A systematic assessment of the concept and practice of public-private mix for tuberculosis care and control.

PPM has improved case detection and treatment outcomes among patients seeking care with private providers. Evidence on reducing patient costs is inconclusive, and there is scope for increasing equity in access to care by systematically engaging those providers who are the primary agents for poor people seeking health care. Guidelines outlining which types of providers best contribute to achieving the four global objectives, along with the resources required by National Tuberculosis Programs for such engagement is needed

Resistance in a new world – a study on networked resistance via internet

Motstånd mot policy, lagförslag, politik, ja allt, har funnits i alla tider. Men idag lever vi i ett samhälle som konstant är uppkopplat mot internet. Förändras sättet att forma och skapa motstånd genom ny teknik? Genom att undersöka en motståndsrörelse mot ett lagförslag, Stop Online Piracy Act, så exemplifieras en ny motståndsrörelse. Två sociologiska teoretiker, Manuel Castells och Howard Rheingold, har också undersökt vad som händer när motståndsrörelser kombineras ny teknik. Båda menar att samhället har förändrats genom internet, och därmed även makten inom samhället. Genom att makten har förändrats, så måste även motståndsrörelser förändras, bli mer globala och nätverkande. Jag har använt teorier om motståndsrörelser, Castells nya sociala rörelser och Rheingolds Smart Mobs, och applicerat dessa på motståndsrörelsen mot SOPA. För att se hur motståndsrörelsen verkade, genomförde jag observationer på hemsidor där motståndsrörelsen verkade och gjorde även en enkätundersökning inom en hemsida där motståndet verkade. Resultatet är att människor som identifierade sig med motståndet kunde lätt dela med sig information, inom sin egna nätverk med hjälp av internet. Informationen om motståndet sprids då mycket snabbt. Motståndet använde internet som en primär förmedlare av information, genom specifika hemsidor som fungerar som plakat. Nätverk inom motståndet skapades genom att personer sedan länkar vidare till dessa informationshemsidor. Inom rörelsen fanns även en valfrihet i hur stor grad av motstånd som uttrycks, från att sprida information, till att aktivt protestera. Detta gör att motståndsrörelsen kan få många individer att visa motstånd, genom akt-ioner som ger mediauppmärksamhet, och enkla medel för att visa motstånd. Argument mot SOPA var att lagförslaget skulle censurera internet. Censur är något känsligt för många internetanvändare, motstånd mot censur är en del av internetkulturen menar Castells. Motståndet byggs upp genom nätverk så att dessa kan försvinna och sedan bli aktiva igen, internet används som informationskanal och därmed kan självständiga nätverk konvergera mot samma mål. Valfriheten för att visa motstånd gör det enklare, och aktioner ger mediauppmärksamhet vilket för ut motståndets punkter till andra nätverk. Motståndet mot SOPA är ett exempel på en evolution av motståndsrörelsen. Det grundläggande sättet att visa motstånd har inte föränd-rats, men metoderna för att få ut information har

Health Data Sharing - a solution to Nordic health care challenges

Nordic Innovation's Health, Demography and Quality of Life program addresses the challenges the health care system in the Nordics are facing. Our welfare system is at risk of breaking down because of a growing proportion of elderly people, increasing amount of chronic illnesses and lifestyle diseases. There is an urgent need for change, and Nordic cooperation is a key factor. Sharing of health data could build our position as global welfare ideals and to reach the vision that lays the foundation for this program:  By 2030. the Nordics will be the most sustainableand integrated health region in the world. providing the best possible personalized health care for all its citizen.  This summary report highlights the most important results from the three studies: - Business case for Sharing of Nordic Health Data- Health Use Case- Bridging Nordic Dat

Jämförelse mellan populära molnlagringstjänster : Ur ett hastighetsperspektiv

Molnlagringstjänster används alltmer och är en växande marknad. Uppsatsen har fokuserat på att undersöka olika molnlagringstjänster ur ett hastighetsperspektiv. När små filer utbyts mellan klient och server har hastigheten på överföringen en mindre betydelse. Vid större överföringar får hastighetsaspekten en alltmer viktig roll. Regelbundna hastighetsmätningar har utförts mot de mest populära molnlagringstjänsterna. Testerna har utförts från Sverige och USA. Testerna har utförts under flera dagar och under olika tidpunkter på dygnet, för att undersöka om hastighetsskillnader existerar. Resultaten visar att stora skillnader finns i hastighet mellan Sverige och USA. Inom Sverige hade Mega och Goolgle Drive högst medelhastighet. Inom USA hade Google Drive högst medelhastighet, men här var variationerna mellan tjänsterna ej lika stora som i Sverige. I resultaten mellan olika tidpunkter var det svårare att urskilja ett mönster, med undantag för Google Drive i Sverige som konsistent fungerade bäst på natten/morgonen. Även Mega fungerade bäst under natten.Cloud Storage services have seen increased usage and is an emerging market. This paper has focused on examining various cloud storage services from a speed perspective. When small files are exchanged between client and server, the speed of the service is of little importance. For larger transfers however, the speed of the service used plays a more important role. Regular speed measurements have been carried out against the most popular cloud storage services. The tests have been performed from Sweden and USA. The tests have been carried out over several days and at different times of day, to determine if speed differences exist. The results show that there are significant differences in speed between Sweden and the United States. In Sweden, Mega and Google Drive had the highest average speed. Within the United States, Google Drive had the highest average speed, but the variability between the services was not as great as in Sweden. In the results between different timeperiods, it was difficult to discern a pattern, with the exception of Google Drive in Sweden which consistently worked best during the night / morning. Mega also worked best during the night

The effect of engaging unpaid informal providers on case detection and treatment initiation rates for TB and HIV in rural Malawi (Triage Plus): A cluster randomised health system intervention trial

Background The poor face barriers in accessing services for tuberculosis (TB) and Human Immuno-deficiency Virus (HIV) disease. A cluster randomised trial was conducted to investigate the effectiveness of engaging unpaid informal providers (IPs) to promote access in a rural district. The intervention consisted of training unpaid IPs in TB and HIV disease recognition, sputum specimen collection, appropriate referrals, and raising community awareness. Methods In total, six clusters were defined in the study areas. Through a pair-matched cluster randomization process, three clusters (average cluster population = 200,714) were allocated to receive the intervention in the Early arm. Eleven months later the intervention was rolled out to the remaining three clusters (average cluster population = 209,564)—the Delayed arm. Treatment initiation rates for TB and Anti-Retroviral Therapy (ART) were the primary outcome measures. Secondary outcome measures included testing rates for TB and HIV. We report the results of the comparisons between the Early and Delayed arms over the 23 month trial period. Data were obtained from patient registers. Poisson regression models with robust standard errors were used to express the effectiveness of the intervention as incidence rate ratios (IRR). Results The Early and Delayed clusters were well matched in terms of baseline monthly mean counts and incidence rate ratios for TB and ART treatment initiation. However there were fewer testing and treatment initiation facilities in the Early clusters (TB treatment n = 2, TB testing n = 7, ART initiation n = 3, HIV testing n = 20) than in the Delayed clusters (TB treatment n = 4, TB testing n = 9, ART initiation n = 6, HIV testing n = 18). Overall there were more HIV testing and treatment centres than TB testing and treatment centres. The IRR was 1.18 (95% CI: 0.903–1.533; p = 0.112) for TB treatment initiation and 1.347 (CI:1.00–1.694; p = 0.049) for ART initiation in the first 12 months and the IRR were 0.552 (95% CI:0.397–0.767; p<0.001) and 0.924 (95% CI: 0.369–2.309, p = 0.863) for TB and ART treatment initiations respectively for the last 11 months. The IRR were 1.152 (95% CI:1.009–1.359, p = 0.003) and 1.61 (95% CI:1.385–1.869, p<0.001) for TB and HIV testing uptake respectively in the first 12 months. The IRR was 0.659 (95% CI:0.441–0.983; p = 0.023) for TB testing uptake for the last 11 months. Conclusions We conclude that engagement of unpaid IPs increased TB and HIV testing rates and also increased ART initiation. However, for these providers to be effective in promoting TB treatment initiation, numbers of sites offering TB testing and treatment initiation in rural areas should be increased. Trial registration ClinicalTrials.gov NCT02127983

Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable?

Private-public mix (PPM) DOTS is widely advocated as a DOTS adaptation for promoting progress towards the international tuberculosis (TB) control targets of detecting 70% of TB cases and successfully treating 85% of these. Private health care plays a central role in health-care provision in many developing countries that have a high burden of TB. It is therefore encouraging that PPM projects are being set up in various countries around the world to explore possible interaction between the national TB programmes and other partners in the fight against TB. The objective of this review was to use the published literature to assess the range of providers included in PPMs for their ability to provide case-detection services for the vulnerable. From a case-detection perspective, we identify the essential elements of a pro-poor PPM model, namely, cost-effectiveness from a patient perspective, accessibility, acceptability and quality. The review revealed that a very large part of the total spectrum of potential PPM-participating partners has not yet been explored; current models focus on private-for-profit health-care providers and nongovernmental organizations. We conclude that it is important to think critically about the type of private providers who are best suited to meeting the needs of the poor, and that more should be done to document the socioeconomic status of patients accessing services through PPM pilots

Community prevalence of chronic respiratory symptoms in rural Malawi: Implications for policy

Background No community prevalence studies have been done on chronic respiratory symptoms of cough, wheezing and shortness of breath in adult rural populations in Malawi. Case detection rates of tuberculosis (TB) and chronic airways disease are low in resource-poor primary health care facilities. Objective To understand the prevalence of chronic respiratory symptoms and recorded diagnoses of TB in rural Malawian adults in order to improve case detection and management of these diseases. Methods A population proportional, cross-sectional study was conducted to determine the proportion of the population with chronic respiratory symptoms that had a diagnosis of tuberculosis or chronic airways disease in two rural communities in Malawi. Households were randomly selected using Google Earth Pro software. Smart phones loaded with Open Data Kit Essential software were used for data collection. Interviews were conducted with 15795 people aged 15 years and above to enquire about symptoms of chronic cough, wheeze and shortness of breath. Results Overall 3554 (22.5%) participants reported at least one of these respiratory symptoms. Cough was reported by 2933, of whom 1623 (55.3%) reported cough only and 1310 (44.7%) combined with wheeze and/or shortness of breath. Only 4.6% (164/3554) of participants with chronic respiratory symptoms had one or more of the following diagnoses in their health passports (patient held medical records): TB, asthma, bronchitis and chronic obstructive pulmonary disease) Conclusions The high prevalence of chronic respiratory symptoms coupled with limited recorded diagnoses in patient-held medical records in these rural communities suggests a high chronic respiratory disease burden and unmet health need

Smoking.

<p>Smoking.</p