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This review examines what is known about the production and use of home brew in the Pacific Islands countries and territories. Data collection involved interviews of 78 men and women from the Marshall Islands, Papua New Guinea, Toga, and Tuvalu. The interviews were conducted in 2013 by local interviewers. The questions fell into four key areas: people's history of home-brew consumption, the reasons for home-brew use, the effects of home brew, and people's perceptions about home brew. An open ethnographic approach revealed that males are the main consumers of home brew, that home brew is consumed in private venues by those with low socioeconomic status, and that there are positive and negative outcomes associated with the use of home brew. Finally, policy implications of the findings are included in this article.

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Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach--one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions.

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Governments and health service providers around the world are under pressure to improve health outcomes while containing rising healthcare costs. In response to such challenges, many regions have implemented services that have been successful in other countries-but 'importing' initiatives has many challenges. This article summarizes factors found to be critical to the success of adapting a US disease management and health promotion programme for use in Italy and the UK. Using three illustrative case studies, it describes how in each region the programme needed to adapt (i) the form and content of the disease management service, (ii) the involvement and integration with local clinicians and services and (iii) the evaluation of programme outcomes. We argue that it is important to implement evidence-based practice by learning lessons from other countries and service initiatives, but that it is equally important to take into consideration the '3Ps' that are critical for successful service implementation: payers, practitioners and patients.

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Improved health care, lifestyle changes and changing demography mean that more people are living longer and often with chronic diseases that cannot currently be cured. Advances in health care that support longer life are to be celebrated, but health care systems cannot cope with the increasing incidence and cost of chronic diseases. Across low-, medium- and high-income countries, 50­80% of the health budget is spent on chronic diseases. Without intervention, this will continue to rise, as risk factors such as tobacco use, unhealthy diet and lack of physical activity remain prevalent. Chronic diseases cause 86% of deaths across the 53 Member States in the WHO European Region. Countries have set up interventions to reduce the social, health and financial effects of chronic diseases. However, when used in isolation, these interventions may have limited long-term impact, especially given the need to tackle inequality in health and problems with transferring initiatives across the varied contexts of the Region. Chronic disease management is a systematic approach for coordinating health care interventions and communication at the individual, organizational, regional or national level. Evidence indicates that coordinated approaches are more effective than single or uncoordinated interventions, but the best strategies for integrating interventions across different providers, regions and funding systems remain uncertain.

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Chronische Krankheiten sind für 86% der Todesfälle in den 53 Mitgliedstaaten der Europäischen Region der WHO verantwortlich. Die Länder haben Maßnahmen ergriffen, um die sozialen, gesundheitlichen und finanziellen Auswirkungen chronischer Erkrankungen einzudämmen. Wenn diese Maßnahmen isoliert eingesetzt werden, ist ihre Langzeitwirkung jedoch begrenzt, insbesondere was die notwendige Bekämpfung der Ungleichbehandlung im Gesundheitswesen betrifft und auch im Hinblick auf die Schwierigkeit, die Initiativen auf die verschiedenen lokalen Rahmenbedingungen der Region zu übertragen. Krankheitsmanagement ist ein systematisches Verfahren zur Koordination vonGesundheitsversorgungsmaßnahmen und zum Informationsaustausch auf individueller, institutioneller, regionaler oder nationaler Ebene. Die vorliegenden Erkenntnisse sprechen dafür, dass koordinierte Lösungen wirksamer sind als einzelne oder unkoordinierte Maßnahmen, aber es ist unklar, welche Strategien am besten geeignet sind, um die verschiedenen Dienstleister, Regionen und Finanzierungssysteme optimal in die Maßnahmen einzubinden.

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В 53 государствах-членах Европейского региона ВОЗ в 86% случаев причиной смерти является хроническое заболевание. Страны должны разработать и внедрить мероприятия по снижению социальных, медицинских и финансовых последствий хронических болезней. Однако когда эти мероприятияпроводятся изолированно друг от друга, они могут иметь ограниченный долгосрочный эффект, особенно если учитывать необходимость решения проблемы неравенства в отношении здоровья, а также сложности распространения инициатив в многообразных условиях Региона. Ведение хронических болезней требует системного подхода, позволяющего координировать мероприятия в области здравоохранения и осуществлять коммуникации на индивидуальном, организационном, региональном или национальном уровне. Фактические данные подтверждают, что согласованный подход является более эффективным, чем отдельные, не связанныемежду собой вмешательства, однако остается неясным, какие стратегии лучше всего подходят для интегрированных мероприятий, охватывающих различных поставщиков услуг, регионы и системы финансирования.

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Les maladies chroniques sont à l’origine de 86 % des décès dans les 53 États membres de la Région européenne de l’OMS. Les pays ont mis en place des interventions pour réduire leur impact social, sanitaire et financier. Toutefois,lorsqu’elles sont menées isolément, ces interventions risquent de n’avoir qu’un effet limité à long terme, en raison notamment de la nécessité de s’attaquer aux inégalités en santé et des problèmes que pose la transposition desinitiatives dans les divers contextes de la Région.La prise en charge des maladies chroniques est une approche systématique visant à coordonner les interventions en soins de santé et les communicationsau niveau individuel, organisationnel, régional ou national. Les données factuelles montrent que des approches coordonnées sont plus efficaces que des interventions isolées ou non coordonnées, mais il est difficile de dire quellessont les meilleures stratégies pour coordonner les interventions entre différents prestataires, régions et systèmes financiers.

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Chronic diseases cause 86% of deaths across the 53 Member States in the WHO European Region. Countries have set up interventions to reduce thesocial, health and financial effects of chronic diseases. However, when used in isolation, these interventions may have limited long-term impact, especially given the need to tackle inequality in health and problems with transferring initiatives across the varied contexts of the Region. Chronic disease management is a systematic approach for coordinating health care interventions and communication at the individual, organizational, regional or national level. Evidence indicates that coordinated approaches are more effective than single or uncoordinated interventions, but the best strategies for integrating interventions across different providers, regions and funding systems remain uncertain.

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We have conducted a systematic review of home telecare for frail elderly people and for patients with chronic conditions. We searched 17 electronic databases, the reference lists of identified studies, conference proceedings and Websites for studies available in January 2006. We identified summaries of 8666 studies, which were assessed independently for relevance by two reviewers. Randomized controlled trials of any size and observational studies with 80 or more participants were eligible for inclusion if they examined the effects of using telecommunications technology to (a) monitor vital signs or safety and security in the home, or (b) provide information and support. The review included 68 randomized controlled trials (69%) and 30 observational studies with 80 or more participants (31%). Most studies focused on people with diabetes (31%) or heart failure (29%). Almost two-thirds (64%) of the studies originated in the US; more than half (55%) had been published within the previous three years. Based on the evidence reviewed, the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow-up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of these interventions was less certain. There is insufficient evidence about the effects of home safety and security alert systems. It is important to note that just because there is insufficient evidence about some interventions, this does not mean that those interventions have no effect.

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The National Childbirth Trust wants all women to be able to give birth with confidence and dignity, and believes it is important for women to begin motherhood feeling fit and well, good about themselves, and valued and supported by others. Good health and positive experiences can act as a buffer against the tiredness and demands of looking after a new baby. This paper draws on surveys conducted in 2003 and 2005 to describe what women want and need from birth environments, and how these factors can help or hinder them in having the kind of birth experience they desire.

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