Structure of Social Services in the Czech Republic; The Structure of Social Services — current status in the Czech Republic

A report on social services in the Czech RepublicInternational Labour Organizationunpublishe

Good Occupational Health Practice

This book describes the guidelines for occupational health practice in Finland. The legislation on occupational health services (OHS) was recently amended to include the requirement of systematic and goal-oriented OHS. The rapid changes in the work life bring new challenges and development needs in OHS. In Finland, the concept of “Good Occupational Health Practice” was introduced in the amendments, and quality assurance was included in the concept

China’s diversifying demand for housing for the elderly

Purpose: This paper aims to examine the trends among the elderly population in China about residential preferences and policy applications, as the elderly is a rapidly expanding demographic group that has increasing and diversifying inclinations for demanding the residential facilities for the elderly (RFEs) now and in the foreseeable future. Design/methodology/approach: Based on a review of the existing literature and policies, a model is conceptualised for understanding the demands of the elderly. Their needs for functional supportiveness and richness of residential resources in RFEs are then categorised into focal groups. Findings: The Chinese elderly’s demand for specialised residential facilities is under a shift from seeking deficit relief to pursuing personal choices. It is suggested that there will be a continuing demand for affordable RFEs from a number of key focal groups, including: the functionally impaired; marginally housed; socially isolated; and the elderly requiring social relief. In addition, retirement housing in China is likely to be more affordable for the next elderly generation. However, the immature social welfare system and low average income level of the current elderly generation means that the Chinese Government has tough decisions to make about service priorities. Practical implications: Policy and investment priorities may have to be inclusive of those who demand social relief (free-of-charge) and affordable professional long-term care in RFEs, whereas the rest of the demand could be released by growth in the development of community- and home-based service systems. Originality/value: This study is one of the first to identify the diversifying demands of age-exclusive living facilities for the elderly that deserve priorities in China. The results can inform and guide future policy and project investment in China

Dietary Advice on Prescription: A novel approach to dietary counseling

This article describes a novel approach to giving dietary advice, which is called “Dietary Advice on Prescription” (DAP; Matordning på Recept [MoR] in Swedish). It is the same principle as prescription on medicine and “Physical Activity on Prescription” (PAP; Fysisk aktivitet på Recept [FaR] in Swedish). The main idea is that a written prescription will strengthen the oral advice and emphasize certain aspects of the dietary recommendation. The DAP is on the brink of being tested in a planned study

PrEP as a feature in the optimal landscape of combination HIV prevention in sub-Saharan Africa

INTRODUCTION: The new WHO guidelines recommend offering pre-exposure prophylaxis (PrEP) to people who are at substantial risk of HIV infection. However, where PrEP should be prioritised, and for which population groups, remains an open question. The HIV landscape in sub-Saharan Africa features limited prevention resources, multiple options for achieving cost saving, and epidemic heterogeneity. This paper examines what role PrEP should play in optimal prevention in this complex and dynamic landscape. METHODS: We use a model that was previously developed to capture subnational HIV transmission in sub-Saharan Africa. With this model, we can consider how prevention funds could be distributed across and within countries throughout sub-Saharan Africa to enable optimal HIV prevention (that is, avert the greatest number of infections for the lowest cost). Here, we focus on PrEP to elucidate where, and to whom, it would optimally be offered in portfolios of interventions (alongside voluntary medical male circumcision, treatment as prevention, and behaviour change communication). Over a range of continental expenditure levels, we use our model to explore prevention patterns that incorporate PrEP, exclude PrEP, or implement PrEP according to a fixed incidence threshold. RESULTS: At low-to-moderate levels of total prevention expenditure, we find that the optimal intervention portfolios would include PrEP in only a few regions and primarily for female sex workers (FSW). Prioritisation of PrEP would expand with increasing total expenditure, such that the optimal prevention portfolios would offer PrEP in more subnational regions and increasingly for men who have sex with men (MSM) and the lower incidence general population. The marginal benefit of including PrEP among the available interventions increases with overall expenditure by up to 14% (relative to excluding PrEP). The minimum baseline incidence for the optimal offer of PrEP declines for all population groups as expenditure increases. We find that using a fixed incidence benchmark to guide PrEP decisions would incur considerable losses in impact (up to 7%) compared with an approach that uses PrEP more flexibly in light of prevailing budget conditions. CONCLUSIONS: Our findings suggest that, for an optimal distribution of prevention resources, choices of whether to implement PrEP in subnational regions should depend on the scope for impact of other possible interventions, local incidence in population groups, and total resources available. If prevention funding were to become restricted in the future, it may be suboptimal to use PrEP according to a fixed incidence benchmark, and other prevention modalities may be more cost-effective. In contrast, expansions in funding could permit PrEP to be used to its full potential in epidemiologically driven prevention portfolios and thereby enable a more cost-effective HIV response across Africa

The effect of a nutritional education program on the nutritional status of elderly patients in a long-term care hospital in Jeollanamdo province: health behavior, dietary behavior, nutrition risk level and nutrient intake

This study was conducted to assess improvements in nutritional status following the application of nutrition education to elderly patients in a long-term care hospital. The study was carried out from January to May 2009, during which a preliminary survey, a pretest, the application of nutrition education, and a post-test were applied in stages. The number of subjects at pretest was 81, and the number of participants included in the final analysis was 61 (18 men, 43 women), all of whom participated in both the nutrition education program and the post-test. The survey consisted of general demographic items, health behaviors, dietary behaviors, the Nutrition Screening Initiative checklist, and nutrient intake assessment (24 hour recall method). The nutrition education program lasted for four weeks. It included a basic education program, provided once a week, and mini-education program, which was offered daily during lunch times. The survey was conducted before and after the education program using the same assessment method, although some items were included only at pretest. When analyzing the changes in elderly patients after the nutritional education program, we found that, among subjective dietary behaviors, self-rated perceptions of health (P < 0.001) and of depression (P < 0.001) improved significantly and that dietary behavior scores also improved significantly (P < 0.001), while nutritional risk levels decreased. In terms of nutrient intake, subjects' intake of energy, protein, fat, carbohydrate, calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, and vitamin C all increased significantly (P < 0.001). These results indicated that nutritional education is effective in improving the nutritional status of elderly patients. We hope that the results of this study can be used as preliminary data for establishing guidelines for nutrition management tailored to elderly patients in long-term care hospitals

Oral Health Care Reform in Finland – aiming to reduce inequity in care provision

<p>Abstract</p> <p>Background</p> <p>In Finland, dental services are provided by a public (PDS) and a private sector. In the past, children, young adults and special needs groups were entitled to care and treatment from the public dental services (PDS). A major reform in 2001 – 2002 opened the PDS and extended subsidies for private dental services to all adults. It aimed to increase equity by improving adults' access to oral health care and reducing cost barriers. The aim of this study was to assess the impacts of the reform on the utilization of publicly funded and private dental services, numbers and distribution of personnel and costs in 2000 and in 2004, before and after the oral health care reform. An evaluation was made of how the health political goals of the reform: integrating oral health care into general health care, improving adults' access to care and lowering cost barriers had been fulfilled during the study period.</p> <p>Methods</p> <p>National registers were used as data sources for the study. Use of dental services, personnel resources and costs in 2000 (before the reform) and in 2004 (after the reform) were compared.</p> <p>Results</p> <p>In 2000, when access to publicly subsidised dental services was restricted to those born in 1956 or later, every third adult used the PDS or subsidised private services. By 2004, when subsidies had been extended to the whole adult population, this increased to almost every second adult. The PDS reported having seen 118 076 more adult patients in 2004 than in 2000. The private sector had the same number of patients but 542 656 of them had not previously been entitled to partial reimbursement of fees.</p> <p>The use of both public and subsidised private services increased most in big cities and urban municipalities where access to the PDS had been poor and the number of private practitioners was high. The PDS employed more dentists (6.5%) and the number of private practitioners fell by 6.9%. The total dental care expenditure (PDS plus private) increased by 21% during the study period. Private patients who had previously not been entitled to reimbursements seemed to gain most from the reform.</p> <p>Conclusion</p> <p>The results of this study indicate that implementation of a substantial reform, that changes the traditionally defined tasks of the public and private sectors in an established oral health care provision system, proceeds slowly, is expensive and probably requires more stringent steering than was the case in Finland 2001 – 2004. However, the equity and fairness of the oral health care provision system improved and access to services and cost-sharing improved slightly.</p

Oral health indices predict individualised recall interval

Objectives: The individualised recall interval (IRI) is part of the oral health examination. This observational, register-based study aimed to explore how oral health indices DMFT (decayed, missing, filled teeth), DT (decayed teeth), CPI (Community Periodontal Index, maximum value of individual was used) and number of teeth are associated with IRI for adults. Methods: Oral health examination includes an assessment of all oral tissues, diagnosis, a treatment plan and assessment and a determination of the interval before the next assessment. It is called the IRI. This cross-sectional study population included 42,533 adults (age range 18-89 years), who had visited for an oral health examination during 2009, provided by the Helsinki City Social Services and Health Care. The recall interval was categorised into an ordinal scale (0-12, 13-24, 25-36 and 37-60 months) and was modelled using a proportional odds model. ORs less than one indicated a shorter recall interval. Results: Recall interval categories in the study population were 0-12 months (n = 4,569; 11%), 13-24 months (n = 23,732; 56%), 25-36 months (n = 12,049; 28%), and 37-60 months (n = 2,183; 5%). The results of statistical models clearly showed an association between the length of recall intervals and oral health indices. In all models, higher values of DMFT, DT and CPI indicated a shorter recall interval. The number of teeth were not so relevant. The association was not influenced when different combinations of other predictors (age, gender, socioeconomic status, chronic diseases) were included in the model. The severity of periodontitis predicted a short recall interval, for example, in the Model 1, CPI maximum value 4 was OR = 0.35 (95% confidence interval 0.31-0.40). Conclusions: The oral health indices showed a clear association with the length of the IRI. Poor oral health reduced IRI. The indices provide information about the amount of oral health prevention required and are useful to health organisations.Peer reviewe