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PubMed2005

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience.

INTRODUCTION: Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. DESCRIPTION OF THE PROJECT: Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. LESSON LEARNED: A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.

Community Participation↗
PubMed2001

Options in radioactive waste management revisited: a proposed framework for robust decision making.

Deregulation, with concurrent pressure on electricity utilities, has fundamentally changed the once-"closed" radioactive waste management system controlled by the so-called "nuclear establishment." Advocacy coalitions may change-who knows in which direction-but policy learning may also take place. This article presents a framework to evaluate the management options for a specified concept of "sustainability." When weighing the different objectives in view of the long-lasting potential danger of radiotoxic substances, the overall goal of a sound waste management system is to demonstrate safety. The first-priority objective of a disposal system, therefore, is its stability so that it can comply with the protection goal, that is, the long-term protection of humans and the environment from ionizing radiation. The complementary objective is flexibility, defined here as intervention potential. Because trade-offs within the "sustainability triangle" of ecology, economy, and society are unavoidable, the concept of "integral robustness"-both technical and societal-is introduced into radioactive waste management. A system is robust if it is not sensitive to significant parameter changes. In the present case, it has to have a conservative, passively stable design with built-in control and intervention mechanisms. With regard to technical implementation, a concept called "monitored long-term geological disposal" is presented. Such an "extended" final disposal concept emphasizes technical robustness, recognizes evaluation demands (for a potential break-off of a project), and enhances process-based transparency. This open approach admittedly sets high challenges with regard to technicalities as well as the institutional setting and the management process. It requires "mutual learning" by and from all stakeholders to achieve a truly sustainable radioactive waste management system.

Decision Making↗
PubMed2001

DIABCARE Quality Network in Europe--a model for quality management in chronic diseases.

The DIABCARE Q-Net project developed a complete and integrated information technology system to monitor diabetes care, according to the gold standards of the St Vincent Declaration Action Program. This is the first Telematic platform for standardized documentation on medical quality and evaluation across Europe, which will serve as a model for other chronic diseases. Quality development starts from the comparison of diabetes services, based on the key data on diabetes care in the basic information sheet. This is a 141 field form, which is to be completed once a year for each patient under the care of the diabetes team. The system performs an analysis of the local data and compares the data with peer teams by means of telecommunication of anonymous data. These data are collected regionally. At the next level these regional data are compared on a national basis across Europe using dedicated communication lines. National data can be compared transnationally by the use of the Internet and the DIABCARE benchmarking servers. These different lines are used according to the necessary security standards. Medical data are transferred via dedicated lines, aggregated data via the Internet. The architecture follows the open-platform concept in order to allow for heterogeneous technical environments. Already at the start of the project, the necessity for expanding the quality approach to telemedicine methodology was identified and included. For each level, specific programs are available to improve the performance of diabetes care delivery: DIABCARE data as client and DIABCARE server as regional and DIABCARE 'international server' as transnational server. Functioning pilots were established across all levels. The clients have been linked to the servers on a routine basis. According to the open architecture design, the various countries decided on different systems at the entry point: full system--Portugal; fax systems--Italy, Bavaria; implementation into doctor's office systems--Norway; paper forms and chip cards--France. This system can improve the local, regional and national diabetes care. Initiatives in several countries proved the feasibility of the system. The most extensive use, from Portugal, will be reported later in this paper. The exploitation of the DIABCARE Q-Net system will be performed with the DIABCARE International European Economic Interest Grouping as a co-ordinator and several commercial companies as contractors to market the products inside the system. The key project participants are: DIABCARE Office EURO, DIABCARE Portugal, DIABCARE France, DIABCARE Bavaria, DIABCARE UK, DIABCARE Netherlands, DIABCARE Norway, DIABCARE Italy, DIABCARE Sweden, DIABCARE Austria, DIABCARE Spain, GSF Research Centre for Health and Environment, FAST Research Institute for Applied Software Technology, Tromsø University Hospital, Stavanger Technical College, Technical University of Ilmenau, World Health Organisation (WHO), Regional Office for Europe.

Benchmarking↗
PubMed1990

The exponential multidimensional demographic projection model.

"This paper presents the multidimensional demographic projection on the basis of an exponential specification, which avoids the problems associated with the widely used specification on the basis of the linear integration hypothesis. It generalizes earlier work by Gill (1986) on Markov models for closed populations to include the case of open populations. A numerical illustration is also provided." (SUMMARY IN FRE)

Forecasting↗
PubMed1998

Development of standard methods with special reference to Europe.

For a long time, many different microbiological methods were used around the world in order to enumerate or detect contaminants in foods. The development of commercial, but also scientific and technical exchanges between countries has stimulated new developments and a desire to harmonize methods. The example of AFNOR (French Association for Standardization) is first presented. Then, the new developments under CEN (European Committee for Standardization) are described, emphasizing a Measurements and Testing project. The MicroVal project, now integrated as a task force within CEN Technical Committee 275/Working Group 6 is described. Finally, the possibility of working towards an international consensus through the Codex Alimentarius is discussed.

Food Microbiology↗
PubMed2002

Development of a CD-ROM Internet Hybrid: a new thoracic surgery curriculum.

The TSDA Prerequisite Curriculum Committee has successfully developed the content for a didactic curriculum to be mastered by the residents before their matriculation in a thoracic surgical residency program. In addition the committee assembled an innovative electronic format consisting of a CD-ROM Internet Hybrid to teach this curricular material. By use of a serialized CD-ROM Internet Hybrid it is possible to store relatively dense high bandwidth portions of the curriculum including video and audio materials on the CD-ROM and yet allow constant updating and interaction of the other portions of the curriculum. In addition, it is possible to track the performance and utilization by the residents during the entire course of their residency program. By studying the relationship between the utilization of the curriculum, particularly as it relates to certain subject areas, and comparing that to performance or standardized examinations as well as other measurements of resident satisfaction, the efficacy of the prerequisite curriculum will be tracked during the upcoming years. It is anticipated that the process of developing the content of the prerequisite curriculum will allow the residents and program directors to focus on the subject material currently deemed necessary for successful initiation of a thoracic surgery residency, and that by keeping this subject material outline up-to-date, the changing spectrum of what we anticipate our residents will know at the time of their matriculation will continue to mature. Although electronic-based education has been available for a number of years, a prospective randomized study comparing it with traditional textbook-based learning is novel. Multiple attempts have been made to implement Web-based or CD-ROM-based educational tools in other specialties with variable results. It is our anticipation that successful completion of this project will not only allow for the use of an innovative highly technical means of education for our residents but may in turn become broadly applicable to many other types of educational projects within thoracic surgery education. This may also be applicable to other types of educational projects in the postgraduate education industry and other venues as well. The conduct of a scientific study monitoring the impact of this curriculum project as well as the acceptance of the project by the resident is also relatively unique and will be scrutinized by numerous professional medical and educational groups.

CD-ROM↗
PubMed1996

The end of the demographic explosion in the Mediterranean?

"We...compare the UN projections made in 1994 to the previous set in 1992 and to the Blue Plan projections, for [Algeria, Egypt, Morocco, Syria, Tunisia, and Turkey, the] six most populated [developing countries in the Mediterranean region].... We shall also consider more briefly the lesser populated countries. This will enable us to appreciate the changes that have occurred in the UN's perception of population growth in this region."

Africa↗
PubMed2003

Immunization safety priority project at the World Health Organization.

In 1999, the World Health Organization's (WHO) Department of Vaccines and Biologicals launched the Immunization Safety Priority Project with the aim of establishing a comprehensive system to ensure the safety of all immunizations given in national immunization programs. Countries are the primary focus of the project. WHO has a role, not only because of its technical and normative role, but also because of its privileged relationship with country authorities and other partners, and its global vision and mandate. The four major areas of focus in the project are to (1) promote and coordinate research and development of safer and simpler delivery systems; (2) ensure vaccine safety, from vaccine development all the way through clinical trials and vaccine distribution until use; (3) broaden access to safer and more efficient systems for vaccine delivery and management of sharps waste; and (4) establish efficient mechanisms to detect serious or potentially serious adverse events following immunization, and enable prompt and effective response. The project emphasizes the importance of advocating safety and building capacity at national levels.

Advisory Committees↗
PubMed2000

A case management demonstration project for the frail elderly in Israel.

This article presents an evaluation of an innovative community-based case management demonstration project for the frail elderly in Israel. The evaluation study was part of a nine-countries European project within the framework of the 1999 International Year of the Older People. The Department for the Aged of the Israeli Ministry of Labor and Social Affairs and the author initiated the project. The basis for the project development is described, including institutional structure, workers' qualifications, technical resources, and clients assessment criteria. The findings showed increased quality of life for the elders and their caregivers, more coordination and cooperation between various social and health services, activation of a variety of services, and client satisfaction. Recommendations are made to continue and expand this type of project to a larger segment of the elderly population.

Activities of Daily Living↗
PubMed1991

[World population today and tomorrow].

"In 1989/90 the world's population was approximately 5.2 billions. According to U.N.-projections (medium variant) every 10 to 11 years this figure will grow by one billion, corresponding to an increase of 100 [million] people per year.... This article discusses the causes for the population growth and the impact on the settlement system, the food-situation, the ecological system, and the development process in the Third World." (SUMMARY IN ENG)

Conservation of Natural Resources↗
PubMed1999

The General Practice computer system project: a doctor's desktop for Australia.

The Australian Department of Health and Family Services engaged the IBM consulting practice to develop a functional specification and technical architecture for a General Practice computer system (GPCS) in January, 1997. The project was completed in September, 1997. This paper describes the rationale for development of the specification, the process that was undertaken and provides an overview of the completed specification and architecture. The paper also explores a number of issues related to computing in general practice which were raised during the consultative process, and considers factors which were found to be important in obtaining adoption and use of computer technology on the doctor's desk.

Australia↗
PubMed1992

PACS experiences in Trieste.

The installation of a commercial PACS in the Hospitals of Trieste has been the start-point for a project of technology assessment, aimed at the evaluation of technical, clinical and economic aspects related to the introduction of this new and expensive technology in the health care system. During more than two years of use of this system in the clinical environment, several research activities have been carried out concerning the analysis of the organization of radiology departments in Italy, the analysis of work and data volumes, the evaluation of technical and clinical performances of PACS versus conventional film-based radiology, the integration between PACS and RIS, the experimentation of teleradiology applications. An overview of the most important activities and related results is given in this paper as well as some indications about future developments of the Trieste Project.

Computer Communication Networks↗