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Registry data for cross-country comparisons of migrants' healthcare utilization in the EU: a survey study of availability and content
Signe Nielsen, Allan Krasnik, Aldo Rosano
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-210
Abstract: A questionnaire survey on availability of healthcare utilization registries in which migrants can be identified was carried out among all national statistic agencies and other relevant national health authorities in the 27 EU countries in 2008-9 as part of the Migrant and Ethnic Minority Health Observatory-project (MEHO). The information received was compared with information from a general survey on availability of survey and registry data on migrants conducted by Agency of Public Health, Lazio Region, Italy within the MEHO-project; thus, the information on registries was double-checked to assure accuracy and verification.Available registry data on healthcare utilization which allow for identification on migrants on a national/regional basis were only reported in 11 EU countries: Austria, Belgium, Denmark, Finland, Greece, Italy, Luxembourg, the Netherlands, Poland, Slovenia, and Sweden. Data on hospital care, including surgical procedures, were most frequently available whereas only few countries had data on care outside the hospital. Regarding identification of migrants, five countries reported having information on both citizenship and country of birth, one reported availability of information on country of birth, and five countries reported availability of information on citizenship.Lack of registry data in 16 EU countries, shortage of data on healthcare utilization, and the diversity in the definition of migrant status hampers cross-national comparisons and calls for an urgent establishment of registries, expansion of the existing registry information, and adoption of a common, generally acceptable definition and identification method of migrants across the EU.Migrant health and access to healthcare are fundamental elements of integration and human rights. Most EU countries grant equal access to healthcare for migrants with permanent residence compared to non-migrants [1,2]; nevertheless, differences in health care utilization between migrants and the indigeno
A qualitative assessment of implementing a cross-cultural survey on cancer wards in Denmark - a description of barriers
Maria Kristiansen, Amani Hassani, Allan Krasnik
BMC Medical Research Methodology , 2010, DOI: 10.1186/1471-2288-10-4
Abstract: Participant observation at the involved wards was combined with qualitative interviews with selected nurses and informal talks with a wider group of nurses at the wards involved in the survey.One possible way to increase the participation of migrant patients in research is through the involvement of the hospital staff in contact with patients. Involvement of nurses on cancer wards in the delivery of questionnaires to patients was challenging, despite a general willingness to participate in psychosocial research. The main difficulties were found to be both external (policy changes, general strike among nurses) and internal on the wards (heavy workload, lack of time, focus on medical aspects of cancer rather than psychosocial aspects). These factors interacted and resulted in a lower priority being given to psychosocial research. Further, nurses expressed a feeling that researchers in general did not recognize their contribution in research, making it more difficult to engage fully in studies.Involving hospital staff in research is feasible but not straightforward. Awareness of the influence of possible external and internal factors and efforts to deal with these factors are fundamental to the successful implementation of psychosocial cancer research in a hospital setting.Studying disease patterns and access to health services among migrant populations has become increasingly important given the growing number of immigrants and their descendants in Europe. A rising number of studies point to inequalities in morbidity and mortality for diseases such as diabetes, heart disease, psychotic disorders and cancer [1-3]. Furthermore, there is documentation of inequality in access to health services among migrants compared with the background population in various European countries [1,4-6]. However, little is known about access to social resources, such as social support, and how this relates to factors such as migrant status, social position, gender and age.Research in the f
Does a public single payer system deliver integrated care? A national survey study among professional stakeholders in Denmark
Martin Strandberg-Larsen,Allan Krasnik
International Journal of Integrated Care , 2008,
Abstract: Background: Integrated health care delivery is a goal of health care systems; to date there has been limited information on the integration of medical care in practice. Purpose: To examine and compare perceptions of clinical integration and to identify associated strategic, cultural, technical and structural factors. Design and setting: A national survey addressed to: all county administrative managers (n=15); all hospital managers (n=44); and randomized selected samples of hospital department physician managers (n=200) and general practitioners (n=700) in Denmark. Results: Several initiatives have been implemented in Denmark to integrate care. Nevertheless, most physicians agree that only half of all patients experience well coordinated pathways. Clinical integration is a strategic priority at the managerial levels, but this is not visible at the functional levels. Financial incentives are not used to encourage coordination. The information communication technology to facilitate clinical integration is perceived to be inadequate. Conclusion: The scope for improvement is high due to the structural composition of the system. Increased managerial stewardship, alignment of the financial incentives, and expanded use of information communication technology to link sub-organisations will be a way to move the system forward to meet its explicit goal of providing an integrated delivery of services.
Does a public single payer system deliver integrated services? A national survey study among professional stakeholders in Denmark
Martin Strandberg-Larsen,Allan Krasnik
International Journal of Integrated Care , 2008,
Measurement of integrated healthcare delivery: a systematic review of methods and future research directions
Martin Strandberg-Larsen,Allan Krasnik
International Journal of Integrated Care , 2009,
Abstract: Background: Integrated healthcare delivery is a policy goal of healthcare systems. There is no consensus on how to measure the concept, which makes it difficult to monitor progress. Purpose: To identify the different types of methods used to measure integrated healthcare delivery with emphasis on structural, cultural and process aspects. Methods: Medline/Pubmed, EMBASE, Web of Science, Cochrane Library, WHOLIS, and conventional internet search engines were systematically searched for methods to measure integrated healthcare delivery (published – April 2008). Results: Twenty-four published scientific papers and documents met the inclusion criteria. In the 24 references we identified 24 different measurement methods; however, 5 methods shared theoretical framework. The methods can be categorized according to type of data source: a) questionnaire survey data, b) automated register data, or c) mixed data sources. The variety of concepts measured reflects the significant conceptual diversity within the field, and most methods lack information regarding validity and reliability. Conclusion: Several methods have been developed to measure integrated healthcare delivery; 24 methods are available and some are highly developed. The objective governs the method best used. Criteria for sound measures are suggested and further developments should be based on an explicit conceptual framework and focus on simplifying and validating existing methods.
Access to healthcare and alternative health-seeking strategies among undocumented migrants in Denmark
Dan Biswas, Maria Kristiansen, Allan Krasnik, Marie Norredam
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-560
Abstract: Qualitative design using semi-structured interviews and observations. The participants included ten undocumented South Asian migrants and eight ER nurses.Undocumented migrants reported difficulties accessing healthcare. The barriers to healthcare were: limited medical rights, arbitrariness in healthcare professionals' attitudes, fear of being reported to the police, poor language skills, lack of network with Danish citizens, lack of knowledge about the healthcare system and lack of knowledge about informal networks of healthcare professionals. These barriers induced alternative health-seeking strategies, such as self-medication, contacting doctors in home countries and borrowing health insurance cards from Danish citizens. ER nurses expressed willingness to treat all patients regardless of their migratory status, but also reported challenges in the encounters with undocumented migrants. The challenges for ER nurses were: language barriers, issues of false identification, insecurities about the correct standard procedures and not always being able to provide appropriate care.Undocumented migrants face formal and informal barriers to the Danish healthcare system, which lead to alternative health-seeking strategies that may have adverse effects on their health. This study shows the need for policies and guidelines, which in accordance with international human rights law, ensure access to healthcare for undocumented migrants and give clarity to healthcare professionals.In recent years there has been increasing focus on the flow of irregular migration to Europe [1]. It is estimated that there are between 1.9-3.8 million undocumented migrants in the European Union (EU), corresponding to 7-13 percent of the foreign resident population in 2008 [2,3]. Undocumented migrants enter Europe through both legal and illegal channels and typically find employment within the informal economy, where they serve as a low-cost and flexible labour force [1,4,5]. Figure 1 gives definitions
Are joint health plans effective for coordination of health services? An analysis based on theory and Danish pre-reform results
Martin Strandberg-Larsen,Mikkel Bernt Nielsen,Allan Krasnik
International Journal of Integrated Care , 2007,
Abstract: Background: Since 1994 formal health plans have been used for coordination of health care services between the regional and local level in Denmark. From 2007 a substantial reform has changed the administrative boundaries of the system and a new tool for coordination has been introduced. Purpose: To assess the use of the pre-reform health plans as a tool for strengthening coordination, quality and preventive efforts between the regional and local level of health care. Methods: A survey addressed to: all counties (n=15), all municipalities (n=271) and a randomised selected sample of general practitioners (n=700). Results: The stakeholders at the administrative level agree that health plans have not been effective as a tool for coordination. The development of health plans are dominated by the regional level. At the functional level 27 percent of the general practitioners are not familiar with health plans. Among those familiar with health plans 61 percent report that health plans influence their work to only a lesser degree or not at all. Conclusion: Joint health planning is needed to achieve coordination of care. Efforts must be made to overcome barriers hampering efficient whole system planning. Active policies emphasising the necessity of health planning, despite involved cost, are warranted to insure delivery of care that benefits the health of the population.
How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark
Jensen Natasja Koitzsch,Norredam Marie,Priebe Stefan,Krasnik Allan
BMC Family Practice , 2013, DOI: 10.1186/1471-2296-14-17
Abstract: Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.
Issues to Consider When Measuring and Applying Socioeconomic Position Quantitatively in Immigrant Health Research
Signe Smith Nielsen,Nana Folmann Hempler,Allan Krasnik
International Journal of Environmental Research and Public Health , 2013, DOI: 10.3390/ijerph10126354
Abstract: The relationship between migration and health is complex, yet, immigrant-related inequalities in health are largely influenced by socioeconomic position. Drawing upon previous findings, this paper discusses issues to consider when measuring and applying socioeconomic position in quantitative immigrant health research. When measuring socioeconomic position, it is important to be aware of four aspects: (1) there is a lack of clarity about how socioeconomic position should be measured; (2) different types of socioeconomic position may be relevant to immigrants compared with the native-born population; (3) choices of measures of socioeconomic position in quantitative analyses often rely on data availability; and (4) different measures of socioeconomic position have different effects in population groups. Therefore, caution should be used in the collection, presentation, analyses, and interpretation of data and researchers need to display their proposed conceptual models and data limitations as well as apply different approaches for analyses.
Mental health among children seeking asylum in Denmark – the effect of length of stay and number of relocations: a cross-sectional study
Signe S Nielsen, Marie Norredam, Karen L Christiansen, Carsten Obel, J?rgen Hilden, Allan Krasnik
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-293
Abstract: The population included all 260 parent-accompanied asylum-seeking children aged 4–16 years living in the asylum centres managed by the Danish Red Cross in October–December 2006. Mental health was evaluated using the Strengths and Difficulties Questionnaire. School teachers evaluated children aged 4–16; and the 11–16-year-olds completed the self-report version. To assess the association between organisational factors and mental health, binary logistic regression analyses were done using backwards elimination. We received responses for 246 children equivalent to 95% of the study population.Using teachers' reports, we found that children who had been asylum-seeking for more than one year in Denmark had an increased risk of having mental difficulties (odds ratio 5.5, 95% CI 1.8–16.3); four or more relocations in the asylum system were also associated with a higher risk (3.0, 1.4–6.7). When the self-report data were included, the associations were even stronger.Protracted stays at asylum centres and multiple relocations within the asylum system appear to have an adverse effect on asylum-seeking children's mental health. A limit to the duration of the children's stay in the asylum system should be ensured. Follow-up studies with inclusion of other conditions, such as parental mental health and the children's previous trauma, are needed to clarify the influence of the different factors and their interactions.Children seeking asylum not only suffer mentally from conflict-related exposures before migration, during the process of seeking asylum the organisational conditions in the host country may also adversely affect their mental health [1-3]. The literature shows several environmental risk factors for mental illness in refugee children, such as number of transitions, time taken for immigration status to be determined, time spent in the host country, and cultural isolation [1,2,4,5]. In particular, prolonged stay within the asylum system, including detention, has shown to h
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