Suchergebnisse

Purpose
Vietnam is historically hit by extensive disasters. However, the most vulnerable populations are far from being backed by national/local programmes to reduce disaster impacts on their well-being. In practice, political and socio-economic top-down organisation, channels efforts and limited resources into wealthier parts of the country. The paper aims to discuss these issues.


Design/methodology/approach
Learning from 30 years work in Vietnam, this paper presents how "horizontal" solidarity and networking should be promoted and reinforced to really target the needs of vulnerable poor communities. Findings on conditions and challenges are based on practical experience, from family/village level to provincial/national administration, in promoting safe housing and safer communities and in evaluating the barriers for extending and sharing such practices.


Findings
Political environments in South East Asian countries become similar to Vietnamese systems, and share a common attitude towards DRR (and CCA): official statements reaffirm the need for DRR at all levels, and the CC threats for local development. But year after year, the situation of marginalised or low-income poor facing disasters does not really see progress.


Originality/value
New data collecting methods and technologies are proposed, resilience is quoted as criteria for development, but the major issue remains: how could communities be "at the frontline" when receiving so little "backline" support and resources, compared to benefits from capitalist development shared by only richer parts of society – not concerned in the same way by disasters? The SFDRR in encouraging non-compulsory Civil Society involvement will remain inadequate faced with the increased vulnerability by Vietnam and South East Asian inhabitants.

This article offers an account of incorporating visual methods into a research framework inspired by graphic medicine, where comics are used in patient care. We conducted interviews, focused on sexual wellbeing, with 12 leukaemia survivors. The findings from these interviews were transformed into visual representations. We outline how our study was guided by feminist research principles and reflect on the tension between the flexibility that visual methods require and the rigidity of National Health Service ethical regulations

Résumé Objectif : Analyser les remboursements de l'Assurance maladie aux personnes traitées pour diabète en France, mesurer leur évolution entre 2001 et 2007 et identifier les facteurs associés aux consommations de soins. Méthodes : Analyse des données d'Entred 2007 (6 710 adultes bénéficiaires du régime général, traités pour diabète en métropole), regroupant des données des bases de remboursement et les réponses à différents questionnaires complétés par les patients et leurs médecins. Résultats : Le remboursement moyen était estimé à 5 300 euros par personne diabétique traitée en 2007, et 10 % des personnes concentraient 50 % des remboursements. Extrapolés à la France entière, les remboursements versés à l'ensemble des personnes diabétiques s'élevaient à 12,5 milliards d'euros, dont 4,7 consacrés à l'hospitalisation, 3,4 aux médicaments et 1,0 aux soins infirmiers. Les principaux facteurs associés à ces montants élevés étaient, chez les personnes diabétiques de type 2, l'âge, le traitement par insuline, l'existence de complications dont l'insuffisance rénale terminale traitée et les comorbidités sévères. L'augmentation des remboursements (80 % entre 2001 et 2007 en euros constants, soit 7,1 à 12,5 milliards) s'expliquait principalement par l'augmentation du nombre de malades et l'intensification du suivi et des traitements. Conclusion : Face à la forte progression des coûts pour la collectivité, il devient indispensable d'améliorer l'efficience des soins délivrés aux diabétiques. Prat Organ Soins 2010;41(1):1-10

PurposeThe purpose of this paper is to discuss the findings from the body of case studies offered in the issue, combined with three external perspectives on local voices and action.Design/methodology/approachUsing as its basis the eight key case studies and three external contributions to the special issue, the paper offers a theoretical framework as a basis for discussion of this material. Through this, it identifies possible modes of action understood through the theoretical framework and elaborated through the specific cases. It concludes with proposals for further work.FindingsThe discussion finds that from a local perspective, the ambitions of local populations and local NGOs to achieve emancipatory change depend on the scope for local collaboration and partnerships to exercise influence on underlying risk factors. It resolves the suggested tension between operating within, and outside the system through the concept of "legitimate subversion".Originality/valueIt is felt that the original recording of case studies of local level action combined with the process of iterative critical reflection on the part of the contributors offers a novel approach to knowledge creation from practice, and offers insights bridging theoretical and practitioner perspectives into means of addressing underlying risk factors affecting local populations.

Purpose
The purpose of this paper is to individually examine the findings from eight case studies presented in this special issue and comparatively identify the findings regarding local learning and action.


Design/methodology/approach
Underlying research questions regarding power and powerlessness in regard to addressing underlying risk factors affecting local populations form the basis for the discussion. Proceedings of a collaborative workshop conducted with the contributing authors are analysed qualitatively to identify learning relating to the research questions emerging from the case studies individually and collectively.


Findings
A number of strategies and tactics for addressing underlying risk factors affecting local populations were identified from the case studies, including collaboration and cohesion. Campaigning, lobbying, communications and social mobilisation in an attempt to bridge the gap between local concerns and the decision-making of government and other powerful actors. Innovation and local mobilisation to address shortcomings in government support for disaster reduction and development. Communications as a first base to influence behaviour of both communities and government. Social change through empowerment of women to act in disaster reduction and development.


Research limitations/implications
The outcomes of the action research conducted by the authors individually and collectively highlight the necessity for bridging different scales of action through a range of strategies and tactics to move beyond local self-reliance to influence on underlying risk factors. The action research process employed may have wider applications in gathering and formalising local-level experience and knowledge.


Practical implications
The case studies and their analysis present a range of practical strategies and tactics to strengthen local resilience and address underlying risk factors which are replicable in other contexts.


Originality/value
Practitioners are activists and do not often engage in critical reflection and analysis. The method presented here offers a means of achieving this in order to generate learning from local-level experience. The findings contribute to the consideration of cross-scale action to address underlying risk factors which impact local communities.

Objective Robson's Ten Group Classification System (TGCS) creates clinically relevant sub‐groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates. Design Observational study using routine data. Setting Twenty‐seven EU member states plus Iceland, Norway, Switzerland and the UK. Population All births at ≥22 weeks of gestational age in 2015. Methods National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups. Main outcome measures Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups. Results Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions. Conclusions Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence‐based caesarean policies. Tweetable abstract Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons.