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BackgroundThe use of electronic health records (EHR) in clinical settings is considered pivotal to a patient-centered health care delivery system. However, uncertainty in cost recovery from EHR investments remains a significant concern in primary care practices. ObjectiveGuided by the question of “When implemented in primary care practices, what will be the return on investment (ROI) from an EHR implementation?”, the objectives of this study are two-fold: (1) to assess ROI from EHR in primary care practices and (2) to identify principal factors affecting the realization of positive ROI from EHR. We used a break-even point, that is, the time required to achieve cost recovery from an EHR investment, as an ROI indicator of an EHR investment. MethodsGiven the complexity exhibited by most EHR implementation projects, this study adopted a retrospective mixed-method research approach, particularly a multiphase study design approach. For this study, data were collected from community-based primary care clinics using EHR systems. ResultsWe collected data from 17 primary care clinics using EHR systems. Our data show that the sampled primary care clinics recovered their EHR investments within an average period of 10 months (95% CI 6.2-17.4 months), seeing more patients with an average increase of 27% in the active-patients-to-clinician-FTE (full time equivalent) ratio and an average increase of 10% in the active-patients-to-clinical-support-staff-FTE ratio after an EHR implementation. Our analysis suggests, with a 95% confidence level, that the increase in the number of active patients (P=.006), the increase in the active-patients-to-clinician-FTE ratio (P

Objective: Despite emerging evidence that electronic health records (EHRs) can improve the efficiency and quality of medical care, most physicians in office practice in the United States do not currently use an EHR. We sought to measure the correlates of EHR adoption. Design: Mailed survey to a stratified random sample of all medical practices in Massachusetts in 2005, with one physician per practice randomly selected for survey. Measurements: EHR adoption rates. Results: The response rate was 71% (1345/1884). Overall, while 45% of physicians were using an EHR, EHRs were present in only 23% of practices. In multivariate analysis, practice size was strongly correlated with EHR adoption; 52% of practices with 7 or more physicians had an EHR, as compared with 14% of solo practices (adjusted odds ratio, 3.66; 95% confidence interval, 2.28–5.87). Hospital-based practices (adjusted odds ratio, 2.44; 95% confidence interval, 1.53–3.91) and practices that teach medical students or residents (adjusted odds ratio, 2.30; 95% confidence interval, 1.60–3.31) were more likely to have an EHR. The most frequently cited barriers to adoption were start-up financial costs (84%), ongoing financial costs (82%), and loss of productivity (81%). Conclusions: While almost half of physicians in Massachusetts are using an EHR, fewer than one in four practices in Massachusetts have adopted EHRs. Adoption rates are lower in smaller practices, those not affiliated with hospitals, and those that do not teach medical students or residents. Interventions to expand EHR use must address both financial and non-financial barriers, especially among smaller practices.

International audience; Using a large sample of 125 countries we evaluate the effect of the pre-Covid-19 fiscal space on the size of the fiscal stimulus packages in response to the virus. We find that higher ratings and higher tax revenues (to public debt) predict the size of fiscal stimuli, while public debt (to GDP) does not. These findings vary with countries' level of economic development and the type of fiscal stimuli.

Background: Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians’ electronic health record (EHR)-writing and -reading competence. Purposes: This study aims to investigate physicians’ self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Methods: Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Results: Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct ( r = − 0.33, p

One of the main topics of discussion today is women’s empowerment. The Human Development Reports of the United Nations Organization analyzes this topic by using three dimensions: reproductive health and family planning, violence against girls and women, and socioeconomic empowerment. In this paper, we will talk about the socioeconomic empowerment of women in EU Countries.

Background: Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians’ electronic health record (EHR)-writing and -reading competence. Purposes: This study aims to investigate physicians’ self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Methods: Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Results: Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= − 0.33, p

Audit committees are responsible for overseeing internal controls and internal audit functions, as well as the external financial reporting process in banks. They are one of the most important organizational structures in the banks after the board of directors, and certain functions in the banks report directly to the audit committees. The paper analyzes the audit committees and internal audit function in the five largest banks in North Macedonia, whether they work efficiently and effectively, and whether the committees fulfill their responsibility to the internal audit function as best they can. The research was conducted through a structured questionnaire sent to the largest banks, namely to members of the audit committees, as well as employees of the internal audit department in those banks. All the results of the research are summarized in a conclusion that assesses the placement and adequacy of audit committees and internal audit function in the banks, as well as the extent to which the audit committees exercise their responsibility to the internal audit function.

Highlights • We study the impacts of women’s Self-help group membership on women’s and men’s empowerment. • We measure empowerment using two alternate indices: the A-WEAI and the Pro-WEAI. • We find that SHG membership has a significant positive impact on aggregate measures of women’s empowerment. • We also find that SHG membership reduces the gap between men’s and women’s empowerment scores. • The impacts are driven by increase in control over income, decisionmaking over credit, and active involvement in groups., Women’s groups are important rural social and financial institutions in South Asia. In India, a large majority of women’s groups programs are implemented through self-help groups (SHGs). Originally designed as savings and credit groups, the role of SHGs has expanded to include creating health and nutrition awareness, improving governance, and addressing social issues related to gender- and caste-based discrimination. This paper uses panel data from 1470 rural Indian women from five states to study the impact of SHG membership on women’s empowerment in agriculture, using the project-level Women’s Empowerment in Agriculture Index (pro-WEAI) and the abbreviated Women’s Empowerment in Agriculture Index (A-WEAI). Because SHG membership was not randomized and women who self-select to be SHG members may be systematically different from non-members, we employ nearest neighbor matching methods to attribute the impact of SHG membership on women’s empowerment in agriculture and intrahousehold inequality. Our findings suggest that SHG membership has a significant positive impact on aggregate measures of women’s empowerment and reduces the gap between men’s and women’s empowerment scores. This improvement in aggregate empowerment is driven by improvements in women’s scores, not a deterioration in men’s. Greater control over income, greater decisionmaking over credit, and (somewhat mechanistically, given the treatment) greater and more active involvement in groups within the community lead to improvements in women’s scores. However, impacts on other areas of empowerment are limited. The insignificant impacts on attitudes towards domestic violence and respect within the household suggest that women’s groups alone may be insufficient to change deep-seated gender norms that disempower women. Our results have implications for the design and scale-up of women’s group-based programs in South Asia, including the possibility that involving men is needed to change gender norms.

Highlights • We examine linkages between women’s empowerment and nutrition in 6 countries. • Women’s empowerment and gender equality are positively associated with child HAZ. • Tradeoffs exist between domains of empowerment and women’s nutritional outcomes. • Higher workload is associated with more diverse child diets but lower women’s BMI. • Women’s empowerment accounts for a small share of the variance in nutrition outcomes., Although women’s empowerment and gender equality are often linked with better maternal and child nutrition outcomes, recent systematic reviews find inconclusive evidence. This paper applies a comparable methodology to data on the Women’s Empowerment in Agriculture Index (WEAI), an internationally-validated measure based on interviews of women and men within the same household, from six countries in Africa and Asia to identify which dimensions of women’s empowerment are related to household-, woman-, and child-level dietary and nutrition outcomes. We examine relationships between women’s empowerment and household-level dietary diversity; women’s dietary diversity and BMI; and child-related outcomes, controlling for woman, child, and household characteristics. We also test for differential associations of women’s empowerment with nutrition outcomes for boys and girls. We find few significant associations between the aggregate empowerment scores and nutritional outcomes. The women’s empowerment score is positively associated only with child HAZ, while lower intrahousehold inequality is associated with a higher likelihood of exclusive breastfeeding and higher HAZ but with lower BMI. However, analysis of the subdomain indicators finds more significant associations, suggesting that tradeoffs exist among different dimensions of empowerment. Women’s empowerment accounts for a small share of the variance in nutritional outcomes, with household wealth and country-level factors accounting for the largest share of the variation in household and women’s dietary diversity. In contrast, most of the variation in child outcomes comes from child age. Improving nutritional outcomes requires addressing the underlying determinants of poor nutrition in addition to empowering women and improving gender equality.

Economic sanctions have the reputation of harming the population in the sanctioned countries. In this paper, I investigate under what circumstances such harm occurs and what is its magnitude. I estimate the impact of in utero exposure to sanctions episodes on infant weight, child height, and child mortality. Using a large child level data set from 69 countries, I find that being exposed to sanctions leads to lower infant weight and higher probability of death before age three. I find negative effects only for children exposed to the first two years of sanctions.

Survival from out-of-hospital cardiac arrest (OHCA) varies across the developed world. Although not all OHCA are recoverable, the survival rate in Scotland is lower than in comparable countries, with higher average survival rates of 7.9% in England and 9% across Europe. The purpose of this paper is to explore the barriers, facilitators and public attitudes to administering bystander cardiopulmonary resuscitation (CPR) which could inform future policy and initiatives to improve the rate of bystander CPR. Data was collected via a cross-sectional general population survey of 1027 adults in Scotland. 52% of respondents had been trained in CPR. Of those who were not trained, two fifths (42%) expressed a willingness to receive CPR training. Fewer than half (49%) felt confident administering CPR, rising to 82% if they were talked through it by a call handler. Multivariate analyses identified that people in social grade C2DE were less likely than those in social grade ABC1 to be CPR trained and less confident to administer CPR if talked through by a call handler. The older a person was, the less likely they were to be CPR trained, show willingness to be CPR trained or be confident to administer bystander CPR with or without instruction from an emergency call handler. These findings are particularly relevant considering that most OHCA happen in the homes of older people. In a developed country such as Scotland with widely available CPR training, only half of the adult population reported feeling confident about administering bystander CPR. Further efforts tailored specifically for people who are older, unemployed and have a lower social grade are required to increase knowledge, confidence and uptake of training in bystander CPR.

Good governance (GG) is an important concept that has evolved as a set of normative principles for low- and middle-income countries (LMICs) to strengthen the functional capacity of their public bodies, and as a conditional prerequisite to receive donor funding. Although much is written on good governance, very little is known on how to implement it. This paper documents the process of developing a strategy to implement a GG model for Health Technology Management (HTM) in the public health sector, based on lessons learned from twenty years of experience in policy development and implementation in Benin. The model comprises six phases: (i) preparatory analysis, assessing the effects of previous policies and characterizing the HTM system; (ii) stakeholder identification and problem analysis, making explicit the perceptions of problems by a diverse range of actors, and assessing their ability to solve these problems; (iii) shared analysis and visioning, delineating the root causes of problems and hypothesizing solutions; (iv) development of policy instruments for pilot testing, based on quick-win solutions to understand the system's responses to change; (v) policy development and validation, translating the consensus solutions identified by stakeholders into a policy; and (vi) policy implementation and evaluation, implementing the policy through a cycle of planning, action, observation and reflection. The policy development process can be characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. Interactive and analytical tools of action research were used to integrate knowledge amongst actor groups, identify consensus solutions and develop the policy in a way that satisfies criteria of GG. This model could be useful for other LMICs where resources are constrained and the majority of healthcare technologies are imported.

Women’s empowerment has been thoroughly discussed during the last two decades, yet the research on the components of empowerment on the national level is still lacking. This paper aims to fill that gap by investigating which national causes and effects of women’s empowerment that are generally visible across developing countries. Previous studies on meso- and micro level have shown that an increase in women’s education, an increase in women’s economic independence as well as a strong legal framework is positively associated with women’s empowerment. Furthermore, a strengthening of women’s reproductive rights, an increase in children’s health and a better representation of women in parliament have been identified as effects of women’s empowerment. These hypotheses are tested through a structural equation model where women’s empowerment is estimated as a latent factor. The final model, which suffers from bad fit, shows that the quality of education is a strong determinant of women’s empowerment, and that women’s empowerment significantly affects the general level of children’s health. It also indicates that the strength of the legal framework is actually negatively correlated with women’s empowerment - a finding that calls for further research.

This paper conducts an empirical investigation of the effects of temporary versus persistent fiscal policy shocks. Using data from the US I show that short lived fiscal expansions have a positive effect on output and consumption; while persistent fiscal shocks generate negative effects on consumption and - to a lesser extent - on output. Persistent fiscal expansions are associated with an increase in precautionary savings, collapse in consumers' confidence and an increase the yield curve's term premium. Consistently with consumption smoothing, short-lived fiscal expansions generate a temporary deficit in the current account, while persistent fiscal shocks leave the external balance unaffected. I find evidence of non linearity in the effects of temporary and persistent fiscal shocks according to (i) the level of public debt and (ii) the state of the business cycle. Persistent fiscal shocks have larger negative effects on consumption and output if they take place at high levels of public debt, possibly due to the higher costs of fiscal stabilization. The state of the business cycle is also very relevant. Persistent fiscal shocks generate negative multipliers in times of economic boom, but these negative multipliers disappear in periods of recession when credit constraints are more likely to bind. On the other hand, temporary fiscal shocks have positive effects both in times of expansion and in times of recession, but with the multipliers being way larger in the latter case. Differently with what hypothesized by the earlier literature on non-Keynesian fiscal effects, I find little evidence that these effects are asymmetric depending on the size of the shocks.

Aims. To explicate a model of empowerment appropriate to clients living with a chronic illness, in particular chronic obstructive pulmonary disease. Background. Empowerment is a concept central to nursing practice and is viewed from a variety of perspectives in nursing literature. Empowerment shapes how those living with a chronic illness view their illness and approach their involvement in self‐care. This concept analysis was conducted as part of the literature review to inform the development of the Pulmonary Rehabilitation in Nurse‐led Community Environments trial. Design. Review of the literature on empowerment, with particular focus on empowerment in chronic illness. Methods. A search of electronic databases to March 2010 for literature related to ‘empowerment’ was conducted. Papers included in the review had reference to ‘empowerment’ in the abstract. The literature was then organised following guidance on the structure for concept analysis proposed by Norris (1982, Concept Clarification in Nursing) and Rodgers (Journal of Advanced Nursing, 1989). Results. Empowerment in chronic illness is a process with both the nurse and client contributing to its evolvement. The nurse must feel empowered, communicate effectively and surrender control in the empowerment process. The client must be motivated to change and possess specific competencies to engage in the empowerment process. Both the nurse and client experience a transformation when empowered. Conclusion. Despite identification of the characteristics, antecedents and consequences of empowerment in chronic illness, empowerment remains an evolving concept, with evident immaturity revealed in its competing definitions. Relevance to clinical practice. This concept analysis provides nurses with an understanding of what patient attributes contribute to empowerment in chronic illness and how nurses on an individual level can influence the empowerment process for patients, through effective communication, surrendering control and focusing on goals. peer-reviewed

Electronic health records (EHRs) have emerged as a major topic in health care and are central to the federal government's strategy for transforming healthcare delivery in the United States. Recent federal actions that aim to promote the use of EHRs promise to have significant implications for laboratories and for pathology practices. Under the HITECH (Health Information Technology Economic and Clinical Health) Act, an EHR incentive program has been established through which individual physicians and hospitals can qualify to receive incentive payments if they achieve "meaningful use" of "certified" EHR technology. The rule also establishes payment penalties in future years for eligible providers who have not met the requirements for meaningful use of EHRs. Meaningful use must be achieved using EHR technology that has been certified in accordance with functional and technical criteria that are set forth a regulation that parallels the meaningful use criteria in the incentive program. These actions and regulations are important to laboratories and pathologists for a number of reasons. Several of the criteria and requirements in the meaningful use rules and EHR certification criteria relate directly or indirectly to laboratory testing and laboratory information management, and future stage requirements are expected to impact the laboratory as well. Furthermore, as EHR uptake expands, there will be greater expectations for electronic interchange of laboratory information and laboratory information system (LIS)-EHR interfaces. Laboratories will need to be aware of the technical, operational, and business challenges that they may face as expectations for LIS-EHR increase. This paper reviews the important recent federal efforts aimed at accelerating EHR use, including the incentive program for EHR meaningful use, provider eligibility, and EHR certification criteria, from a perspective of their relevance for laboratories and pathology practices.

To measure user expectations and knowledge of the issues involved in the transition from a paper-based system to an EHR, we created an on-line questionnaire, and invited physicians from several specialties at Beth Israel Medical Center (BIMC) to respond to it. As expected, most participants had positive expectations for the EHR and its features, but respondents were more skeptical of electronic clinical decision support systems (CDSS) than we had expected. The responses of this "EHR-naïve" group of physicians underscore the importance of managing expectations with the implementation of the EHR and of the delicate balance involved in preserving physician independence when proposing a clinical decision support system.

This paper examines whether there is a political budget cycle (PBC) in countries in the euro area. Using a multivariate model for the period 1999-2004 and various election indicators we find strong evidence that the Stability and Growth Pact has not restricted fiscal policy makers in the euro area in pursuing expansionary policies before elections. In an election-year – but not in the year prior to the election – the budget deficit increases. This result is in line with third generation PBC models, which are based on moral hazard. We also find a significant but small partisan effect on fiscal policy outcomes.

This paper investigates fiscal sustainability in an overlapping generations economy with endogenous growth coming from human capital formation through educational spending. We assess how budgetary imbalances affect economic dynamics and the outlook for economic growth, thereby providing a rationale for fiscal rules ensuring sustainability. Our results show that the appropriate response of fiscal policy to temporary shocks is not trivial in the absence of fiscal rules. Fiscal rules allow for a timely reaction, thereby avoiding possibly disruptive fiscal adjustment in the future: the more adjustment is delayed, the larger is its necessary scale. We perform a rough calibration of the model to simulate the effects of a demographic shock (change in the population growth rate) under different fiscal policy scenarios.