Accessibility to primary health care in low-density regions. A case study: NUTS III - Baixo Alentejo - Portugal

This study diagnosed the situation regarding the physical accessibility of the resident population to primary health care, based on the characteristics of the population served, their spatial distribution in the territory, based on space-time analysis. Thus, bearing the different means of transport available and the specific features of a low-density territory, we considered several mobility profiles under analysis, and selected the Baixo Alentejo as the study area. In methodological terms, besides using the location of primary health facilities and their areas of influence, the use of the road network and its restrictions, we selected the use the new 1x1 km grid, recently implemented throughout the EU (European Union), instead of using the statistical units or administrative boundaries. Its advantages allow overcoming some of the issues of the usual base cartography. The final results can be divided into two groups: conclusions related to the methodologies used and conclusions related to the accessibility of primary health care equipment in the study area.

Design, Implementation and Detection of Hardware Trojans in Sequential systems

For decades, digital systems have been designed based on assumptions that the underlying hardware, though not perfectly reliable, is free of malicious elements. The demand for IC’s is greatly increasing due to tremendous technological development. Without appropriate resources the companies are hard pressed to produce trusted IC’s. This is driving the companies into the ‘fabless’ trend predominant in semiconductor industry, where the companies are depending on cheaper foundries for the IC fabrication instead of depending on their own resources. This growth brings with it a big rise in threat level in terms of Hardware Trojans that hits the manufacturing companies which make use of Integrated Circuits. This transcends many industries, including strategic organizations and telecommunication companies, mobile phones and computers, embedded systems used in domestic applications and health care equipment. These adversarial inclusions are generally triggered to do malicious modifications in the end user system by the intruder, which is difficult to detect in their quiescent state. This paper focuses on understanding Hardware Trojans, their implications and detection methodologies. It is extremely important for all industries and more so for defense organizations, who are involved in developing systems to protect the nation’s boundaries.

The impact of Benin’s first public procurement code and its amendment on healthcare equipment acquisition prices

PurposeTo satisfy donors and reduce public procurement acquisition prices, Benin has implemented and amended its first public procurement code guided by top-down principles of good governance.Design/methodology/approachThis study aims to measure the impact of the code and its amendment on public procurement acquisition prices of health-care equipment from 1995 to 2010.FindingsA segmented linear regression analysis was performed using interrupted time-series data. The analysis shows that the code and its amendment did not reduce acquisition prices, indicating the limited impact of the code. The authors recommend the implementation of bottom-up processes in establishing the public procurement system, and the development of a reference pricelist of the most widely used health-care equipment, as possible solutions for improving the effectiveness of the code.

“Is there a neurologist on this flight?”

Purpose of reviewNeurologists are being asked to offer their services in response to in-flight medical conditions. This review updates the latest understanding of how neurologists should manage in-flight neurologic emergencies should they be called upon to serve. A review of the existing literature was conducted for sharing of best practices in this unique scenario.Recent findingsIn-flight neurologic emergencies are on the rise. This article provides a synthesis of current best practices for in-flight emergencies including epidemiology, airline responsibility, available health care equipment on jetliners, legal ramifications of helping, and pathophysiology of why in-flight neurologic emergencies are so common.SummaryIn-flight neurologic emergencies are common and all physicians are increasingly being asked to respond to in-flight emergencies. Understanding one's responsibility, available equipment, and how to best prevent these scenarios with one's own patients may help to make this complex situation more manageable.

Documentation and investigation of missing health care equipment: The need to safeguard high priced devices in health care institutions

Objective: Missing medical equipment in health care settings decrease productivity, increase spending to replace losses, and potentially endanger patient safety. By documenting and investigating the causes of these incidents, strategies to prevent future occurrences can be developed.Methods: As an example of this approach, we describe the inadvertent disposal of an expensive medical device during a randomized controlled trial (RCT) conducted within a medical facility. The incident was carefully documented and investigated shortly after it occurred. This information was used to develop targeted interventions to prevent further occurrences.Results: The device was a mattress overlay connected to a computer monitor that generated a continuous pressure image for use by nursing staff in the prevention of pressure injuries. An Environmental Services staff member disposed of one of these devices when the room of an enrolled patient was cleaned following their transfer to another unit. Miscommunication (or a misunderstanding of communicated information) and lack of awareness were identified as the main causes of this error.Discussion: By using the loss as a learning opportunity, the investigation of the incident led to strategies for preventing future occurrences. These included frequent training sessions for staff and improvements in signage. A detailed, factual and timely investigation of the events around the loss of armamentarium coupled with analysis on how to prevent future occurrences should be considered for all incidents involving high cost equipment.Conclusions: A standardized, non-judgmental approach to documenting and investigating the causes of costly equipment loss can lead to strategies for improved asset management and the prevention of further incidents of this nature.

The Effects of Housing on Health and Health Risks in an Aging Population: A Qualitative Study in Rural Thailand

Background. Over the last decade, Thailand has experienced an aging population, especially in rural areas. Research finds a strong, positive relationship between good quality housing and health, and this paper assesses the impact and living experience of housing of older people in rural Thailand.Methods. This was a mixed-method study, using data from observations of the physical adequacy of housing, semistructured interviews with key informants, and archival information from health records for 13 households in rural Thailand.Results. There were four main themes, each of which led to health risks for the older people: “lighting and unsafe wires,” “house design and composition,” “maintenance of the house,” and “health care equipment.” The housing was not appropriately designed to accommodate health care equipment or to fully support individual daily activities of older people. Numerous accidents occurred as a direct result of inadequate housing and the majority of houses had insufficient and unsafe lighting, floor surfaces and furniture that created health risks, and toilets or beds that were at an unsuitable height for older people.Conclusion. This paper provides an improved and an important understanding of the housing situation among older people living in rural areas in Thailand.