Essential Concepts in Modern Health Services

Health services have the functions to define community health problems, to identify unmet needs and survey the resources to meet them, to establish SMART objectives, and to project administrative actions to accomplish the purpose of proposed action programs. For maximum efficacy, health systems should rely on newer approaches of management as management-by-objectives, risk-management, and performance management with full and equal participation from professionals and consumers. The public should be well informed about their needs and what is expected from them to improve their health. Inefficient use of budget allocated to health services should be prevented by tools like performance management and clinical governance. Data processed to information and intelligence is needed to deal with changing disease patterns and to encourage policies that could manage with the complex feedback system of health. e-health solutions should be instituted to increase effectiveness and improve efficiency and informing human resources and populations. Suitable legislations should be introduced including those that ensure coordination between different sectors. Competent workforce should be given the opportunity to receive lifetime appropriate adequate training. External continuous evaluation using appropriate indicators is vital. Actions should be done both inside and outside the health sector to monitor changes and overcome constraints

Medical Tourism and the Libyan National Health Services

Medical tourism is a term that is used frequently by the media and travel agencies as a catchall phrase to describe a process where people travel to other countries to obtain medical, dental, and/or surgical care [1,2]. Leisure aspects of traveling are usually included on such a medical travel trip [1]. The term is also used to describe a situation where doctors travel to other places to deliver services to endogenous populations [3].Many factors have led to the recent increase in popularity of medical tourism. Among these factors are the absence of a particular service and the high cost of health care in some countries of origin on one side, and the ease and affordability of international travel, and the improvement of technology and standards of care in host countries on the other side. This phenomenon cannot be separated from globalization and tendency for a more liberal world trade. In countries that operate from a public health-care system, it can take a considerable amount of time to get needed medical care. In Britain and Canada, for example, the waiting period for a hip replacement can be a year or more, while in Bangkok or Bangalore, a patient can be in the operating room the morning after getting off a plane [2]. The post-surgery mortality rate in the 15,000 heart operations done every year in Scots Heart Institute and Research Centre in Delhi and Faridabad is only 0.8%, which is less than half of most major hospitals in the United States or Europe [2]. However, the real attraction is price [2]. The cost of surgery in India, Thailand or South Africa can be one-tenth of the price of comparable treatment in the United States or Western Europe [2]. A heart operation as an example costs €32000 in the United States, €16000 in Europe, but less than €3000 in India. A full facelift that would cost $20,000 in the U.S. runs at about$1,250 in South Africa [2]. In addition, clinics in these countries provide single-patient rooms that resemble guestrooms in four-star hotels [2].Interventions aimed at medical tourism include cancer treatment, neurosurgery, organ transplantation, aesthetic treatment, dental treatments, eye surgery, kidney dialysis, « preventive health screening» and hip resurfacing [2]. Other opportunities are constantly being exploited. Examples include different services as aphaeresis tourism in India [4] and climatotherapy in Egypt [5].Medical tourism is a rapidly growing industry in many countries. India is becoming a «global health destination». Encouraged by the government, India is promoting the «high-tech healing» of its private healthcare sector as a tourist attraction [1,2]. More than 100 000 foreigners visited India for medical treatment in the year 2005. India estimates that medical tourism could bring as much as $2.2 billion per year by 2012. Besides India, popular international medical travel destinations include Singapore and Thailand. About 374, 000 visitors came to Singapore purely to seek healthcare in 2005, half of them from the Middle East [2]. South Africa promotes an attractive «medical safari» catchphrase: Come to see African wildlife and get a facelift in the same trip. Other countries include Tunisia which is attracting Italians, British and French besides the so- called traditional visitors from Libya and Algeria [6]. The list of countries currently promoting medical tourism include many others such as Argentina, Bolivia, Brazil, Cuba, Costa Rica, Jamaica, Jordan, Hungary, Latvia, Lithuania, Malaysia and the Philippines [2,3]. Some hospitals in certain countries are gaining the confidence of their customers by obtaining hospital accreditation from international bodies in the United States [2]. Dubai, already known for its festival and other luxury attractions, is planning to open the Dubai Healthcare City by 2010. This is expected to be the largest international medical centre between Europe and Southeast Asia and it is hoped to become an internationally recognized location of choice for quality healthcare and an integrated centre of excellence for clinical and wellness services, medical education and research [2]. An international medical travel conference (IMTC) was held in December 2006 and some web sites such as ArabMedicare.com were established to accompany the needs of this growing market.In spite of the aforementioned rewards, medical tourism is not without risks [3]. Medical tourism can do harm to national health services of the host as well as the country of origin. Besides cultural and language issues, there are risks inherent in traveling as accidents, exposure to different infectious diseases, risks from traveling soon after surgery, impossibility of treating chronic disease after a single consultation, the non familiarity of how a certain specialty applies to other communities, the on-off consultations, the limited possibility for follow up, the absence of record of the consultation [3], and most importantly fraud and abuse.The total amount of money spent by Libyans on both forms of medical tourism is difficult to estimate. It ranges between$100-200 millions per year for treatment abroad, but the accurate figures are not available. The form of medical tourism where doctors rather than patients travel, gained a momentum with the increased role of private practice in health service delivery. There is a real threat from the growing market of medical tourism in the region on the public health oriented national health system in Libya. The two neighboring countries that are mostly visited by Libyans have a lower performance of National Health Service in comparison to Libyan National Health services with an objective assessment as revealed by infant mortality rate, life expectancy at birth, maternal mortality ratio and proportion of low birth weight [7]. Giving the non-popularity of tourism among the Libyan population, traveling in itself is an important event in one’s life. We should not deny that in many cases quality of care, communication skills of health-care givers and patient satisfaction are better in visited countries. Demands are rarely seen to be an important element in the predominantly centralized planning of health services in Libya. Initial visits to these «tourist» private clinics are seen as means to attract other clients. This goes usually through undermining National Health Services in Libya. In many instances there is no justification for that. In addition to our tendency to idealize others, many of the criteria used by patients are very subjective and represent demands rather than needs. Some of these subjective criteria that we met were related to quality of food or clothes offered in hospitals or certain procedures that are seen as novel experience.It is unlikely that this phenomenon of medical tourism will decrease in magnitude. It is also unreasonable to think that a country with a small population will be able to deliver all service demands and needs of the population. For example, the cost-benefit analysis of some interventions as hepatic transplantation would not permit the minimum number of transplantations needed to insure quality unless these interventions are organized at the regional level. Solutions are multifaceted. These would include; improving hospital based services and ambulatory care; increasing responsiveness of national health services to patients’ needs as basic amenities that are highly valued by the consumers such as clean waiting rooms or adequate beds and food in hospitals; partnership with the private sector; delivering quality care with continuous evaluation by different indicators related to structure, process and outcome of healthcare services, and using clinical governance, performance management and SMART objectives and targets to evaluate performance of health establishments. Health insurance schemes can also play an important role in controlling this phenomenon as well as supervising treatment processes and ensuring stewardship

The French Health Care System; What can We Learn?

All public systems look for the best organizational structure to funnel part of their national income into healthcare services. Appropriate policies may differ widely across country settings. Most healthcare systems fall under one of two broad categories, either Bismark or Beveridge systems. There is no simple ideal model for the organization of health services, but most healthcare systems that follow the Beveridge healthcare model are poor performers. The Libyan Health system is a low responsive, inefficient and underperforming system that lacks goals and/or SMART. (Specific, Measurable, Achievable, Realistic, Time specific) objectives. A look at different organization models in the world would reinforce efforts to reorganize and improve the performance of the Libyan National Healthcare services. The French Health Care System (FHCS) ranked first according to the WHO and the European Health Consumer Powerhouse. The FHCS was described to have a technically efficient, generous healthcare system that provides the best overall health care. This makes the FHCS a practical model of organization having many of the essential aspects of a modern national health service. In this review, we describe the main features of the FHCS, current challenges and future trends with particular attention paid to aspects that could be of importance to the Libyan Healthcare System

A palynological investigation of vatica L. (dipterocarpaceae) in Peninsular Malaysia

Pollen morphology of 24 species of Vatica L. had been investigated using light and scanning electron microscopes. Vatica is a stenopalynous genus, the pollens are radially symmetrical, isopolar, subprolate to suboblate sometimes prolate rarely oblate, all tricolpate. Exine ornamentation varies from thin to medium reticulate. On the basis of pollen shape two groups of Vatica have been recognized. Within the genus pollen diversity is valuable for identification and delimiting species

直接効果・間接効果の推定および未測定の交絡に対する感度解析

要旨あり疫学研究のデザインとデータ解析：最近の理論的展開と実践研究詳

Simultaneous Modeling of Disease Screening and Severity Prediction: A Multi-task and Sparse Regularization Approach

Disease prediction is one of the central problems in biostatistical research. Some biomarkers are not only helpful in diagnosing and screening diseases but also associated with the severity of the diseases. It should be helpful to construct a prediction model that can estimate severity at the diagnosis or screening stage from perspectives such as treatment prioritization. We focus on solving the combined tasks of screening and severity prediction, considering a combined response variable such as \{healthy, mild, intermediate, severe\}. This type of response variable is ordinal, but since the two tasks do not necessarily share the same statistical structure, the conventional cumulative logit model (CLM) may not be suitable. To handle the composite ordinal response, we propose the Multi-task Cumulative Logit Model (MtCLM) with structural sparse regularization. This model is sufficiently flexible that can fit the different structures of the two tasks and capture their shared structure of them. In addition, MtCLM is valid as a stochastic model in the entire predictor space, unlike another conventional and flexible model, the non-parallel cumulative logit model (NPCLM). We conduct simulation experiments and real data analysis to illustrate the prediction performance and interpretability

Heat treatment enhances the plant phenolic (+)-catechin, a weak antimicrobial agent when combined with copper sulphate

The aim of the study was to compare the antimicrobial activities of freshly-made, heat-treated (HT), and 14 d stored (+)-Catechin solutions with (+)-catechin flavanol isomers in the presence of copper sulphate. (+)-Catechin activity was investigated when combined with different ratios of Cu(2+) ; 100°C heat treatment; autoclaving; and 14 d storage against Staphylococcus aureus. Cu(2+) -(+)-Catechin complexation, isomer structure-activity relationships, and H2 O2 generation were also investigated. Freshly-made, HT, and 14d stored flavanols showed no activity. Whilst combined Cu(2+) -autoclaved (+)-Catechin and -HT(+)-Catechin activities were similar, HT(+)-Catechin was more active than either freshly-made (+)-catechin (generating more H2 O2 ) or (-)-Epicatechin (though it generated less H2 O2 ) or 14d-(+)-Catechin (which had similar activity to Cu(2+) controls - though it generated more H2 O2 ). When combined with Cu(2+) , in terms of rates of activity, HT(+)-Catechin was lower than (-)-Epigallocatechin gallate and greater than freshly-made (+)-Catechin. Freshly-made and HT(+)-Catechin formed acidic complexes with Cu(2+) as indicated by pH and UV-vis measurements although pH changes did not account for antimicrobial activity. Freshly-made and HT(+)-Catechin both formed Cu(2+) complexes. The HT(+)-Catechin complex generated more H2 O2 which could explain its higher antimicrobial activity. This article is protected by copyright. All rights reserved

Libyan National Health Services The Need to Move to Management-by-Objectives

In the last four decades, there has been a substantial horizontal expansion of health services in Libya. This resulted in improvement in morbidity and mortality, in particularly those related to infectious disease. However, measures such as the national performance gap indicator reveal an underperforming health system. In this article, we discuss aspects related to the Libyan health system and its current status including areas of weakness. Overcoming current failures and further improvement are unlikely to occur spontaneously without proper planning. Defining community health problems, identifying unmet needs, surveying resources to meet them, establishing SMART (specific, measurable, achievable, and realistic and time specific) objectives, and projecting administrative action to accomplish the proposed programs, are a must. The health system should rely on newer approaches such as management-by-objectives and risk-management rather than the prevailing crisis-management attitude

Nudge-Based Interventions on Health Promotion Activity Among Very Old People: A Pragmatic, 2-Arm, Participant-Blinded Randomized Controlled Trial

OBJECTIVES: Social distancing due to the coronavirus disease 2019 crisis can exacerbate inactivity in older adults. Novel approaches for older adults must be designed to improve their activity and maintain their health. This study examined the effect of nudge-based behavioral interventions on health-promoting activities in older adults in Japan. DESIGN: Two-arm, participant-blinded randomized controlled trial. SETTING AND PARTICIPANTS: Japanese continuing care retirement community residents (n = 99, median age 82 years, 73% women) INTERVENTION: Two-step nudge-based behavioral intervention promoting tablet usage. METHODS: We enrolled participants from an ongoing Internet of Things project in a retirement community in Japan. For the health promotion program, tablet computers were installed in a common area for participants to receive information about their health. The intervention group received a 1-time loss-emphasized nudge (first step), followed by asking questions about when they planned to use it again (second step). The control group used the tablet computers without being asked those questions. The main outcome was the participants' mean daily tablet activity every 4 weeks for the next 16 weeks. RESULTS: Ninety-nine individuals were randomly assigned to the intervention or control group. The rate ratios for tablet use were significantly higher in the intervention group in the second and third periods. The subgroup analysis showed that these effects were largely attributable to men. CONCLUSIONS AND IMPLICATIONS: Nudge-based interventions can be effective in promoting activities for older adults, especially older men. The finding of this study indicates a possible intervention to engage people who are socially isolated