Health, inequality and poverty

With the objective to identify, among 317 municipalities and delegations of the country, those requiring with higher priority drug abuse prevention and treatment services, it was made a cross-sectional study, based on the Delphi method, which is a structured methodology to systematically collect expert opinions on an issue, so that the individual assessments are transformed to produce a collective judgment on the subject that was carried out, and apply a weight to the variables under study. In this case we had a panel of 55 experts, whose assessed the risk level of 33 updated demographic, health, economic, education, housing, geographic, touristic, socio-familiar, drug trafficking and use of illegal drugs. The studied variables were: Proportion of urban concentration, average growth rate, average age, proportion of male population, international migration rate, Proportion of health services, Homes with water and electricity, Drawnig housing service, Internet housing service, Overcro...

El objetivo de este artículo es analizar, por un lado, la distribución de los servicios de salud pública que cada institución de seguridad social ofrece en los municipios periféricos metropolitanos de la Ciudad de México y, por otro lado, dar algunas razones del porqué de dicha distribución. El análisis trata de demostrar la carencia territorial que existe en la construcción de la política social y en particular, en el sector salud. El rango espacial, cobertura y accesibilidad de los servicios de salud en la parte oriente del Estado de México ha sido calculado a partir de variables como número de doctores, enfermeras, consultorios y camas de hospital, que ofrecen las diferentes instituciones públicas, particularmente del IMSS, ISSSTE e ISSEMYM. Los resultados tienden a demostrar que hay una desigual distribución de los recursos de salud, tanto humanos como materiales, al igual que un desorden territorial en dicha distribución, ya que existe alta concentración en zonas urbanas. El an...

The food environment can have a greater influence than nutritional knowledge and attitudes on how people make food-related decisions 1,2. This poster describes methods used to assess the food environment in and around Loma Linda, California that can be applied to other communities, and discusses ongoing initiatives and challenges to improving local access to healthy food.

Introduction: Health sector reforms motivated by the need for efficiency, effectiveness and equity in the delivery of services have interested authorities in the planning competencies of managers, because planning sets the stage for the effective management of health systems. The huge public and private cost of oral health makes planning an important dimension for health authorities when considering the allocation of funds. Productivity in the oral health service sector is not often reported on, despite the cost involved in rendering oral health services. This study explores and describes the management planning experiences of oral health managers in the public sector in Lesotho, Africa, which consists of clinics in 10 districts serving hundreds of rural and remote mountainous communities. Methods: The study used a qualitative research design. Of the purposive sample of 14 public sector dentists then available, seven dentists (2 female and 5 male) met the criteria for participation (≥1 year of experience in district oral health planning), and consented to and were available for participation. Data were collected by in-depth, one-on-one interviews with 6 participants, and textual data were collected from the seventh. Interviews were audiotaped and transcribed verbatim. Data were organised and analysed using the Tesch method, with themed topics coded and categorised by a researcher and an independent coder for analysis.

El objetivo de este artículo es analizar, por un lado, la distribución de los servicios de salud pública que cada institución de seguridad social ofrece en los municipios periféricos metropolitanos de la Ciudad de México y, por otro lado, dar algunas razones del porqué de dicha distribución. El análisis trata de demostrar la carencia territorial que existe en la construcción de la política social y en particular, en el sector salud. El rango espacial, cobertura y accesibilidad de los servicios de salud en la parte oriente del Estado de México ha sido calculado a partir de variables como número de doctores, enfermeras, consultorios y camas de hospital, que ofrecen las diferentes instituciones públicas, particularmente del IMSS, ISSSTE e ISSEMYM. Los resultados tienden a demostrar que hay una desigual distribución de los recursos de salud, tanto humanos como materiales, al igual que un desorden territorial en dicha distribución, ya que existe alta concentración en zonas urbanas. El an...

Introduction: the stage of autarky and early years of developmentalism was one of the periods in the contemporary history of Spain when inequalities in food and nutrition became more pronounced. Objectives: to examine malnutrition among the rural population (municipalities with fewer than 2000 inhabitants), including territorial inequalities and the delayed onset of a rural food and nutrition transition. Methods: we analysed the rural food and nutrition surveys carried out by the General Commission for Supplies and Transport (Spanish initials: CAT) and the Food and Nutrition Education Programme (Spanish initials: EDALNU) between 1964 and 1972. Results: the rural population presented a deficit of animal proteins, calcium and vitamins A and B 2 , due to scant consumption of protective foods. Andalucía and inland Spain were the regions with the highest percentage of people whose diet did not meet nutritional requirements. These deficiencies were not only responsible for the prevalence of caries and skin, mucous membrane and eye lesions, but were also behind delayed growth (height and weight). This was not the result so much of poverty as of the persistence of poor eating habits. Conclusions: besides evidencing the delayed onset of a food and nutritional transition in the Spanish rural population, our findings document policies that sought to encourage the consumption of protective foods in rural areas and empower the population with regard to food and nutrition. ©

Background Dual practice and multiple job holding are widespread among health workers throughout the world. Although dual practice can help the financially strained public sector retain skilled workers, there are also potential negative consequences if it is not regulated. In Cambodia, there is substantial anecdotal evidence of dual practice among physicians but there is very little data on the extent and prevalence of the practice. This study was conducted by the University of Health Sciences (UHS) to gain insight in to the employment practices of UHS alumni. Results from this survey may help to inform policymakers in rational planning for future health system development related to capacity building and regulation of human resources for health. Methods Data were collected from a self-administered survey of UHS graduates who graduated between 1999 and 2012. A total of 162 medical graduates were randomly sampled from a total of 1867 medical graduates between 1999 and 2012. Contacted...

Childhood tuberculosis (TB) case detection remains low in many high-burden countries, including Cambodia. This study aimed to determine the barriers to childhood TB detection and management from the perspectives of healthcare providers and caregivers in Cambodia.We conducted in-depth interviews with 16 healthcare providers from four operational districts and 28 caregivers of children with TB and children in close contact with bacteriological confirmed pulmonary TB residing under the selected districts. Data were analysed using thematic analyses.Identified key barriers to childhood TB case detection and management included inadequate TB staff, limited knowledge on childhood TB, poor collaboration among healthcare providers, limited quality of TB diagnostic tools, and interruption of supplies of childhood TB medicines, lack of collaboration from caregivers, ignorance of healthcare provider's advice, parent movement, transportation costs, out-of-pocket expenditure, time-consuming, ...

In a well-meaning tweet Tuesday afternoon, New York Gov. Andrew M. Cuomo called the novel coronavirus "the great equalizer"-capable of sickening anyone, 20-somethings and senior citizens, ordinary Americans or famous actors. All of us could potentially contract covid-19 in coming days and weeks-including the governor's brother, CNN anchor Chris Cuomo, who came down with the disease Tuesday. Certainly, Gov. Cuomo's broader point, that no one is immune to the coronavirus, is soberingly valid. But his

Healthy lifestyle behaviors are recommended to reduce cancer risk and overall mortality. Adherence to cancer-preventive health behaviors and subsequent cancer risk has not been evaluated in a diverse sample of postmenopausal women. We examined the association between the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines score and risk of incident cancer, cancer-specific mortality, and all-cause mortality in 65,838 postmenopausal women enrolled in the Women's Health Initiative Observational Study. ACS guidelines scores (0–8 points) were determined from a combined measure of diet, physical activity, body mass index (current and at age 18 years), and alcohol consumption. After a mean follow-up of 12.6 years, 8,632 incident cancers and 2,356 cancer deaths were identified. The highest ACS guidelines scores compared with the lowest were associated with a 17% lower risk of any cancer [HR, 0.83; 95% confidence interval (CI), 0.75–0.92], 22% lower...

Background The relationship between obesity and health-related quality of life (HRQoL) may be confounded by factors such as multimorbidity. The aim of the study was to explore this relationship, controlling for long-term conditions and other health, lifestyle and demographic factors in a general adult population. There was specific interest in the impact of high weight status, measured by body mass index (BMI) levels (obesity, morbid obesity) compared with individuals of normal weight. Methods Health, lifestyle and demographic data were collected from 64,631 individuals aged 16 years and over registered in the Yorkshire Health Study; a long-term cohort study. Data were collected in 2 waves: from patients attending GP surgeries in the South Yorkshire region; and using online recruitment across the entire Yorkshire and Humber area. Univariable and multivariable regression methods were utilised to identify factors associated with HRQoL as measured by the EQ-5D summary score. Long-term ...

The reluctance of physicians to stay in remote and rural hospitals has resulted in a shortage of doctors in these settings, and therefore a decline in the quality of care and an intolerable overload on functioning doctors. However, mature paramedics find it difficult to comply with the demands of ambulance work and look for easier tasks that suit their age. The two problems may have a common solution if senior paramedics are incorporated into in-hospital work. Paramedics' skills, education and experience enable them to become useful physician assistants who may relieve much of the doctors' burden, allowing physicians in remote hospitals to concentrate on genuine medical duties. However, the objection of doctors' and nurses' professional organizations constitute a substantial obstacle to this solution.

Environmental Injustice within COVID-19 Pandemic process in Turkey

Dr. Şenay Güneymen

COVID-19 Pandemic, caused by SARS-Cov-2 virus that infects humans through respiratory system, has affected the populations of the World since December, 2019. Originated from China’s Wuhan City, COVID-19 has been defined as pandemic in March, 12, 2020 by World Health Organisation. COVID-19 Pandemic has led to functional and administrative reorganisation for many countries in order to restructure use of public spaces for work, transportation and recreational purposes and has marked ethical stress for states to both protect citizens from infection and also guard their right to live and right to health. Through the process of pandemics, management of the process has included regulations and policy formulations with regard to the pace and changing impact of pandemics Control of mobility at the national level and also mobility through the borders of countries have been put on the agenda for states at the first stage. COVID-19 Pandemics has also been subject to social and economic crises through which (prolonged) closures and limitations have contributed to a larger extent.
Environmental injustice is basically defined as the unequal and disparate distibution of environmental benefits or loads mostly at the cost of causing disadvantages for the fragile groups such as low representation, low-income, marginalized ethnic origin, informal and marginal working conditions. This study, based on the evaluation of environmental injustice within COVID-19 Pandemic process in Turkey via social inequality , consists of concepts and study areas having interrelations with each other. These concepts can be denoted as environmental injustice, environmental inequality and health inequality. Within an interdisciplinary platform for research, these concepts bring together the areas of public health and environmental and social policy areas together.
From a theoretical point of view, among the types of environmental justice such as distributive justice, procedural justice, justice at the policy level, intra national, international and intergenerational justice, this study focuses on distributive justice within context of social inequality. Extending the limit of narrow definition of distributive justice based on the equal distibution of environmental benefits and loads among population and assessment of the role of regulation in the process, the study looks deeper into the the causes of unequal distribution of them context dependent to social inequality, which comprises the relations leading to environmental and health inequalities. The recognition and capacity notions have also been taken into consideration in developing an evaluation standpoint with regard to distributive justice. The right to health complements the evaluation of the problem as a human right and a constitutional right.
In this study, environmental injustice and its outcome as environmetal inequality within COVID-19 Pandemic process takes into consideration of unequal distirbution of environmental conditions revealing unequal exposure levels to infection risk. To set more clearly, via survival strategies and mostly working practices, some groups are exposed to infection risk more compared to other groups taking the adavantage of being able to be protected from it to a larger extent.  The adequacy of regulation and policy regarding pandemics management and empowerment mechanisms are also subject to be evaluated complementarily.
After a general overview of COVID-19 Pandemics process in the World and in Turkey, the evolution of pandemics has been viewed via evaluating changes in number of cases and deaths caused by COVID-19. The legislation and regulation and its related policy formulations have been generally discussed.
Environmental injustice within COVID-19 Pandemic process based on Turkey’s experience stresses that Turkey has entered the pandemic process and its crises conditions through deepening social and economic inequalities. Due to the lack of detailed data for relating socio-economic parameters with morbidity and mortality rates concerning the pandemic in Turkey, the study briefly discussed the conditions for health inequalities and environmental injustice wtih regard to distributive justice within the context of social inequality. After discussing basic criticisms and demands of major actors as representatives of democratic initiatives and occupational institutions in Turkish society, policy proposals based on environmental justice and health equality, have set a multiple layer for intervention and general approach to social inequality, environmental injustice and health inequality.
This study, including current literature review that is interdisciplinary, setting a conceptual framework and interrelated perspective to evaluate environmental injustice within COVID-19 Pandemic, aims to put forth the subject, the variables and interrelated context with social inequality and health inequalities  with regard to COVID-19 pandemic. It is foreseen to contribute to cognize, reflect on and critically evaluate environmental injustice within COVID-19 Pandemic process with its complex relations to social inequality and health inequalites via Turkey Case. It is also expected to contribute to evaluation of the reality of the pandemic process in Turkey to further develop a human based and participatory approach to pandemic management policies.

Resumen Introducción: El estudio de la mortalidad contribuye para conocer la situación de la salud de la población e indica los retos en las políticas públicas para disminuir las muertes prematuras y/o evitables. Objetivo: Identificar como impacta el indicador de ...

Efficient human resources development is vital for facilitating tuberculosis control in developing countries, and appropriate training of front-line staff is an important component of this process. Africa and Central Asia are over-represented in global tuberculosis statistics. Although the African region contributes only about 11% of the world population, it accounts for at least 25% of annual TB notifications, a proportion that continues to increase due to poor case management and the adverse impact of HIV/AIDS. Central Asia's estimated current average tuberculosis prevalence rate of 240/100 000 is significantly higher than the global average of 217/100 000. With increased resources currently becoming available for countries in Africa and Central Asia to improve tuberculosis control, it is important to highlight context-specific training benchmarks, and propose how human resources deficiencies may be addressed, in part, through efficient (re)training of frontline tuberculosis workers. This article compares the quality, quantity and distribution of tuberculosis physicians, laboratory staff, community health workers and nurses in Nigeria and Kyrgyzstan, and highlights implications for (re)training tuberculosis workers in developing countries.

Household habitat conditions matter for diseases transmission and control, especially in the case of the novel coronavirus (COVID-19). These conditions include availability and adequacy of sanitation facilities, and number of persons per room. Despite this, little attention is being paid to these conditions as a pathway to understanding the transmission and prevention of COVID-19, especially in Africa, where household habitat conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa. We conducted a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018 to understand the status of households for prevention of COVID-19 transmission in home. We assessed handwashing capacity and self-isolation capacity using multiple parameters, and identified households with elderly persons, who are most at risk of the disea...

We developed and piloted a methodology to establish TB related work load at primary care level for clinical and laboratory staff. Workload is influenced by activities to be implemented, time to perform them, their frequency and patient load. Of particular importance is the patient pathway for diagnosis and treatment and the frequency of clinic visits. Using observation with checklists, clocking, interviews and review of registers, allows assessing the contribution of different factors on the workload.

BackgroundThe coronavirus disease 2019 (COVID-19) has resulted in an enormous dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the pandemic, chief being a nationwide lockdown. This has resulted in income loss for individuals and firms, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor.MethodsUsing the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/June 2020, this...

Starting from the year 2020, COVID-19 already became one of the deadliest breakouts in the history of mankind. With millions of people affected worldwide & thousands of death toll, the world economy took a deep downturn. The level of inequality between rich & poor is at the highest level for a couple of years. The ongoing pandemic is widening that further as evident from various articles & research papers. Oronce et al. (2020) investigated the relationship between the level of income inequality & the number of COVID-19 deaths & cases. The result obtained from this paper is not surprising with the evidence from rising worldwide inequality. COVID-19 has made the situation worse for this vulnerable group of people. Oronce et al. (2020) analyzed the situation based on the idea of the GINI coefficient which is one of the widely used tools to measure the level of inequality. The variables set in this paper to measure the adverse impact of inequality are state-level inequality & and the number of deaths along with the number of cases caused by COVID-19. Oronce et al. (2020) provides an outstanding regional comparison that substantiates the claim that the level of inequality is positively proportionate with the number of cases & deaths due to COVID-19. The model depicted in this paper was based on the Spearman rank-order correlation test where log-transformation of the number of deaths & cases were taken. Oronce et al. (2020) also accounted adjustment for some related variables which may give rise to a biased result. Few of the racial variables like origin, age, gender was taken into consideration along with the socioeconomic condition. The correlation obtained shows a positive relationship between state-level GINI index & the number of deaths & cases both pre & post-adjustment for confounding variables. So, the claim by the writers at the beginning of the paper has some substantial base to consider. Though this outcome is not fully proofed as the individual level of data was not used by the writers.

We developed and piloted a methodology to establish TB related work load at primary care level for clinical and laboratory staff. Workload is influenced by activities to be implemented, time to perform them, their frequency and patient load. Of particular importance is the patient pathway for diagnosis and treatment and the frequency of clinic visits. Using observation with checklists, clocking, interviews and review of registers, allows assessing the contribution of different factors on the workload.

Desde mediados del siglo XX las condiciones de salud presentaron un panorama divergente, en el que se experimentó el incremento de la esperanza de vida y en contraste, la persistente insatisfacción de las necesidades básicas con efectos en las tasas de morbilidad y mortalidad. Pobreza y salud componen una asociación de tipo bidireccional : la pobreza da paso a la mala salud y la mala salud perpetúa la pobreza. En este capítulo se observan las correlaciones de cinco enfermedades características de la pobreza distribuidas en México.

In this unfinished rough powerpoint for a series of lectures I explore why the United States is markedly different from other representative democracies and welfare states.  I trace the tradition of using a combination of bribery and corruption of the Congress and Judiciary, and violence and racist terror as a means of marginalizing organized labour and frustrating democratic control.  I explore how the contemporary crisis of social inequality, political corruption and racist authoritarian government long predates Trump, first emerging after Reconstruction in the Kleptocracy of the Gilded Age, receding somewhat under Roosevelt's leadership and with the Bretton Woods consensus, only to re-emerge with the Reagan revolution and the political triumph of the racist reaction to the Civil Rights and Feminist Movements, and the radicalism of the 1960s.  On the foreign policy side, the resurgent power of the oligarchy within the country and the brutal repression of the poor and marginalization of labour and the voices of the black radical tradition, symbolized by the ruins of Detroit and the South Bronx, would be matched by the consolidation of the policies of the so-called Washington Consensus.  This policy approach, enforced by the IMF, World Bank, and American military force and paramilitary violence, is often sold as Globalization, critiqued as Neo-liberalism, but might more accurately be described as a return to racist colonialism of the filibusters, Teddy Roosevelt, and Woodrow Wilson.  The talk, which is intended to engage non-academic audiences and avoid jargon and theory, ought to be read in conjunction with Richard Iton's Solidarity Blues, and WIlkinson and Pickett's The Spirit Level.

BACKGROUND
Although the rising pandemic of obesity has received major attention in many countries,
the effects of this attention on trends and the disease burden of obesity remain
uncertain.
METHODS
We analyzed data from 68.5 million persons to assess the trends in the prevalence
of overweight and obesity among children and adults between 1980 and 2015. Using
the Global Burden of Disease study data and methods, we also quantified the burden
of disease related to high body-mass index (BMI), according to age, sex, cause, and
BMI in 195 countries between 1990 and 2015.
RESULTS
In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since
1980, the prevalence of obesity has doubled in more than 70 countries and has
continuously increased in most other countries. Although the prevalence of obesity
among children has been lower than that among adults, the rate of increase in
childhood obesity in many countries has been greater than the rate of increase in
adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of
which occurred in persons who were not obese. More than two thirds of deaths
related to high BMI were due to cardiovascular disease. The disease burden related
to high BMI has increased since 1990; however, the rate of this increase has been
attenuated owing to decreases in underlying rates of death from cardiovascular
disease.
CONCLUSIONS
The rapid increase in the prevalence and disease burden of elevated BMI highlights
the need for continued focus on surveillance of BMI and identification, implementation,
and evaluation of evidence-based interventions to address this problem.
(Funded by the Bill and Melinda Gates Foundation.)

The health of a community can be seen in the health of its individual members as it relates to the environment. The built environment, through opportunity for physical activity and availability of resources, strongly affects the health of the individual in mapping the options residents have for making healthful choices. The social environment is the result of individual interactions that serve to reinforce social norms and resist behaviors out of the norm. Research shows low socioeconomic status impedes the ability of the individual to make healthy choices, and curtail the development of the community resulting in negative health outcomes on a community level.

Should we grant a fresh start to those who come to regret their past lifestyle choices? A negative response to this question can be located in the luck egalitarian literature. As a responsibility-sensitive theory of justice, luck egalitarianism considers it just that people’s relative positions reflect their past choices, including those they regret. In a recent article, Vansteenkiste, Devooght and Schokkaert argue against the luck egalitarian view, maintaining instead that those who regret their past choices in health are disadvantaged in a relevant way and should receive compensation. Employing the ideal that people should be made equal as measured by equivalent resources they purport to show the fairness of such an arrangement through a hypothetical scenario. Relaxing the implicit assumptions of this scenario brings forth several unattractive consequences of the fresh start idea. The main problem is that in striving to ensure that people’s past choices do not affect their own opportunities, the authors must accept that these choices put heavy strains on the opportunities available to other people. Furthermore, the luck egalitarian position is more compelling than they admit.

This encyclopedia entry introduces the concept of reproductive health and rights. The article discusses the history of institutionalization of the concept, it's conceptualization, current world status on reproductive health and rights, and the relation between reproductive health and rights and poverty.

Health for urban poor is made unaffordable by poor policies and lack of vision for health of the nation. Severe illness or hospitalization is a great economic shock for the marginal communities. Poverty and ill health forma a vicious cycle that it never allows a poor man to be healthy. It is for governments to develop policies and systems to provide access of health care for all. Public - Private - Partnership (PPP) is one of the methods/models by which the health can be made available to the public by overcoming the limitations of the state.  As a result of privatization, neglect and corruption the public (government) health systems are ruining and private share in the health care is growing very rapidly in India. Though the PPP model of development was initially used in only huge infrastructural projects, gradually it also evaded into service sector. There are few best practices in PPP modeled health care , as well as there are ill methods by which the public money is exploited by deserting the government health systems. While explaining the need for PPP model in urban health; this paper highlights the pros and cons of each PPP method. And also indicates the precautions to be taken for optimizing the benefit to the public. (This paper was presented in a state level seminar  on Urban Health Management in Dr. MCRHRD at Hyderabad.)

El texto que había que leer y responder las consignas se divide en distintas áreas. La primera corresponde al área temática, donde se enuncia el aspecto de la realidad que se va a estudiar, en este caso la SALUD. El segundo corresponde al tema que se va a investigar, la SALUD y LA POBREZA. Y la tercer y última área corresponde al problema de la investigación, ¿dónde?, ¿cuándo?, en el texto a analizar se identifica:

(with Chhea, C. and Warren, N.)  A decade after health sector reform, public health services in rural Cambodia remain under-utilised for multiple reasons related to financial, structural and personnel factors. Ineffectiveness of rural public health services has led to a significant increase in private providers, often the same people who staff public facilities. Public health clinics are often portrayed as low quality, with long waiting times and unexpected costs; in contrast, private clinics are seen to provide more convenient health care. Several strategies, including contract management and health equity funds, have been introduced to improve public sector performance and encourage utilization; these efforts are ongoing. However, the feasibility of these strategies remains in question, particularly in terms of cost-effectiveness and sustainability.

Methods: In this article the strategies of and barriers met by health workers who remain in rural areas and deliver public health services are elucidated. Ethnographic research conducted in 2008 with health providers involved in treating tuberculosis patients in Kampong Speu Province, Cambodia is drawn on. Participants were recruited from the provincial health department, provincial hospital and four health centres. Data collection involved in-depth interviews, participation in meetings and workshops aimed at health workers, and observation of daily activities at the health facilities. Data were transcribed verbatim, imported into NVivo software (www.qsrinternational.com) for management, and analysed using a grounded theory approach.

Results: Primary healthcare service delivery in rural Cambodia was reliant on the retention of mid-level of health staff, primarily midwives and nurses. Its performance was influenced by institutional characteristics relating to the structure of the health system. Personal factors were impacted on by these structural issues and affected the performance of health staff. Institutional factors worked against the provision of high-quality public health services, and included the fragmentation of service delivery and structure, limited capacity and shortage of high-qualified health staff, competition with the private sector, and shortage of medical supplies. These factors all de-motivated health staff, and undermined their performance in public service positions. Personal factors were paramount for staff retention. These included: optimism and appreciation of work responsibilities and position, the personal ability to cope with financial barriers, and institutional benefits such as opportunities for professional development, job security, financial opportunities (via performance-based allowances), and status in society. Individual financial coping strategies were the dominant factor underlying retention, but alone were often de-motivating: clients were diverted from the public services, which led to distrust, and thus undermined the capacity of public system. There was significant interaction between institutional and personal factors, which impacted on the effectiveness of health staff retention in rural areas. Health workers tended to remain in their government positions for prolonged periods of time because they experienced personal rewards. At the same time, however, their job performance in the public health services were hindered by challenges related to the institutional factors.

Conclusions: The interaction between institutional factors and personal factors was crucial for effectiveness of health staff retention in rural Cambodia. Efforts aimed at ensuring quality of care and encouraging health staff retention should attempt to remove the institutional barriers that discourage the use of rural public health services.

Multidisciplinary teams (MDTs) are conventionally recommended in mental health
care literature as an important way to offer holistic treatment provision to patients. This
study aims to explore multidisciplinary teamwork in contemporary mental health
settings, particularly what aids and hinders the process of multidisciplinary teamworking,
and the social work contribution in such teams. In order to attain an in-depth
exploration of these phenomena, a single case study design was employed. Within this
design, data were generated through semi-structured interviews and structured
observation of a mental health MDT in Ireland. These data were analysed using
interpretative phenomenological analysis. The research highlights how the concept of
mental illness is contested within this MDT, with the medical model dominant within
an environment of fluid working arrangements. Professional role blurring and
stereotyping were found to impact the division of labour on this team, with role
negotiation found to be an integral part of retaining a professional’s practice identity.
This research raises concerns for social work’s capacity to function within mental
health MDTs in Ireland, and highlights ways in which social work educators might
respond in order to empower Irish social workers to meet the challenges of mental
health multidisciplinary teamworking.

Background: Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial= ethnic groups of older women and determines the extent to which emotional=psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship. Methods: The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993)(1994)(1995)(1996)(1997)(1998). Results: Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic= Latina, 3% were Asian=Pacific Islander, and <1% were American Indian=Alaska Native. Obesity (body mass index [BMI] !30 kg=m 2 ) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional=psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial=ethnic group. Conclusions: Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial=ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional=psychological factors.