Service Provision (service + provision)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Service Provision

  • health service provision
  • of service provision
  • public service provision
  • quality of service provision
  • social service provision


  • Selected Abstracts


    When Popular Participation Won't Improve Service Provision: Primary Health Care in Uganda

    DEVELOPMENT POLICY REVIEW, Issue 2 2005
    Frederick Golooba-Mutebi
    Advocates of participatory approaches to service delivery see devolution as key to empowering people to take charge of their own affairs. Participation is portrayed as guaranteeing the delivery of services that are in line with user preferences. It is assumed that people are keen to participate in public affairs, that they possess the capacity to do so, and that all they need is opportunities. Using evidence from ethnographic research in Uganda, this article questions these views. It shows that, to succeed in the long term, devolution and participation must take place in the context of a strong state, able to ensure consistent regulation, and a well-informed public backed up by a participatory political culture. [source]


    Poverty and Local Governments: Economic Development and Community Service Provision in an Era of Decentralization

    GROWTH AND CHANGE, Issue 3 2009
    LINDA LOBAO
    ABSTRACT Social scientists have given substantial attention to poverty across U.S. localities. However, most work views localities through the lens of population aggregates, not as units of government. Few poverty researchers question whether governments of poorer localities have the capacity to engage in economic development and service activities that might improve community well-being. This issue is increasingly important as responsibilities for growth and redistribution are decentralized to local governments that vary dramatically in resources. Do poorer communities have less activist local governments? Are they more likely to be engaged in a race to the bottom, focusing on business attraction activities but neglecting services for families and working people? We bring together two distinct literatures, critical research on decentralization and research on local development efforts, that provide contrasting views about the penalty of poverty. Data are from a unique, national survey of county governments measuring activity across two time points. The most consistent determinants of activity are local government capacity, devolutionary pressures, and inertia or past use of strategies. Net of these factors, levels and changes in poverty do not significantly impact government activity. There is no evidence the nations' poorest counties are racing to the bottom. Findings challenge views that poverty is a systematic structural barrier to pursuing innovative economic development policies and suggest that even poorer communities can take steps to build local capacity, resources, and networks that expand programs for local businesses and low-wage people. [source]


    The Embedded Nature of Rural Legal Services: Sustaining Service Provision in Wales

    JOURNAL OF LAW AND SOCIETY, Issue 2 2007
    Alex Franklin
    There is a considerable amount of literature on embeddedness as part of sociological theory of economic action. Cultural and structural embeddedness often work together to shape the framework of economic relations, but, in an analysis of rural solicitors, we find unevenness between cultural and structural embeddedness. There are strong traits of the former, through a sense of place and belonging, but much less evidence of the latter with the structural relationships appearing relatively weak and underdeveloped. In a discussion supported by empirical data from a recent survey of rural legal practices in Wales, a number of causes are identified. The paper concludes that trends towards increasingly specialized rather than generalized legal service provision, set alongside the increasingly differentiated nature of rural space, suggest that the longer-term sustainability of rural legal practices may require both greater investment at the level of structural embeddedness alongside continuing reinvestment at the cultural level. [source]


    The Organization of Public Service Provision

    JOURNAL OF PUBLIC ECONOMIC THEORY, Issue 3 2004
    William Jack
    This paper addresses the question of how the responsibility for the delivery of social services, including health, education, and welfare programs, should be divided between state and central governments. We combine a random voting model and the incomplete contracts paradigm to formalize the trade-off between central and state responsibility for service delivery, and find that authority should rest with the party for whom the marginal impact of the service on re-election chances is greater. This in turn means that, other things equal, states with lower than average health, education, or welfare status should be given responsibility for service delivery, while authority in states with above average indicators should reside with the central government. Also, we show that there is no presumption that states that are given authority for service delivery should necessarily be granted expanded tax authority. [source]


    Equity in Regional Service Provision

    JOURNAL OF REGIONAL SCIENCE, Issue 4 2001
    Alan T. Murray
    Most transportation agencies stipulate that an important planning goal is to provide equitable and just public transport services. However, who is to be served and the type of service that should be provided has been ambiguous. This paper develops a methodology for examining equity in the provision of public transportation services. An approach for identifying areas in need of public transport is developed based upon the use of socio-demographic and economic information. Public transport need is then related to levels of access to service. This approach makes it possible to establish the degree to which public transport services may be considered equitable in relation to need and suitable access. A detailed analysis of the southeast Queensland region of Australia illustrates how this approach may be used to inform public transport decision making. [source]


    Policymaking in the Parallelogram of Forces: Common Agency and Human Service Provision

    POLICY STUDIES JOURNAL, Issue 3 2004
    Anthony M. Bertelli
    The "congressional dominance" literature in political science provides valuable insights into the legislative control of administrative agencies. However, this literature tends to be conceptualized with respect to regulatory agencies, and it is not especially helpful in understanding the dynamics of policymaking in the provision of human services. After distinguishing the tasks of regulation and human services provision, we present an alternative: a common agency model of human service policy as the outcome of interest group bargaining. We illustrate its implications with an analytic narrative of service provision for the seriously mentally ill. [source]


    Policymaking in the Parallelogram of Forces: Common Agency and Human Service Provision

    POLICY STUDIES JOURNAL, Issue 2 2004
    Anthony Bertelli
    The "congressional dominance" literature in political science provides valuable insights into the legislative control of administrative agencies. However, this literature tends to be conceptualized with respect to regulatory agencies, and it is not especially helpful in understanding the dynamics of policymaking in the provision of human services. After distinguishing the tasks of regulation and human services provision, we present an alternative: a common agency model of human service policy as the outcome of interest group bargaining. We illustrate its implications with an analytic narrative of service provision for the seriously mentally ill. [source]


    Service provision for elderly depressed persons and political and professional awareness for this subject: a comparison of six European countries

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2003
    Anke Bramesfeld
    Abstract Objective Under-treatment of depression in late-life is a subject of rising public health concern throughout Europe. This study investigates and compares the availability of services for depressed elderly persons in Denmark, France, Germany, Sweden, Switzerland and the UK. Additionally, it explores factors that might contribute to an adequate services supply for depressed elderly people. Method Review of the literature and guide supported expert interviews. Analysis of the practice of care provision for depressed elderly persons and of indicators for political and professional awareness, such as university chairs, certification processes and political programmes in gerontopsychiatry. Results Only Switzerland and the UK offer countrywide community-oriented services for depressed elderly persons. Clinical experience in treating depression in late-life is not regularly acquired in the vocational training of the concerned professionals. Indicators suggest that the ,medical society' and health politics in Switzerland and the UK regard psychiatric disease in the elderly more importantly than it is the case in the other investigated countries. Conclusions Service provision for depressed elderly persons seems to be more elaborated and better available in countries where gerontopsychiatry is institutionalised to a greater extend in the ,medical society' and health politics. Copyright 2003 John Wiley & Sons, Ltd. [source]


    Service provision for men with antisocial personality disorder who make contact with mental health services

    PERSONALITY AND MENTAL HEALTH, Issue 3 2009
    Mike J. Crawford
    Concerns have been raised about the quality of health services for people with antisocial personality disorder (ASPD). As part of a randomized trial of cognitive behaviour therapy for men with ASPD, we collected prospective data on service utilization over a 12-month period. Among the 52 men that participated, 96% had evidence of anxiety disorder and 64% met criteria for probable alcohol misuse. Almost half the sample presented to emergency medical services and 21% were admitted to a mental health inpatient unit during the following year. Despite this, only 11 (21%) were provided with follow-up care from mental health services. Levels of alcohol and drug misuse were lower among those that were given follow-up (27.3% compared with 63.4%, p < 0.05). Although services for people with personality disorder in Britain have expanded, most men with ASPD do not receive follow-up care from mental health services. Copyright 2009 John Wiley & Sons, Ltd. [source]


    Prison staff and women prisoner's views on self-harm; their implications for service delivery and development: A qualitative study

    CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2010
    Cassandra Kenning
    Background,Rates of self-harm are high among women in prison in the UK. This is the first study to compare the views and attitudes of prison staff and women prisoners and to look at the effects of these attitudes on prisoner/staff relationships. Aims,To explore understanding of self-harm among women prisoners, prison officers and health-care staff and how their perceptions might influence service provision and development. Method,Semi-structured interviews were conducted with women prisoners who self-harm and with staff at a women's prison. Data were analysed thematically. Results,Prison officers often attributed motives to self-harm such as ,manipulation' and ,attention-seeking', whereas descriptions by women prisoners, prison governors and health-care staff suggested explanations in affect regulation or self-punishment. Conclusions,Differences between prison officers and other staff working in the prison in their understanding of self-harm by women prisoners may lie in training differences, but there may be other explanations such as self-protection/coping strategies. More training and support for officers may result in improved staff,prisoner relationships and thus, safer service provision. Copyright 2010 John Wiley & Sons, Ltd. [source]


    CPA assessment , the regional assessors' experience

    CYTOPATHOLOGY, Issue 2007
    G. Guthrie
    With the introduction in January 2006 of the new posts of Regional Assessors, the process and focus of CPA assessment changed to reflect the inclusion in the current standards of Quality Management systems and processes. Regional Assessors, trained in Quality Management Systems and their assessment against international standards, now form a vital part of the CPA assessment teams, looking specifically at this aspect of laboratory service provision. Their role in the new assessment process will be explained. The presentation will cover differences and similarities in the nature and number of non-compliances experienced since April 2006 when the new format of assessment was introduced. It will also look at a new format of timetable for assessment visits and explain the benefits of good two-way communication between all parties involved in the process - the laboratory, the assessors, particularly the Regional Assessor assigned to that site, and CPA Office staff. Understanding what is required by the standards, particularly in terms of evidential material, their interpretation and their classification of status , Critical, Non-Critical or Observation - is an aspect of assessment which is often not well understood. The presentation will seek to clarify these issues. The successful and timely clearance by laboratories of any non-compliances raised during the visits is vital to the achievement of accredited status and the presentation will give guidance as to how this is best achieved. The current standards, based on the international ISO 15189 standards, are considerably more challenging than the old ones. There is now a significant emphasis on Quality Management and its understanding, ethos and implementation within the laboratory, a key element which underpins all aspects of a laboratory's service. The achievement of accredited status assures our users of,the type of client and patient focused service expected of a modern laboratory. [source]


    Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care?

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 2006
    T. Becker
    Objective:, To report recent findings regarding differences in the provision, cost and outcomes of mental health care in Europe, and to examine to what extent these studies can provide a basis for improvement of mental health services and use of findings across countries. Method:, Findings from a number of studies describing mental health care in different European countries and comparing provision of care across countries are reported. Results:, The development of systems of mental health care in western Europe is characterized by a common trend towards deinstitutionalization, less in-patient treatment and improvement of community services. Variability between national mental healthcare systems is still substantial. At the individual patient level the variability of psychiatric service systems results in different patterns of service use and service costs. However, these differences are not reflected in outcome differences in a coherent way. Conclusion:, It is conceivable that the principal targets of mental healthcare reform can be achieved along several pathways taking into account economic, political and sociocultural variation between countries. Differences between mental healthcare systems appear to affect service provision and costs. However, the impact of such differences on patient outcomes may be less marked. The empirical evidence is limited and further studies are required. [source]


    Association of British Clinical Diabetologists (ABCD) and Diabetes-UK survey of specialist diabetes services in the UK, 2006.

    DIABETIC MEDICINE, Issue 6 2008

    Abstract Aims To identify the views and working practices of consultant diabetologists in the UK in 2006,2007, the current provision of specialist services, and to examine changes since 2000. Methods All 592 UK consultant diabetologists were invited to participate in an on-line survey. Quantitative and qualitative analyses of responses were undertaken. A composite ,well-resourced service score' was calculated. In addition to an analysis of all respondents, a sub-analysis was undertaken, comparing localities represented both in 2006/2007 and in 2000. Results In 2006/2007, a 49% response rate was achieved, representing 50% of acute National Health Service Trusts. Staffing levels had improved, but remained below recommendations made in 2000. Ten percent of specialist services were still provided by single-handed consultants, especially in Northern Ireland (in 50% of responses, P = 0.001 vs. other nations). Antenatal, joint adult,paediatric and ophthalmology sub-specialist diabetes services and availability of biochemical tests had improved since 2000, but access to psychology services had declined. Almost 90% of consultants had no clinical engagement in providing community diabetes services. The ,well-resourced service score' had not improved since 2000. There was continued evidence of disparity in resources between the nations (lowest in Wales and Northern Ireland, P = 0.007), between regions in England (lowest in the East Midlands and the Eastern regions, P = 0.028), and in centres with a single-handed consultant service (P = 0.001). Job satisfaction correlated with well-resourced service score (P = 0.001). The main concerns and threats to specialist services were deficiencies in psychology access, inadequate staffing, lack of progress in commissioning, and the detrimental impact of central policy on specialist services. Conclusions There are continued disparities in specialist service provision. Without effective commissioning and adequate specialist team staffing, integrated diabetes care will remain unattainable in many regions, regardless of reconfigurations and alternative service models. [source]


    Diabetes service provision: a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

    DIABETIC MEDICINE, Issue 9 2006
    J. Lawton
    Abstract Aims To explore Pakistani and Indian patients' experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services. Design Qualitative, interview study involving 23 Pakistani and nine Indian patients with Type 2 diabetes recruited from general practices and the local community in Edinburgh, Scotland. Data collection and analysis occurred concurrently and recruitment continued until no new themes emerged from the interviews. Results Respondents expressed gratitude for the availability of free diabetes services in Britain, as they were used to having to pay to access health care on the Indian subcontinent. Most looked to services for the prompt detection and treatment of complications, rather than the provision of advice about managing their condition. As respondents attached importance to receiving physical examinations, they could be disappointed when these were not offered by health-care professionals. They disliked relying on interpreters and identified a need for bilingual professionals with whom they could discuss their diabetes care directly. Conclusions Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health-care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients' need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability. [source]


    Diabetes in the elderly: problems of care and service provision

    DIABETIC MEDICINE, Issue 2002
    S. Croxson
    Abstract Diabetes is common in the elderly and old UK citizens, affecting between 10% and 25%. There is considerable associated morbidity and mortality, with dementia being a common problem. The diabetic elder is also at risk of drug side-effects. Most of the evidence base for treatment is based on trials performed in younger diabetic subjects or older nondiabetic subjects; however, we can practice evidence-biased medicine whilst awaiting the results of ongoing trials. The older persons national service framework (NSF) may share some similarities with the diabetes NSF; it was 1 year late, and had no clear funding, amongst several other worries. Residential care, which is more likely to be required by diabetic elders, is also under-funded with major concerns about the quality of care for the diabetic resident. The little evidence that we have regarding care of the older diabetic person also suggests inadequacies. Given the likelihood that we will have to manage with present resources, managed clinical networks may be one way to cope. [source]


    The Audit Commission review of diabetes services in England and Wales, 1998,2001

    DIABETIC MEDICINE, Issue 2002
    B. Fitzsimons
    Abstract Aims of the Audit Commission The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies. Methods Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination. Results Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management. Conclusion As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs. [source]


    Childhood adversity in alcohol- and drug-dependent women presenting to out-patient treatment

    DRUG AND ALCOHOL REVIEW, Issue 4 2001
    RAINE BERRY
    Abstract Eighty alcohol- and/or drug-dependent women who were consecutive admissions to a representative out-patient alcohol and drug service in Christchurch were interviewed with the aim of establishing the extent of exposure to childhood adversity including childhood sexual, physical and emotional abuse and parental problems. The results show that a sizeable percentage of the women came from backgrounds characterized by parental conflict and alcohol and drug problems. Within their first 15 years 51% were subjected to sexual abuse involving attempted or completed oral, anal or vaginal intercourse and 39% were exposed regularly to physical abuse perpetrated by their parents or main parental figures. Over half reported experiencing emotional abuse rated as being ,very distressing' and two-thirds had been exposed to ,very distressing' parental problems. The main implication for clinical practice arising from the results of this study is the need for the development of a broader approach to alcohol and drug service provision. In order to achieve positive treatment outcomes, alcohol and drug services may need to routinely screen and plan treatment for childhood adversity and associated problems in all clients presenting for alcohol and drug treatment. [source]


    Patterns and trends in alcohol-related hospitalizations in Victoria, Australia, 1987/88,1995/96

    DRUG AND ALCOHOL REVIEW, Issue 4 2000
    KIRSTEN HANLIN
    Abstract The objective of this study was to examine patterns and yearly trends in alcohol-related hospitalization rates during the period 1987/88,1995/96 for men and women living in metropolitan and rural/remote Victoria. Alcohol-related hospitalizations were extracted from the Victorian Inpatient Minimum Dataset (VMD) for the years 1987/88,1995/96 (public hospitals) and 1993/94,1995/96 (private hospitals), and adjusted by the appropriate aetiological fractions. Sex-specific age-adjusted rates we expressed per 10000 residents/year. During 1993/94,1995/96, alcohol-related hospitalizations comprised 1.0% of all Victorian hospitalizations (about 12000/year), with men accounting for over two-thirds of alcohol-related hospitalizations. Approximately half of the alcohol-related hospitalizations were for disease conditions and the other half for external cause (injury) conditions. About 80% of all alcohol-related hospitalizations were to public hospitals, with the exception of alcohol dependence (63% to private hospitals). Alcohol-related hospitalization rates were generally higher for people living in rural/remote areas compared to urban areas. During 1987/88,1995/96, the age-adjusted alcohol-related hospitalization rates in public hospitals did not change significantly for disease conditions (14.8,14.7 for men and 6.3,6.4 for women) or female external cause conditions (6.7,6.1), but decreased for external cause conditions (18.4,15.5). In private hospitals during 1993/94,1995/96, the age-adjusted alcohol-related hospitalization rates for disease conditions decreased (5.4,4.1 for men and 3.7,3.0 for women) but increased for external cause conditions (1.8,2.4 for men and 1.0,1.2 for women). These patterns and time-trends in Victorian alcohol-related hospitalizations reflect a combination of alcohol-related morbidity levels, hospital admission practices and patterns and levels of service provision. They suggest a potential need to focus on services and programmes in rural/remote Victoria. [source]


    Problems experienced by community pharmacists delivering opioid substitution treatment in New South Wales and Victoria, Australia

    ADDICTION, Issue 2 2010
    Adam R. Winstock
    ABSTRACT Aims To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers. Design Cross-sectional postal survey. Setting All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia. Participants Completed questionnaires were received from 669 pharmacists (68% response rate). Measurements The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers. Findings In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or ,3 missed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P < 0.001). Treatment termination in last month was predicted having more clients (P < 0.001), the provision of buprenorphine treatment (P = 0.008), having a separate dosing area (P = 0.021), and being a female pharmacist (P = 0.013). Past month refusal to dose was predicted by the pharmacy being in VIC (P < 0.001) and having more clients (P < 0.001). Problems experienced most commonly in the past month with prescribers were difficulty contacting prescriber (21%) and provision of takeaway doses to clients considered unstable by the pharmacist (19%) (higher in VIC: both P < 0.001). Conclusions This study highlights the range of problems experienced by community pharmacists in the delivery of OST and the consequences for people in treatment. Particular attention should be focused upon considering number of clients per pharmacy and improving professional communication between pharmacists and prescribers. [source]


    Justifying the expense of the cancer Clinical Nurse Specialist

    EUROPEAN JOURNAL OF CANCER CARE, Issue 1 2010
    C.A. POLLARD ba
    POLLARD C.A., GARCEA G., PATTENDEN C.J., CURRAN R., NEAL C.P., BERRY D.P. & DENNISON A.R. (2009) European Journal of Cancer Care19, 72,79 Justifying the expense of the cancer Clinical Nurse Specialist In order to maximise patient care, assessment of the adequacy of the service provision by the Clinical Nurse Specialist (CNS) must be regularly undertaken. This study attempted to determine whether CNSs were providing an adequate service via retrospective and prospective audit. The results of a comprehensive audit of the work of the CNS within a tertiary referral Hepatobiliary Unit are presented. The audit involved postal and telephone questionnaires as well as prospective collection of data. The majority of responses from patients were positive, with many finding the CNS a useful and well-utilised contact. Overall, the CNSs performed well in each of their designated tasks; however, areas were still identified which could be further improved. Audit is essential in providing feedback to the CNS and to identify areas which require improvement. The CNS has evolved to meet a clinical gap in patient care, and as a result, the role of a CNS is frequently nebulous or poorly defined. This renders evaluation of the CNS problematic and fraught with difficulties. However, a thorough assessment can still be made using carefully constructed audit looking at each task of the CNS. [source]


    What women want: convenient appointment times for cervical screening tests

    EUROPEAN JOURNAL OF CANCER CARE, Issue 5 2006
    B. OLOWOKURE phd, mfphm
    Little is known about women's preferred appointment times for cervical screening tests. Data from a postal questionnaire survey were used to compare preferred appointment times with those given. Although 33.4%[95% confidence intervals (CI) 31.8%,35.0%] of respondents received appointments between 10h00 and 11h55, only 17.0% (95% CI 15.3%,18.7%) wanted an appointment at that time. Nineteen per cent (95% CI 17.4%,21.0%) of respondents wanted appointments between 18h00 and 20h00, but only 4.4% (95% CI 3.7%,5.1%) received them. Saturday appointments for cervical screening are not given; however, overall approximately 13% of those surveyed would have preferred a Saturday appointment. Preferred times also varied significantly with age and deprivation category. Further research is required to determine whether appointment times for cervical screening can be tailored to meet these expressed needs, and the impact this has on service provision and uptake. [source]


    Examining the Lives of Navajo Native American Teenage Mothers in Context: A 12- to 15-Year Follow-Up

    FAMILY RELATIONS, Issue 2 2009
    Rochelle L. Dalla
    In 1992 and 1995, data were collected from 29 Navajo, reservation-residing teenage mothers. In 2007, follow-up data from 69% (n= 20) of the original sample were collected. Intensive interviews, grounded in ecological systems theory (U. Bronfenbrenner, 1989), allowed for contextual examination of the women's developmental trajectories. Significant educational accomplishments and a strong work ethic (i.e., individual level) exemplified the majority of respondents. Relationships with families of origin and intimate partners (i.e., microsystems) and connections between these (i.e., mesosystems) promoted and challenged participants' optimal development and were significantly influenced by macrosystem factors (e.g., economic constraints, physical isolation). Implications for service provision and continued research are discussed. [source]


    Accounting for Infrastructure Service Delivery by Government: Generational Issues

    FINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 3 2000
    Michael McCrae
    Infrastructure service provision by government creates huge distributional issues about service availability and performance over time and the relative funding burdens borne by successive generations of consumers across time. But providing financial disclosure on these issues through inter-generational accounting pre-supposes that accounting measurement is both generationally neutral (temporal neutrality) and does not legitimate any particular pattern of distribution. At the very least, accounting measurements of service provision costs should possess the attribute of distributional fairness. They should not bias the inter-generational allocation of cost or funding burdens. We argue that the forced application of inappropriate commercial accounting concepts of asset valuation, depreciation and capital maintenance does produce significant generational bias. More flexibility is required to produce the necessary accounting measurement attributes for financial disclosure on whether government has discharged its continuing accountability for inter-generational equity in burden sharing. We discuss three conceptual issues and illustrate the need for flexibility by proposing an alternative ,flow of obligations' approach which does not require reference to valuations of community service resources or arbitrary cost allocations under depreciation. [source]


    HIV and AIDS among fisherfolk: a threat to ,responsible fisheries'?

    FISH AND FISHERIES, Issue 3 2004
    Edward H. Allison
    Abstract Fishing communities are often among the highest-risk groups in countries with high overall rates of HIV/AIDS prevalence. Vulnerability to HIV/AIDS stems from complex, interacting causes that may include the mobility of many fisherfolk, the time fishermen spend away from home, their access to daily cash income in an overall context of poverty and vulnerability, their demographic profile, the ready availability of commercial sex in fishing ports and the subcultures of risk taking and hypermasculinity among some fishermen. The subordinate economic and social position of women in many fishing communities in low-income countries makes them even more vulnerable. HIV/AIDS in fishing communities was first dealt with as a public health issue, and most projects were conducted by health sector agencies and NGOs, focusing on education and health care provision. More recently, as the social and economic impacts of the epidemic have become evident, wider social service provision and economic support have been added. In the last 3 years, many major fishery development programmes in Africa, South/South-East Asia and the Asia-Pacific region have incorporated HIV/AIDS awareness in their planning. The HIV/AIDS pandemic threatens the sustainability of fisheries by eclipsing the futures of many fisherfolk. The burden of illness puts additional stresses on households, preventing them from accumulating assets derived from fishing income. Premature death robs fishing communities of the knowledge gained by experience and reduces incentives for longer-term and inter-generational stewardship of resources. Recent projects championing local knowledge and resource-user participation in management need to take these realities into account. If the fishing communities of developing countries that account for 95% of the world's fisherfolk and supply more than half the world's fish are adversely impacted by HIV/AIDS, then the global supply of fish, particularly to lower-income consumers, may be jeopardized. [source]


    Quality, imagery and marketing: producer perspectives on quality products and services in the lagging rural regions of the European Union

    GEOGRAFISKA ANNALER SERIES B: HUMAN GEOGRAPHY, Issue 1 2001
    Brian Ilbery
    A range of factors, including consumer concerns about food safety, the growing popularity of rural tourism and policy initiatives to promote endogenous rural development, is converging to promote a relocalization of food production and service provision, especially in those regions marginalized by the globalization of the food supply system. The recent outbreak of foot and mouth disease in the UK has starkly illustrated the fragility of localized systems which depend heavily on consumers travelling to them. Within such a context, the importance of successful marketing strategies has become even more apparent. This paper reports on a questionnaire survey which investigated promotional and marketing strategies among a diverse range of producers and service providers in marginal agricultural areas of the EU. The findings suggest that many producers are situated towards the "formal" end of a marketing continuum, whereby ability to promote quality products and services (QPS) lies with a range of intermediaries. This raises doubts about the future economic benefits of QPS, should current marketing structures persist. The discussion offers critical reflections on interdisciplinary and international research of this nature, and advocates further theoretical and methodological development in order to explore in more depth many of the aspects raised in this exploratory investigation. [source]


    A Bayesian Approach to Prediction Using the Gravity Model, with an Application to Patient Flow Modeling

    GEOGRAPHICAL ANALYSIS, Issue 3 2000
    Peter Congdon
    This paper investigates the potential for estimation and prediction by Bayesian methods of hospitalization flows classified by place of residence and hospital site. The focus is especially with respect to emergency (unplanned) admissions to hospitals. The need for strategic modeling and forecasting arises since the structure of U.K. emergency service provision is subject to changes involving site closures or changes in bed numbers. The gravity model, reflecting patient demand, hospital supply, and distance effects has been applied to patient flows, but generally in a situation of unchanged destination states. It may be modified, however, in accordance with major changes in hospital service structure, to include access effects (the interplay of supply and distance) and temporal variation in its parameters. Therefore, prediction may be applied to a "new" situation defined, for example, by closures of entire hospital sites. The modeling approach used may be adapted to other flow models where destinations may be added or eliminated (for example, trade-area models). A case study involves a sector of London subject to such a restructuring following the U.K. government's 1997,98 review of London's emergency services. [source]


    The Diverging Geographies of Social and Business Interaction Patterns: a Case Study of Rural South Australia

    GEOGRAPHICAL RESEARCH, Issue 2 2000
    P.J. Smailes
    Major changes in personal mobility and in country town service provision have taken place in rural South Australia in the period 1968,69 to 1992,93. The later part of this period was one of major rural recession across Australia as a whole. The impact of this recession is considered by investigating changes in three different geographies of rural South Australians. These are their affective identification with place, their local social interaction and their commercial service consumption. There has been a shift of both commercial and social activity up through the hierarchy of settlement, but this is much more pronounced in the case of commercial activity. These differential rates of change are weakening the once mutually reinforcing links between community self-identification, social interaction and trading patterns. The full impact of the rural crisis commencing in 1982,83 on social and commercial spatial patterns is unlikely to have been achieved by 1992,93, and adjustment is likely to continue. [source]


    Financial Exclusion in Rural and Remote New South Wales, Australia: a Geography of Bank Branch Rationalisation, 1981,98

    GEOGRAPHICAL RESEARCH, Issue 2 2000
    N.M. Argent
    The provision of financial services in rural Australia is a significant public policy issue, reflected in the high level of media and political interest in the recent spate of branch closures. There are, however, many aspects of the current debate regarding the delivery of financial services to rural communities that are, at best, less than ideal and, at worst, erroneous. Using telephone directories for New South Wales, non-metropolitan bank branch listings for the period 1981 to 1998 were collated. A recategorisation of these data according to the Rural, Remote and Metropolitan Areas classification reveals, amidst a spatial realignment of financial service provision, that rural and remote New South Wales have been disproportionately affected by a relatively recent and concerted withdrawal of services. The research demonstrates that corporate-level responses to increased competition within the financial system are significantly more important in deciding rural access to banking services than local and regional population trends. Indeed, two-thirds of rural localities that have lost branches had experienced healthy population growth during the study period. In the wake of the post-deregulation reconfiguration of the bank branch network, the socio-economic marginalisation of rural communities is being compounded, a process of ,financial exclusion' recognised in other parts of the developed world. [source]


    Practice and Economic Geography

    GEOGRAPHY COMPASS (ELECTRONIC), Issue 4 2010
    Andrew Jones
    Economic geography has over the last decade become increasingly interested in the role of practice, conceptualised as the regularised or stabilised social actions through which economic agents organize or coordinate production, marketing, service provision, exchange and/or innovation activities. Interest in practice is most clearly manifest in a growing body of research concerned to conceptualise how the regularized social relations and interactions linking economic actors (e.g. entrepreneurs, firms) shape the nature of economies, industries, and regional development processes. However, an emphasis on social practice faces significant challenges in that it lacks conceptual coherence, a clear methodological approach, and relevance for public policy. This article critically assesses the idea that practice-oriented research might or should become a core conceptual or epistemological approach in economic geography. In doing so, we identify at least four distinct strands to economic geographical interest in practice: studies centred on institutions, social relations, governmentality and alternative economies respectively. We then argue however that this shift towards practice-oriented work is less a coherent turn than a development and diversification of longstanding strands of work within the sub-discipline. [source]


    ,Out of Hospital': a scoping study of services for carers of people being discharged from hospital

    HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2009
    Rachel Borthwick BSc (Hons) RM RN
    Abstract Successive government policies have highlighted the need to inform and involve carers fully in the hospital discharge process. However, some research suggests that many carers feel insufficiently involved and unsupported in this process. This paper summarises a scoping review to identify what the UK literature tells us about the service provision for carers, and its effectiveness, around the time of hospital discharge of the care recipient, and also describes a mapping exercise of the work currently being done by Princess Royal Trust for Carers Centres in England to support carers around the time of hospital discharge. The restriction to UK literature was dictated by the nature of the project; a modest review carried out for a UK-based voluntary sector organization. Fifty-three documents were reviewed, of which 19 papers (representing 17 studies) were reporting on primary research. As only five of these studies actually involved an intervention, it appears there is very little research from the UK which evaluates specific interventions to support carers around the time of hospital discharge of the care recipient. While the mapping exercise showed that in some areas there are services and/or initiatives in place which have been designed to improve the process of discharge for carers, in many places there is still a gap between what policy and research suggest should happen and what actually happens to carers at this time. Even where services and initiatives to support carers through the discharge process exist, there is only limited evidence from research or evaluation to demonstrate their impact on the carer's experience. Further research, both quantitative and qualitative, is required to address these areas and enable commissioners, providers and carers' organizations to work together towards a service in which patients and carers alike receive the support and help they need at this significant time of transition. [source]