Clinical Support Systems Program: why do we need clinical practice improvement? A government perspective.
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"The purpose of this paper is to look at what has been achieved by the transmigration program [in Indonesia], to examine the major problems that have arisen and to consider the present constraints which now cast some doubt upon the future of the program." A historical overview of government policies from 1905 to 1988 is provided, and problems of land supply, land use, and lack of funds are discussed. Data are from the 1961 and 1980 Indonesian censuses. (SUMMARY IN FRE AND SPA)
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The Rural Health Support Education and Training (RHSET) Program is a Commonwealth Government grants program established in 1990 to enhance the access to rural communities to effective health services. The emphasis has been on professional workforce issues. Up until December 1997, 431 applications for funding had been approved and close to $37 million allocated. This article considers the grants awarded in that period according to their main topic of interest within three broad groupings: policy and tertiary service provision; health discipline-specific groups; and special interest groups such as Aboriginal and Torres Strait Islanders and community organisations. Each subgroup is introduced and its contents outlined. It also suggests that despite heightened government interest in rural and remote health, a niche can still be found for RHSET. It further argues that the time has come for a major evaluation of project activity to ensure non-duplication and to develop performance indicators for evaluating projects addressing rural and remote area workforce issues.
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To effectively confront teenage pregnancy, the characteristics, attitudes, and behaviors of males, along with females, need to be better understood. This pilot study examined young males who visited the family planning clinic of a public health department to obtain free condoms. Questionnaires were distributed over a 4-week period. Nearly 30% of males reported having sex 11+ times a month. However, an equal proportion reported having sex three or fewer times in the same interval. Most males reported using condoms during sex, although one quarter reported use as "seldom." The health department was a major source of condoms and was positively evaluated because condoms were free and there were "no questions asked." Only one third of the males reported using another method of contraception. Results suggest a major role of the health department in condom availability and the potential need for contraceptive services for males.
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This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians, providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care.
Past agricultural management practices have contributed to the loss of soil organic carbon (SOC) and emission of greenhouse gases (e.g., carbon dioxide and nitrous oxide). Fortunately, however, conservation-oriented agricultural management systems can be, and have been, developed to sequester SOC, improve soil quality, and increase crop productivity. Our objectives were to (i) review literature related to SOC sequestration in cotton (Gossypium hirsutum L.) production systems, (ii) recommend best management practices to sequester SOC, and (iii) outline the current political scenario and future probabilities for cotton producers to benefit from SOC sequestration. From a review of 20 studies in the region, SOC increased with no tillage compared with conventional tillage by 0.48 +/- 0.56 Mg C ha(-1) yr(-1) (H(0): no change, p < 0.001). More diverse rotations of cotton with high-residue-producing crops such as corn (Zea mays L.) and small grains would sequester greater quantities of SOC than continuous cotton. No-tillage cropping with a cover crop sequestered 0.67 +/- 0.63 Mg C ha(-1) yr(-1), while that of no-tillage cropping without a cover crop sequestered 0.34 +/- 47 Mg C ha(-1) yr(-1) (mean comparison, p = 0.04). Current government incentive programs recommend agricultural practices that would contribute to SOC sequestration. Participation in the Conservation Security Program could lead to government payments of up to Dollars 20 ha(-1). Current open-market trading of C credits would appear to yield less than Dollars 3 ha(-1), although prices would greatly increase should a government policy to limit greenhouse gas emissions be mandated.
This regulation amends the Child Support Enforcement program regulations governing medical support enforcement activities and responds to comments made on the proposed regulations published in the Federal Register on August 4, 1983 (48 FR 35468). The regulation also implements section 16 of Pub. L. 98-378. Under this regulation, the IV-D agency must obtain basic medical support information and provide this information to the State Medicaid agency. Also, if the custodial parent does not have satisfactory health insurance coverage, the IV-D agency must petition the court or administrative authority to include medical support in new or modified support orders and inform the State Medicaid agency of any new or modified support orders that include a medical support obligation. Finally, the IV-D agency must take steps to enforce medical support which has been ordered by a court or administrative process under State law by assuring that coverage is acquired as ordered. These activities increase the use of available third party resources in the form of private health insurance, thus increasing medical cost savings to State and Federal governments under the Medicaid program. Federal funding is available to IV-D agencies for required medical support activities. Prior to these regulations, medical support activities were pursued by IV-D agencies only under optional cooperative agreements with Medicaid agencies.
A sample of 665 low-income women from a predominantly rural area of north central Florida rated the value of 25 features of family planning providers and reported their perceptions of how characteristic each feature was of different types of providers. A well-trained, trustworthy and friendly staff, the presence of a doctor if you need one and a staff that is gentle with the examination were the most desirable features of family planning services. The respondents' perceptions of public health clinics suggest that the strongest qualities of such facilities are that they treat people from different backgrounds, accept Medicaid, are easy to find and teach you how to avoid pregnancy and how to take care of yourself and stay healthy. Features thought most characteristic of private physician services were a well-trained staff, privacy and the presence of a doctor if you need one. Voluntary organizations were seen as providing services for people of different backgrounds, having a friendly staff, serving as a referral agency and teaching about staying healthy and avoiding pregnancy. However, voluntary organizations were rated lower than public health clinics or private physicians on nearly all features. The total scores for public health clinics and private physicians were not significantly different from each other, but both were noticeably higher than the score for voluntary organizations. Ethnicity affected ratings dramatically, with black respondents clearly more favorable toward public health clinics and private physicians than white respondents; conversely, whites were more positive toward voluntary organizations than were blacks. For many of these low-income respondents, the high ratings of private physicians may have represented their expectations rather than their actual experience.
This study investigates the role of 46 public Consultori of Rome, as far as the hormonal contraception with "pill', the most common contraceptive method used by roman women, is concerned. With a series of phone calls, a hypothetic potential customer asked for an appointment directly with the gynaecologist for getting adviced to use "pill" for the first time. The results show that, although the wait for the first appointment directly the gynaecologist is not long (11,3 days as an average), it is very difficult to get it and this was possible only in 12 cases out of 46. We have noted that the first appointment for "pill" was offered with no-medical personnel, like social assistants, sanitary assistants or midwives, in most 16 of cases, and that in a significant number of Consultori was not possible to obtain an appointment whatever. In public Consultory of Rome we have found a different attitude in giving appointment to women for contraception with pill, even inside the same USL (Local Sanitary Unit, the basic structure of public health in Italy, in which Consultori have the role of prevention and promotion of maternity and tutelage of infancy). From this study the need emerges of uniformity in the attitude of Consultori staff in managing the customers, in order to avoid that women, finding so many difficulties, give up referring to these public structure for beginning contraception and choose private professionals or decide not to use the "pill".
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The Arab Republic of Egypt has used family planning service delivery as the main vehicle for implementing its national family planning policy since 1965. This paper reports results of a study undertaken during 1975-77 using a systematic sample of 100 health units offering family planning services in two governorates of Egypt. The findings suggest that there is considerable potential for improving the service delivery system through better management. Broadening the choice of technology offered, increasing the quantity and quality of outreach and communication activities for new and continuing contraceptors, and improving staff availability could lead to improvements in national program participation and continuation.