<p> After decades of global intervention to conquer diseases, healthcare in many countries is still lacking. Assessments of medical laboratories in developing countries today find poor infrastructure conditions with no standardized processes or quality assurance to guarantee accurate results and enable quality healthcare. Bringing healthcare programs in developing countries up to international standards remains a challenge. </p><p> Currently, there is a scarcity of scientific research related to the determinants of success in implementing quality management systems (QMS). There has been little research dedicated to identifying the critical success factors for medical laboratories striving to improve the accuracy and reliability of their testing services in developing countries. </p><p> In over nine years of research, the author realized there was a need for incorporating Critical Success Factor (CFS) methodology into laboratory modernization efforts. This time frame included CDC sponsored trips to several African countries and collaborating with the Vietnam Administration for Medical Services/Ministry of Health (VAMS), Centers for Disease Control-Vietnam (CDC-vn) and seven universities to build laboratory capacity and initiate laboratory improvements to meet national and international laboratory standards. In 2017, VAMS approved a proposed study to identify CSFs in four laboratories in Vietnam. </p><p> The research question this study sought to answer was "What are the top five critical success factors for successful implementation of QMS into laboratories in Vietnam?" with an outcome of improved accuracy and reliability of testing results. This study utilized both qualitative and quantitative research methods employing principles of descriptive research. A demographic survey, semi-structured interview, content analysis, and benchmarking were utilized to identify the top five CSFs and barriers. Content analysis was employed to review CSF definitions and categorize all 220 listed CSFs into ten comprehensive and mutually exhaustive categories. Two research assistants assisted the researcher place each CSF into one of the ten categories. Rigorous and non-rigorous methods measured interrater reliability with the categorization of CSFs. Cohen Kappa values were > 0.85 indicating excellent reliability and accuracy between the assistants and the researcher. Chi-square values were all > 0.05 (p &lt; 0.05) indicating demographic variables did not statistically impact findings. </p><p> Qualitative responses were gathered through personal interviews, a demographic survey, and benchmarking. Using a stratified convenience sampling, participants represented four levels of stakeholders: laboratory staff, laboratory managers, hospital administrators, and clinicians utilizing laboratory services. </p><p> Data from this study found the top five CSFs were: staff knowledge of QMS, laboratory management leadership knowledge and skills, staff commitment to the QMS change process, mentorship, and hospital administration support. In addition to determining the top five CSFs, the study revealed information about encountered or perceived barriers to successful QMS implementation. The participants in this study identified lack of staff knowledge on QMS, lack of financial support from the hospital administration, ineffective laboratory manager leadership knowledge and skills, lack of laboratory infrastructure, and lack of sufficient resources. </p><p> The study&rsquo;s findings add to the body of knowledge in strengthening medical laboratory services and may serve as a basis for continued research in this area of health care. Local, national, and international partners may use this information to tailor training materials and activities to better meet the needs of participating laboratories across Vietnam.</p><p>

Today, there are children sleeping under bridges with no food to eat and nowhere to go. Without our help someone's daughter will continue to cry herself to sleep as she sleeps in the woods with only a blanket, someone's son will feed himself with trash from a dumpster, someone's granddaughter sleeping under a bridge will be raped and someone's grandson will commit suicide because he lost all hope. These children need our help. (Enough is Enough, 2022). Although there are some government agencies and organizations that try to identify what can be done to help the homeless youth population, minimal progress is taking place. The United States Government and other organizations are offering some assistance, but more funding is needed to save the lives of this vulnerable population. In addition, homeless youth need to have available access and knowledge that these resources exist and are available to help them fully transition back into society. This study examined the growing reality of youth homelessness and the impact of interventions for housing, mental health, and substance use. The primary goal of this theses is to bring awareness and educate the public on the homeless youth crisis currently being faced throughout our country. In addition, the resource guide that was created with the research found from this study will be distributed in places homeless youth can access such as local schools, shelters, churches, police and fire stations, as well as online databases.

This thesis examines the implications of the changes introduced by the NHS and Community Care Act 1990 for mental health services. It focuses on two main issues. Firstly, the impact on mental health services of the 'market' system of purchasers and providers introduced by the 1990 Act. Second.ly, the extent to which the 1990 changes had led to any increase in user participation and involvement in the planning and delivery of psychiatric services. Analysis of the existing theoretical literature found that there had been little research which focused on the specific implications of health care 'markets' for mental health services. In addition, much of the work on the development of psychiatry had not focused on the role of the local context in influencing the nature of mental health service provision. In this thesis these issues are explored through a case study of the mental health services of one English county. Semistructured, qualitative interviews were und.ertaken with managers, professionals and individuals in purchaser, provider and voluntary sector organisations. People using community mental health services in the county were also interviewed. This contrasts with many previous studies which have tended to concentrate exclusively on users of in-patient services. The study found that local circumstances played a significant role in the relationships between those purchasing, providing and participating in mental health services. The imminent closure of a large Victorian psychiatric hospital and the uncertainty about which services would replace it had been a source of tension between the newly formed purchaser and provider organisations in the county under study. The lack of any strong existing groups in the local area representing users of mental health services was also significant. It meant that increased user participation in the county after the 1990 Act was reliant on initiatives by managers and professionals rather than organised pressure from user groups and users themselves. The variety of different local mental health agencies purchasing and providing mental health services in the county called for a degree of cooperation between organisations which conflicted with the competition encouraged by the 'market' system introduced by the 1990 Act. The focus, first, on psychiatric services in the examination of 'markets' and, second, the importance of the local context in mental health service development provides the basis for the study's contribution to theoretical and policy debates both about the 1990 Act and psychiatric services in general.

Refugees who have fled from the ongoing civil war in Syria that arrived in Germany often develop post-traumatic stress symptoms (PTSS). The aim of this study was to determine health care services utilization (HCSU), health care costs and health-related quality of life (HrQoL) of Syrian refugees with mild to moderate PTSS without current treatment in Germany. The study was based on the baseline sample of a randomized controlled trial of a self-help app for Syrian refugees with PTSS (n = 133). HCSU and HrQoL based on the EQ-5D-5L and its visual analogue scale (EQ-VAS) were assessed with standardized interviews. Annual health care costs were calculated using extrapolated four-month HCSU and standardized unit costs. Associations between health care costs, HrQoL and PTSS severity were examined using generalized linear models. Overall, 85.0% of the sample utilized health care services within four months. The mean total annual health care costs were EUR 1920 per person. PTSS severity was not associated with health care costs. The EQ-5D-5L index score and the EQ-VAS score was 0.82 and 73.6, respectively. For Syrian refugees with higher PTSS severity, the EQ-5D-5L index score was lower (−0.17; p < 0.001). The HCSU and the resulting health care costs of Syrian refugees with mild to moderate PTSS without current treatment are low and those with a higher PTSS severity had a lower HrQoL.

Background Over one million asylum seekers were registered in Germany in 2016, most from Syria and Afghanistan. The Refugee Convention guarantees access to healthcare, however delivery mechanisms remain heterogeneous. There is an urgent need for more data describing the health conditions of asylum seekers to guide best practices for healthcare delivery. In this study, we describe the state of health of asylum seekers presenting to a multi-specialty primary care refugee clinic. Methods Demographic and medical diagnosis data were extracted from the electronic medical records of patients seen at the ambulatory refugee clinic in Dresden, Germany between 15 September 2015 and 31 December 2016. Data were de-identified and analyzed using Stata version 14.0. Results Two-thousand-seven-hundred and fifty-three individual patients were seen in the clinic. Of these, 2232 (81.1%) were insured by the state indicating arrival within the last 3 months. The median age was 25, interquartile range 16–34. Only 786 (28.6%) were female, while 1967 (71.5%) were male. The most frequent diagnoses were respiratory (17.4%), followed by miscellaneous symptoms and otherwise not classified ailments (R series, 14.1%), infection (10.8%), musculoskeletal or connective tissue (9.3%), gastrointestinal (6.8%), injury (5.9%), and mental or behavioral (5.1%) categories. Conclusions This study illustrates the diverse medical conditions that affect the asylum seeker population. Asylum seekers in our study group did not have a high burden of communicable diseases, however several warranted additional screening and treatment, including for tuberculosis and scabies. Respiratory illnesses were more common amongst newly arrived refugees. Trauma-related mental health disorders comprised half of mental health diagnoses.

Submitted by Ana Paula de Medeiros Duro (ana_3005@yahoo.com.br) on 2015-04-24T18:18:01Z No. of bitstreams: 1 Estudo de caso para ensino.pdf: 1144554 bytes, checksum: 818b157f20101529f6b4c42b4799eaf6 (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2015-04-24T18:34:16Z (GMT) No. of bitstreams: 1 Estudo de caso para ensino.pdf: 1144554 bytes, checksum: 818b157f20101529f6b4c42b4799eaf6 (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2015-04-28T12:08:19Z (GMT) No. of bitstreams: 1 Estudo de caso para ensino.pdf: 1144554 bytes, checksum: 818b157f20101529f6b4c42b4799eaf6 (MD5) / Made available in DSpace on 2015-04-28T12:08:32Z (GMT). No. of bitstreams: 1 Estudo de caso para ensino.pdf: 1144554 bytes, checksum: 818b157f20101529f6b4c42b4799eaf6 (MD5) Previous issue date: 2015-03-30 / The concern for patient safety, which is an important factor in the matter of health care quality, is currently a highly relevant topic among researchers from around the world. Malpractices occur anywhere where health care is provided and in most situations preventive measures are possible. The objective of this case study is to reveal, through a bibliographic review, the debate over the topic of patient safety since the twenty-first century, focusing on the relevance as a global public health issue. In addition, the studyresearch discusses the challenges related to gaps and perspectives on this issue and its approach in the Brazilian reality. The results of this analysis suggest that investigation on the subject of patient safety has weaknesses in its approach to be better defined and established. They have also identified barriers, such as a high demand in the emergency rooms of urban cities, the low self-confidence of the professionals that makes the malpractice, wiliness of all professionals and managers to take preventive routines, and challenges to be faced, such as the lack of strategy development and specific political health actions, both for research and for health literature on public administration. / A preocupação com a segurança do paciente, fator importante na dimensão da qualidade do cuidado de saúde, é, atualmente, um tema de grande relevância entre pesquisadores do todo o mundo. Os 'erros' ocorrem em qualquer local onde se prestam cuidados de saúde e na maioria das situações são passíveis de medidas preventivas. O objetivo deste estudo de caso para ensino é desvelar, através de uma revisão bibliográfica, o debate em torno do tema da segurança do paciente a partir do século XXI, enfocando sua relevância enquanto problema global de saúde pública. Além disso, este estudo discorre sobre os desafios relacionados às lacunas e perspectivas neste tema e sua abordagem na realidade brasileira. Os resultados da análise sugerem que a investigação sobre a segurança do paciente apresenta falhas nas suas abordagens a serem melhor definidas e estabelecidas. Foram identificadas ainda, as barreiras, como grande demanda dos prontos-socorros das grandes cidades, o medo do profissional que cometeu o erro, adesão de todos os profissionais e dos gestores, e desafios para serem enfrentados, como o desenvolvimento de estratégias e ações políticas de saúde específicas, tanto para a pesquisa na área de saúde quanto para a literatura de saúde pública em gestão pública.

O advento da Constituição Federal de 1988, que positivou a saúde como direito social de todos dependente de políticas de Estado (art. 196, CF) e criou o Sistema Único de Saúde (SUS) para garantir ações e serviços assistenciais universais, igualitários e integrais (art. 198, CF), propiciou, em pouco tempo, o incremento da judicialização da saúde no Brasil, em dimensões preocupantes, sobretudo por conta do significativo impacto orçamentário gerado. Mas a ingerência do Poder Judiciário nas políticas públicas de saúde, que ocorre principalmente em ações civis individuais de medicamentos e produtos de interesse à saúde, aguarda ainda uma crítica mais definitiva, que ultrapasse posicionamentos meramente teóricos e avalie o fenômeno empiricamente. O presente estudo desenvolve, em primeiro lugar, uma análise da CF e da legislação sanitária, inclusive a Lei Orgânica da Saúde (Lei 8.080/90) e os novos marcos legais da integralidade (Lei 12.401/11, Lei 12.466/11, Decreto 7.508/11 e LC 141/12), para identificar o regime jurídico-constitucional do SUS e o conteúdo material do direito à saúde, que corresponde ao que foi denominado integralidade sistêmica ou regulada (análise jurídica). Em seguida, o estudo faz uma pesquisa retrospectiva das ações judiciais de medicamentos, insumos terapêuticos e produtos de interesse à saúde, registradas no sistema informatizado do CODES (Coordenação de Demandas Estratégicas do SUS) da Secretaria de Estado da Saúde de São Paulo, durante o período de 2010 a 2014, objetivando constatar as suas principais características, buscando compreender o fenômeno enquanto realidade prática (análise fenomenológica). Em conclusão, verificou-se que, em regra, as ordens judiciais determinam escolha de marca comercial, medicamentos não previstos nos protocolos clínicos e nas relações de medicamentos, sem registro na Anvisa, importados e experimentais, e mesmo sem qualquer relação com as atividades assistenciais do SUS, frequentemente com base em prescrições médicas irregulares e privadas, gerando grande impacto orçamentário e desorganização das atividades administrativas. O confronto com o regime jurídico-constitucional do SUS e a legislação demonstra que o Poder Judiciário descumpre, em bloco, o ordenamento jurídico sanitário, uma ruptura do Estado Democrático de Direito que coloca em risco o projeto constitucional do SUS. Algumas sugestões de enfrentamento do problema são apresentadas / The advent of the Federal Constitution of 1988, which stated health as a social right for everyone dependent on government policies (art. 196, CF) and created the Unified Health System (\"SUS\") to ensure universal, egalitarian and integral assistance services and actions (art. 198, CF), provided, in a short time, the increased judicialization of health in Brazil, in alarming proportions, particularly due to significant budget impact generated. But the interference of the Judiciary in public health policies, which occurs primarily in individual civil actions of drugs and supplies, still awaiting a more definitive critical, going beyond merely theoretical positions and assess the phenomenon empirically. This study develops, first, an analysis of CF and health legislation, including the Organic Law of Health (Law 8.080/90) and the new legal frameworks of integrality (Law 12.401/11, Law 12.466/11, Decree 7.508/11 and LC 141/12), to identify the legal and constitutional arrangements of the \"SUS\" and the material content of the right to health, which corresponds to what is called systemic or regulated integrality (legal analysis). Then, the study makes a retrospective survey of judicial decisions concerning medications, therapeutic supplies and health-related products, recorded in the computerized system CODES (Coordination Strategic Demands of SUS) of the Secretariat of Health for the State of São Paulo, during the period from 2010 to 2014, aiming to realize its main features, trying to understand the phenomenon as a practical reality (phenomenological analysis). In conclusion, the study found that, as a rule, the court orders determine the choice of trade mark, medications not covered in the clinical protocols and relationships of drugs, without registration at ANVISA, imported and experimental, and even unrelated to the welfare activities of the \"SUS\", often based on rough and private medical prescriptions, generating large budget impact and disruption of administrative activities. The confrontation with the legal and constitutional arrangements of the \"SUS\" and the legislation shows that the Judiciary violates, as a whole, the health law, a breach of the Democratic State of Law that endangers the constitutional SUS project. Some suggestions of trouble confrontation are presented

O advento da Constituição Federal de 1988, que positivou a saúde como direito social de todos dependente de políticas de Estado (art. 196, CF) e criou o Sistema Único de Saúde (SUS) para garantir ações e serviços assistenciais universais, igualitários e integrais (art. 198, CF), propiciou, em pouco tempo, o incremento da judicialização da saúde no Brasil, em dimensões preocupantes, sobretudo por conta do significativo impacto orçamentário gerado. Mas a ingerência do Poder Judiciário nas políticas públicas de saúde, que ocorre principalmente em ações civis individuais de medicamentos e produtos de interesse à saúde, aguarda ainda uma crítica mais definitiva, que ultrapasse posicionamentos meramente teóricos e avalie o fenômeno empiricamente. O presente estudo desenvolve, em primeiro lugar, uma análise da CF e da legislação sanitária, inclusive a Lei Orgânica da Saúde (Lei 8.080/90) e os novos marcos legais da integralidade (Lei 12.401/11, Lei 12.466/11, Decreto 7.508/11 e LC 141/12), para identificar o regime jurídico-constitucional do SUS e o conteúdo material do direito à saúde, que corresponde ao que foi denominado integralidade sistêmica ou regulada (análise jurídica). Em seguida, o estudo faz uma pesquisa retrospectiva das ações judiciais de medicamentos, insumos terapêuticos e produtos de interesse à saúde, registradas no sistema informatizado do CODES (Coordenação de Demandas Estratégicas do SUS) da Secretaria de Estado da Saúde de São Paulo, durante o período de 2010 a 2014, objetivando constatar as suas principais características, buscando compreender o fenômeno enquanto realidade prática (análise fenomenológica). Em conclusão, verificou-se que, em regra, as ordens judiciais determinam escolha de marca comercial, medicamentos não previstos nos protocolos clínicos e nas relações de medicamentos, sem registro na Anvisa, importados e experimentais, e mesmo sem qualquer relação com as atividades assistenciais do SUS, frequentemente com base em prescrições médicas irregulares e privadas, gerando grande impacto orçamentário e desorganização das atividades administrativas. O confronto com o regime jurídico-constitucional do SUS e a legislação demonstra que o Poder Judiciário descumpre, em bloco, o ordenamento jurídico sanitário, uma ruptura do Estado Democrático de Direito que coloca em risco o projeto constitucional do SUS. Algumas sugestões de enfrentamento do problema são apresentadas / The advent of the Federal Constitution of 1988, which stated health as a social right for everyone dependent on government policies (art. 196, CF) and created the Unified Health System (\"SUS\") to ensure universal, egalitarian and integral assistance services and actions (art. 198, CF), provided, in a short time, the increased judicialization of health in Brazil, in alarming proportions, particularly due to significant budget impact generated. But the interference of the Judiciary in public health policies, which occurs primarily in individual civil actions of drugs and supplies, still awaiting a more definitive critical, going beyond merely theoretical positions and assess the phenomenon empirically. This study develops, first, an analysis of CF and health legislation, including the Organic Law of Health (Law 8.080/90) and the new legal frameworks of integrality (Law 12.401/11, Law 12.466/11, Decree 7.508/11 and LC 141/12), to identify the legal and constitutional arrangements of the \"SUS\" and the material content of the right to health, which corresponds to what is called systemic or regulated integrality (legal analysis). Then, the study makes a retrospective survey of judicial decisions concerning medications, therapeutic supplies and health-related products, recorded in the computerized system CODES (Coordination Strategic Demands of SUS) of the Secretariat of Health for the State of São Paulo, during the period from 2010 to 2014, aiming to realize its main features, trying to understand the phenomenon as a practical reality (phenomenological analysis). In conclusion, the study found that, as a rule, the court orders determine the choice of trade mark, medications not covered in the clinical protocols and relationships of drugs, without registration at ANVISA, imported and experimental, and even unrelated to the welfare activities of the \"SUS\", often based on rough and private medical prescriptions, generating large budget impact and disruption of administrative activities. The confrontation with the legal and constitutional arrangements of the \"SUS\" and the legislation shows that the Judiciary violates, as a whole, the health law, a breach of the Democratic State of Law that endangers the constitutional SUS project. Some suggestions of trouble confrontation are presented