by Delphi technique. The psychometric properties of the questionnaire were assessed in terms of content validity, construct validity, data quality and reliability. Exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) was performed to identify the primary deterrents. Thirty-three items were generated from literature search followed by Delphi exercise. After assessing psychometric properties, the final instrument included 29 items whereas the EFA and CFA highlighted 5 main factors, namely lack of professional challenge, social segregation, socio-cultural gap, hostile professional environment, and lack of financial incentives as underpinning students' demotivation towards working in rural areas. The MSDRI instrument is the first valid and reliable measure for identifying deterring factors for MBBS students to work in rural areas of India. The use of it may be very helpful for policymakers as well as healthcare organizations in formulating effective measures to encourage medical students to work in rural areas, which suffer from a chronic shortage of medical personnel

Towards an international taxonomy of integrated primary care: a Delphi consensus approach

Background Developing integrated service models in a primary care setting is considered an essential strategy for establishing a sustainable and affordable health care system. The Rainbow Model of Integrated Care (RMIC) describes the theoretical foundations of integrated primary care. The aim of this study is to refine the RMIC by developing a consensus-based taxonomy of key features. Methods First, the appropriateness of previously identified key features was retested by conducting an international Delphi study that was built on the results of a previous national Delphi study. Second, categorisation of the features among the RMIC integrated care domains was assessed in a second international Delphi study. Finally, a taxonomy was constructed by the researchers based on the results of the three Delphi studies. Results The final taxonomy consists of 21 key features distributed over eight integration domains which are organised into three main categories: scope (person-focused vs. population-based), type (clinical, professional, organisational and system) and enablers (functional vs. normative) of an integrated primary care service model. Conclusions The taxonomy provides a crucial differentiation that clarifies and supports implementation, policy formulation and research regarding the organisation of integrated primary care. Further research is needed to develop instruments based on the taxonomy that can reveal the realm of integrated primary care in practice

Harvesting the wisdom of the crowd: using online ratings to explore care experiences in regions.

Regional population health management (PHM) initiatives need an understanding of regional patient experiences to improve their services. Websites that gather patient ratings have become common and could be a helpful tool in this effort. Therefore, this study explores whether unsolicited online ratings can provide insight into (differences in) patient's experiences at a (regional) population level