Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines.
This study used an embedded mixed methods design. We collected cross-sectional data from 135 drug sensitive pulmonary TB patients aged 18 years or above in Thiruvananthapuram, Kerala using a structured questionnaire to get the proportion of patients following all treatment guidelines. We also did eight in-depth interviews (four men and four women) from within the survey sample. The in-depth interviews were inductively analysed for getting deeper insights about reasons for the choices people made regarding the treatment guidelines. Written informed consent was taken from all participants and the study was implemented after the necessary programmatic and ethical clearances.
Of the 105 men and 30 women studied, uninterrupted daily drug consumption was reported by 80 persons (59.3%, 95% Confidence Intervals (CI) 50.8-67.2%). Overall, 38 (28.2%, 95% CI 21.3%-36.3%) persons were able to follow all seven aspects of advised guidelines. Living in an extended/ joint family (Adjusted Odds ratio (AOR) 2.6, 95% CI 1.1-6.0), approximate monthly household expenditure of over rupees 13,500 (AOR 2.9, 95% CI 1.3-6.7) and no perceived delay in seeking initial care (AOR 3.2, 95% CI 1.2-8.7) were significantly associated with following all aspects of treatment guidelines. In-depth interviews revealed reflective treatment related behaviours were influenced by bodily experiences, moral perceptions, social construct of TB, programmatic factors and substance use. Sometimes behaviours were non-reflective also. Programmatic stress was on individual agency for changing behaviour but capability and opportunity for these were influenced social aspects like stigma, gender roles and poverty.
TB patients live amidst a syndemic of biomedical and social problems. These problems influence the capabilities and opportunities of such TB patients to follow treatment guidelines. Interventions should balance focus on individual agency and social abd economic factors.

In addition to outcome assessments, cost effectiveness of surgical treatments becomes increasingly important. Both, insurance companies and hospital administrations aim for short and efficient procedures to reduce costs.Microsurgical procedures are often surpassing traditional treatment options in terms of function and aesthetics. However, they are more expensive as they require a high level of surgical expertise, more theatre capacity and longer inpatient treatment. Adequate reimbursement is mandatory, if we want to continuously perform these procedures with the best possible quality and outcome. To cover the case-related expenses of each specialty, multidisciplinary procedures require appropriate distribution of reimbursements to each department.The main diagnosis as well as all complications and relevant comorbidities should be documented to obtain the correct DRG. The additional financial benefit of a microsurgical procedure in a multidisciplinary case can be calculated by specifying the procedural increment in pay. Therefore, a fair distribution of revenues to each participating department should be performed. Different models exist, which lead to a benefit in compensation for all departments. Unfortunately, distribution of resources is still insufficiently managed in many hospitals, which hampers high quality multidisciplinary microsurgical procedures. Still, picking the best possible procedure for our patients, independently of financial incentives, is of utmost importance.
Im Zuge des zunehmenden Kostendrucks im Gesundheitssystem werden Therapien neben ihrer Qualität zunehmend auch hinsichtlich ihrer Wirtschaftlichkeit bewertet. Mikrochirurgische Eingriffe haben sich vor allem im Langzeitverlauf in vielen Bereichen als funktionell und ästhetisch überlegen gezeigt. Im Vergleich zu Alternativeingriffen sind sie aber auf Grund ihrer Komplexität sowie langen Operationszeiten und stationären Verweildauern mit hohen Kosten verbunden. Damit diese langfristig in hoher Qualität angeboten werden können, muss entsprechend von Seiten der Kostenträger, insbesondere auch bei interdisziplinären Eingriffen, eine adäquate, kostendeckende Vergütung erfolgen. Um einen korrekten DRG-Erlös zu erhalten sollten daher neben der Hauptdiagnose auch die relevanten Nebendiagnosen und Prozeduren richtig und vollständig dokumentiert werden. Auch der finanzielle Mehrwert eines interdisziplinären Eingriffs lässt sich durch die Erhöhung des Erlöses mit mikrochirurgischem Operationsanteil errechnen.Zwischen den Kliniken eines Krankenhauses sollte daher eine interdisziplinäre Erlösaufteilung stattfinden. Für eine faire und transparente interdisziplinäre Leistungsverrechnung existieren mehrere Modelle, mit denen alle beteiligten Kliniken einen Mehrwert erwirtschaften können. Leider bestehen an vielen Krankenhäusern unzureichende interdisziplinäre Vergütungsmodelle, welche eine qualitativ hochwertige, kostendeckende Patientenversorgung mit mikrochirurgischen Eingriffen erschweren. Ungeachtet des zunehmenden Kostendrucks und nicht medizinischer wirtschaftlicher Aspekte muss unser Handeln als Arzt immer die bestmögliche Patientenversorgung sicherstellen.

According to the UN High Commissioner for Refugees, there are approximately 40 million refugees and other internally displaced people worldwide, with the overwhelming majority coming from and still living in developed countries. 80% of all refugees are estimated to be women and children. Many refugees spend months and even years in what are designed to be temporary settings where efforts are made to accommodate their basic needs such as food, clean water, shelter, security, and primary health care during emergency situations. Women refugees, however, have certain unique needs beyond what traditionally have been considered basic in relief programs. Many women in developing countries suffer considerable health risks during the best of times due to their poverty or low social status. When fleeing conflict or natural disaster, their health status is at even higher risk of being compromised by severe living conditions and the complete absence of reproductive health services. The recognition that women refugees often face serious and sometimes life-threatening reproductive health-related situations led to the development of a field manual on reproductive health for use at the local level. Planned for publication in late 1998 or early 1999, the guide will describe the goals of a minimum array of reproductive health services in the early phase of an emergency and provide direct guidance on care relating to sexual violence, STDs, family planning, adolescents\' needs, and other reproductive health concerns such as female genital mutilation and treatment for septic and incomplete abortion. The manual has garnered worldwide attention and support, as well as scrutiny by abortion opponents in the US, in particular New Jersey Republican Representative Chris Smith.

UNAIDS, AIDSCAP, and the Harvard School of Public Health held a seminar before the Vancouver AIDS Conference in the attempt to find agreement upon a statistical picture of the shape of the HIV/AIDS epidemic in various regions of the world. These three bodies corroborated to produce this paper describing the scope of HIV infection in sub-Saharan Africa, including discussion of HIV-2, explosions in the incidence of HIV infection, the presence of sexually transmitted diseases (STD), the safety of the blood supply, urban versus rural rates of HIV spread, the disproportionate risk young women have compared to other population subgroups of contracting HIV, migration and urbanization, the effect of economic development programs upon a population\'s risk of contracting HIV and other STDs, and the growing burden of caring for people with AIDS.

The author, Executive Director of the UN Population Fund, is pleased that Turkey is focusing upon improving service provision and broadening its approach to reproductive health including family planning, as recommended at the 1994 International Conference on Population and Development (ICPD). Both the ICPD and the Fourth World Conference on Women emphasized that family planning is an integral part of reproductive health, which was recognized as essential to the goals of gender equality and the empowerment of women, issues perceived to be cornerstones of population and development programs. Reproductive health and family planning programs, the need for a comprehensive approach to reproductive health, and reaching a consensus upon the roles of men and women in contemporary Islamic societies are discussed.

Pakistan was the first developing country to be concerned about the population problem. The first family planning/population related efforts in Pakistan spawned from the nongovernmental sector in the form of the establishment of the Family Planning Association of Pakistan in 1953. The efforts of the association were then later acknowledged in the First Five-Year Public Sector Development Plan which made a lump sum provision of Rs. 5 million for population activities. The First Five-Year Plan (1955-60) recognized that measures should be taken to limit the size of the Pakistani family in order to reduce the incidence of malnutrition and overcrowding. There has never been an organized and consistent religious opposition to family planning in Pakistan. Islamic provisions in the constitution and diverse views of different groups of religious leaders do, however, pose an ongoing hidden political threat to the government which could be exploited through their street power in urban areas. The author notes that the governments in Pakistan will always be reluctant to aggressively promote family planning. Under these circumstances, the government must seek the cooperation of credible nongovernmental organizations which tend to operate through community-based volunteers who generally have more influence in persuading communities to accept a given point of view. Greater involvement of local community groups in a planned and meaningful way will broaden the base of program promoters and supporters across the country and will create a climate conducive to large-scale adoption of the small family norm as a way of life.

This article, written by the Head of the department responsible for preparing the 1999 Russian census, first summarizes current demographic trends in the country. The main emphasis is on initiating a debate on methodological issues concerning the upcoming census, particularly on topics such as migration, households and families, ethnic and national groups, age and sex composition, and labor force activities. The paper is followed by a discussion of these topics (pp. 24-30). (SUMMARY IN ENG)

These Guidelines provide concrete examples of measures aimed at eliminating sex discrimination in regard to recruitment and appointment, post assignment, and promotion. Among the Guidelines is one stating that employers should avoid imposing different recruitment ages for men and women.

This article discusses three relatively simple approaches to evaluate health promotion activities: 1) comparative studies; 2) interviews, questionnaires; and 3) ethnographic investigation. Comparatives studies involves observing what happens to people involved in a particular health promotion activity and comparing this with what happens to another group of people not involved in the activity. Observations can reveal whether the project has caused a change and how it caused such change. Interviews and questionnaires, on the other hand, were used to collect data from participants before and after the project activity. This method can measure changes over time and provide information on various activity processes. Ethnographic investigation is a method wherein the evaluator can understand how a particular health promotion activity works by participating in the project. Overall, evaluating HIV/AIDS health promotion activities will often require more than one approach since AIDS covers a wide range of issues.

This document summarizes guidelines for contraceptive social marketing project development prepared by the International Contraceptive Social Marketing Project (ICSMP) as an aid to consultants and technical assistance contractors. The ICSMP has developed a checklist to guide planning in 4 major areas: 1) project organization and management structure, 2) target market, 3) product line, and 4) pricing strategy and project costs. A clear statement of project objectives is essential, and these objectives must be internally consistent so that strategies to accomplish them can be unified. The position of each governmental entity and sponsoring agency involved in the social marketing project must be clearly understood. Projects receiving US government funds must have a mechanism for financial and programmatic reporting and accountability. Thorough knowledge of commercial rules and regulations in a country is necessary for planning. To ascertain whether the necessary resources are available, it is necessary to examine the existing marketing infrastructure in terms of distribution, advertising, market research, and packagaing capabilities. The target market should be specified in quantifiable terms; in addition, a consumer profile that defines the overall demographics of the country, the family planning environment, and potential social marketing consumers should be developed. The couple years of protection projection can be translated into the percentage of the target market that the project expects to capture. It is necessary to price products early in project development in order to assess program costs. Revenue projections should be based on previous calculations of couple year of protection goals, product line, product price, and price structure. Each element of the advertsing budget should be justifiable in terms of project objectives. Finally, positions and anticpated salaries for staff should be specified through the 1st 3 years of project implementation.