Comparing the quality of life in children with cancer in Tabriz Children Medical and Training Center reported by themselves and their parents, 2013

زمینه و هدف: با توجه به درمان های فعلی، حدود 75 درصد از کودکان مبتلا به سرطان به بقای بدون بیماری دست می-یابند. این درمان های پیچیده و تهاجمی می توانند بر روی کیفیت زندگی کودکان تاثیر بگذارند. پیشرفت های اخیرِ ابزارهای استاندارد کیفیت زندگی ما را قادر به داشتن دید دقیق تری از تاثیرِ بیماری برکیفیت زندگی کودکان می سازد. هدف از این مطالعه، توصیف و مقایسه کیفیت زندگی کودکان مبتلا به سرطان براساس گزارشات کودکان و والدینشان بوده است. روش بررسی: در این مطالعه توصیفی- مقایسه‌ای به روش نمونه گیری در دسترس، تعداد 150 خانواده ی واجد شرایط از بین مراجعه کنندگان مرکز آموزشی درمانی کودکان تبریز انتخاب و وارد مطالعه شدند. کودک و والدینش پرسشنامه های کیفیت زندگی کودکان Kid-KINDL را تکمیل نمودند و جنبه های مختلف کیفیت زندگی در این کودکان مقایسه شد. یافته ها: در بعد روانشناختی، خانوادگی و اجتماعی، کودکان و هر دو والد کیفیت زندگی را بیشتر از حد متوسط بیان نمودند (05/0

Customers' Satisfaction with primary health care: comparison of two district health centers with and without ISO certificate in Kerman University of Medical Sciences

Background and Aims: One of the principles of the quality management systems in organizations is attention to customer centered approach and one of the scales for evaluation of the efficacy of provided services is customer satisfaction. This research aimed to compare satisfaction levels of customers attending primary health care centers in Bardsir (with ISO certificate) and Zarand (without ISO certificate) districts affiliated to Kerman University of Medical Sciences. Material and Methods: This comparative and cross- sectional study was carried out in 2011 with 960 people (n= 480 in each district). The data gathering instrument was a validated self-construct questionnaire including two main parts of general and specialty services for evaluation of satisfaction rate. Data were analyzed through SPSS version 18.0 and using descriptive statistics, Chi-square, Pearson correlation and logistic regression model. Judgment criterion for desired satisfaction was attaining 75% of the score of each part. Results: The desired satisfaction level of customers of health centers affiliated to Zarand district was more than that of Bardsir district (83.3% vs. 70.2%, P <0.01). Moreover, there was a significant difference between two districts in regard to satisfaction levels of general services (P <0.05). Result of logistic regression model showed no significant relationship between total satisfaction and demographic variables. Discussion: As compared with Zarand district, implementation of ISO quality management system in the Bardsir district has not enriched total customers' satisfaction. Thus, the utilization of quality management approaches based on needs rather than organizational emotions and fashions are emphasized. Keywords: Satisfaction, Customer, ISO, Health centers, Health car

Optimizing community case management strategies to achieve equitable reduction of childhood pneumonia mortality:An application of Equitable Impact Sensitive Tool (EQUIST) in five low- and middle-income countries

BACKGROUND: The aim of this study was to populate the Equitable Impact Sensitive Tool (EQUIST) framework with all necessary data and conduct the first implementation of EQUIST in studying cost–effectiveness of community case management of childhood pneumonia in 5 low– and middle–income countries with relation to equity impact. METHODS: Wealth quintile–specific data were gathered or modelled for all contributory determinants of the EQUIST framework, namely: under–five mortality rate, cost of intervention, intervention effectiveness, current coverage of intervention and relative disease distribution. These were then combined statistically to calculate the final outcome of the EQUIST model for community case management of childhood pneumonia: US$ per life saved, in several different approaches to scaling–up. RESULTS: The current ‘mainstream’ approach to scaling–up of interventions is never the most cost–effective. Community–case management appears to strongly support an ‘equity–promoting’ approach to scaling–up, displaying the highest levels of cost–effectiveness in interventions targeted at the poorest quintile of each study country, although absolute cost differences vary by context. CONCLUSIONS: The relationship between cost–effectiveness and equity impact is complex, with many determinants to consider. One important way to increase intervention cost–effectiveness in poorer quintiles is to improve the efficiency and quality of delivery. More data are needed in all areas to increase the accuracy of EQUIST–based estimates

Stakeholders' perceptions of rehabilitation services for individuals living with disability:A survey study

Background: The World Health Organization (WHO) was tasked with developing health system guidelines for the implementation of rehabilitation services. Stakeholders' perceptions are an essential factor to take into account in the guideline development process. The aim of this study was to assess stakeholders' perceived feasibility and acceptability of eighteen rehabilitation services and the values they attach to ten rehabilitation outcomes.   Methods: We disseminated an online self-administered questionnaire through a number of international and regional organizations from the different WHO regions. Eligible individuals included persons with disability, caregivers of persons with disability, health professionals, administrators and policy makers. The answer options consisted of a 9-point Likert scale.   Results: Two hundred fifty three stakeholders participated. The majority of participants were health professional (64 %). In terms of outcomes, 'Increasing access' and 'Optimizing utilization' were the top service outcomes rated as critical (i.e., 7, 8 or 9 on the Likert scale) by >70 % of respondents. 'Fewer hospital admissions', 'Decreased burden of care' and 'Increasing longevity' were the services rated as least critical (57 %, 63 % and 58 % respectively). In terms of services, 'Community based rehabilitation' and 'Home based rehabilitation' were found to be both definitely feasible and acceptable (75 % and 74 % respectively). 'Integrated and decentralized rehabilitation services' was found to be less feasible than acceptable according to stakeholders (61 % and 71 % respectively). As for 'Task shifting', most stakeholders did not appear to find task shifting as either definitely feasible or definitely acceptable (63 % and 64 % respectively).   Conclusion: The majority of stakeholder's perceived 'Increasing access' and 'Optimizing utilization' as most critical amongst rehabilitation outcomes. The feasibility of the 'Integrated and decentralized rehabilitation services' was perceived to be less than their acceptability. The majority of stakeholders found 'Task shifting' as neither feasible nor acceptable

Regional Differences in Intervention Coverage and Health System Strength in Tanzania.

Assessments of subnational progress and performance coverage within countries should be an integral part of health sector reviews, using recent data from multiple sources on health system strength and coverage. As part of the midterm review of the national health sector strategic plan of Tanzania mainland, summary measures of health system strength and coverage of interventions were developed for all 21 regions, focusing on the priority indicators of the national plan. Household surveys, health facility data and administrative databases were used to compute the regional scores. Regional Millennium Development Goal (MDG) intervention coverage, based on 19 indicators, ranged from 47% in Shinyanga in the northwest to 71% in Dar es Salaam region. Regions in the eastern half of the country have higher coverage than in the western half of mainland. The MDG coverage score is strongly positively correlated with health systems strength (r = 0.84). Controlling for socioeconomic status in a multivariate analysis has no impact on the association between the MDG coverage score and health system strength. During 1991-2010 intervention coverage improved considerably in all regions, but the absolute gap between the regions did not change during the past two decades, with a gap of 22% between the top and bottom three regions. The assessment of regional progress and performance in 21 regions of mainland Tanzania showed considerable inequalities in coverage and health system strength and allowed the identification of high and low-performing regions. Using summary measures derived from administrative, health facility and survey data, a subnational picture of progress and performance can be obtained for use in regular health sector reviews

Socioeconomic Inequality in Malnutrition in Developing Countries

Epidemiological evidence points to a small set of primary causes of child mortality that are the main killers of children aged less than 5 years: pneumonia, diarrhoea, low birth weight, asphyxia and, in some parts of the world, HIV and malaria. Malnutrition is the underlying cause of one out of every two such deaths. The evidence also shows that child death and malnutrition are not equally distributed throughout the world. They cluster in sub-Saharan Africa and south Asia, and in poor communities within these regions. Disparities in health outcomes between the poor and the rich are increasingly attracting attention from researchers and policy-makers, thereby fostering a substantial growth in the literature on health equity. “Socioeconomic inequality” in malnutrition refers to the degree to which childhood malnutrition rates differ between more and less socially and economically advantaged groups. This is different from “pure inequality”, which takes into account all factors influencing childhood malnutrition. The available literature documenting socioeconomic inequality in malnutrition focuses mainly on individual countries or regions. At a more global level, Wagstaff and Watanabe provided evidence on socioeconomic inequality in malnutrition across 20 developing countries. Other relevant cross-country studies include those of Pradhan et al., who describe total inequality, and Smith et al., who describe inequalities between urban and rural populations. The latter two studies, however, provide no evidence on socioeconomic inequality within developing countries

Pensions and the health of older people in South Africa: Is there an effect?

This paper critically reviews evidence from low and middle income countries that pensions are associated with better health outcomes for older people. It draws on new, nationally representative survey data from South Africa to provide a systematic analysis of pension effects on health and quality of life. It reports significant associations with the frequency of health service utilisation, as well as with awareness and treatment of hypertension. There is, however, no association with actual control of hypertension, self-reported health or quality of life. The paper calls for a more balanced and integrated approach to social protection for older people

Addressing Inequity to Achieve the Maternal and Child Health Millennium Development Goals: Looking Beyond Averages.

Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs

DSL and Engine for Pervasive Treasure Hunt Games

The purpose of this master thesis was to eliminate the technical barrier for creating pervasive games. In order to achieve this a domain-specific language (DSL) was made along with an engine to interpret the DSL scripts. This was done by using a customized development method, combining the DSL lifecycle and an iterative game development method. The goal was to make pervasive games more established in society and to make them more popular. Initial stage was to analyze pervasive games and making a game specification. This resulted into the four pervasive dimensions, goal, mobility, social, and temporal, with their three levels, low, medium, and high. These dimensions and levels, along with certain game elements, made it possible to create a DSL expressive enough to make pervasive treasure hunt games. The conclusion was that a DSL can be used to create pervasive games, thus making them more available for the audiences. This could eventually make pervasive games more popular

Financial Distress Risi! of LBOs - Euidence from Nordic Countries

Masteroppgave(MSc) in Master of Science in Business, Finance - Handelshøyskolen BI, 2022In this master thesis, we study the financial distress risk and bankruptcy rate of leveraged buyout companies in the Nordic market between 2000 and 2020. Furthermore, we examine industry effects on financial distress risk using the same panel data sample. Our findings suggest that buyout firms experience a higher financial distress risk compared to comparable firms not subject to a leveraged buyout transaction. However, our results do not let us conclude that buyout companies experience a higher probability of bankruptcy than comparable nonbuyout companies. Lastly, our analysis examining industry effects does not have statistical power to analyse a firm’s financial distress post an LBO transaction by the industry they operate in