Weaving public health education into the fabric of a family medicine residency.

PubMed

Potts, Stacy E; Deligiannidis, Konstantinos E; Cashman, Suzanne B; Caggiano, Marie E; Carter, Lisa H; Haley, Heather-Lyn; Ferguson, Warren J

2011-10-01

Policymakers and accrediting bodies have recognized the importance of integrating public health, population health, and prevention into graduate medical education programs. The high prevalence of chronic illness, coupled with the impact of behavioral and societal determinants of health, necessitate an urgent call for family medicine residencies to prepare future leaders to meet these challenges. The University of Massachusetts Worcester Family Medicine Residency recently developed an integrated curriculum that strives to develop a culture of incorporating fundamental public health principles into everyday practice. This public health curriculum was designed to integrate new topics within the current residency structure through longitudinal and concentrated experiences. This strategy has substantially improved public health and prevention education without substantial impact on the already strained residency curricular structure. This paper describes the integration of public health and prevention education into a family medicine residency to help residents acquire the fundamental skills necessary to improve a population's health. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Public Health Surveillance Strategies for Mass Gatherings: Super Bowl XLIX and Related Events, Maricopa County, Arizona, 2015.

PubMed

Ayala, Aurimar; Berisha, Vjollca; Goodin, Kate; Pogreba-Brown, Kristen; Levy, Craig; McKinney, Benita; Koski, Lia; Imholte, Sara

2016-01-01

Super Bowl XLIX took place on February 1, 2015, in Glendale, Arizona. In preparation for this event and associated activities, the Maricopa County Department of Public Health (MCDPH) developed methods for enhanced surveillance, situational awareness, and early detection of public health emergencies. Surveillance strategies implemented from January 22 to February 6, 2015, included enhanced surveillance alerts; animal disease surveillance; review of NFL clinic visits; syndromic surveillance for emergency room visits, urgent care facilities, and hotels; real-time onsite syndromic surveillance; all-hazards mortality surveillance; emergency medical services surveillance, review of poison control center reports; media surveillance; and aberration detection algorithms for notifiable diseases. Surveillance results included increased influenzalike illness activity reported from urgent care centers and a few influenza cases reported in the NFL clinic. A cyanide single event exposure was investigated and determined not to be a public health threat. Real-time field syndromic surveillance documented minor injuries at all events and sporadic cases of gastrointestinal and neurological (mostly headaches) disease. Animal surveillance reports included a cat suspected of carrying plague and tularemia and an investigation of highly pathogenic avian influenza in a backyard chicken flock. Laboratory results in both instances were negative. Aberration detection and syndromic surveillance detected an increase in measles reports associated with a Disneyland exposure, and syndromic surveillance was used successfully during this investigation. Coordinated enhanced epidemiologic surveillance during Super Bowl XLIX increased the response capacity and preparedness of MCDPH to make informed decisions and take public health actions in a timely manner during these mass gathering events.

Challenges and Opportunities for Advancing Work on Climate Change and Public Health.

PubMed

Gould, Solange; Rudolph, Linda

2015-12-09

Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change's health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities.

Challenges and Opportunities for Advancing Work on Climate Change and Public Health

PubMed Central

Gould, Solange; Rudolph, Linda

2015-01-01

Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change’s health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities. PMID:26690194

How Research Influences Policy: The Evidence We Need to "Speak Truth to Power"--A Reflection on an AAHE Scholar Address Three Decades on

ERIC Educational Resources Information Center

Green, Lawrence W.

2017-01-01

Thirty years after expressing concerns about the translation and communication of science to the public and to policy makers, this reflection finds that the same issues face public health education perhaps even more urgently today with the advent of politicians who actively dispute science, and a public that has voted in support of their campaign…

Gender issues in medical and public health education.

PubMed

Wong, Y L

2000-01-01

There is no doubt that gender bias has been inherent in medical and public health education, research, and clinical practice. This paper discusses the central question for medical and public health educators viz. whether women's health concerns and needs could be best addressed by the conventional biomedical approach to medical and public health education, research, and practice. Gender inequalities in health and gender bias in medical and public health education are revealed. It is found that in most public health and prevention issues related to women's health, the core issue is male-female power relations, and not merely the lack of public health services, medical technology, or information. There is, thus, an urgent need to gender-sensitize public health and medical education. The paper proposes a gender analysis of health to distinguish between biological causes and social explanations for the health differentials between men and women. It also assessed some of the gender approaches to public health and medical education currently adopted in the Asia-Pacific region. It poses the pressing question of how medical and public health educators integrate the gender perspective into medical and public health education. The paper exhorts all medical and public health practitioners to explore new directions and identify innovative strategies to formulate a gender-sensitive curriculum towards the best practices in medicine and public health that will meet the health needs of women and men in the 21st century.

Promoting Health in American-Occupied Japan Resistance to Allied Public Health Measures, 1945-1952

PubMed Central

2009-01-01

As soon as the authority of the Public Health and Welfare Section (PHW) of the Supreme Commander for Allied Powers waned in May 1951, the Japanese government overturned several measures it had implemented. Although the PHW contributed greatly toward improving public health conditions, not all of its activities were models of cooperative success. Many Japanese perceived some measures—terminated pensions for wounded Japanese veterans, lack of support for segregated orphanages for mixed-race children, and suppression of Japanese atomic bomb medical reports—as promoting US national interest at the expense of Japanese public health needs. Similarly, the PHW's upgrade of nursing education and separation of the professions of medicine and pharmacy were reversed because neither professionals nor the public saw these measures as urgent. Their reinstitution toward the end of the twentieth century suggests that the progressive measures were sound, but broke too sharply with Japanese tradition and were enforced prematurely. PMID:19542032

Strengthening Health Systems in Poor Countries: A Code of Conduct for Nongovernmental Organizations

PubMed Central

Johnson, Wendy; Fort, Meredith; Shakow, Aaron; Hagopian, Amy; Gloyd, Steve; Gimbel-Sherr, Kenneth

2008-01-01

The challenges facing efforts in Africa to increase access to antiretroviral HIV treatment underscore the urgent need to strengthen national health systems across the continent. However, donor aid to developing countries continues to be disproportionately channeled to international nongovernmental organizations (NGOs) rather than to ministries of health. The rapid proliferation of NGOs has provoked “brain drain” from the public sector by luring workers away with higher salaries, fragmentation of services, and increased management burdens for local authorities in many countries. Projects by NGOs sometimes can undermine the strengthening of public primary health care systems. We argue for a return to a public focus for donor aid, and for NGOs to adopt a code of conduct that establishes standards and best practices for NGO relationships with public sector health systems. PMID:18923125

Public health ethics related training for public health workforce: an emerging need in the United States.

PubMed

Kanekar, A; Bitto, A

2012-01-01

Ethics is a discipline, which primarily deals with what is moral and immoral behavior. Public Health Ethics is translation of ethical theories and concepts into practice to address complex multidimensional public health problems. The primary purpose of this paper was to conduct a narrative literature review-addressing role of ethics in developing curriculum in programs and schools of public health, ethics-related instruction in schools and programs of public health and the role of ethics in developing a competent public health workforce. An open search of various health databases including Google scholar and Ebscohost yielded 15 articles related to use of ethics in public health practice or public health training and the salient features were reported. Results indicated a variable amount of ethics' related training in schools and programs of public health along with public health practitioner training across the nation. Bioethics, medical ethics and public health ethics were found to be subspecialties' needing separate ethical frameworks to guide decision making. Ethics based curricular and non-curricular training for emerging public health professionals from schools and programs of public health in the United States is extremely essential. In the current age of public health challenges faced in the United States and globally, to have an ethically untrained public health force is arguably, immoral and unethical and jeopardizes population health. There is an urgent need to develop innovative ethic based curriculums in academia as well as finding effective means to translate these curricular competencies into public health practice.

Patient perceptions of asthma-related financial burden: public vs. private health insurance in the United States.

PubMed

Patel, Minal R; Caldwell, Cleopatra H; Song, Peter X K; Wheeler, John R C

2014-10-01

Given the complexity of the health insurance market in the United States and the confusion that often stems from these complexities, patient perception about the value of health insurance in managing chronic disease is important to understand. To examine differences between public and private health insurance in perceptions of financial burden with managing asthma, outcomes, and factors that explain these perceptions. Secondary analysis was performed using baseline data from a randomized clinical trial that were collected through telephone interviews with 219 African American women seeking services for asthma and reporting perceptions of financial burden with asthma management. Path analysis with multigroup models and multiple variable regression analyses were used to examine associations. For public (P < .001) and private (P < .01) coverage, being married and more educated were indirectly associated with greater perceptions of financial burden through different explanatory pathways. When adjusted for multiple morbidities, asthma control, income, and out-of-pocket expenses, those with private insurance used fewer inpatient (P < .05) and emergency department (P < .001) services compared with those with public insurance. When also adjusted for health insurance, greater financial burden was associated with more urgent office visits (P < .001) and lower quality of life (P < .001). African American women who perceive asthma as a financial burden regardless of health insurance report more urgent health care visits and lower quality of life. Burden may be present despite having and being able to generate economic resources and health insurance. Further policy efforts are indicated and special attention should focus on type of coverage. Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Urgency to Assess the Health Impact of Ambient Air Pollution in China.

PubMed

Yang, Bo-Yi; Liu, Yimin; Hu, Li-Wen; Zeng, Xiao-Wen; Dong, Guang-Hui

2017-01-01

As the world's second-largest economy, China is going on suffering from environmental pollution, especially for ambient air pollution, which has become a major threat to public health; public awareness of the detrimental effects of air pollution on health is increasing-particularly in relation to haze days. Considering the nonlinear relationship of ambient air pollution exposure and health impacts, and the differences in specific sources of air pollution with those in North America and Europe, conducting health impact assessments of ambient air pollution in China has thus become an urgent task for public health practitioners. Systematic review of the health effects of exposure to ambient air pollution from quantitative studies conducted in Chinese could provide vital information for epidemiology-based health impact assessments and the implementation of a national environmental protection policy.

Science in Emergency Response at CDC: Structure and Functions.

PubMed

Iskander, John; Rose, Dale A; Ghiya, Neelam D

2017-09-01

Recent high-profile activations of the US Centers for Disease Control and Prevention (CDC) Emergency Operations Center (EOC) include responses to the West African Ebola and Zika virus epidemics. Within the EOC, emergency responses are organized according to the Incident Management System, which provides a standardized structure and chain of command, regardless of whether the EOC activation occurs in response to an outbreak, natural disaster, or other type of public health emergency. By embedding key scientific roles, such as the associate director for science, and functions within a Scientific Response Section, the current CDC emergency response structure ensures that both urgent and important science issues receive needed attention. Key functions during emergency responses include internal coordination of scientific work, data management, information dissemination, and scientific publication. We describe a case example involving the ongoing Zika virus response that demonstrates how the scientific response structure can be used to rapidly produce high-quality science needed to answer urgent public health questions and guide policy. Within the context of emergency response, longer-term priorities at CDC include both streamlining administrative requirements and funding mechanisms for scientific research.

Climate Change: From Science to Practice.

PubMed

Wheeler, Nicola; Watts, Nick

2018-03-01

Climate change poses a significant threat to human health. Understanding how climate science can be translated into public health practice is an essential first step in enabling robust adaptation and improving resiliency to climate change. Recent research highlights the importance of iterative approaches to public health adaptation to climate change, enabling uncertainties of health impacts and barriers to adaptation to be accounted for. There are still significant barriers to adaptation, which are context-specific and thus present unique challenges to public health practice. The implementation of flexible adaptation approaches, using frameworks targeted for public health, is key to ensuring robust adaptation to climate change in public health practice. The BRACE framework provides an excellent approach for health adaptation to climate change. Combining this with the insights provided and by the adaptation pathways approach allows for more deliberate accounting of long-term uncertainties. The mainstreaming of climate change adaptation into public health practice and planning is important in facilitating this approach and overcoming the significant barriers to effective adaptation. Yet, the immediate and future limits to adaptation provide clear justification for urgent and accelerated efforts to mitigate climate change.

Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia.

PubMed

Santric Milicevic, Milena; Vasic, Milena; Edwards, Matt; Sanchez, Cristina; Fellows, John

2018-06-01

At the beginning of the 21st century, planning the public health workforce requirements came into the focus of policy makers. The need for improved provision of essential public health services, driven by a challenging non-communicable disease and causes of death and disability within Serbia, calls for a much needed estimation of the requirements of the public health professionals. Mid and long-term public health specialists' supply and demand estimations out to 2025were developed based on national staffing standards and regional distribution of the workforce in public health institutes of Serbia. By 2025, the supply of specialists, taking into account attrition rate of -1% reaches the staffing standard. However, a slight increase in attrition rates has the impact of revealing supply shortage risks. Demand side projections show that public health institutes require an annual input of 10 specialists or 2.1% annual growth rate in order for the four public health fields to achieve a headcount of 487 by 2025 as well as counteract workforce attrition rates. Shortage and poor distribution of public health specialists underline the urgent need for workforce recruitment and retention in public health institutes in order to ensure the coordination, management, surveillance and provision of essential public health services over the next decade. Copyright © 2018 Elsevier B.V. All rights reserved.

Adoption and implementation of a computer-delivered HIV/STD risk-reduction intervention for African American adolescent females seeking services at county health departments: implementation optimization is urgently needed.

PubMed

DiClemente, Ralph J; Bradley, Erin; Davis, Teaniese L; Brown, Jennifer L; Ukuku, Mary; Sales, Jessica M; Rose, Eve S; Wingood, Gina M

2013-06-01

Although group-delivered HIV/sexually transmitted disease (STD) risk-reduction interventions for African American adolescent females have proven efficacious, they require significant financial and staffing resources to implement and may not be feasible in personnel- and resource-constrained public health clinics. We conducted a study assessing adoption and implementation of an evidence-based HIV/STD risk-reduction intervention that was translated from a group-delivered modality to a computer-delivered modality to facilitate use in county public health departments. Usage of the computer-delivered intervention was low across 8 participating public health clinics. Further investigation is needed to optimize implementation by identifying, understanding, and surmounting barriers that hamper timely and efficient implementation of technology-delivered HIV/STD risk-reduction interventions in county public health clinics.

Adoption and Implementation of a Computer-delivered HIV/STD Risk-Reduction Intervention for African American Adolescent Females Seeking Services at County Health Departments: Implementation Optimization is Urgently Needed

PubMed Central

DiClemente, Ralph J.; Bradley, Erin; Davis, Teaniese L.; Brown, Jennifer L.; Ukuku, Mary; Sales, Jessica M.; Rose, Eve S.; Wingood, Gina M.

2013-01-01

Although group-delivered HIV/STD risk-reduction interventions for African American adolescent females have proven efficacious, they require significant financial and staffing resources to implement and may not be feasible in personnel- and resource-constrained public health clinics. We conducted a study assessing adoption and implementation of an evidence-based HIV/STD risk-reduction intervention that was translated from a group-delivered modality to a computer-delivered modality to facilitate use in county public health departments. Usage of the computer-delivered intervention was low across eight participating public health clinics. Further investigation is needed to optimize implementation by identifying, understanding and surmounting barriers that hamper timely and efficient implementation of technology-delivered HIV/STD risk-reduction interventions in county public health clinics. PMID:23673891

Implementation of Assessment of Polar Biomedical Research

DTIC Science & Technology

1988-08-01

biomedicine in educational programs and professional society activities and publications is urgently needed. RECENT STATEMENTS ON POLAR BIOMEDICAL RESEARCH...study methods for training administrators, community health aides, paraprofessionals, and professionals ; 3. to conduct research to increase the...to be studied as well as the professionals and agencies involved in providing health care; and • ensure that results of all research are reported

Chemical Pesticides and Human Health: The Urgent Need for a New Concept in Agriculture.

PubMed

Nicolopoulou-Stamati, Polyxeni; Maipas, Sotirios; Kotampasi, Chrysanthi; Stamatis, Panagiotis; Hens, Luc

2016-01-01

The industrialization of the agricultural sector has increased the chemical burden on natural ecosystems. Pesticides are agrochemicals used in agricultural lands, public health programs, and urban green areas in order to protect plants and humans from various diseases. However, due to their known ability to cause a large number of negative health and environmental effects, their side effects can be an important environmental health risk factor. The urgent need for a more sustainable and ecological approach has produced many innovative ideas, among them agriculture reforms and food production implementing sustainable practice evolving to food sovereignty. It is more obvious than ever that the society needs the implementation of a new agricultural concept regarding food production, which is safer for man and the environment, and to this end, steps such as the declaration of Nyéléni have been taken.

Chemical Pesticides and Human Health: The Urgent Need for a New Concept in Agriculture

PubMed Central

Nicolopoulou-Stamati, Polyxeni; Maipas, Sotirios; Kotampasi, Chrysanthi; Stamatis, Panagiotis; Hens, Luc

2016-01-01

The industrialization of the agricultural sector has increased the chemical burden on natural ecosystems. Pesticides are agrochemicals used in agricultural lands, public health programs, and urban green areas in order to protect plants and humans from various diseases. However, due to their known ability to cause a large number of negative health and environmental effects, their side effects can be an important environmental health risk factor. The urgent need for a more sustainable and ecological approach has produced many innovative ideas, among them agriculture reforms and food production implementing sustainable practice evolving to food sovereignty. It is more obvious than ever that the society needs the implementation of a new agricultural concept regarding food production, which is safer for man and the environment, and to this end, steps such as the declaration of Nyéléni have been taken. PMID:27486573

'High profile health facilities can add to your trouble': Women, stigma and un/safe abortion in Kenya.

PubMed

Izugbara, Chimaraoke O; Egesa, Carolyne; Okelo, Rispah

2015-09-01

Public health discourses on safe abortion assume the term to be unambiguous. However, qualitative evidence elicited from Kenyan women treated for complications of unsafe abortion contrasted sharply with public health views of abortion safety. For these women, safe abortion implied pregnancy termination procedures and services that concealed their abortions, shielded them from the law, were cheap and identified through dependable social networks. Participants contested the notion that poor quality abortion procedures and providers are inherently dangerous, asserting them as key to women's preservation of a good self, management of stigma, and protection of their reputation, respect, social relationships, and livelihoods. Greater public health attention to the social dimensions of abortion safety is urgent. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Role of government in public health: Current scenario in India and future scope

PubMed Central

Lakshminarayanan, Subitha

2011-01-01

The new agenda for Public Health in India includes the epidemiological transition, demographical transition, environmental changes and social determinants of health. Based on the principles outlined at Alma-Ata in 1978, there is an urgent call for revitalizing primary health care in order to meet these challenges. The role of the government in influencing population health is not limited within the health sector but also by various sectors outside the health systems. This article is a literature review of the existing government machinery for public health needs in India, its success, limitations and future scope. Health system strengthening, human resource development and capacity building and regulation in public health are important areas within the health sector. Contribution to health of a population also derives from social determinants of health like living conditions, nutrition, safe drinking water, sanitation, education, early child development and social security measures. Population stabilization, gender mainstreaming and empowerment, reducing the impact of climate change and disasters on health, improving community participation and governance issues are other important areas for action. Making public health a shared value across the various sectors is a politically challenging strategy, but such collective action is crucial. PMID:21694957

The World report on ageing and health: a policy framework for healthy ageing

PubMed Central

Beard, John R; Officer, Alana; de Carvalho, Islene Araujo; Sadana, Ritu; Pot, Anne Margriet; Michel, Jean-Pierre; Lloyd-Sherlock, Peter; Epping-Jordan, JoAnne E; Peeters, G M E E (Geeske); Mahanani, Wahyu Retno; Thiyagarajan, Jotheeswaran Amuthavalli; Chatterji, Somnath

2015-01-01

Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report. PMID:26520231

Scrub Typhus Outbreak in a Remote Primary School, Bhutan, 2014.

PubMed

Tshokey, Tshokey; Graves, Stephen; Tshering, Dorji; Phuntsho, Kelzang; Tshering, Karchung; Stenos, John

2017-08-01

Scrub typhus in Bhutan was first reported in 2009. We investigated an outbreak of scrub typhus in a remote primary school during August-October 2014. Delay in recognition and treatment resulted in 2 deaths from meningoencephalitis. Scrub typhus warrants urgent public health interventions in Bhutan.

Mapping Africa's advanced public health education capacity: the AfriHealth project.

PubMed

Ijsselmuiden, C B; Nchinda, T C; Duale, S; Tumwesigye, N M; Serwadda, D

2007-12-01

Literature on human resources for health in Africa has focused on personal health services. Little is known about graduate public health education. This paper maps "advanced" public health education in Africa. Public health includes all professionals needed to manage and optimize health systems and the public's health. Data were collected through questionnaires and personal visits to departments, institutes and schools of community medicine or public health. Simple descriptive statistics were used to analyse the data. For more than 900 million people, there are fewer than 500 full-time staff, around two-thirds of whom are male. More men (89%) than women (72%) hold senior degrees. Over half (55%) of countries do not have any postgraduate public health programme. This shortage is most severe in lusophone and francophone Africa. The units offering public health programmes are small: 81% have less than 20 staff, and 62% less than 10. On the other hand, over 80% of Africans live in countries where at least one programme is available, and there are six larger schools with over 25 staff. Programmes are often narrowly focused on medical professionals, but "open" programmes are increasing in number. Public health education and research are not linked. Africa urgently needs a plan for developing its public health education capacity. Lack of critical mass seems a key gap to be addressed by strengthening subregional centres, each of which should provide programmes to surrounding countries. Research linked to public health education and to educational institutions needs to increase.

Assessing the sustained impact and mediators of health behavior change of the "Healthy Habits, Healthy Girls – Brazil" clustered randomized controlled trial for Brazilian adolescents

USDA-ARS?s Scientific Manuscript database

Pediatric obesity is a major public health concern in low- and middle-income countries (LMIC) such as Brazil. There is an urgent need for preventive programs for adolescents, the assessment of their sustained impact, as well as identification of the mediators of effects on body composition. This stu...

[Health communication and public media: professionals need to be heard].

PubMed

Meijman, F J

2008-08-09

The exchange of information on individual healthcare and public health as well as public opinion on medical matters are characterized by their own systems of values, norms and conventions that are not always compatible. All of these aspects put together give public communication on health and care its complex and dynamic nature--where the interests of the individual and the community are often opposed. In this respect, the free interaction of publicity forces and the educational role of healthcare providers have traditionally been the backbone of policy in the Netherlands. There is only limited support by public money, only a few restrictions (for example, on direct-to-consumer drug-advertising) but no substantive guidance from the government. Websites funded from public money that provide information on healthcare have only been set up in the last few years. The Health Council of the Netherlands has recently proposed trust marking for screening tests only. Research is urgently needed with regard to health literacy, direct-to-consumer advertising and public communication on the appropriate use of care. Furthermore, professional opinion in the public arena is required as well as a more active role on the part of clinical and scientific professionals in the area of public debate.

Improved Space-Time Forecasting of next Day Ozone Concentrations in the Eastern U.S.

EPA Science Inventory

There is an urgent need to provide accurate air quality information and forecasts to the general public and environmental health decision-makers. This paper develops a hierarchical space-time model for daily 8-hour maximum ozone concentration (O3) data covering much of the easter...

Salutogenesis.

PubMed

Lindström, Bengt; Eriksson, Monica

2005-06-01

The editor of the journal has taken the initiative to develop glossaries on central concepts in health promotion. The aim of this paper is to explain and clarify the key concepts of the salutogenic theory sense of coherence coined by Aaron Antonovsky. The explanations and interpretations are the result of an analysis of the scientific evidence base of the first 25 years of salutogenic research, described and discussed in an ongoing project on a systematic review by the above authors. The contemporary evidence shows the salutogenic approach could have a more central position in public health and health promotion research and practice. Furthermore, it could contribute to the solution of some of the most urgent public health problems of our time such as the question of mental health promotion. Finally, it could create a solid theoretical framework for health promotion.

The impact of globalization on public health: implications for the UK Faculty of Public Health Medicine.

PubMed

Lee, K

2000-09-01

There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.

Chemical incidents: are we ready in the West Midlands? Testing the communication arrangements of on-call public health doctors.

PubMed

Pooransingh, S; Kibble, A; Saunders, P

2005-01-01

Primary care trusts are responsible for handling major chemical hazards. This includes the testing and exercising of plans in a regular and routine manner. The Chemical Hazards and Poisons Division (Birmingham), which provides a 24-h, 365-day resource for the West Midlands region in the UK, undertook an audit to test the out-of-hours communication arrangements of public health doctors. The audit revealed that there is an urgent need to: (1) review contact details within on-call packs; (2) ensure that doctors performing on-call duties know, at the very least, the names of the primary care trusts/local authorities, county councils/other trusts in the area; and (3) ensure a failsafe method for contacting the person on call for public health.

The Dissemination and Implementation of Evidence-Based Psychological Treatments: A Review of Current Efforts

ERIC Educational Resources Information Center

McHugh, R. Kathryn; Barlow, David H.

2010-01-01

Recognizing an urgent need for increased access to evidenced-based psychological treatments, public health authorities have recently allocated over $2 billion to better disseminate these interventions. In response, implementation of these programs has begun, some of it on a very large scale, with substantial implications for the science and…

Analysis of State Bullying Laws and Policies

ERIC Educational Resources Information Center

Stuart-Cassel, Victoria; Bell, Ariana; Springer, J. Fred

2011-01-01

Bullying in schools has become widely viewed as an urgent social, health, and education concern that has moved to the forefront of public debate on school legislation and policy. The Columbine High School shooting in 1999 was the first of many high-profile incidents of violent behavior that appeared to implicate bullying as an underlying cause…

Protection of sexual and reproductive health rights: addressing violence against women.

PubMed

García-Moreno, Claudia; Stöckl, Heidi

2009-08-01

Violence against women is recognized as a global public health and human rights problem in need of urgent attention. It affects women's health, including their sexual and reproductive health, and their human rights. While progress has been made in the last 15 years, there is still a long way to go. International human rights law and public health provide tools to governments and non-governmental actors to ensure women a life free from violence and its consequences. Health policies and services need to address violence more systematically and health providers must take action. At a minimum, they should be informed and able to respond appropriately to violence, providing appropriate care and referral to other services. Equally, if not more important, is to provide support to interventions that prevent violence against women from happening in the first place.

Slow Progress In Finalizing Measles And Rubella Elimination In The European Region.

PubMed

Biellik, Robin; Davidkin, Iria; Esposito, Susanna; Lobanov, Andrey; Kojouharova, Mira; Pfaff, Günter; Santos, José Ignacio; Simpson, John; Mamou, Myriam Ben; Butler, Robb; Deshevoi, Sergei; Huseynov, Shahin; Jankovic, Dragan; Shefer, Abigail

2016-02-01

All countries in the World Health Organization European Region committed to eliminating endemic transmission of measles and rubella by 2015, and disease incidence has decreased dramatically. However, there was little progress between 2012 and 2013, and the goal will likely not be achieved on time. Genuine political commitment, increased technical capacity, and greater public awareness are urgently needed, especially in Western Europe. Project HOPE—The People-to-People Health Foundation, Inc.

Education and personalized genomics: deciphering the public's genetic health report

PubMed Central

Lamb, Neil E; Myers, Richard M; Gunter, Chris

2010-01-01

Where do members of the public turn to understand what genetic tests mean in terms of their own health? Now that genome-wide association studies and complete genome sequencing are widely available, the importance of education in personalized genomics cannot be overstated. Although some media have introduced the concept of genetic testing to better understand health and disease, the public's understanding of the scope and impact of genetic variation has not kept up with the pace of the science or technology. Unfortunately, the likely sources to which the public turn to for guidance – their physician and the media – are often no better prepared. We examine several venues for information, including print and online guides for both lay and health-oriented audiences, and summarize selected resources in multiple formats. We also note on the roadblocks to progress and discuss ways to remove them, as urgent action is needed to connect people with their genomes in a meaningful way. PMID:20161675

HIV, Hepatitis C, TB, Harm Reduction, and Persons Deprived of Liberty

PubMed Central

Lines, Rick

2016-01-01

Abstract HIV, hepatitis C virus (HCV), and TB in prisons and other places of detention are serious public health concerns, with prevalence and incidence considerably higher than in the general community because of the overrepresentation of risky behavior, substandard conditions, overcrowding, people who inject drugs, and the wholly inadequate prevention, care, and treatment of these conditions, including the denial of harm reduction services. This is not only a severe public health crisis but also a serious human rights concern. This article works to clarify the standards established by human rights law with regards to HIV, HCV, TB, and harm reduction in prisons by examining international and regional case law, minimum standards on the treatment of prisoners and public health, as well as the work of UN treaty bodies, Special Rapporteurs, and prison monitoring bodies. It is imperative that urgent steps are taken to close the gap between human rights and public health standards on the one hand, and effective implementation in prison settings on the other. PMID:28559684

Communication and marketing as climate change-intervention assets a public health perspective.

PubMed

Maibach, Edward W; Roser-Renouf, Connie; Leiserowitz, Anthony

2008-11-01

The understanding that global climate change represents a profound threat to the health and well-being of human and nonhuman species worldwide is growing. This article examines the potential of communication and marketing interventions to influence population behavior in ways consistent with climate change prevention and adaptation objectives. Specifically, using a framework based on an ecologic model of public health, the paper examines: (1) the potential of communication and marketing interventions to influence population behaviors of concern, including support for appropriate public policies; (2) potential target audiences for such programs; and (3) the attributes of effective climate change messages. Communication and marketing interventions appear to have considerable potential to promote important population behavior change objectives, but there is an urgent need for additional translational research to effectively harvest this potential to combat climate change.

Re-visioning public health ethics: a relational perspective.

PubMed

Kenny, Nuala P; Sherwin, Susan B; Baylis, Françoise E

2010-01-01

Canada is in the forefront of thinking about the unique and complex issues of contemporary public health ethics. However, an inordinate focus on the urgent issues of emergency preparedness in pandemic and reliance on bioethical analysis steeped in the autonomy and individual rights tradition of health care and research do not serve adequately as the basis for an ethic of public health with its focus on populations, communities and the common good. This paper describes some concerns regarding the focus on pandemic ethics in isolation from public health ethics; identifies inadequacies in the dominant individualistic ethics framework; and summarizes nascent work on the concepts of relational autonomy, relational social justice and relational solidarity that can inform a re-visioning of public health ethics. While there is still much work to be done to further refine these principles, they can help to reclaim and centre the common and collective good at risk in pandemic and other emergency situations. Minimally, these principles require a policy-making process that is truly transparent, fair and inclusive; is sensitive and responsive to the workings of systemic inequalities; and requires public recognition of the fact that we enter any crisis with varying degrees of inequity. Public policy response to crisis must not forseeably increase existing inequities.

[A role of Russian psychiatrists in the formation of forensic psychiatry in Russia in the beginning of XIX century].

PubMed

Bezchasniy, K V

2016-01-01

The formation of forensic psychiatry knowledge as a special area of concern was due to fundamental changes in the social, economic and political life of Russia society. It reflected public awareness of the urgent need in solving the problem of support, preserve and maintain the mental health of the people. Forensic psychiatry was based on the development of psychiatry, public health and community medicine. Author describes of the role of Russian psychiatrists in the formation of forensic psychiatry, their active particitpation in internation professional meetings and in the development of the problem of responsibility.

Strengthening public health nutrition research and training capacities in West Africa: Report of a planning workshop convened in Dakar, Senegal, 26-28 March 2009.

PubMed

Brown, Kenneth H; McLachlan, Milla; Cardosa, Placido; Tchibindat, Félicité; Baker, Shawn K

2010-01-01

A three-day workshop was convened in Dakar, Senegal, to provide participants from West African and international academic and research institutions, public health agencies, and donor organisations an opportunity to review current public health nutrition research and training capabilities in West Africa, assess needs for strengthening the regional institutional and workforce capacities, and discuss appropriate steps required to advance this agenda. The workshop included presentations of background papers, experiences of regional and international training programmes and small group discussions. Participants concluded that there is an urgent need to: (1) increase the throughput of public health nutrition training programmes, including undergraduate education, pre-service and in-service professional training, and higher education in public health nutrition and related research skills; and (2) enhance applied research capacity, to provide the evidence base necessary for nutrition program planning and evaluation. A Task Team was appointed to inform the regional Assembly of Health Ministers of the workshop conclusions and to develop political and financial support for a regional nutrition initiative to: (1) conduct advocacy and nutrition stewardship; (2) survey existing training programmes and assist with curriculum development; and (3) develop a plan for a regional applied research institute in Public Health Nutrition.

43 CFR 404.13 - What criteria will Reclamation use to prioritize requests for assistance under the program?

Code of Federal Regulations, 2010 CFR

2010-10-01

... urgent and compelling need for a rural water supply project that would: (1) Address present or future water supply needs; or (2) Promote public health and safety by addressing present and preventing future violations of drinking water standards; (b) The extent to which a rural water supply project promotes and...

City Connects: Redesigning Student Support for Academic Success. The Abell Report. Volume 29, No. 3

ERIC Educational Resources Information Center

Manekin, Sarah

2016-01-01

Public school systems employ a range of professionals to provide support to children and youth in schools. For students living in poverty and experiencing trauma, the work of these professionals is particularly necessary and urgent. Ranging from the treatment of acute mental health issues and accommodations for students with special needs, to…

Global health in the 21st century

PubMed Central

Laaser, Ulrich; Brand, Helmut

2014-01-01

Introduction Since the end of the 1990s, globalization has become a common term, facilitated by the social media of today and the growing public awareness of life-threatening problems common to all people, such as global warming, global security and global divides. Review For the main parameters of health like the burden of disease, life expectancy and healthy life expectancy, extreme discrepancies are observed across the world. Infant mortality, malnutrition and high fertility go hand in hand. Civil society, as an indispensable activator of public health development, mainly represented by non-governmental organisations (NGOs), is characterised by a high degree of fragmentation and lack of public accountability. The World Federation of Public Health Associations is used as an example of an NGO with a global mission and fostering regional cooperation as an indispensable intermediate level. The lack of a globally valid terminology of basic public health functions is prohibitive for coordinated global and regional efforts. Attempts to harmonise essential public health functions, services and operations are under way to facilitate communication and mutual understanding. Recommendations 1) Given the limited effects of the Millennium Development Goal agenda, the Post-2015 Development Goals should focus on integrated regional development. 2) A code of conduct for NGOs should be urgently developed for the health sector, and NGOs should be registered and accredited. 3) The harmonisation of the basic terminology for global public health essentials should be enhanced. PMID:24560267

Global health in the 21st century.

PubMed

Laaser, Ulrich; Brand, Helmut

2014-01-01

Since the end of the 1990s, globalization has become a common term, facilitated by the social media of today and the growing public awareness of life-threatening problems common to all people, such as global warming, global security and global divides. For the main parameters of health like the burden of disease, life expectancy and healthy life expectancy, extreme discrepancies are observed across the world. Infant mortality, malnutrition and high fertility go hand in hand. Civil society, as an indispensable activator of public health development, mainly represented by non-governmental organisations (NGOs), is characterised by a high degree of fragmentation and lack of public accountability. The World Federation of Public Health Associations is used as an example of an NGO with a global mission and fostering regional cooperation as an indispensable intermediate level.The lack of a globally valid terminology of basic public health functions is prohibitive for coordinated global and regional efforts. Attempts to harmonise essential public health functions, services and operations are under way to facilitate communication and mutual understanding. 1) Given the limited effects of the Millennium Development Goal agenda, the Post-2015 Development Goals should focus on integrated regional development. 2) A code of conduct for NGOs should be urgently developed for the health sector, and NGOs should be registered and accredited. 3) The harmonisation of the basic terminology for global public health essentials should be enhanced.

Innovation in the role of the Office of the Ombudsman of the Unified Health System (SUS) - reflections and potential benefits.

PubMed

Fernandes, Fernando Manuel Bessa; Moreira, Marcelo Rasga; Ribeiro, José Mendes; Ouverney, Assis Mafort; Oliveira, Flávio José Fonseca de; Moro, Maria Francisca Abritta

2016-08-01

This article seeks to reflect on the potential of innovative practices in the design and work of the government bodies that comprise the National System of Offices of the Ombudsman of the Unified Health System. It is divided into two parts, seeking to answer the following question: How to think of and implement innovative practices - which include sustainability - when the people are voicing their urgent demands and these are being heard by the public authorities? These grievances are all the more urgent as they involve the area of Health and can they be promptly discussed, attended and resolved? In the first part, the article discusses the polysemic concept of innovation, focusing on its application in the three spheres of public administration, and highlights the importance of its close correlation with the different notions of information and knowledge in a society such as the one we live in. In the second, it develops a task-force of ideas for the office of the ombudsman and based on this, a draft operational concept of innovation in the role of the office of the ombudsman, considering the context of high speed change and transformations and the complexity inherent to contemporary life and the need for resource management and expertise development in information management.

Climate change and health in Israel: adaptation policies for extreme weather events.

PubMed

Green, Manfred S; Pri-Or, Noemie Groag; Capeluto, Guedi; Epstein, Yoram; Paz, Shlomit

2013-06-27

Climatic changes have increased the world-wide frequency of extreme weather events such as heat waves, cold spells, floods, storms and droughts. These extreme events potentially affect the health status of millions of people, increasing disease and death. Since mitigation of climate change is a long and complex process, emphasis has recently been placed on the measures required for adaptation. Although the principles underlying these measures are universal, preparedness plans and policies need to be tailored to local conditions. In this paper, we conducted a review of the literature on the possible health consequences of extreme weather events in Israel, where the conditions are characteristic of the Mediterranean region. Strong evidence indicates that the frequency and duration of several types of extreme weather events are increasing in the Mediterranean Basin, including Israel. We examined the public health policy implications for adaptation to climate change in the region, and proposed public health adaptation policy options. Preparedness for the public health impact of increased extreme weather events is still relatively limited and clear public health policies are urgently needed. These include improved early warning and monitoring systems, preparedness of the health system, educational programs and the living environment. Regional collaboration should be a priority.

Climate Change and Health on the U.S. Gulf Coast: Public Health Adaptation is Needed to Address Future Risks.

PubMed

Petkova, Elisaveta P; Ebi, Kristie L; Culp, Derrin; Redlener, Irwin

2015-08-11

The impacts of climate change on human health have been documented globally and in the United States. Numerous studies project greater morbidity and mortality as a result of extreme weather events and other climate-sensitive hazards. Public health impacts on the U.S. Gulf Coast may be severe as the region is expected to experience increases in extreme temperatures, sea level rise, and possibly fewer but more intense hurricanes. Through myriad pathways, climate change is likely to make the Gulf Coast less hospitable and more dangerous for its residents, and may prompt substantial migration from and into the region. Public health impacts may be further exacerbated by the concentration of people and infrastructure, as well as the region's coastal geography. Vulnerable populations, including the very young, elderly, and socioeconomically disadvantaged may face particularly high threats to their health and well-being. This paper provides an overview of potential public health impacts of climate variability and change on the Gulf Coast, with a focus on the region's unique vulnerabilities, and outlines recommendations for improving the region's ability to minimize the impacts of climate-sensitive hazards. Public health adaptation aimed at improving individual, public health system, and infrastructure resilience is urgently needed to meet the challenges climate change may pose to the Gulf Coast in the coming decades.

Environmental health research recommendations from the Inter-Environmental Health Sciences Core Center Working Group on unconventional natural gas drilling operations.

PubMed

Penning, Trevor M; Breysse, Patrick N; Gray, Kathleen; Howarth, Marilyn; Yan, Beizhan

2014-11-01

Unconventional natural gas drilling operations (UNGDO) (which include hydraulic fracturing and horizontal drilling) supply an energy source that is potentially cleaner than liquid or solid fossil fuels and may provide a route to energy independence. However, significant concerns have arisen due to the lack of research on the public health impact of UNGDO. Environmental Health Sciences Core Centers (EHSCCs), funded by the National Institute of Environmental Health Sciences (NIEHS), formed a working group to review the literature on the potential public health impact of UNGDO and to make recommendations for needed research. The Inter-EHSCC Working Group concluded that a potential for water and air pollution exists that might endanger public health, and that the social fabric of communities could be impacted by the rapid emergence of drilling operations. The working group recommends research to inform how potential risks could be mitigated. Research on exposure and health outcomes related to UNGDO is urgently needed, and community engagement is essential in the design of such studies.

Let's talk about sex: gender norms and sexual health in English schools.

PubMed

Jamal, Farah; Bonell, Chris; Wooder, Kai; Blake, Simon

2015-03-01

The sexual health of young people in England is an urgent public health concern. While interventions to address young people's sexual health have focussed on knowledge, skills and contraception access, amazingly none in the UK has explicitly addressed the effects of the social hierarchies of gender and gendered behavioural ideals that shape young people's sexual expectations, attitudes and behaviour. The lack of attention to gender is a persistent gap in health research, practice and policy. A rigorous evaluation of such an intervention package would go some way to building an evidence base for challenging gender norms, which appear to be strongly associated with adverse sexual health outcomes.

Public health impact of plastics: An overview

PubMed Central

Rustagi, Neeti; Pradhan, S. K.; Singh, Ritesh

2011-01-01

Plastic, one of the most preferred materials in today's industrial world is posing serious threat to environment and consumer's health in many direct and indirect ways. Exposure to harmful chemicals during manufacturing, leaching in the stored food items while using plastic packages or chewing of plastic teethers and toys by children are linked with severe adverse health outcomes such as cancers, birth defects, impaired immunity, endocrine disruption, developmental and reproductive effects etc. Promotion of plastics substitutes and safe disposal of plastic waste requires urgent and definitive action to take care of this potential health hazard in future. PMID:22412286

Public health workforce research in review: a 25-year retrospective.

PubMed

Hilliard, Tracy M; Boulton, Matthew L

2012-05-01

The Robert Wood Johnson Foundation commissioned a systematic review of public health workforce literature in fall 2010. This paper reviews public health workforce articles published from 1985 to 2010 that support development of a public health workforce research agenda, and address four public health workforce research themes: (1) diversity; (2) recruitment, retention, separation, and retirement; (3) education, training, and credentialing; and (4) pay, promotion, performance, and job satisfaction. PubMed, ERIC, and Web of Science databases were used to search for articles; Google search engine was used to identify gray literature. The study used the following inclusion criteria: (1) articles written in English published in the U.S.; (2) the main theme(s) of the article relate to at least one of the four public health workforce research themes; and (3) the document focuses on the domestic public health workforce. The literature suggests that the U.S. public health workforce is facing several urgent priorities that should be addressed, including: (1) developing an ethnically/racially diverse membership to meet the needs of an increasingly diverse nation; (2) recruiting and retaining highly trained, well-prepared employees, and succession planning to replace retirees; (3) building public health workforce infrastructure while also confronting a major shortage in the public health workforce, through increased education, training, and credentialing; and (4) ensuring competitive salaries, opportunities for career advancement, standards for workplace performance, and fostering organizational cultures which generate high levels of job satisfaction for effective delivery of services. Additional research is needed in all four thematic areas reviewed to develop well-informed, evidence-based strategies for effectively addressing critical issues facing the public health workforce. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

[Historical development and current demands on medical training, further and advanced training in hygiene and infection prevention].

PubMed

Exner, M; Kramer, A

2012-11-01

New risks in nosocomial infections and the dramatic increase in antibiotic-resistant pathogens in healthcare facilities have pointed to the urgent need for a good education of students and practitioners in the basics of hospital hygiene and infection prevention. On the other hand in the last 10 years a large number of institutes of hygiene in universities were closed with remarkable consequences concerning the decreased education in modern hygiene and public health. A broad historical overview over the last 200 years of teaching hygiene and public health at German universities is given which was integrated into the education of medical students. Nowadays many universities do not teach modern hygiene and public health. The demand of re-establishing new institutes of hygiene by the German Medical Council is discussed. The curriculum for the formation of hospital hygienists is presented.

The Lesotho Hospital PPP experience: catalyst for integrated service delivery.

PubMed

Coelho, Carla Faustino; O'Farrell, Catherine Commander

2011-01-01

For many years, Lesotho urgently needed to replace its main public hospital, Queen Elizabeth II. The project was initially conceived as a single replacement hospital, but eventually included the design and construction of a new 425 bed public hospital and adjacent primary care clinic, the renovation and expansion of three strategically located primary care clinics in the region and the management of all facilities, equipment and delivery of all clinical services in the health network by a private operator under contract for 18 years. The project's design was influenced by the recognition that a new facility alone would not address the underlying issues in service provision. The creation of this PPP health network and the contracting mechanism has increased accountability for service quality, shifted Government to a more strategic role and may also benefit other public facilities and providers in Lesotho. The county is considering the PPP approach for other health facilities.

Stakeholder prioritization of zoonoses in Japan with analytic hierarchy process method.

PubMed

Kadohira, M; Hill, G; Yoshizaki, R; Ota, S; Yoshikawa, Y

2015-05-01

There exists an urgent need to develop iterative risk assessment strategies of zoonotic diseases. The aim of this study is to develop a method of prioritizing 98 zoonoses derived from animal pathogens in Japan and to involve four major groups of stakeholders: researchers, physicians, public health officials, and citizens. We used a combination of risk profiling and analytic hierarchy process (AHP). Profiling risk was accomplished with semi-quantitative analysis of existing public health data. AHP data collection was performed by administering questionnaires to the four stakeholder groups. Results showed that researchers and public health officials focused on case fatality as the chief important factor, while physicians and citizens placed more weight on diagnosis and prevention, respectively. Most of the six top-ranked diseases were similar among all stakeholders. Transmissible spongiform encephalopathy, severe acute respiratory syndrome, and Ebola fever were ranked first, second, and third, respectively.

The Public Mind: Views of Pennsylvania Citizens. Smoking, Education, Tax Reform, Crime Control, Welfare Reform, Health Care Reform. Report No. 6.

ERIC Educational Resources Information Center

Mansfield Univ., PA. Rural Services Inst.

The sixth annual survey conducted by the Rural Services Institute examined the opinions of Pennsylvania residents on crime control, welfare reform, smoking, and education reform proposals. Sixty percent of respondents believed that the most urgent issue facing Pennsylvania was violent crime and strongly supported measures to reduce the…

Mutations of novel influenza A(H10N8) virus in chicken eggs and MDCK cells.

PubMed

Yang, Jian; Zhang, Ting; Guo, Li; Hu, Yongfeng; Li, Jinlin; Su, Haoxiang; Xiao, Yan; Ren, Xianwen; Dong, Jie; Sun, Lilian; Xiao, Yan; Li, Li; Yang, Fan; Wang, Jianwei; Yuan, Hui; Jin, Qi

2014-09-01

The recent emergence of human infection with influenza A(H10N8) virus is an urgent public health concern. Genomic analysis showed that the virus was conserved in chicken eggs but presented substantial adaptive mutations in MDCK cells. Our results provide additional evidence for the avian origin of this influenza virus.

[Analysis of the public health status and assessment of vaccination status in maternal health services and child and adolescent preventive health care of a district city].

PubMed

Mielke, U; Schneemilch, N

1991-01-01

A total of 23 maternity centres and 8 youth welfare centres in the county town of Magdeburg were inspected in 1987 and 1988 to review the condition of buildings and layout of rooms. Checks were also made on anti-infectious routines and compliance with the vaccination regulations. In all of these areas a number of deficiencies were found, and the results of follow-up inspections clearly show that the attention being given to public health regulations for sterilization and disinfection and to the storage of vaccines, is still inadequate. Urgent action is also required to improve conditions which are beyond the control of staff, such as buildings in need of repair, lack of space and the installation of washbasins, toilets, etc.

Unexpected plateauing of childhood obesity rates in developed countries

PubMed Central

2014-01-01

Surveys performed in the past 10 to 15 years show a yet unexplained stabilization or decline in prevalence rates of childhood obesity in developed countries. The projected continuous increase in obesity prevalence throughout future decades seems not to occur at present. Apparently, saturation has been reached, which might be related to societal adjustments. Hence, we postulate a cumulative effect of public health programs for obesity prevention resulting, for example, in an increase in physical activity, and a decline in television viewing and in the consumption of sugar-sweetened soft drinks by children. Effective public health programs are urgently needed for developing countries, where obesity rates in children still continued to increase during the past decade. PMID:24485015

Patients' Needs for Care in Public Mental Health: Unity and Diversity of Self-Assessed Needs for Care.

PubMed

Bellier-Teichmann, Tanja; Golay, Philippe; Bonsack, Charles; Pomini, Valentino

2016-01-01

Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients' needs are organized. This study investigates both general and specific dimensions of patients' needs for care. Patients' needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients' perceptions. A patient-centered psychiatric practice facilitates empowerment as it is based on the patients' personal motivations, needs, and wants. Four seventy-one patients' profiles were analyzed through exploratory factor analysis. A four-factor bifactor model, including one general factor and three specific factors of needs, was most adequate. Specific factors were (a) "finances" and "administrative tasks"; (b) "transports," "public places," "self-care," "housework," and "food"; and (c) "family," "children," "intimate relationships," and "friendship." As revealed by the general factor, patients expressing urgent needs in some domains are also more susceptible to report urgent needs in several other domains. This general factor relates to high versus low utilizers of public mental healthcare. Patients also present specific needs in life domains, which are organized in three dimensions: management, functional disabilities, and familial and interpersonal relationships. These dimensions relate to the different types of existing social support described in the literature.

[Attaching importance to study on acute health risk assessment and adaptation of air pollution and climate change].

PubMed

Shi, X M

2017-03-10

Air pollution and climate change have become key environmental and public health problems around the world, which poses serious threat to human health. How to assess and mitigate the health risks and increase the adaptation of the public have become an urgent topic of research in this area. The six papers in this issue will provide important and rich information on design, analysis method, indicator selection and setting about acute health risk assessment and adaptation study of air pollution and climate change in China, reflecting the advanced conceptions of multi-center and area-specific study and multi-pollutant causing acute effect study. However, the number and type of the cities included in these studies were still limited. In future, researchers should further expand detailed multi-center and multi-area study coverage, conduct area specific predicting and early warning study and strengthen adaptation study.

HIV, Hepatitis C, TB, Harm Reduction, and Persons Deprived of Liberty: What Standards Does International Human Rights Law Establish?

PubMed

Sander, Gen; Lines, Rick

2016-12-01

HIV, hepatitis C virus (HCV), and TB in prisons and other places of detention are serious public health concerns, with prevalence and incidence considerably higher than in the general community because of the overrepresentation of risky behavior, substandard conditions, overcrowding, people who inject drugs, and the wholly inadequate prevention, care, and treatment of these conditions, including the denial of harm reduction services. This is not only a severe public health crisis but also a serious human rights concern. This article works to clarify the standards established by human rights law with regards to HIV, HCV, TB, and harm reduction in prisons by examining international and regional case law, minimum standards on the treatment of prisoners and public health, as well as the work of UN treaty bodies, Special Rapporteurs, and prison monitoring bodies. It is imperative that urgent steps are taken to close the gap between human rights and public health standards on the one hand, and effective implementation in prison settings on the other.

Communication Between Infectious Disease Physicians and US State and Local Public Health Agencies

PubMed Central

Polgreen, Philip M.; Beekmann, Susan E.; Cairns, Catherine; Filice, Gregory A.; Layton, Marcelle; Hughes, James M.

2016-01-01

Strong working relationships between infectious disease (ID) physicians and public health have resulted in the early detection of emerging infectious threats. From May 6 through June 5, 2015, we surveyed ID physicians in the Infectious Diseases Society of America’s Emerging Infections Network about communications with public health. A total of 688 of 1491 (46%) members completed the survey, 624 (91%) of whom knew how to reach their health department directly for an urgent issue. Only 38 (6%) described communications with their health department as poor. Interest in newer technologies (eg, mobile smartphone applications) showed mixed results. Interest in a smartphone application differed significantly by years of ID experience, with 81 of 146 (55%) respondents with <5 years of ID experience, 172 of 359 (48%) respondents with 5 to 24 years of ID experience, and 61 of 183 (33%) respondents with ≥25 years of ID experience in favor of a smartphone application (P < .001). As more physicians adopt newer communication technologies, health departments should be prepared to incorporate these tools to communicate with ID physicians. PMID:28123206

Communication Between Infectious Disease Physicians and US State and Local Public Health Agencies: Strengths, Challenges, and Opportunities.

PubMed

Santibañez, Scott; Polgreen, Philip M; Beekmann, Susan E; Cairns, Catherine; Filice, Gregory A; Layton, Marcelle; Hughes, James M

2016-09-01

Strong working relationships between infectious disease (ID) physicians and public health have resulted in the early detection of emerging infectious threats. From May 6 through June 5, 2015, we surveyed ID physicians in the Infectious Diseases Society of America's Emerging Infections Network about communications with public health. A total of 688 of 1491 (46%) members completed the survey, 624 (91%) of whom knew how to reach their health department directly for an urgent issue. Only 38 (6%) described communications with their health department as poor. Interest in newer technologies (eg, mobile smartphone applications) showed mixed results. Interest in a smartphone application differed significantly by years of ID experience, with 81 of 146 (55%) respondents with <5 years of ID experience, 172 of 359 (48%) respondents with 5 to 24 years of ID experience, and 61 of 183 (33%) respondents with ≥25 years of ID experience in favor of a smartphone application ( P < .001). As more physicians adopt newer communication technologies, health departments should be prepared to incorporate these tools to communicate with ID physicians.

Climate change and health in Israel: adaptation policies for extreme weather events

PubMed Central

2013-01-01

Climatic changes have increased the world-wide frequency of extreme weather events such as heat waves, cold spells, floods, storms and droughts. These extreme events potentially affect the health status of millions of people, increasing disease and death. Since mitigation of climate change is a long and complex process, emphasis has recently been placed on the measures required for adaptation. Although the principles underlying these measures are universal, preparedness plans and policies need to be tailored to local conditions. In this paper, we conducted a review of the literature on the possible health consequences of extreme weather events in Israel, where the conditions are characteristic of the Mediterranean region. Strong evidence indicates that the frequency and duration of several types of extreme weather events are increasing in the Mediterranean Basin, including Israel. We examined the public health policy implications for adaptation to climate change in the region, and proposed public health adaptation policy options. Preparedness for the public health impact of increased extreme weather events is still relatively limited and clear public health policies are urgently needed. These include improved early warning and monitoring systems, preparedness of the health system, educational programs and the living environment. Regional collaboration should be a priority. PMID:23805950

Private health care in Nigeria: walking the tightrope.

PubMed

Ogunbekun, I; Ogunbekun, A; Orobaton, N

1999-06-01

The persistently low quality and inadequacy of health services provided in public facilities has made the private sector an unavoidable choice for consumers of health care in Nigeria. Ineffective state regulation, however, has meant little control over the clinical activities of private sector providers while the price of medical services has, in recent years, grown faster than the average rate of inflation. Reforms that are targeted at reorganizing the private sector, with a view to enhancing efficiency in the supply of services, are urgently required if costs are to be contained and consumers assured of good value for money.

Sustained impact of the "Healthy Habits, Healthy Girls – Brazil" school-based randomized controlled trial for adolescents living in low-income communities

USDA-ARS?s Scientific Manuscript database

Pediatric obesity is a major public health concern in low- and middle-income countries, such as Brazil. There is an urgent need for preventive programs for adolescents and, the assessment of their sustained impact. This paper reports the longer-term (6-month post intervention) effects of the "H3G-Br...

The application of HIV molecular epidemiology to public health.

PubMed

Paraskevis, D; Nikolopoulos, G K; Magiorkinis, G; Hodges-Mameletzis, I; Hatzakis, A

2016-12-01

HIV is responsible for one of the largest viral pandemics in human history. Despite a concerted global response for prevention and treatment, the virus persists. Thus, urgent public health action, utilizing novel interventions, is needed to prevent future transmission events, critical to eliminating HIV. For public health planning to prove effective and successful, we need to understand the dynamics of regional epidemics and to intervene appropriately. HIV molecular epidemiology tools as implemented in phylogenetic, phylodynamic and phylogeographic analyses have proven to be powerful tools in public health planning across many studies. Numerous applications with HIV suggest that molecular methods alone or in combination with mathematical modelling can provide inferences about the transmission dynamics, critical epidemiological parameters (prevalence, incidence, effective number of infections, Re, generation times, time between infection and diagnosis), or the spatiotemporal characteristics of epidemics. Molecular tools have been used to assess the impact of an intervention and outbreak investigation which are of great public health relevance. In some settings, molecular sequence data may be more readily available than HIV surveillance data, and can therefore allow for molecular analyses to be conducted more easily. Nonetheless, classic methods have an integral role in monitoring and evaluation of public health programmes, and should supplement emerging techniques from the field of molecular epidemiology. Importantly, molecular epidemiology remains a promising approach in responding to viral diseases. Copyright © 2016 Elsevier B.V. All rights reserved.

HIV, drugs and the legal environment

PubMed Central

Strathdee, Steffanie A.; Beletsky, Leo; Kerr, Thomas

2014-01-01

A large body of scientific evidence indicates that policies based solely on law enforcement without taking into account public health and human rights considerations increase the health risks of people who inject drugs (PWIDs) and their communities. Although formal laws are an important component of the legal environment supporting harm reduction, it is the enforcement of the law that affects PWIDs' behavior and attitudes most acutely. This commentary focuses primarily on drug policies and policing practices that increase PWIDs' risk of acquiring HIV and viral hepatitis, and avenues for intervention. Policy and legal reforms that promote public health over the criminalization of drug use and PWID are urgently needed. This should include alternative regulatory frameworks for illicit drug possession and use. Changing legal norms and improving law enforcement responses to drug-related harms requires partnerships that are broader than the necessary bridges between criminal justice and public health sectors. HIV prevention efforts must partner with wider initiatives that seek to improve police professionalism, accountability, and transparency and boost the rule of law. Public health and criminal justice professionals can work synergistically to shift the legal environment away from one that exacerbates HIV risks to one that promotes safe and healthy communities. PMID:25265900

Marijuana Legalization: Impact on Physicians and Public Health.

PubMed

Wilkinson, Samuel T; Yarnell, Stephanie; Radhakrishnan, Rajiv; Ball, Samuel A; D'Souza, Deepak Cyril

2016-01-01

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health.

Marijuana Legalization: Impact on Physicians and Public Health

PubMed Central

Wilkinson, Samuel T.; Yarnell, Stephanie; Radhakrishnan, Rajiv; Ball, Samuel A.; D'Souza, Deepak Cyril

2016-01-01

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health. PMID:26515984

Germs, genomics and global public health: How can advances in genomic sciences be integrated into public health in the developing world to deal with infectious diseases?

PubMed

Pang, T

2009-12-01

Scientific and technological advances derived from the genomics revolution have a central role to play in dealing with continuing infectious disease threats in the developing world caused by emerging and re-emerging pathogens. These techniques, coupled with increasing knowledge of host-pathogen interactions, can assist in the early identification and containment of outbreaks as well as in the development of preventive vaccination and therapeutic interventions, including the urgent need for new antibiotics. However, the effective application of genomics technologies faces key barriers and challenges which occur at three stages: from the research to the products, from the products to individual patients, and, finally, from patients to entire populations. There needs to be an emphasis on research in areas of greatest need, in facilitating the translation of research into interventions and, finally, the effective delivery of such interventions to those in greatest need. Ultimate success will depend on bringing together science, society and policy to develop effective public health implementation strategies to provide health security and health equity for all peoples.

Evidences to validate public policies: a review with an international research perspective.

PubMed

Gregori, Dario

2014-01-01

Nutrition and related health issues are nowadays topics of general interest. The prevalence of overweight and obesity has increased with alarming speed over the past twenty years, being described by the World Health Organization as a global epidemic. An evidence-based approach to public health interventions should be based on the best available information. Given the substantial investment of society in fundamental and applied health research, and the high expectations of society for reducing the burden of illness, attention to these matters should have high priority. There's an urgent need to foster the development of international standards, such as food labeling and profiling. Considering the complex network involved in obesity development, it is necessary to promote multiple-concurrent interventions, taking into account that by focusing on a single intervention in isolation, all other factors being constant, each individual policy change is likely to appear ineffective.

The global burden of obesity and the challenges of prevention.

PubMed

Seidell, Jacob C; Halberstadt, Jutka

2015-01-01

The prevalence of obesity is increasing at an alarming rate in many parts of the world. About 2 billion people are overweight and one third of them obese. The plight of the most affected populations, like those in high-income countries in North America, Australasia and Europe, has been well publicized. However, the more recent increases in population obesity in low- and middle-income countries that are now increasingly being observed have been less recognized. Based on the existing prevalence and trend data and the epidemiological evidence linking obesity with a range of physical and psychosocial health conditions, it is reasonable to describe obesity as a public health crisis that severely impairs the health and quality of life of people and adds considerably to national health-care budgets. Intersectoral action to manage and prevent obesity is urgently required to reverse current trends.

Dietary capsaicin and its anti-obesity potency: from mechanism to clinical implications

PubMed Central

Zheng, Jia; Zheng, Sheng; Feng, Qianyun; Zhang, Qian

2017-01-01

Obesity is a growing public health problem, which has now been considered as a pandemic non-communicable disease. However, the efficacy of several approaches for weight loss is limited and variable. Thus, alternative anti-obesity treatments are urgently warranted, which should be effective, safe, and widely available. Active compounds isolated from herbs are similar with the practice of Traditional Chinese Medicine, which has a holistic approach that can target to several organs and tissues in the whole body. Capsaicin, a major active compound from chili peppers, has been clearly demonstrated for its numerous beneficial roles in health. In this review, we will focus on the less highlighted aspect, in particular how dietary chili peppers and capsaicin consumption reduce body weight and its potential mechanisms of its anti-obesity effects. With the widespread pandemic of overweight and obesity, the development of more strategies for the treatment of obesity is urgent. Therefore, a better understanding of the role and mechanism of dietary capsaicin consumption and metabolic health can provide critical implications for the early prevention and treatment of obesity. PMID:28424369

Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries: The Urgent Need for Scaling Up

PubMed Central

Magrath, Ian; Kingham, T. Peter; Elzawawy, Ahmed

2016-01-01

Noncommunicable diseases are now recognized by the United Nations and WHO as a major public health crisis. Cancer is a main part of this problem, and health care systems are facing a great challenge to improve cancer care, control costs, and increase systems efficiency. The disparity in access to care and outcomes between high-income countries and low- and middle-income countries is staggering. The reasons for this disparity include cost, access to care, manpower and training deficits, and a lack of awareness in the lay and medical communities. Diagnosis and treatment play an important role in this complex environment. In different regions and countries of the world, a variety of health care systems are in place, but most of them are fragmented or poorly coordinated. The need to scale up cancer care in the low- and middle-income countries is urgent, and this article reviews many of the structural mechanisms of the problem, describes the current situation, and proposes ways for improvement. The organization of cancer services is also included in the analysis. PMID:26578618

Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.

PubMed

Khan, Yasmin; Sanford, Sarah; Sider, Doug; Moore, Kieran; Garber, Gary; de Villa, Eileen; Schwartz, Brian

2017-04-28

Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. This research indicates that relationships are central to effective communication between public health agencies and emergency department clinicians at the local level. Our framework which is grounded in qualitative evidence focuses on strategies to promote effective communication in the emerging public health incident setting and may be useful in informing practice.

The crisis in access to essential medicines in India: key issues which call for action.

PubMed

Bhargava, Anurag; Kalantri, S P

2013-01-01

The government is planning to introduce free generic and essential medicines in public health facilities. Most people in India buy healthcare from the private sector, a compulsion that accounts for a high proportion of healthcare-related expenditure. To reduce the burden of healthcare costs, the government must improve availability and affordability of generic and essential medicines in the market. It can do so because India's large pharmaceutical industry is a major source of generic medicines worldwide. In this article, we discuss three factors that have impeded access to generic and essential medicines: (1) mistaken notions among policymakers, prescribers and patients about branded drugs and generic drugs in India; (2) high prices of medicines due to the progressive dismantling of the system of regulation of medicine prices, and (3) a drug approval and regulatory system that allows medicines (including fixed dose combinations) of doubtful efficacy, rationale, safety and public health relevance to dominate the market at the cost of access to affordable generic and essential medicines. The consequences of ill-health and wasted expenditure on drugs raise issues of public health ethics.Improving access to essential medicines in India is an urgent public health and ethical imperative. This should include improved public provisioning, a system of regulation of drug prices, and an evidence-based drug approval process.

The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis.

PubMed

Krawczyk, Noa; Kerrigan, Deanna; Bastos, Francisco Inácio

2017-07-01

Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation's most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care.

The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis

PubMed Central

Krawczyk, Noa; Kerrigan, Deanna; Bastos, Francisco Inácio

2018-01-01

Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation’s most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care. PMID:27856941

Harnessing the language of overdose prevention to advance evidence-based responses to the opioid crisis.

PubMed

Collins, Alexandra B; Bluthenthal, Ricky N; Boyd, Jade; McNeil, Ryan

2018-05-01

Language has significant implications for how we view and respond to public health issues. Conventional moralistic messaging around drug use stigmatizes people who use drugs and inhibits the implementation of evidence-based harm reduction interventions that do not condemn drug use. However, within the context of the unprecedented North American opioid overdose crisis, we argue that shifting conventional moral messaging around overdose prevention and response strategies is key to supporting the rapid roll-out of evidence-based harm reduction interventions. Reframing overdose prevention to highlight the imperative to address the ongoing public health emergency is an important first step in implementing urgently needed response strategies. Copyright © 2018 Elsevier B.V. All rights reserved.

Ethical issues in predictive genetic testing: a public health perspective.

PubMed

Fulda, K G; Lykens, K

2006-03-01

As a result of the increase in genetic testing and the fear of discrimination by insurance companies, employers, and society as a result of genetic testing, the disciplines of ethics, public health, and genetics have converged. Whether relatives of someone with a positive predictive genetic test should be notified of the results and risks is a matter urgently in need of debate. Such a debate must encompass the moral and ethical obligations of the diagnosing physician and the patient. The decision to inform or not will vary depending on what moral theory is used. Utilising the utilitarian and libertarian theories produces different outcomes. The principles of justice and non-maleficence will also play an important role in the decision.

Ethical issues in predictive genetic testing: a public health perspective

PubMed Central

Fulda, K G; Lykens, K

2006-01-01

As a result of the increase in genetic testing and the fear of discrimination by insurance companies, employers, and society as a result of genetic testing, the disciplines of ethics, public health, and genetics have converged. Whether relatives of someone with a positive predictive genetic test should be notified of the results and risks is a matter urgently in need of debate. Such a debate must encompass the moral and ethical obligations of the diagnosing physician and the patient. The decision to inform or not will vary depending on what moral theory is used. Utilising the utilitarian and libertarian theories produces different outcomes. The principles of justice and non‐maleficence will also play an important role in the decision. PMID:16507657

The future of UK healthcare: problems and potential solutions to a system in crisis.

PubMed

Montgomery, H E; Haines, A; Marlow, N; Pearson, G; Mythen, M G; Grocott, M P W; Swanton, C

2017-08-01

The UK's Health System is in crisis, central funding no longer keeping pace with demand. Traditional responses-spending more, seeking efficiency savings or invoking market forces-are not solutions. The health of our nation demands urgent delivery of a radical new model, negotiated openly between public, policymakers and healthcare professionals. Such a model could focus on disease prevention, modifying health behaviour and implementing change in public policy in fields traditionally considered unrelated to health such as transport, food and advertising. The true cost-effectiveness of healthcare interventions must be balanced against the opportunity cost of their implementation, bolstering the central role of NICE in such decisions. Without such action, the prognosis for our healthcare system-and for the health of the individuals it serves-may be poor. Here, we explore such a new prescription for our national health. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Evolution of public and non-profit funding for mental health research in France between 2007 and 2011.

PubMed

Gandré, Coralie; Prigent, Amélie; Kemel, Marie-Louise; Leboyer, Marion; Chevreul, Karine

2015-12-01

Since 2007, actions have been undertaken in France to foster mental health research. Our objective was to assess their utility by estimating the evolution of public and non-profit funding for mental health research between 2007 and 2011, both in terms of total funding and the share of health research budgets. Public and non-profit funding was considered. Core funding from public research institutions was determined through a top-down approach by multiplying their total budget by the ratio of the number of psychiatry-related publications to the total number of publications focusing on health issues. A bottom-up method was used to estimate the amount of project-based grants and funding by non-profit organizations, which were directly contacted to obtain this information. Public and non-profit funding for mental health research increased by a factor of 3.4 between 2007 and 2011 reaching €84.8 million, while the share of health research funding allocated to mental health research nearly doubled from 2.2% to 4.1%. Public sources were the main contributors representing 94% of the total funding. Our results have important implications for policy makers, as they suggest that actions specifically aimed at prioritizing mental health research are effective in increasing research funding. There is therefore an urgent need to further undertake such actions as funding in France remains particularly low compared to the United Kingdom and the United States, despite the fact that the epidemiological and economic burden represented by mental disorders is expected to grow rapidly in the coming years. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.

Mastitis treatment-Reduction in antibiotic usage in dairy cows.

PubMed

Krömker, V; Leimbach, S

2017-08-01

Animal-friendly, economical, resource-saving milk production provides the basis for sustained consumer acceptance. Bovine mastitis plays a decisive role in the dairy industry-disturbing animal health and welfare and causing considerable economic losses on the other hand. Currently, antimicrobial treatment is indispensable to keep bovine udder health, animal welfare and economic aspects in balance. On the contrary, emergence and spread of antimicrobial resistance (AMR) is an urgent matter of particular public interest, and as a consequence, antimicrobial usage (AMU) in production livestock is a critically discussed subject. In urgent need of future reduction in AMU in the dairy industry, this review article describes and discusses possible approaches promising prompt implementation, including therapeutical alternatives as well as pro- and metaphylactic concepts such as the implementation of evidence-based mastitis therapy concepts and selective dry cow treatment (sDCT), in search of the most effective and contemporary methods for decreasing AMU and AMR in dairy production. © 2017 Blackwell Verlag GmbH.

Into the Dark Domain: The UK Web Archive as a Source for the Contemporary History of Public Health

PubMed Central

Gorsky, Martin

2015-01-01

With the migration of the written record from paper to digital format, archivists and historians must urgently consider how web content should be conserved, retrieved and analysed. The British Library has recently acquired a large number of UK domain websites, captured 1996–2010, which is colloquially termed the Dark Domain Archive while technical issues surrounding user access are resolved. This article reports the results of an invited pilot project that explores methodological issues surrounding use of this archive. It asks how the relationship between UK public health and local government was represented on the web, drawing on the ‘declinist’ historiography to frame its questions. It points up some difficulties in developing an aggregate picture of web content due to duplication of sites. It also highlights their potential for thematic and discourse analysis, using both text and image, illustrated through an argument about the contradictory rationale for public health policy under New Labour. PMID:26217072

Sources and Resources Into the Dark Domain: The UK Web Archive as a Source for the Contemporary History of Public Health.

PubMed

Gorsky, Martin

2015-08-01

With the migration of the written record from paper to digital format, archivists and historians must urgently consider how web content should be conserved, retrieved and analysed. The British Library has recently acquired a large number of UK domain websites, captured 1996-2010, which is colloquially termed the Dark Domain Archive while technical issues surrounding user access are resolved. This article reports the results of an invited pilot project that explores methodological issues surrounding use of this archive. It asks how the relationship between UK public health and local government was represented on the web, drawing on the 'declinist' historiography to frame its questions. It points up some difficulties in developing an aggregate picture of web content due to duplication of sites. It also highlights their potential for thematic and discourse analysis, using both text and image, illustrated through an argument about the contradictory rationale for public health policy under New Labour.

Science-policy challenges for biodiversity, public health and urbanization: examples from Belgium

NASA Astrophysics Data System (ADS)

Keune, H.; Kretsch, C.; De Blust, G.; Gilbert, M.; Flandroy, L.; Van den Berge, K.; Versteirt, V.; Hartig, T.; De Keersmaecker, L.; Eggermont, H.; Brosens, D.; Dessein, J.; Vanwambeke, S.; Prieur-Richard, A. H.; Wittmer, H.; Van Herzele, A.; Linard, C.; Martens, P.; Mathijs, E.; Simoens, I.; Van Damme, P.; Volckaert, F.; Heyman, P.; Bauler, T.

2013-06-01

Internationally, the importance of a coordinated effort to protect both biodiversity and public health is more and more recognized. These issues are often concentrated or particularly challenging in urban areas, and therefore on-going urbanization worldwide raises particular issues both for the conservation of living natural resources and for population health strategies. These challenges include significant difficulties associated with sustainable management of urban ecosystems, urban development planning, social cohesion and public health. An important element of the challenge is the need to interface between different forms of knowledge and different actors from science and policy. We illustrate this with examples from Belgium, showcasing concrete cases of human-nature interaction. To better tackle these challenges, since 2011, actors in science, policy and the broader Belgian society have launched a number of initiatives to deal in a more integrated manner with combined biodiversity and public health challenges in the face of ongoing urbanization. This emerging community of practice in Belgium exemplifies the importance of interfacing at different levels. (1) Bridges must be built between science and the complex biodiversity/ecosystem-human/public health-urbanization phenomena. (2) Bridges between different professional communities and disciplines are urgently needed. (3) Closer collaboration between science and policy, and between science and societal practice is needed. Moreover, within each of these communities closer collaboration between specialized sections is needed.

Globalization of public health law and ethics.

PubMed

Sohn, Myongsei

2012-09-01

The Constitution of the World Health Organization (1946) states that the "enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social position." The international legal framework for this right was laid by the Universal Declaration of Human Rights (1948) and reaffirmed in the International Covenant on Economic, Social, and Cultural Rights (1966) and the Declaration of Alma-Ata (1978). In recent years, the framework has been developed on 10 key elements: national and international human rights, laws, norms, and standards; resource constraints and progressive realization; obligations of immediate effect; freedoms and entitlements; available, accessible, acceptable, and good quality; respect, protect, and fulfill; non-discrimination, equality, and vulnerability; active and informed participation; international assistance and cooperation; and monitoring and accountability. Whereas public health law plays an essential role in the protection and promotion of the right to health, the emergence of SARS (2003) highlighted the urgent need to reform national public health laws and international obligations relating to public health in order to meet the new realities of a globalized world, leading to the WHO Framework Convention on Tobacco Control (2003) and the revision of the WHO International Health Regulations (2005). The Asian Institute for Bioethics and Health Law, in conjunction with the Republic of Korea's Ministry of Health and Welfare and the WHO International Digest of Health Legislation, conducted a comparative legal analysis of national public health laws in various countries through a project entitled Domestic Profiles of Public/Population Health Legislation (2006), which underscored the importance of recognizing the political and social contexts of distinct legal cultures, including Western, Asian, Islamic, and African.

Job satisfaction among public health professionals working in public sector: a cross sectional study from Pakistan

PubMed Central

2013-01-01

Background Job satisfaction largely determines the productivity and efficiency of human resource for health. It literally depicts the extent to which professionals like or dislike their jobs. Job satisfaction is said to be linked with the employee’s work environment, job responsibilities and powers and time pressure; the determinants which affect employee’s organizational commitment and consequently the quality of services. The objective of the study was to determine the level of and factors influencing job satisfaction among public health professionals in the public sector. Methods This was a cross sectional study conducted in Islamabad, Pakistan. Sample size was universal including 73 public health professionals, with postgraduate qualifications and working in government departments of Islamabad. A validated structured questionnaire was used to collect data from April to October 2011. Results Overall satisfaction rate was 41% only, while 45% were somewhat satisfied and 14% of professionals highly dissatisfied with their jobs. For those who were not satisfied, working environment, job description and time pressure were the major causes. Other factors influencing the level of satisfaction were low salaries, lack of training opportunities, improper supervision and inadequate financial rewards. Conclusion Our study documented a relatively low level of overall satisfaction among workers in public sector health care organizations. Considering the factors responsible for this state of affairs, urgent and concrete strategies must be developed to address the concerns of public health professionals as they represent a highly sensitive domain of health system of Pakistan. Improving the overall work environment, review of job descriptions and better remuneration might bring about a positive change. PMID:23298253

[The green rural economy: challenges to research and to public health policies posed by agricultural modernization].

PubMed

Rigotto, Raquel Maria; Carneiro, Fernando Ferreira; Marinho, Alice Maria Correia Pequeno; Rocha, Mayara Melo; Ferreira, Marcelo José Monteiro; Pessoa, Vanira Matos; Teixeira, Ana Cláudia de Araújo; da Silva, Maria de Lourdes Vicente; Braga, Lara de Queiroz Viana; Teixeira, Maiana Maia

2012-06-01

In this paper, we ask ourselves who should, can and has the will to promote health in the rural zone today. The fields of science and public policy were chosen as our primary focus of dialogue conducted from the perspective of the right to health and a healthy environment. Seven lessons emerged: (1) in addition to the surveillance of isolated chemical risks, the relation between agrochemicals and health should be investigated in the context of conservative agricultural modernization; (2) it is mandatory and urgent to discover the health problems related to the use of agrochemicals; (3) the State has been successful in its support of agribusiness, but highly inefficient at enforcing policies to safeguard social rights; (4) sectors of society linked to rural organizations have played an important role in the public policies combating agrochemicals and protecting health; (5) studies must help deconstruct the myths surrounding the Green Revolution model; (6) we are faced with the challenge of contributing to the construction of an emerging scientific paradigm founded on an ethical-political commitment to the most vulnerable social elements; (7) rural communities are creating agro-ecological alternatives for life in semiarid areas.

Discrimination in a universal health system: explaining socioeconomic waiting time gaps.

PubMed

Johar, Meliyanni; Jones, Glenn; Keane, Micheal P; Savage, Elizabeth; Stavrunova, Olena

2013-01-01

One of the core goals of a universal health care system is to eliminate discrimination on the basis of socioeconomic status. We test for discrimination using patient waiting times for non-emergency treatment in public hospitals. Waiting time should reflect patients' clinical need with priority given to more urgent cases. Using data from Australia, we find evidence of prioritisation of the most socioeconomically advantaged patients at all quantiles of the waiting time distribution. These patients also benefit from variation in supply endowments. These results challenge the universal health system's core principle of equitable treatment. Copyright © 2012 Elsevier B.V. All rights reserved.

Associations between diagnostic activity and measures of patient experience in primary care: a cross-sectional ecological study of English general practices

PubMed Central

Lyratzopoulos, Georgios; Mendonca, Silvia C; Gildea, Carolynn; McPhail, Sean; Peake, Michael D; Rubin, Greg; Singh, Hardeep; Hamilton, William; Walter, Fiona M; Roland, Martin; Abel, Gary A

2018-01-01

Background Lower use of endoscopies and urgent referrals for suspected cancer has been linked to poorer outcomes for patients with cancer; it is important to examine potential predictors of variable use. Aim To examine the associations between general practice measures of patient experience and practice use of endoscopies or urgent referrals for suspected cancer. Design and setting Cross-sectional ecological analysis in English general practices. Method Data were taken from the GP Patient Survey and the Cancer Services Public Health Profiles. After adjustment for practice population characteristics, practice-level associations were examined between the use of endoscopy and urgent referrals for suspected cancer, and the ability to book an appointment (used as proxy for ease of access), the ability to see a preferred doctor (used as proxy for relational continuity), and doctor/nurse communication skills. Results Taking into account practice scores for the ability to book an appointment, practices rated higher for the proxy measure of relational continuity used urgent referrals and endoscopies less often (for example, 30% lower urgent referral and 15% lower gastroscopy rates between practices in the 90th/10th centiles, respectively). In contrast, practices rated higher for doctor communication skills used urgent referrals and endoscopies more often (for example, 26% higher urgent referral and 17% higher gastroscopy rates between practices in the 90th/10th centiles, respectively). Patients with cancer in practices that were rated higher for doctor communication skills were less likely to be diagnosed as emergencies (1.7% lower between practices in the 90th than in the 10th centile). Conclusion Practices where patients rated doctor communication highly were more likely to investigate and refer patients urgently but, in contrast, practices where patients could see their preferred doctor more readily were less likely to do so. This article discusses the possible implications of these findings for clinical practice. PMID:29255108

A Calorimeter Design for Rapidly Estimating the Level of Foodborne Microorganisms

DTIC Science & Technology

1975-12-01

of control, could produce a severe public health crisis and impair troop efficiency. Rapid microbiological quality measuring techniques are urgently...would more effectively use the volume of the calorimeter sample chamber. Then we could increase the volume, make it easy to add the growth medium and...from this paper are also represented in Table III. His results were criticized by Forest & Walker (1962P who claimed that the effect observed was due

Molecular Signature Reveals Which Liver Cancer Patients May Benefit from a New Drug | Center for Cancer Research

Cancer.gov

Only one drug currently on the market has the potential to extend survival for patients with advanced-stage liver cancer and only 30 percent of patients are eligible to receive it. As the fastest-growing type of cancer by incidence in the United States, liver cancer represents a major public health problem and there is an urgent need to develop new treatment strategies.

Readying health services for climate change: a policy framework for regional development.

PubMed

Bell, Erica

2011-05-01

Climate change presents the biggest threat to human health in the 21st century. However, many public health leaders feel ill equipped to face the challenges of climate change and have been unable to make climate change a priority in service development. I explore how to achieve a regionally responsive whole-of-systems approach to climate change in the key operational areas of a health service: service governance and culture, service delivery, workforce development, asset management, and financing. The relative neglect of implementation science means that policymakers need to be proactive about sourcing and developing models and processes to make health services ready for climate change. Health research funding agencies should urgently prioritize applied, regionally responsive health services research for a future of climate change.

Readying Health Services for Climate Change: A Policy Framework for Regional Development

PubMed Central

2011-01-01

Climate change presents the biggest threat to human health in the 21st century. However, many public health leaders feel ill equipped to face the challenges of climate change and have been unable to make climate change a priority in service development. I explore how to achieve a regionally responsive whole-of-systems approach to climate change in the key operational areas of a health service: service governance and culture, service delivery, workforce development, asset management, and financing. The relative neglect of implementation science means that policymakers need to be proactive about sourcing and developing models and processes to make health services ready for climate change. Health research funding agencies should urgently prioritize applied, regionally responsive health services research for a future of climate change. PMID:21421953

At the crossroads: new paradigms of food security, public health nutrition and school food.

PubMed

Ashe, Leah M; Sonnino, Roberta

2013-06-01

Public health nutrition sits at the nexus of a global crisis in food, environmental and health systems that has generated - along with numerous other problems - an urgent and changing problem of food insecurity. The 'new' food insecurity, however, is different from the old: it is bimodal, encompassing issues of both under- and over-consumption, hunger and obesity, quantity and quality; it has assumed a decidedly urban dimension; and it implicates rich and poor countries alike. The complexity of the expressions of this challenge requires new approaches to public health nutrition and food policy that privilege systemic, structural and environmental factors over individual and mechanistic ones. In this context, the current paper argues that school food systems rise with buoyant potential as promising intervention sites: they are poised to address both modes of the food security crisis; integrate systemic, structural and environmental with behavioural approaches; and comprise far-reaching, system-wide efforts that influence the wider functioning of the food system. Based on a discussion of Bogotá and other pioneering policies that explicitly aim to create a broader food system with long-term foundations for good public health and food security, the paper suggests a new research and action agenda that gives special attention to school food in urban contexts.

Current Scenario of Spurious and Substandard Medicines in India: A Systematic Review

PubMed Central

Khan, A. N.; Khar, R. K.

2015-01-01

Globally, every country is the victim of substandard or spurious drugs, which result in life threatening issues, financial loss of consumer and manufacturer and loss in trust on health system. The aim of this enumerative review was to probe the extent on poor quality drugs with their consequences on public health and the preventive measures taken by the Indian pharmaceutical regulatory system. Government and non-government studies, literature and news were gathered from journals and authentic websites. All data from 2000 to 2013 were compiled and interpreted to reveal the real story of poor quality drugs in India. For minimizing spurious/falsely-labelled/falsified/counterfeit drugs or not of standard quality drugs, there is urgent requirement of more stringent regulation and legal action against the problem. However, India has taken some preventive steps in the country to fight against the poor quality drugs for protecting and promoting the public health. PMID:25767312

Strategy to combat obesity and to promote physical activity in Arab countries.

PubMed

Musaiger, Abdulrahman O; Al Hazzaa, Hazzaa M; Al-Qahtani, Aayed; Elati, Jalila; Ramadan, Jasem; Aboulella, Nebal A; Mokhtar, Najat; Kilani, Hashem A

2011-01-01

Obesity has become a major public health problem in the Arab countries, creating a health and economic burden on these countries' government services. There is an urgent need to develop a strategy for prevention and control of obesity. The third Arab Conference on Obesity and Physical Activity was held in Bahrain in January 2010, and proposed the Strategy to Combat Obesity and Promote Physical Activity in Arab Countries. This strategy provides useful guidelines for each Arab country to prepare its own strategy or plan of action to prevent and control obesity. The strategy focused on expected outcomes, objectives, indicators to measure the objectives, and action needs for 9 target areas: child-care centers for preschool children, schools, primary health care, secondary care, food companies, food preparation institutes, media, public benefit organizations, and the workplace. Follow-up and future developments of this strategy were also included.

A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries.

PubMed

Coarasa, Jorge; Das, Jishnu; Gummerson, Elizabeth; Bitton, Asaf

2017-04-12

Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.

Is Sugar the new Tobacco? Insights from Laboratory Studies, Consumer Surveys and Public Health.

PubMed

Le Bodo, Yann; Paquette, Marie-Claude; Vallières, Maggie; Alméras, Natalie

2015-03-01

In the Americas, mean energy intake from added sugar exceeds recent World Health Organization recommendations for free sugars in the diet. As a leading contributor to this excess, sugar-sweetened beverage (SSB) overconsumption represents a risk for the population's health. This article provides an overview of clinical and epidemiological evidence, marketing practices, corporate influence and prevention strategies related to added sugar and SSB. For each aspect of this multidimensional profile, we briefly compare SSB to the case of tobacco pointing to similarities but also major differences. Tobacco control has demonstrated the effectiveness of long term multifaceted prevention strategies in multiple settings supported by strong public policies which may be applied to the consumption of SSB. However, translating these policies to the specific case of SSB is urgently needed, to inform preventive actions, decide which intervention mix will be used, and evaluate the process and impact of the chosen strategy.

Strategy to combat obesity and to promote physical activity in Arab countries

PubMed Central

Musaiger, Abdulrahman O; Al Hazzaa, Hazzaa M; Al-Qahtani, Aayed; Elati, Jalila; Ramadan, Jasem; AboulElla, Nebal A; Mokhtar, Najat; Kilani, Hashem A

2011-01-01

Obesity has become a major public health problem in the Arab countries, creating a health and economic burden on these countries’ government services. There is an urgent need to develop a strategy for prevention and control of obesity. The third Arab Conference on Obesity and Physical Activity was held in Bahrain in January 2010, and proposed the Strategy to Combat Obesity and Promote Physical Activity in Arab Countries. This strategy provides useful guidelines for each Arab country to prepare its own strategy or plan of action to prevent and control obesity. The strategy focused on expected outcomes, objectives, indicators to measure the objectives, and action needs for 9 target areas: child-care centers for preschool children, schools, primary health care, secondary care, food companies, food preparation institutes, media, public benefit organizations, and the workplace. Follow-up and future developments of this strategy were also included. PMID:21660292

Evidence-based disease management: its role in cardiovascular risk reduction.

PubMed

Fanning, Etta L

2004-01-01

Cardiovascular disease remains the most pressing healthcare problem in the United States. Traditional risk factors--hypertension, obesity, and diabetes-are still unresolved issues; and new risk factors--pre-diabetes, insulin resistance, and pediatric and adolescent diabetes-have emerged. There is an urgent need to identify the risk factors for cardiovascular disease, and address risk reduction with disease management and treatment for each factor, based on qualitative and quantitative approaches for developing the evidence base for public health action. The objectives of this paper are to review (i) the burden of cardiovascular illness-morbidity, mortality, and cost; (ii) risk factors and the emerging epidemic of adolescent obesity; (iii) the challenges of attaining target endpoints; and (iv) the attributes of a successful programmatic healthcare initiative for potential impact on cardiovascular care and, eventually, public health.

Event-based surveillance of food- and waterborne diseases in Europe: urgent inquiries (outbreak alerts) during 2008 to 2013.

PubMed

Gossner, C M; de Jong, B; Hoebe, C J; Coulombier, D

2015-06-25

During 2008 to 2013, 215 outbreak alerts, also known as 'urgent inquiries' (UI), for food- and waterborne diseases were launched in Europe, the majority of them (135; 63%) being related to salmonellosis. For 110 (51%) UI, a potential food vehicle of infection was identified, with vegetables being the most reported category (34;31%). A total of 28% (n = 60) of the outbreaks reported had an international dimension, involving at least two countries (mean: 4; standard deviation: 2; range:2–14). Participating countries posted 2,343 messages(initial posts and replies, excluding updates), with a median of 11 messages per urgent inquiry (range:1–28). Of 60 multicountry UI, 50 involved between two and four countries. The UI allowed early detection of multicountry outbreaks, facilitated the identification of the suspected vehicles and consequently contributed to the timely implementation of control measures. The introduction of an epidemic intelligence information system platform in 2010 has strengthened the role of the Food- and Waterborne Diseases and Zoonoses network in facilitating timely exchange of information between public health authorities of the participating countries.

The development and perspectives of Chinese bioethics.

PubMed

Li, Hongwen; Cong, Yali

2008-12-01

Bioethics began to emerge in the late 1980s in China, which was borrowed and introduced from western countries. But the Chinese bioethics has a different model from western bioethics in its philosophical basis and culture environment which have been influenced by Confucianism, Taoism and Buddhism. Academic researchers of bioethics, policy makers and the public have different opinions to the bioethical issues. Though sharing some similarities with those of western bioethics, the Chinese bioethics has certain different and urgent topics, such as health inequality in health care reform, physician-patient relationship, and different model of the informed consent.

Uncovering factors affecting use of the emergency department for less urgent health problems in urban and rural areas.

PubMed

Hodgins, Marilyn J; Wuest, Judith

2007-09-01

People who access the emergency department for less urgent health problems have been described as inappropriate users of the health-care system.Yet little is known about the factors precipitating such use and how these differ based on location of the emergency department. In this descriptive-correlational study guided by Andersen's Model of Health Services Use, 1612 people who presented to an emergency department with a less urgent health problem were interviewed. Analysis revealed rural/urban differences in the characteristics of patients, nature of the problems, actions taken, and factors precipitating the visit. Despite its popularity, the predictive capabilities of Andersen's model were limited in explaining use of self-treatment or willingness to wait for treatment. The findings show that an emergency department's roles and functions vary according to its location. Such insights provide direction for developing services that respond to the needs of people with less urgent health problems that are cognizant of geographic location.

Psychosocial Stress During First Pregnancy Predicts Infant Health Outcomes in the First Postnatal Year.

PubMed

Phelan, A L; DiBenedetto, M R; Paul, I M; Zhu, J; Kjerulff, K H

2015-12-01

To evaluate the impact of psychosocial stress during pregnancy on infant health outcomes in the first postnatal year. A sample of 3000 women completed a stress inventory (the Psychosocial Hassles Scale) during their third trimester before first childbirth. Infant health outcomes were measured via maternal report at 1, 6 and 12 months postpartum. Poisson regression was used to model the effect of maternal stress during pregnancy on infant health outcomes in the first year, controlling for age, race/ethnicity, education, insurance coverage, marital status, and cigarette smoking during pregnancy. Women who were younger, minority, unmarried, publicly insured and without a college degree were more likely to report high levels of prenatal stress. High prenatal stress was a significant predictor of maternal reporting of gastrointestinal illness (p < 0.0001), respiratory illness (p = 0.025), and total illness in the first year (p < 0.0001). High prenatal stress was also a significant predictor of urgent care visits (p < 0.0001) and emergency department visits (p = 0.001). It was not a significant predictor of hospitalizations (p = 0.36). Maternal prenatal stress is associated with increased maternal reporting of infant illness, as well as increased frequency of both urgent care visits and emergency department visits.

Brazilian physicians hold national strike against medical insurance companies.

PubMed

Falavigna, Asdrubal; da Silva, Pedro Guarise

2012-01-01

The Brazilian Health System has two different forms of access, public and private. The purpose of the public health system is to provide universal, complete access, free of charge, for the entire population. The private sector is composed by people who have private insurance. Nowadays, about 43 million Brazilians, or 26.3% of the population, have private health insurance. The main motivations of the physicians for the strike were the low payment for medical services and the constant interference of the private health insurance companies in medical autonomy. For this reason, Brazilian physicians held a 24-hour strike against the Medical Insurance Companies that did not accept to negotiate new fees in almost all Brazilian states. At least 120,000 physicians from all specialties stopped elective activities during that day, only providing urgent or emergency care. It is estimated that the strike affected 25 to 35 million Brazilians, about 76% of the total number of medical insurance users. Copyright © 2012 Elsevier Inc. All rights reserved.

Alcohol and alcohol-related harm in China: policy changes needed

PubMed Central

Tang, Yi-lang; Xiang, Xiao-jun; Wang, Xu-yi; Cubells, Joseph F; Babor, Thomas F

2013-01-01

Abstract In China, alcohol consumption is increasing faster than anywhere else in the world. A steady increase in alcohol production has also been observed in the country, together with a rise in alcohol-related harm. Despite these trends, China’s policies on the sale and consumption of alcoholic beverages are weak compared with those of other countries in Asia. Weakest of all are its policies on taxation, drink driving laws, alcohol sale to minors and marketing licenses. The authors of this descriptive paper draw attention to the urgent need for public health professionals and government officials in China to prioritize population surveillance, research and interventions designed to reduce alcohol use disorders. They describe China’s current alcohol policies and recent trends in alcohol-related harm and highlight the need for health officials to conduct a thorough policy review from a public health perspective, using as a model the World Health Organization’s global strategy to reduce the harmful use of alcohol. PMID:23599550

An international perspective on hazardous waste practices.

PubMed

Orloff, Kenneth; Falk, Henry

2003-08-01

In developing countries, public health attention is focused on urgent health problems such as infectious diseases, malnutrition, and infant mortality. As a country develops and gains economic resources, more attention is directed to health concerns related to hazardous chemical wastes. Even if a country has little industry of its own that generates hazardous wastes, the importation of hazardous wastes for recycling or disposal can present health hazards. It is difficult to compare the quantities of hazardous wastes produced in different countries because of differences in how hazardous wastes are defined. In most countries, landfilling is the most common means of hazardous waste disposal, although substantial quantities of hazardous wastes are incinerated in some countries. Hazardous wastes that escape into the environment most often impact the public through air and water contamination. An effective strategy for managing hazardous wastes should encourage waste minimization, recycling, and reuse over disposal. Developing countries are especially in need of low-cost technologies for managing hazardous wastes.

In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of Provider Training And Huge Quality Gaps

PubMed Central

Das, Jishnu; Holla, Alaka; Das, Veena; Mohanan, Manoj; Tabak, Diana; Chan, Brian

2013-01-01

This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What’s more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes. PMID:23213162

The International Monetary Fund's effects on global health: before and after the 2008 financial crisis.

PubMed

Stuckler, David; Basu, Sanjay

2009-01-01

In April 2009, the G20 countries committed US $750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF provides loans to financially ailing countries, but with strict conditions, typically involving a mix of privatization, liberalization, and fiscal austerity programs. These loan conditions have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. As more countries are being exposed to IMF policies, there is a need to establish what we know and do not know about the IMF's effects on global health. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund's effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programs have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to prevent the current wave of IMF programs from further undermining public health in financially ailing countries and limiting progress toward the health Millennium Development Goals.

Chronic kidney disease in low- and middle-income countries

PubMed Central

Stanifer, John W.; Muiru, Anthony; Jafar, Tazeen H.; Patel, Uptal D.

2016-01-01

Most of the global burden of chronic kidney disease (CKD) is occurring in low- and middle-income countries (LMICs). As a result of rapid urbanization in LMICs, a growing number of populations are exposed to numerous environmental toxins, high infectious disease burdens and increasing rates of noncommunicable diseases. For CKD, this portends a high prevalence related to numerous etiologies, and it presents unique challenges. A better understanding of the epidemiology of CKD in LMICs is urgently needed, but this must be coupled with strong public advocacy and broad, collaborative public health efforts that address environmental, communicable, and non-communicable risk factors. PMID:27217391

The Healthy Aging Research Network: Resources for Building Capacity for Public Health and Aging Practice

PubMed Central

Wilcox, Sara; Altpeter, Mary; Anderson, Lynda A.; Belza, Basia; Bryant, Lucinda; Jones, Dina L.; Leith, Katherine H.; Phelan, Elizabeth A.; Satariano, William A.

2015-01-01

There is an urgent need to translate science into practice and help enhance the capacity of professionals to deliver evidence-based programming. We describe contributions of the Healthy Aging Research Network in building professional capacity through online modules, issue briefs, monographs, and tools focused on health promotion practice, physical activity, mental health, and environment and policy. We also describe practice partnerships and research activities that helped inform product development and ways these products have been incorporated into real-world practice to illustrate possibilities for future applications. Our work aims to bridge the research-to-practice gap to meet the demands of an aging population. PMID:24000962

Severe childhood obesity: an under-recognised and growing health problem.

PubMed

Bass, Rosara; Eneli, Ihuoma

2015-11-01

Childhood obesity is a serious and urgent public health problem. In the last 10 years, there has been a concerted effort in the USA and globally to develop and implement educational, medical and public health interventions designed to attenuate its growth. The success of these efforts was probably responsible for the plateau in the prevalence rate of childhood obesity noted in the last two years. While the attenuation of the overall prevalence of childhood obesity is promising, data from the same cohort reveal a concerning upward trend in the number of children with severe obesity. The consequences of severe childhood obesity can be devastating. When compared to their moderately obese peers, children with severe obesity are at greater risk for adult obesity, early atherosclerosis, hypertension, type 2 diabetes, metabolic syndrome, fatty liver disease and premature death. The determinants for severe obesity include the same lifestyle, environmental, familial and societal risk factors reported for overweight or obesity. While all these risk factors must be screened for, genetic influences are distinct considerations that may have greater bearing especially with early-onset obesity. Treatments for severe childhood obesity include lifestyle intervention, specialised low-calorie diets and bariatric surgery. Outcomes of these treatments vary, with bariatric surgery clearly the most successful of the three for both short-term and long-term weight loss. Severe obesity in children and adolescents remains a challenging health condition. The enormous medical, emotional and financial burden these children and their families endure signals an urgent need to further investigate and standardise treatment modalities and improve outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Health Needs of Urban Blacks.

ERIC Educational Resources Information Center

Blackwell, James E.; And Others

Interviews were conducted with 237 adult blacks in the Boston area to determine their most urgent needs and the most urgent needs of blacks in general, to characterize the information flow from health services agencies, and to characterize access to and utilization of health services. The respondents ranked better economic conditions, family and…

An evaluation of emergency guidelines issued by the World Health Organization in response to four infectious disease outbreaks.

PubMed

Norris, Susan L; Sawin, Veronica Ivey; Ferri, Mauricio; Raques Sastre, Laura; Porgo, Teegwendé V

2018-01-01

The production of high-quality guidelines in response to public health emergencies poses challenges for the World Health Organization (WHO). The urgent need for guidance and the paucity of structured scientific data on emerging diseases hinder the formulation of evidence-informed recommendations using standard methods and procedures. In the context of the response to recent public health emergencies, this project aimed to describe the information products produced by WHO and assess the quality and trustworthiness of a subset of these products classified as guidelines. We selected four recent infectious disease emergencies: outbreaks of avian influenza A-H1N1 virus (2009) and H7N9 virus (2013), Middle East respiratory syndrome coronavirus (MERS-CoV) (2013), and Ebola virus disease (EVD) (2014 to 2016). We analyzed the development and publication processes and evaluated the quality of emergency guidelines using AGREE-II. We included 175 information products of which 87 were guidelines. These products demonstrated variable adherence to WHO publication requirements including the listing of external contributors, management of declarations of interest, and entry into WHO's public database of publications. For guidelines, the methods for development were incompletely reported; WHO's quality assurance process was rarely used; systematic or other evidence reviews were infrequently referenced; external peer review was not performed; and they scored poorly with AGREE II, particularly for rigour of development and editorial independence. Our study suggests that WHO guidelines produced in the context of a public health emergency can be improved upon, helping to assure the trustworthiness and utility of WHO information products in future emergencies.

Work disability resulting from chronic health conditions.

PubMed

Lerner, Debra; Allaire, Saralynn H; Reisine, Susan T

2005-03-01

To describe current programs and policies for addressing work disability among adults with chronic health conditions, and to identify opportunities for new research aimed at reducing the problem. The authors conducted secondary data analysis and a literature review. Millions of Americans with a chronic health condition have a work disability or are at risk of developing one. This public health problem is costing hundreds of billions of dollars a year nationally in lost productivity and diminishing the quality of life of millions of Americans. The medical care system, employers, and government--three traditional sources of help for adults with chronic health problems--are not sufficiently oriented toward the primary or secondary prevention of work disability. New research is urgently needed to reduce the burden of work disability on individuals and society.

Awareness and attitude of the public toward personalized medicine in Korea

PubMed Central

Lee, Iyn-Hyang; Kang, Hye-Young; Suh, Hae Sun; Lee, Sukhyang; Oh, Eun Sil

2018-01-01

Objectives As personalized medicine (PM) is expected to greatly improve health outcomes, efforts have recently been made for its clinical implementation in Korea. We aimed to evaluate public awareness and attitude regarding PM. Methods We performed a self-administered questionnaire survey to 703 adults, who participated in the survey on a voluntary basis. The primary outcome measures included public knowledge, attitude, and acceptance of PM. We conducted multinomial multivariate logistic analysis for outcome variables with three response categories and performed multivariate logistic regression analyses for dichotomous outcome variables. Results Only 28% of participants had knowledge that genetic factors can contribute to inter-individual variations in drug response and the definition of PM (199 out of 702). Higher family income was correlated with greater knowledge concerning PM (OR = 3.76, p = 0.034). A majority of respondents preferred integrated pharmacogenomic testing over drug-specific testing and agreed to inclusion of pharmacogenomic testing in the national health examination (64% and 77%, respectively), but only 51% were willing to pay for it. Discussion Our results identify the urgent need for public education as well as the potential health disparities in access to PM. This study helps to frame policies for implementing PM in clinical practice. PMID:29451916

Resetting the bar: Establishing baselines for persistent contaminants after Hurricane Sandy in the coastal environments of New Jersey and New York, USA

USGS Publications Warehouse

Reilly, Timothy J.; Focazio, Michael J.; Simmons, Dale L.

2016-01-01

In the immediate aftermath of natural disasters, public health officials and other first responders engage in many activities to protect the public and ecosystems in the affected area. These activities include critical tasks designed to minimize adverse consequences resulting from chemical and microbial contaminant exposures, such as acute disease incidence and transmission. However, once these urgent priorities have been met and situations requiring immediate attention have been stabilized, questions regarding the potential longer term threats to humans and ecosystems associated with persistent contaminant exposures remain. Research conducted to address these questions is frequently challenged by the lack of available baseline contaminant information collected before the event for comparison and perspective. In addition, deployments of field crews and collection of environmental samples typically occur days, weeks, or months after the event. Consequently, during and in the aftermath of disasters, public health agencies commonly advise the public to disinfect water, avoid contact with disturbed infrastructure (such as sewer lines), and (or) refrain from use of recreational waters, with the general focus on acute health threats; however, the persisting effects of such releases on local recreational waters, fisheries, and other estuarine habitats are often undetermined.

Second-hand smoke: a neglected public health challenge.

PubMed

Singh, Rana J; Lal, Pranay G

2011-01-01

Exposure to secondhand smoke (SHS) causes an estimated 5% of the global burden of disease, slightly higher than the burden from direct use of tobacco. This review highlights the urgent need to address this ignored public health issue by presenting the evidence and impact of SHS on those exposed using global studies including those from the South-East Asia Region. The burden of morbidity from SHS exposure is higher in low-income countries in Southeast Asia region compared to the rest of the world. SHS exposure affects those most vulnerable, especially women and children. While several countries in the region have enacted legislation which offer protection to those exposed to SHS, most measures are partial and inadequate. As a result, implementation and compliance at national and sub-national level within the countries of the Southeast Asia region is variable. Governments must ensure that legislation mandates comprehensive smoke-free environments in order to provide public health benefit which offers universal protection to everyone and everywhere. Where comprehensive legislation exists, stringent implementation and enforcement, along with awareness building, education and monitoring through regular compliance studies must be done to sustain smokefree status of public places within jurisdictions.

Do Low Income Youth of Color See "The Bigger Picture" When Discussing Type 2 Diabetes: A Qualitative Evaluation of a Public Health Literacy Campaign.

PubMed

Schillinger, Dean; Tran, Jessica; Fine, Sarah

2018-04-24

As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement and norm change. We examined whether and how TBP PSAs advance health literacy among low-income, minority youth. We showed nine PSAs, asking individuals open-ended questions via questionnaire, then facilitating a focus group to reflect upon the PSAs. Questionnaire responses revealed a balance between individual vs. public health literacy. Some focused on individual responsibility and behaviors, while others described socio-environmental forces underlying risk. The focus group generated a preponderance of public health literacy responses, emphasizing future action. Striking sociopolitical themes emerged, reflecting tensions minority and low-income youth experience, such as entrapment vs. liberation. Our findings speak to the structural barriers and complexities underlying diabetes risk, and the ability of spoken word medium to make these challenges visible and motivate action. Delivering TBP content to promote interactive reflection has potential to change behavioral norms and build capacity to confront the social, economic and structural factors that influence behaviors.

Oral health status of San Francisco public school kindergarteners 2000-2005.

PubMed

Chung, Lisa H; Shain, Sara G; Stephen, Samantha M; Weintraub, Jane A

2006-01-01

To determine the prevalence of dental caries and oral health disparities in San Francisco kindergarten public school children from 2000-2005. The San Francisco Department of Public Health in partnership with the San Francisco Dental Society and assistance from the National Dental Association, has been conducting annual dental screenings of kindergarten children enrolled in the San Francisco Unified School District since 2000. Outcomes assessed from this series of cross-sectional screenings included prevalence of caries experience, untreated caries, treatment needs, and caries severity by child's sex, race/ethnicity, residential zip code, and a proxy for socioeconomic status. Of 76 eligible schools, 62-72 participated, and 86-92% of enrolled children (n=3,354-3,527) were screened yearly. Although there was a small, significant decrease over the time period, in 2005, 50.1% of children had caries experience; 28.8% had untreated caries and 7.6% had urgent treatment needs. Each year caries prevalence was greatest for Asian children, those attending schools with > 50% children eligible for the free or reduced-price meal program, and children living in zip codes in and around Chinatown and San Francisco's southern border. Despite signs of improvement, caries remains a public health problem especially in Asian and Hispanic children, and children living in certain sections of San Francisco.

Air pollution: costs and paths to a solution in Hong Kong--understanding the connections among visibility, air pollution, and health costs in pursuit of accountability, environmental justice, and health protection.

PubMed

Hedley, Anthony J; McGhee, Sarah M; Barron, Bill; Chau, Patsy; Chau, June; Thach, Thuan Q; Wong, Tze-Wai; Loh, Christine; Wong, Chit-Ming

2008-01-01

Air quality has deteriorated in Hong Kong over more than 15 yr. As part of a program of public accountability, photographs on Poor and Better visibility days were used as representations of the relationships among visibility, air pollution, adverse health effects, and community costs for health care and lost productivity. Coefficients from time-series models and gazetted costs were used to estimate the health and economic impacts of different levels of pollution. In this population of 6.9 million, air quality improvement from the annual average to the lowest pollutant levels of Better visibility days, comparable to the World Health Organization air quality guidelines, would avoid 1335 deaths, 60,587 hospital bed days, and 6.7 million doctor visits for respiratory complaints each year. Direct costs and productivity losses avoided would be over US$240 million a year. The dissemination of these findings led to increased demands for pollution controls from the public and legislators, but denials of the need for urgent action arose from the government. The outcome demonstrates the need for more effective translation of the scientific evidence base into risk communication and public policy.

What gets measured gets done: an assessment of local data uses and needs in large urban health departments.

PubMed

Castrucci, Brian C; Rhoades, Elizabeth K; Leider, Jonathon P; Hearne, Shelley

2015-01-01

The epidemiologic shift in the leading causes of mortality from infectious disease to chronic disease has created significant challenges for public health surveillance at the local level. We describe how the largest US city health departments identify and use data to inform their work and we identify the data and information that local public health leaders have specified as being necessary to help better address specific problems in their communities. We used a mixed-methods design that included key informant interviews, as well as a smaller embedded survey to quantify organizational characteristics related to data capacity. Interview data were independently coded and analyzed for major themes around data needs, barriers, and achievements. Forty-five public health leaders from each of 3 specific positions-local health official, chief of policy, and chief science or medical officer-in 16 large urban health departments. Public health leaders in large urban local health departments reported that timely data and data on chronic disease that are available at smaller geographical units are difficult to obtain without additional resources. Despite departments' successes in creating ad hoc sources of local data to effect policy change, all participants described the need for more timely data that could be geocoded at a neighborhood or census tract level to more effectively target their resources. Electronic health records, claims data, and hospital discharge data were identified as sources of data that could be used to augment the data currently available to local public health leaders. Monitoring the status of community health indicators and using the information to identify priority issues are core functions of all public health departments. Public health professionals must have access to timely "hyperlocal" data to detect trends, allocate resources to areas of greatest priority, and measure the effectiveness of interventions. Although innovations in the largest local health departments in large urban areas have established some methods to obtain local data on chronic disease, leaders recognize that there is an urgent need for more timely and more geographically specific data at the neighborhood or census tract level to efficiently and effectively address the most pressing problems in public health.

Viruses vector control proposal: genus Aedes emphasis.

PubMed

Reis, Nelson Nogueira; Silva, Alcino Lázaro da; Reis, Elma Pereira Guedes; Silva, Flávia Chaves E; Reis, Igor Guedes Nogueira

The dengue fever is a major public health problem in the world. In Brazil, in 2015, there were 1,534,932 cases, being 20,320 cases of severe form, and 811 deaths related to this disease. The distribution of Aedes aegypti, the vector, is extensive. Recently, Zika and Chikungunya viruses had arisen, sharing the same vector as dengue and became a huge public health issue. Without specific treatment, it is urgently required as an effective vector control. This article is focused on reviewing vector control strategies, their effectiveness, viability and economical impact. Among all, the Sterile Insect Technique is highlighted as the best option to be adopted in Brazil, once it is largely effectively used in the USA and Mexico for plagues related to agribusiness. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

Low Caregiver Health Literacy is Associated with Higher Pediatric Emergency Department Use and Non-urgent Visits

PubMed Central

Morrison, Andrea K.; Schapira, Marilyn M.; Gorelick, Marc H.; Hoffmann, Raymond G.; Brousseau, David C.

2014-01-01

Objective We sought to determine the association between low caregiver health literacy and child emergency department (ED) use, both the number and urgency of ED visits. Methods This year long cross-sectional study utilized the Newest Vital Sign to measure the health literacy of caregivers accompanying children to a pediatric ED. Prior ED visits were extracted from a regional database. ED visit urgency was classified by resources utilized during the index ED visit. Regression analyses were used to model the outcomes: 1) prior ED visits and 2) ED visit urgency, stratified by chronic illness. Analyses were weighted by triage level. Results Overall, 503 caregivers completed the study; 55% demonstrated low health literacy. Children of caregivers with low health literacy had more prior ED visits (aIRR 1.5; 95% C.I.1.2, 1.8) and increased odds of a non-urgent index ED visit (AOR 2.4; 1.3, 4.4). Among children without chronic illness, low caregiver health literacy was associated with an increased proportion of non-urgent index ED visits (48% vs 22%; AOR 3.2; 1.8, 5.7). Conclusions Over half of caregivers presenting with their children to the ED have low health literacy. Low caregiver health literacy is an independent predictor of higher ED use and use of the ED for non-urgent conditions. In children without a chronic illness, low health literate caregivers had more than three times great odds of presenting for a non-urgent condition than those with adequate health literacy. PMID:24767784

Food industry: friend or foe?

PubMed

Yach, D

2014-01-01

Open discourse and tolerance between the food industry and public sector is limited. As a result, the public and private sectors are reluctant to collaborate on pressing nutritional issues. Those in the public sector have never heard what they could do to encourage a food company's transition towards healthier foods and beverages, whereas many in the private sector dismissed policies and actions initiated within the public sector. During my career, I have sought to engage the broadest possible stakeholder groups required to develop evidence-based policies and with the aim of improving public health. My recent experience in industry confirmed my view about the need for scientific exchange regardless of the disagreements about policy. Open discourse and partnering is essential if we are to tackle complex food and health issues and improve the global food system. Private-public engagement can provide faster and more sustainable results than government alone without impacting profits. Moreover, a high-quality product in smaller portions will have higher profit margins than a bargain-sized product of lower quality. The food industry and private sector must come together to implement innovative strategies to address urgent nutritional needs. © 2013 The Author. obesity reviews © 2013 International Association for the Study of Obesity.

Historically Black Medical Schools: Addressing the Minority Health Professional Pipeline and the Public Mission of Care For Vulnerable Populations

PubMed Central

Norris, Keith C.; Baker, Richard S.; Taylor, Robert; Montgomery-Rice, Valerie; Higginbotham, Eve J.; Riley, Wayne J.; Maupin, John; Drew-Ivie, Sylvia; Reede, Joan Y.; Gibbons, Gary

2013-01-01

Substantial changes in not only access to care, cost, and quality of care, but also health professions education are needed to ensure effective national healthcare reform. Since the actionable determinants of health such as personal beliefs and behaviors, socioeconomic factors, and the environment disproportionately affect the poor (and often racial/ethnic minorities), many have suggested that focusing efforts on this population will both directly and indirectly improve the overall health of the nation. Key to the success of such strategies are the ongoing efforts by historically black medical schools (HBMSs) as well as other minority serving medical and health professional schools, who produce a disproportionate percentage of the high-quality and diverse health professionals that are dedicated to maintaining the health of an increasingly diverse nation. Despite their public mission, HBMSs receive limited public support threatening their ability to not only meet the increasing minority health workforce needs but to even sustain their existing contributions. Substantial changes in health education policy and funding are needed to ensure HBMSs as well as other minority-serving medical and health professional schools can continue to produce the diverse, high-quality health professional workforce necessary to maintain the health of an increasingly diverse nation. We explore several model initiatives including focused partnerships with legislative and business leaders that are urgently needed to ensure the ability of HBMSs to maintain their legacy of providing compassionate, quality care to the communities in greatest need. PMID:19806842

Global occupational health: current challenges and the need for urgent action.

PubMed

Lucchini, Roberto G; London, Leslie

2014-01-01

Global occupational health and safety (OHS) is strictly linked to the dynamics of economic globalization. As the global market is increasing, the gap between developed and underdeveloped countries, occupational diseases, and injuries affect a vast number of workers worldwide. Global OHS issues also become local in developed countries due to many factors, including untrained migrant workers in the informal sector, construction, and agriculture. To identify the current status and challenges of global occupational health and safety and the needs for preventive action. Absence of OHS infrastructure amplifies the devastating consequences of infectious outbreaks like the Ebola pandemic and tuberculosis. Interventions in global OHS are urgently needed at various levels: 1. Increased governmental funding is needed for international organizations like the World Health Organization and the International Labor Organization to face the increasing demand for policies, guidance, and training. 2. Regulations to ban and control dangerous products are needed to avoid the transfer of hazardous production to developing countries. 3. The OHS community must address global OHS issues through advocacy, position papers, public statements, technical and ethical guidelines, and by encouraging access of OHS professionals from the developing countries to leadership positions in professional and academic societies. 4. Research, education, and training of OHS professionals, workers, unions and employers are needed to address global OHS issues and their local impact. 5. Consumers also can influence significantly the adoption of OHS practices by demanding the protection of workers who are producing he goods that are sold in the global market. Following the equation of maximized profits prompted by the inhibition of OHS is an old practice that has proven to cause significant costs to societies in the developed world. It is now an urgent priority to stop this process and promote a harmonized global market where the health of workers is guaranteed in the global perspective. Copyright © 2014 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies

PubMed Central

Pillemer, Karl; Burnes, David; Riffin, Catherine; Lachs, Mark S.

2016-01-01

Purpose: Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, and the general public. In this article, we provide an overview of global issues in the field of elder abuse, with a focus on prevention. Design and Methods: This article provides a scoping review of key issues in the field from an international perspective. Results: By drawing primarily on population-based studies, this scoping review provided a more valid and reliable synthesis of current knowledge about prevalence and risk factors than has been available. Despite the lack of scientifically rigorous intervention research on elder abuse, the review also identified 5 promising strategies for prevention. Implications: The findings highlight a growing consensus across studies regarding the extent and causes of elder mistreatment, as well as the urgent need for efforts to make elder mistreatment prevention programs more effective and evidence based. PMID:26994260

An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy.

PubMed

Karwalajtys, Tina; Kaczorowski, Janusz

2010-01-01

Cardiovascular disease (CVD) is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.

[Hospital emergency and health system organization in France].

PubMed

Moreau, François

2003-01-01

There is no legal definition of the term "emergency" in France. Given the vagueness of this term, a law was passed on 6 January 1986 in France defining the principle of urgent medical assistance as "providing the sick, the wounded and pregnant women, wherever they are, with the appropriate emergency care to meet their condition". The Ethical Medical Code of 6 September 1995 (Art. 77) specifies that "regarding constant availability of health care, the duty of every doctor is to take part in the day and night on-call rota". To understand the emergency care system in France, it should be stressed that the health system is a joint system, with a private sector and a public sector jointly organizing and providing health care. The patient can access either system as he chooses.

Investigating links between shale gas development and health impacts through a community survey project in Pennsylvania.

PubMed

Steinzor, Nadia; Subra, Wilma; Sumi, Lisa

2013-01-01

Across the United States, the race for new energy sources is picking up speed and reaching more places, with natural gas in the lead. While the toxic and polluting qualities of substances used and produced in shale gas development and the general health effects of exposure are well established, scientific evidence of causal links has been limited, creating an urgent need to understand health impacts. Self-reported survey research documenting the symptoms experienced by people living in proximity to gas facilities, coupled with environmental testing, can elucidate plausible links that warrant both response and further investigation. This method, recently applied to the gas development areas of Pennsylvania, indicates the need for a range of policy and research efforts to safeguard public health.

Access, continuity of care and consultation quality: which best predicts urgent cancer referrals from general practice?

PubMed

Rogers, Stephen; Gildea, Carolynn; Meechan, David; Baker, Richard

2014-12-01

For some cancers, late presentation is associated with poor survival. In England, less than half of patients are diagnosed following a general practitioner-initiated urgent referral. We explore whether particular practice or practitioner characteristics are associated with use of the urgent referral system. The study sample was 603/614 practices in the East Midlands. Logistic regression models were fitted to investigate relationships between cancer detection rate, how easy it is to book appointments quickly, in advance or with a preferred doctor, and whether patients have confidence and trust in the doctor. The percentage of patients who definitely have confidence and trust in the doctor was positively associated with the cancer detection rate [odds ratio = 1.08 (95% confidence interval (CI) 1.01, 1.15) per 10 percentage points]. When all four survey variables were modelled together, the percentage of patients who were able to see a preferred doctor was negatively associated with the cancer detection rate [odds ratio = 0.93 (95% CI 0.88, 0.98) per 10 percentage points]. Our analyses suggest that in the UK National Health Service, confidence and trust in the doctor may be more important in cancer detection than the ease of access or whether there is choice of doctor. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Sites of institutional racism in public health policy making in New Zealand.

PubMed

Came, Heather

2014-04-01

Although New Zealanders have historically prided ourselves on being a country where everyone has a 'fair go', the systemic and longstanding existence of health inequities between Māori and non-Māori suggests something isn't working. This paper informed by critical race theory, asks the reader to consider the counter narrative viewpoints of Māori health leaders; that suggest institutional racism has permeated public health policy making in New Zealand and is a contributor to health inequities alongside colonisation and uneven access to the determinants of health. Using a mixed methods approach and critical anti-racism scholarship this paper identifies five specific sites of institutional racism. These sites are: majoritarian decision making, the misuse of evidence, deficiencies in both cultural competencies and consultation processes and the impact of Crown filters. These findings suggest the failure of quality assurance systems, existing anti-racism initiatives and health sector leadership to detect and eliminate racism. The author calls for institutional racism to be urgently addressed within New Zealand and this paper serves as a reminder to policy makers operating within other colonial contexts to be vigilant for such racism. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Syrian public health and humanitarian crisis: A 'displacement' in global governance?

PubMed

Akbarzada, Sumaira; Mackey, Tim K

2018-07-01

Ongoing failure by the international community to resolve the Syrian conflict has led to destruction of critical infrastructure. This includes the collapse of the Syrian health system, leaving millions of internally displaced persons (IDPs) in urgent need of healthcare services. As the conflict intensifies, IDP populations are suffering from infectious and non-communicable disease risks, poor maternal and child health outcomes, trauma, and mental health issues, while healthcare workers continually exit the country. Healthcare workers who remain face significant challenges, including systematic attacks on healthcare facilities and conditions that severely inhibit healthcare delivery and assistance. Within this conflict-driven public health crisis, the most susceptible population is arguably the IDP. Though the fundamental 'right to health' is a recognised international legal principle, its application is inadequate due to limited recognition by the UN Security Council and stymied global governance by the broader international community. These factors have also negatively impacted other vulnerable groups other than IDPs, such as refugees and ethnic minorities, who may or may not be displaced. Hence, this article reviews the current Syrian conflict, assesses challenges with local and global governance for IDPs, and explores potential governance solutions needed to address this health and humanitarian crisis.

Use of performance indicators to assess the solid waste management of health services.

PubMed

Assis, Mayara C; Gomes, Vanielle A P; Balista, Wagner C; Freitas, Rodrigo R DE

2017-01-01

Modern society faces serious challenges, among them, the complexity of environmental problems. Thus, there are several possible sources of environmental degradation, however, the waste produced by health services have an important peculiarity due to its toxic or pathogenic characteristics, since when managed improperly provide also health risk public. The involvement of solid waste from healthcare services environmental impact integrates matters a little more complex, because in addition to environmental health, they also interfere with the healthiness of environments that generate, with the consequences of nosocomial infections, occupational health and public. Thus, the management has become an urgent need, especially when we see no use of performance indicators management in healthcare environments in the city of São Mateus, ES. For this, we used the Analytic Hierarchy Process Method to prioritize such indicators as the potential improvement in health services waste management process - WHS and thus environmental analysis was performed with the use of a template for SWOT analysis. The results showed that the performance indicator training strategies developed with employees has the greatest potential to assist in improvements in WHS (Health Services Waste) management process followed indicator knowledge of the regulations associated with procedures performed by employees and importance of biosafety regulations.

Contraceptive information on pregnancy resource center websites: a statewide content analysis.

PubMed

Swartzendruber, Andrea; Steiner, Riley J; Newton-Levinson, Anna

2018-04-24

Most pregnancy resource centers (PRCs) in the US are affiliated with national organizations that have policies against promoting or providing contraceptives, yet many provide information about contraception on their websites. In 2016, the state of Georgia passed a new law to publicly fund PRCs. This study sought to describe the contraceptive information on Georgia PRC websites. We systematically identified all accessible Georgia PRC websites April-June 2016. We downloaded entire websites and used defined protocols to code and thematically analyze content about contraceptives. Of the 64 websites reviewed, 20 (31%) presented information about contraceptives. Most of the content was dedicated to emergency contraception. Emphasis on risks and side effects was the most prominent theme. However, no site presented information about the frequency or prevalence of risks and side effects. Sites also emphasized contraceptive failure and minimized effectiveness. We found a high degree of inaccurate and misleading information about contraceptives. Georgia PRC websites presented skewed information that may undermine confidence in the safety and efficacy of contraceptive methods and discourage use. Public funding for PRCs, an increasing national trend, should be rigorously examined. Increased regulation is urgently needed to ensure that online information about contraceptives presented by publicly funded centers is unbiased, complete and accurate. We examined contraceptive information on Georgia PRC websites and found sites minimize benefits and emphasize barriers to use. They contain high levels of medically inaccurate and misleading information that may undermine public health goals. Public funding for PRCs should be rigorously examined; increased regulation is urgently needed. Copyright © 2018 Elsevier Inc. All rights reserved.

Counterfeit Drug Penetration into Global Legitimate Medicine Supply Chains: A Global Assessment

PubMed Central

Mackey, Tim K.; Liang, Bryan A.; York, Peter; Kubic, Thomas

2015-01-01

Counterfeit medicines are a global public health risk. We assess counterfeit reports involving the legitimate supply chain using 2009–2011 data from the Pharmaceutical Security Institute Counterfeit Incident System (PSI CIS) database that uses both open and nonpublic data sources. Of the 1,510 identified CIS reports involving counterfeits, 27.6% reported China as the source country of the incident/detection. Further, 51.3% were reported as counterfeit but the specific counterfeit subcategory was not known or verifiable. The most prevalent therapeutic category was anti-infectives (21.1%) with most reports originating from health-related government agencies. Geographically, Asian and Latin American regions and, economically, middle-income markets were most represented. A total of 127 (64.8%) of a total of 196 countries had no legitimate supply chain CIS counterfeit reports. Improvements in surveillance, including detection of security breaches, data collection, analysis, and dissemination are urgently needed to address public health needs to combat the global counterfeit medicines trade. PMID:25897059

Counterfeit drug penetration into global legitimate medicine supply chains: a global assessment.

PubMed

Mackey, Tim K; Liang, Bryan A; York, Peter; Kubic, Thomas

2015-06-01

Counterfeit medicines are a global public health risk. We assess counterfeit reports involving the legitimate supply chain using 2009-2011 data from the Pharmaceutical Security Institute Counterfeit Incident System (PSI CIS) database that uses both open and nonpublic data sources. Of the 1,510 identified CIS reports involving counterfeits, 27.6% reported China as the source country of the incident/detection. Further, 51.3% were reported as counterfeit but the specific counterfeit subcategory was not known or verifiable. The most prevalent therapeutic category was anti-infectives (21.1%) with most reports originating from health-related government agencies. Geographically, Asian and Latin American regions and, economically, middle-income markets were most represented. A total of 127 (64.8%) of a total of 196 countries had no legitimate supply chain CIS counterfeit reports. Improvements in surveillance, including detection of security breaches, data collection, analysis, and dissemination are urgently needed to address public health needs to combat the global counterfeit medicines trade. © The American Society of Tropical Medicine and Hygiene.

Recommendation to reconsider examining cannabis subtypes together due to opposing effects on brain, cognition and behavior.

PubMed

Rømer Thomsen, Kristine; Callesen, Mette Buhl; Feldstein Ewing, Sarah W

2017-09-01

Cannabis use represents a major public health issue throughout the globe. Yet, we still lack the most fundamental knowledge on long-term effects of cannabis on neural, cognitive, and behavioral function. Part of this stems from how cannabis has been measured historically. To this end, most empirical examinations of cannabis have consolidated all types of cannabis collectively. However, this approach obscures differences in how cannabinoids operate. In this commentary, we address the contrasting properties of tetrahydrocannabinol (THC) and cannabidiol (CBD) and their opposing effects on cognitive function. In addition, we address the increase in cannabis potency throughout the past two decades and how that impacts generalizability of early data to evaluations of contemporary public health. We underscore the urgent need for future research to disaggregate examination of THC from CBD, along with the importance of measuring cannabis potency to more effectively unravel its influence on cognitive function and other health issues. Copyright © 2017 Elsevier Ltd. All rights reserved.

The role of professional education in building capacity for health promotion in the global South: a case study from Norway.

PubMed

Mittelmark, Maurice B

2003-01-01

The capacity to train public health professionals is far from sufficient to meet urgent global needs. Foreign aid programs hold much promise to deal with this challenge. A case study from Norway illustrates the possibilities. Since the early 1960s, Norwegian universities have offered English-taught masters and doctoral degree programs, with sufficient financial support that all Third World students have the resources to complete training, regardless of their personal financial circumstances. This facet of the program is its main distinguishing factor, compared to many educational opportunities that are available in other countries. Since the first visiting students were awarded degrees in 1968, almost 10,000 students have participated at more than 25 Norwegian institutions, including many offering public health training. Many eligible applicants have been turned away due to lack of resources, indicating a level of interest that cannot be met with existing resources. Similar programs in more countries could help alleviate the need.

The pharmacoeconomic picture in Saudi Arabia.

PubMed

Alkhenizan, Abdullah

2014-08-01

Saudi Arabia is the largest country in the region and it is the largest oil producing country in the world. It is one of the few countries in the world which was not affected significantly by the global economic crisis. Health care spending is led mainly by governmental expenditure. Private sector share of the health care services is supported by the government and increasing. The demands for pharmaceutical products, medical devices and health care services is fueled by the rapidly growing population and the wide spread of chronic diseases. Publications and expertise in the field of pharmacoeconomics is scarce within the country. There is an urgent need to establish a national center for pharmacoeconomics to lead the country efforts in controlling the cost of health care services. Such a center is needed to promote pharmacoeconomics research and train health care professionals in this field.

Heat stroke internet searches can be a new heatwave health warning surveillance indicator

PubMed Central

Li, Tiantian; Ding, Fan; Sun, Qinghua; Zhang, Yi; Kinney, Patrick L.

2016-01-01

The impact of major heatwave shocks on population morbidity and mortality has become an urgent public health concern. However, Current heatwave warning systems suffer from a lack of validation and an inability to provide accurate health risk warnings in a timely way. Here we conducted a correlation and linear regression analysis to test the relationship between heat stroke internet searches and heat stroke health outcomes in Shanghai, China, during the summer of 2013. We show that the resulting heatstroke index captures much of the variation in heat stroke cases and deaths. The correlation between heat stroke deaths, the search index and the incidence of heat stroke is higher than the correlation with maximum temperature. This study highlights a fast and effective heatwave health warning indicator with potential to be used throughout the world. PMID:27869135

Heat stroke internet searches can be a new heatwave health warning surveillance indicator

NASA Astrophysics Data System (ADS)

Li, Tiantian; Ding, Fan; Sun, Qinghua; Zhang, Yi; Kinney, Patrick L.

2016-11-01

The impact of major heatwave shocks on population morbidity and mortality has become an urgent public health concern. However, Current heatwave warning systems suffer from a lack of validation and an inability to provide accurate health risk warnings in a timely way. Here we conducted a correlation and linear regression analysis to test the relationship between heat stroke internet searches and heat stroke health outcomes in Shanghai, China, during the summer of 2013. We show that the resulting heatstroke index captures much of the variation in heat stroke cases and deaths. The correlation between heat stroke deaths, the search index and the incidence of heat stroke is higher than the correlation with maximum temperature. This study highlights a fast and effective heatwave health warning indicator with potential to be used throughout the world.

Obesity in African-American Women--The Time Bomb is Ticking: An Urgent Call for Change.

PubMed

Fowler, Barbara A

2015-12-01

The "time bomb is ticking" because there is an obesity crisis associated with higher rates of chronic diseases such as stroke, hypertension, type 2 diabetes, and some forms of cancer in African-American women compared to White women. African-American women incur higher medical costs from hospitalizations, decreased productivity in the work setting, lost wages, the needfor medical benefits and pharmacy-associated costs, and more time away from family than White women. Numerous factors, such as the socio-cultural context of eating, acceptance of a larger weight status, the emotionally liberating effects offood, and preference for highfat and high caloric, sugary-content, and sodium-laden food influences the obesity crisis in African-American women. The interplay of poverty and lower socioeconomic status, residential segregation, health literacy, availability of fast foods and scarce produce in local convenience food marts, physical inactivity, and conflicting messages from social media public service announcements (PSAs) and ads in national magazines affect the obesity crisis in African-American women. There is an urgent call for sustainable, community-driven health policy initiatives that improve access to healthy foods in lower-income, minority communities. Furthermore, African-American women are challenged to modify their health behaviors by preparing healthy meals for themselves and theirfamilies, and by engaging in physical activity.

Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis

PubMed Central

DiNicolantonio, James J; Wilson, William

2018-01-01

Because serum magnesium does not reflect intracellular magnesium, the latter making up more than 99% of total body magnesium, most cases of magnesium deficiency are undiagnosed. Furthermore, because of chronic diseases, medications, decreases in food crop magnesium contents, and the availability of refined and processed foods, the vast majority of people in modern societies are at risk for magnesium deficiency. Certain individuals will need to supplement with magnesium in order to prevent suboptimal magnesium deficiency, especially if trying to obtain an optimal magnesium status to prevent chronic disease. Subclinical magnesium deficiency increases the risk of numerous types of cardiovascular disease, costs nations around the world an incalculable amount of healthcare costs and suffering, and should be considered a public health crisis. That an easy, cost-effective strategy exists to prevent and treat subclinical magnesium deficiency should provide an urgent call to action. PMID:29387426

[Urban shrinkage and challenges for the public health-care service].

PubMed

Kabisch, S

2007-10-01

In the 21st century, urban development is facing new challenges caused by the simultaneous growing and shrinking of cities and urban regions. Whilst the development patterns and instruments of urban growth are well-known and widely accepted, the processes of shrinkage with its broad consequences, sphere of impact and speed need intensive investigation. In particular, urban restructuring including housing demolition brings about psychological stress situations for the affected inhabitants. Until the present time public services, including health-care, are poorly prepared to cope with the new situation. To take account of these new challenges, the adaptation of tasks, instruments and targets is urgently needed. To be successful, a continuous cooperation and communication between municipal institutions and housing enterprises responsible for urban and housing development is indispensable. Furthermore, appropriately focussed scientific research results can support the creation of adequate strategies and instruments.

Breaking the silence surrounding hepatitis C by promoting self-efficacy: hepatitis C public service announcements.

PubMed

Grow, Jean M; Christopher, Stephanie A

2008-10-01

Hepatitis C virus (HCV) is the most common chronic bloodborne virus in the United States. Despite this fact, there is a startling lack of awareness about HCV among individuals who might have contracted the virus. In this study, grounded in self-efficacy theory, we analyze public service announcements for HCV. Using focus groups to contextualize the responses of individuals living with HCV, we conclude that stigma and structural barriers pose the greatest challenges for health communicators trying to reach at-risk populations. The findings suggest that expanded use of celebrity appeals, realistic drug-use portrayals, more extensive use of social networking in tandem with nontraditional media, tapping into veterans, and maximizing self-efficacy messages while minimizing fear tactics offer new hope for successful health communication strategies. With 3.9 million people in the United States infected with HCV, this study offers urgently needed communication strategies to address this silent epidemic.

The Ebola Outbreak: Catalyzing a "Shift" in Global Health Governance?

PubMed

Mackey, Tim K

2016-11-24

As the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of continued debate. Criticism of WHO's performance grew louder in the outbreak's wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies. In order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO's performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance. Despite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the "evolution" in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex nature of modern public health emergencies. Instead, the lasting legacy of the EVD outbreak may be its foreshadowing of a governance "shift" in formal sharing of the complex responsibilities of global health, health security, outbreak response, and managing health emergencies to other international structures, most notably the United Nations. Only time will tell if the legacy of EVD will include a WHO that has the full support of the international community and is capable of leading human society in this brave new era of the globalization of infectious diseases.

Addressing barriers to the prevention, diagnosis and treatment of hepatitis B and C in the face of persisting fiscal constraints in Europe: report from a high level conference.

PubMed

Papatheodoridis, G; Thomas, H C; Golna, C; Bernardi, M; Carballo, M; Cornberg, M; Dalekos, G; Degertekin, B; Dourakis, S; Flisiak, R; Goldberg, D; Gore, C; Goulis, I; Hadziyannis, S; Kalamitsis, G; Kanavos, P; Kautz, A; Koskinas, I; Leite, B R; Malliori, M; Manolakopoulos, S; Matičič, M; Papaevangelou, V; Pirona, A; Prati, D; Raptopoulou-Gigi, M; Reic, T; Robaeys, G; Schatz, E; Souliotis, K; Tountas, Y; Wiktor, S; Wilson, D; Yfantopoulos, J; Hatzakis, A

2016-02-01

In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis. © 2016 John Wiley & Sons Ltd.

Public Health Implications and Risk Factors Assessment of Mycobacterium bovis Infections among Abattoir Personnel in Bauchi State, Nigeria

PubMed Central

Sa'idu, A. S.; Okolocha, E. C.; Dzikwi, A. A.; Gamawa, A. A.; Ibrahim, S.; Kwaga, J. K. P.; Usman, A.; Maigari, S. A.

2015-01-01

Bovine tuberculosis (bTB) is a chronic infectious and contagious zoonotic disease of domestic animals, wild animals, and humans. It poses a public health threat and economic losses due to abattoir condemnation of infected carcasses during meat inspection of slaughtered animals. Bovine tuberculosis is widespread in Africa including Nigeria affecting both cattle and humans, particularly Northern Nigeria. A prospective survey was conducted from June to August 2013 in the three Zonal abattoirs of Bauchi State, Nigeria. A total of 150 structured close-ended questionnaires were administered to abattoir personnel to assess their level of awareness of bTB. This study was aimed at determining the level of public health awareness, attitude, and practices of abattoir workers of bTB in Bauchi State, Nigeria. There was a statistically significant association between respondents' awareness of bTB and their occupational status, age, and duration of exposure to cattle carcasses (P < 0.05); the odds of being aware of bTB were 9.4, 7.3, and 2.1, respectively. In conclusion, these demonstrate the urgent need for public health authorities to intervene in bTB control. The risk of bTB transmission as indicated by the personnel's practices and awareness levels in Bauchi State could be prevented through the use of protective clothing (PPEs). PMID:26464954

Do Low Income Youth of Color See “The Bigger Picture” When Discussing Type 2 Diabetes: A Qualitative Evaluation of a Public Health Literacy Campaign

PubMed Central

Schillinger, Dean; Tran, Jessica; Fine, Sarah

2018-01-01

As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement and norm change. Methods: We examined whether and how TBP PSAs advance health literacy among low-income, minority youth. We showed nine PSAs, asking individuals open-ended questions via questionnaire, then facilitating a focus group to reflect upon the PSAs. Results: Questionnaire responses revealed a balance between individual vs. public health literacy. Some focused on individual responsibility and behaviors, while others described socio-environmental forces underlying risk. The focus group generated a preponderance of public health literacy responses, emphasizing future action. Striking sociopolitical themes emerged, reflecting tensions minority and low-income youth experience, such as entrapment vs. liberation. Conclusion: Our findings speak to the structural barriers and complexities underlying diabetes risk, and the ability of spoken word medium to make these challenges visible and motivate action. Practice Implications: Delivering TBP content to promote interactive reflection has potential to change behavioral norms and build capacity to confront the social, economic and structural factors that influence behaviors. PMID:29695114

Brain drain and health workforce distortions in Mozambique.

PubMed

Sherr, Kenneth; Mussa, Antonio; Chilundo, Baltazar; Gimbel, Sarah; Pfeiffer, James; Hagopian, Amy; Gloyd, Stephen

2012-01-01

Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs), and the private sector. An observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980-2006. Data were collected 26-months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment, and main work duties. Of 723 qualifying physicians between 1980-2006, 95.9% (693) were working full-time, including 71.1% (493) as clinicians, 20.5% (142) as health system managers, and 6.9% (48) as researchers/professors. 25.5% (181) of the sample had left the public sector, of which 62.4% (113) continued working in-country and 37.6% (68) emigrated from Mozambique. Of those cases of internal migration, 66.4% (75) worked for NGOs, 21.2% (24) for donor agencies, and 12.4% (14) in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% (41/113) of internal migration cases had previously held senior-level management positions in the public sector. Internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique. Given the urgent need to strengthen public sector health systems, frank reflection by donors and NGOs is needed to assess how hiring practices may undermine the very systems they seek to strengthen.

Brain Drain and Health Workforce Distortions in Mozambique

PubMed Central

Sherr, Kenneth; Mussa, Antonio; Chilundo, Baltazar; Gimbel, Sarah; Pfeiffer, James; Hagopian, Amy; Gloyd, Stephen

2012-01-01

Introduction Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs), and the private sector. Methods An observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980–2006. Data were collected 26-months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment, and main work duties. Results Of 723 qualifying physicians between 1980–2006, 95.9% (693) were working full-time, including 71.1% (493) as clinicians, 20.5% (142) as health system managers, and 6.9% (48) as researchers/professors. 25.5% (181) of the sample had left the public sector, of which 62.4% (113) continued working in-country and 37.6% (68) emigrated from Mozambique. Of those cases of internal migration, 66.4% (75) worked for NGOs, 21.2% (24) for donor agencies, and 12.4% (14) in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% (41/113) of internal migration cases had previously held senior-level management positions in the public sector. Discussion Internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique. Given the urgent need to strengthen public sector health systems, frank reflection by donors and NGOs is needed to assess how hiring practices may undermine the very systems they seek to strengthen. PMID:22558237

Strange bedfellows: bridging the worlds of academia, public health and the sex industry to improve sexual health outcomes

PubMed Central

2011-01-01

The public health response to sexually transmitted infections, particularly HIV, has been and continues to be overwhelmingly focused on risk, disease and negative outcomes of sex, while avoiding discussion of positive motivations for sex (e.g. pleasure, desire, love). Recent advocacy efforts have challenged this approach and organisations have promoted the eroticisation of safer sex, especially in the context of HIV prevention. This paper is a case study of one of these organizations – The Pleasure Project. It gives a brief background on the public-health approach to sex and sexual health, and recommends an alternative approach which incorporates constructs of pleasure and desire into sexual health interventions. The Pleasure Project’s aims and unorthodox communications strategies are described, as are the response to and impact of its work, lessons learned and ongoing challenges to its approach. The Pleasure Project combines evidence (rigorous and experimental as well as qualitative and anecdotal) with experiential knowledge from the sex industry and safer-sex promotion to communicate messages about eroticising safer sex to influence researchers, public health practitioners and policymakers, mainstream media and the porn world. There are significant barriers to this work, because it challenges common and entrenched norms and values related to sex and pleasure and their role in the public health sphere. Other barriers include: the limited range of existing rigorous intervention trials which incorporate pleasure constructs; the lack of effective indicators to measure pleasure constructs; limited funding and resources; discomfort among public health practitioners, researchers and donors with concepts of pleasure and sex; and rejection of erotic media as a potential tool for prevention. Despite the backdrop of sex-negative public health practice, there is anecdotal evidence that safer sex, including condom use, can be eroticised and made pleasurable, based on qualitative research by The Pleasure Project and other like-minded organisations. Yet there is a need for more research on the effectiveness of pleasure components in sexual health interventions, particularly in high-risk contexts. This need has become urgent as practitioners look for new ways to promote sexual health and as new prevention technologies (including female condoms and microbicides) are introduced or disseminated. PMID:21679380

Determinants of health system delay at public and private directly observed treatment, short course facilities in Lagos State, Nigeria: A cross-sectional study.

PubMed

Adejumo, Olusola Adedeji; Daniel, Olusoji James; Otesanya, Andrew Folarin; Adejumo, Esther Ngozi

2016-09-01

Despite several studies on health system delay (HSD) among tuberculosis (TB) patients in Nigeria, no study has compared HSD in private and public health facilities. This study assessed the determinants of HSD in public and private health facilities offering the directly observed treatment, short course (DOTS). A descriptive cross-sectional study was conducted. A total of 470 new smear-positive TB patients aged 14years and older were consecutively recruited between October 1, 2012, and December 31, 2012, from 34 (23 public and 11 private) DOTS facilities that offered treatment and microscopy services. Mann-Whitney U test and logistic regression were used to assess the determinants of HSD. The median HSD was longer at public DOTS facilities (14days; interquartile range [IQR] 10-21days) than private DOTS facilities (12.5days; IQR 10.0-14.0days, p=.002). Age and human immunodeficiency virus status were determinants of HSD at the public DOTS facilities, whereas sex and income were determinants of HSD at the private DOTS facilities. TB patients who first visited a nonhospital facility were over four times more likely (odds ratio 4.12; 95% confidence interval 2.25-7.54) to have prolonged HSD than those who first visited the government hospital when they first developed the symptoms of TB after controlling for other factors in the model. Determinants of HSD at the public and private DOTS facilities vary. Strategies to reduce HSD at both public and private DOTS facilities in Lagos State, Nigeria, are urgently needed. Copyright © 2016 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

Patient Satisfaction With Care for Urgent Health Problems: A Survey of Family Practice Patients

PubMed Central

Howard, Michelle; Goertzen, James; Hutchison, Brian; Kaczorowski, Janusz; Morris, Kelly

2007-01-01

PURPOSE Patient satisfaction is an important health care outcome. This study compared patients’ satisfaction with care received for an urgent health problem from their family physician, at an after-hours clinic in which their physician participated, at a walk-in clinic, at the emergency department, from telephone health advisory services, or from more than 1 of those services. METHODS We mailed a questionnaire to a random sample of patients from 36 family practices in Thunder Bay, Ontario. We elicited satisfaction with care for the most recent urgent health problem in the past 6 months on a 7-point scale (very dissatisfied to very satisfied). RESULTS The response rate was 62.3% (5,884 of 9,397). Of the 5,722 eligible patients 1,342 (23.4%) reported an urgent health problem, and data were available for both services used and satisfaction for 1,227 patients. After adjusting for sociodemographic characteristics and self-reported health status, satisfaction with care received for most recent urgent health problem was significantly higher among patients who visited or spoke to their family physician (mean 6.1; 95% confidence interval [CI], 5.8–6.4) compared with all other services (all P <.004, adjusted for multiple comparisons), with the exception of patients who used the after-hours clinic affiliated with their physician, whose satisfaction was not significantly different (mean 5.6; 95% CI, 5.2–6.0). CONCLUSIONS Satisfaction was highest for patients receiving care from their own family physician or their physician’s after-hours clinic. These results are important for new primary care models that emphasize continuity and after-hours availability of family physicians. PMID:17893383

Mapping health research capacity in 17 countries of the former Soviet Union and south-eastern Europe: an exploratory study.

PubMed

Santoro, Alessio; Glonti, Ketevan; Bertollini, Roberto; Ricciardi, Walter; McKee, Martin

2016-04-01

Policies to improve health status, tackle disease and ensure equitable access to healthcare should be informed by evidence derived from high-quality research. However, health research capacity is unevenly distributed across countries, as revealed by mapping exercises that have been undertaken to provide a basis for concerted action to strengthen capacity. This study systematically describes capacity to undertake health research in the countries of the former Soviet Union and south-eastern Europe and identifies the elements required to create a national health research system. The mapping exercise comprised two elements: a survey of key informants in the respective countries and a bibliometric analysis of scientific publications in the field of public health. Our results confirm that health research remains a low priority in some countries of the WHO European Region. In these countries, most of the literature was produced by researchers outside the country, often to inform international donors. This study provides important information for countries seeking to initiate action to strengthen their research capacity. There is a need for a comprehensive strategy with sustained investment in training and career development of researchers. There is also a need to create new funding systems to provide financial support to those undertaking policy-relevant research. International collaboration and investment in mechanisms to bridge the gap between research and policy are urgently required. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Poor quality vital anti-malarials in Africa - an urgent neglected public health priority

PubMed Central

2011-01-01

Background Plasmodium falciparum malaria remains a major public health problem. A vital component of malaria control rests on the availability of good quality artemisinin-derivative based combination therapy (ACT) at the correct dose. However, there are increasing reports of poor quality anti-malarials in Africa. Methods Seven collections of artemisinin derivative monotherapies, ACT and halofantrine anti-malarials of suspicious quality were collected in 2002/10 in eleven African countries and in Asia en route to Africa. Packaging, chemical composition (high performance liquid chromatography, direct ionization mass spectrometry, X-ray diffractometry, stable isotope analysis) and botanical investigations were performed. Results Counterfeit artesunate containing chloroquine, counterfeit dihydroartemisinin (DHA) containing paracetamol (acetaminophen), counterfeit DHA-piperaquine containing sildenafil, counterfeit artemether-lumefantrine containing pyrimethamine, counterfeit halofantrine containing artemisinin, and substandard/counterfeit or degraded artesunate and artesunate+amodiaquine in eight countries are described. Pollen analysis was consistent with manufacture of counterfeits in eastern Asia. These data do not allow estimation of the frequency of poor quality anti-malarials in Africa. Conclusions Criminals are producing diverse harmful anti-malarial counterfeits with important public health consequences. The presence of artesunate monotherapy, substandard and/or degraded and counterfeit medicines containing sub-therapeutic amounts of unexpected anti-malarials will engender drug resistance. With the threatening spread of artemisinin resistance to Africa, much greater investment is required to ensure the quality of ACTs and removal of artemisinin monotherapies. The International Health Regulations may need to be invoked to counter these serious public health problems. PMID:22152094

The Seattle–King County Healthy Homes II Project: A Randomized Controlled Trial of Asthma Self-management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers

PubMed Central

Krieger, James; Takaro, Tim K.; Song, Lin; Beaudet, Nancy; Edwards, Kristine

2009-01-01

Objective To compare the marginal benefit of in-home asthma self-management support provided by community health workers (CHWs) with standard asthma education from clinic-based nurses. Design Randomized controlled trial. Setting Community and public health clinics and homes. Participants Three hundred nine children aged 3 to 13 years with asthma living in low-income households. Interventions All participants received nurse-provided asthma education and referrals to community resources. Some participants also received CHW-provided home environmental assessments, asthma education, social support, and asthma-control resources. Outcome Measures Asthma symptom–free days, Pediatric Asthma Caretaker Quality of Life Scale score, and use of urgent health services. Results Both groups showed significant increases in caretaker quality of life (nurse-only group: 0.4 points; 95% confidence interval [CI], 0.3–0.6; nurse + CHW group: 0.6 points; 95% CI, 0.4–0.8) and number of symptom-free days (nurse only: 1.3 days; 95% CI, 0.5–2.1; nurse + CHW: 1.9 days; 95% CI, 1.1–2.8), and absolute decreases in the proportion of children who used urgent health services in the prior 3 months (nurse only: 17.6%; 95% CI, 8.1%–27.2%; nurse + CHW: 23.1%; 95% CI, 13.6%–32.6%). Quality of life improved by 0.22 more points in the nurse + CHW group (95% CI, 0.00–0.44; P=.049). The number of symptom-free days increased by 0.94 days per 2 weeks (95% CI, 0.02–1.86; P = .046), or 24.4 days per year, in the nurse + CHW group. While use of urgent health services decreased more in the nurse + CHW group, the difference between groups was not significant. Conclusion The addition of CHW home visits to clinic-based asthma education yielded a clinically important increase in symptom-free days and a modest improvement in caretaker quality of life. PMID:19188646

Public Health Climate Change Adaptation Planning Using Stakeholder Feedback.

PubMed

Eidson, Millicent; Clancy, Kathleen A; Birkhead, Guthrie S

2016-01-01

Public health climate change adaptation planning is an urgent priority requiring stakeholder feedback. The 10 Essential Public Health Services can be applied to adaptation activities. To develop a state health department climate and health adaptation plan as informed by stakeholder feedback. With Centers for Disease Control and Prevention (CDC) funding, the New York State Department of Health (NYSDOH) implemented a 2010-2013 climate and health planning process, including 7 surveys on perceptions and adaptation priorities. New York State Department of Health program managers participated in initial (n = 41, denominator unknown) and follow-up (72.2%) needs assessments. Surveillance system information was collected from 98.1% of surveillance system managers. For adaptation prioritization surveys, participants included 75.4% of NYSDOH leaders; 60.3% of local health departments (LHDs); and 53.7% of other stakeholders representing environmental, governmental, health, community, policy, academic, and business organizations. Interviews were also completed with 38.9% of other stakeholders. In 2011 surveys, 34.1% of state health program directors believed that climate change would impact their program priorities. However, 84.6% of state health surveillance system managers provided ideas for using databases for climate and health monitoring/surveillance. In 2012 surveys, 46.5% of state health leaders agreed they had sufficient information about climate and health compared to 17.1% of LHDs (P = .0046) and 40.9% of other stakeholders (nonsignificant difference). Significantly fewer (P < .0001) LHDs (22.9%) were incorporating or considering incorporating climate and health into planning compared to state health leaders (55.8%) and other stakeholders (68.2%). Stakeholder groups agreed on the 4 highest priority adaptation categories including core public health activities such as surveillance, coordination/collaboration, education, and policy development. Feedback from diverse stakeholders was utilized by NYSDOH to develop its Climate and Health Strategic Map in 2013. The CDC Building Resilience Against Climate Effects (BRACE) framework and funding provides a collaborative model for state climate and health adaptation planning.

Rapid Spread of Zika Virus in The Americas--Implications for Public Health Preparedness for Mass Gatherings at the 2016 Brazil Olympic Games.

PubMed

Petersen, Eskild; Wilson, Mary E; Touch, Sok; McCloskey, Brian; Mwaba, Peter; Bates, Matthew; Dar, Osman; Mattes, Frank; Kidd, Mike; Ippolito, Giuseppe; Azhar, Esam I; Zumla, Alimuddin

2016-03-01

Mass gatherings at major international sporting events put millions of international travelers and local host-country residents at risk of acquiring infectious diseases, including locally endemic infectious diseases. The mosquito-borne Zika virus (ZIKV) has recently aroused global attention due to its rapid spread since its first detection in May 2015 in Brazil to 22 other countries and other territories in the Americas. The ZIKV outbreak in Brazil, has also been associated with a significant rise in the number of babies born with microcephaly and neurological disorders, and has been declared a 'Global Emergency by the World Health Organization. This explosive spread of ZIKV in Brazil poses challenges for public health preparedness and surveillance for the Olympics and Paralympics which are due to be held in Rio De Janeiro in August, 2016. We review the epidemiology and clinical features of the current ZIKV outbreak in Brazil, highlight knowledge gaps, and review the public health implications of the current ZIKV outbreak in the Americas. We highlight the urgent need for a coordinated collaborative response for prevention and spread of infectious diseases with epidemic potential at mass gatherings events. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Impacts of temperature and its variability on mortality in New England

NASA Astrophysics Data System (ADS)

Shi, Liuhua; Kloog, Itai; Zanobetti, Antonella; Liu, Pengfei; Schwartz, Joel D.

2015-11-01

Rapid build-up of greenhouse gases is expected to increase Earth’s mean surface temperature, with unclear effects on temperature variability. This makes understanding the direct effects of a changing climate on human health more urgent. However, the effects of prolonged exposures to variable temperatures, which are important for understanding the public health burden, are unclear. Here we demonstrate that long-term survival was significantly associated with both seasonal mean values and standard deviations of temperature among the Medicare population (aged 65+) in New England, and break that down into long-term contrasts between ZIP codes and annual anomalies. A rise in summer mean temperature of 1 °C was associated with a 1.0% higher death rate, whereas an increase in winter mean temperature corresponded to a 0.6% decrease in mortality. Increases in standard deviations of temperature for both summer and winter were harmful. The increased mortality in warmer summers was entirely due to anomalies, whereas it was long-term average differences in the standard deviation of summer temperatures across ZIP codes that drove the increased risk. For future climate scenarios, seasonal mean temperatures may in part account for the public health burden, but the excess public health risk of climate change may also stem from changes of within-season temperature variability.

An urgent need for building technical capacity for rapid diagnosis of multidrug-resistant tuberculosis (MDR-TB) among new cases: A case report from Maharashtra, India.

PubMed

Atre, Sachin

2015-01-01

Multidrug-resistant tuberculosis (MDR-TB), the prevalence of which has increased across the globe in recent years, is a serious threat to public health. Timely diagnosis of MDR-TB, especially among new TB cases, is essential to facilitate appropriate treatment, which can prevent further emergence of drug resistance and its spread in the population. The present case report from India aims to address some operational challenges in diagnosing MDR-TB among new cases and potential measures to overcome them. It argues that even after seven years of implementing the DOTS-Plus program for controlling MDR-TB, India still lacks the technical capacity for rapid MDR-TB diagnosis. The case report underscores an urgent need to explore the use of WHO-endorsed techniques such as Xpert MTB/Rif and commercial assays such as Genotype MTBDR for rapid diagnosis of MDR-TB among new cases. Suitable applications may be found for other TB high-burden countries where MDR-TB is a major concern. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Hospital information system institutionalization processes in indonesian public, government-owned and privately owned hospitals.

PubMed

Handayani, P W; Hidayanto, A N; Ayuningtyas, Dumilah; Budi, Indra

2016-11-01

The Hospital Information System (HIS) could help hospitals as a public entity to provide optimal health services. One of the main challenges of HIS implementation is an institutional change. Using institutional theory as the analytical lens, this study aims to explain the institutionalization of HIS as an instance of e-health initiatives in Indonesia. Furthermore, this paper aims for hospital management and researchers to improve the understanding of the social forces that influence hospital personnel's HIS acceptance within an organizational context. We use case studies from four public, government-owned hospitals and four privately owned (public and specialty) hospitals to explain the HIS institutionalization process by exploring the three concepts of institutional theory: institutional isomorphism, institutional logic, and institutional entrepreneurship. This study reveals that differences exist between public, government-owned and private hospitals with regard to the institutionalization process: public, government-owned hospitals' management is more motivated to implement HIS to comply with the regulations, while private hospitals' management views HIS as an urgent requirement that must be achieved. The study findings also reveal that various institutional isomorphism mechanisms and forms of institutional logic emerge during the process. Finally, three factors-self-efficacy, social influence, and management support-have a significant influence on the individual acceptance of HIS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A public health nursing early intervention program for adolescent mothers: outcomes from pregnancy through 6 weeks postpartum.

PubMed

Koniak-Griffin, D; Anderson, N L; Verzemnieks, I; Brecht, M L

2000-01-01

Adolescent pregnancy and parenting remain a major public concern because of their impact on maternal-child health and on the social and economic well-being of the nation. Federal welfare reform legislation has created an urgent need for community-based nursing intervention programs to improve health and social outcomes for disadvantaged adolescent mothers and to promote their self-sufficiency. To evaluate the effects of an early intervention program (EIP) that uses a public health nursing model on health and social outcomes of adolescent mothers and their children and on the quality of mother-child interaction. Pregnant adolescents referred to a county health department were randomly assigned to an experimental (EIP) or control (traditional public health nursing [TPHN]) group. The sample included 121 adolescents from predominantly minority and impoverished backgrounds who were followed from pregnancy through 6 weeks postpartum. Intense and comprehensive home visitation by public health nurses and preparation-for-motherhood classes were provided to adolescents in the EIP. Health outcomes were determined on the basis of medical record data. Other measures included maternal self-report on selected behaviors, nurse interviews, and the Nursing Child Assessment Teaching Scale (NCATS). Early findings indicate reduced premature birth and low-birth-weight (LBW) rates for young mothers receiving both forms of public health nursing care. No significant differences between groups were found for infant birth weight or type of delivery. Infants in the EIP had significantly fewer total days of birth-related hospitalization and rehospitalization than those in the TPHN group during the first 6 weeks of life (chi2(1) = 6.41; p = 0.01). Adolescents in the EIP demonstrated significantly more positive educational outcomes (e.g., lower school dropout rates) than those in the TPHN group (chi2(1) = 6.76; p < 0.009). The early findings of this study demonstrate that pregnant adolescents benefit from both traditional and more intense public health nursing care in terms of prenatal and perinatal outcomes. The EIP was associated with decreased infant morbidity during the first 6 weeks of life and decreased maternal school dropout. Long-term outcomes for the EIP are being evaluated.

A Window of Opportunity for the Transformation of National Mental Health Policy in Turkey Following Two Major Earthquakes

PubMed Central

Munir, Kerim; Ergene, Tuncay; Tunaligil, Verda; Erol, Nese

2011-01-01

Striking at the nation’s highly populated industrial heartlands, two massive earthquakes in 1999 killed over 25,000 people in Turkey. The economic cost and the humanitarian magnitude of the disaster were unprecedented in the country’s history. The crisis also underscored a major flaw in the organization of mental health services in the provinces that were left out of the 1961 reforms that aimed to make basic health services available nationwide. In describing the chronology of the earthquakes and the ensuing national and international response, this article explains how the public and governmental experience of the earthquakes has created a window of opportunity, and perhaps the political will, for significant reform. There is an urgent need to integrate mental health and general health services, and to strengthen mental health services in the country’s 81 disparate provinces. As Turkey continues her rapid transformation in terms of greater urbanization, higher levels of public education, and economic and constitutional reforms associated with its projected entry into the European Union, there have also been growing demands for better, and more equitably distributed, health care. A legacy of the earthquakes is that they exposed the need for Turkey to create a coherent, clearly articulated national mental health policy. PMID:15371066

Threats from emerging and re-emerging neglected tropical diseases (NTDs).

PubMed

Mackey, Tim K; Liang, Bryan A

2012-01-01

Neglected tropical diseases impact over 1 billion of the world's poorest populations and require special attention. However, within the NTDs recognized by the World Health Organization, some are also dually categorized as emerging and re-emerging infectious diseases requiring more detailed examination on potential global health risks. We reviewed the 17 NTDs classified by the WHO to determine if those NTDs were also categorized by the US Centers for Disease Control and Prevention as emerging and re-emerging infectious diseases (''EReNTDs''). We then identified common characteristics and risks associated with EReNTDs. Identified EReNTDs of dengue, rabies, Chagas Disease, and cysticercosis disproportionately impact resource-poor settings with poor social determinants of health, spread through globalization, are impacted by vector control, lack available treatments, and threaten global health security. This traditionally neglected subset of diseases requires urgent attention and unique incentive structures to encourage investment in innovation and coordination. Multi-sectorial efforts and targeted public-private partnerships would spur needed R&D for effective and accessible EReNTD treatments, improvement of social determinants of health, crucial low-income country development, and health system strengthening efforts. Utilization of One Health principles is essential for enhancing knowledge to efficaciously address public health aspects of these EReNTDs globally.

Healthcare-associated infections: challenges to public health in Brazil.

PubMed

Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco

2014-12-01

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.

Recognising and understanding Lyme disease.

PubMed

Pearson, Sandra

2014-09-09

Lyme disease is the most common vector-borne disease in the northern hemisphere and its incidence is rising, leading to increased public health concerns. It is important to understand the nature of the disease because this defines the limitations of current understanding and knowledge. Significant uncertainties in diagnostics and treatment remain. There is an important role for the nurse in raising awareness, giving advice on prevention and correct tick removal, and in recognising signs of Lyme disease to assist access to prompt medical attention. Increased awareness, further research, improved diagnostics and advances in therapeutics are urgently required.

TED-Time and life saving External Defibrillator for home-use.

PubMed

Weiss, Teddy A; Rosenheck, Shimon; Gorni, Shraga; Katz, Ioni; Mendelbaum, Mendel; Gilon, Dan

2014-06-01

Sudden Cardiac Death--SCD --is a major unmet health problem that needs urgent and prompt solution. AICDs are very expensive, risky and indicated for a small group of patients, at the highest risk. AEDs--Automatic External Defibrillators--are designed for public places and although safe, cannot enter the home-market due to their cost and need for constant, high-cost maintenance. We developed TED, a low-cost AED that derives its energy off the mains, designed for home-use, to save SCD victims' lives. Copyright © 2014 Elsevier Inc. All rights reserved.

Water-Related Impacts of Climate Change on Agriculture and Subsequently on Public Health: A Review for Generalists with Particular Reference to Pakistan.

PubMed

Ahmed, Toqeer; Scholz, Miklas; Al-Faraj, Furat; Niaz, Wajeeha

2016-10-27

Water-related impacts due to change in climatic conditions ranging from water scarcity to intense floods and storms are increasing in developing countries like Pakistan. Water quality and waterborne diseases like hepatitis, cholera, typhoid, malaria and dengue fever are increasing due to chaotic urbanization, industrialization, poor hygienic conditions, and inappropriate water management. The morbidity rate is high due to lack of health care facilities, especially in developing countries. Organizations linked to the Government of Pakistan (e.g., Ministry of Environment, Ministry of Climate Change, Planning and Development, Ministry of Forest, Irrigation and Public Health, Pakistan Meteorological Department, National Disaster Management, Pakistan Agricultural Research Centre, Pakistan Council for Research in Water Resources, and Global Change Impact Study Centre), United Nation organizations, provincial government departments, non-governmental organizations (e.g., Global Facility and Disaster Reduction), research centers linked to universities, and international organizations (International Institute for Sustainable Development, Food and Agriculture, Global Climate Fund and World Bank) are trying to reduce the water-related impacts of climate change, but due to lack of public awareness and health care infrastructure, the death rate is steadily increasing. This paper critically reviews the scientific studies and reports both at national and at international level benefiting generalists concerned with environmental and public health challenges. The article underlines the urgent need for water conservation, risk management, and the development of mitigation measures to cope with the water-related impacts of climate change on agriculture and subsequently on public health. Novel solutions and bioremediation methods have been presented to control environmental pollution and to promote awareness among the scientific community. The focus is on diverse strategies to handle the forthcoming challenges associated with water resources management.

Water-Related Impacts of Climate Change on Agriculture and Subsequently on Public Health: A Review for Generalists with Particular Reference to Pakistan

PubMed Central

Ahmed, Toqeer; Scholz, Miklas; Al-Faraj, Furat; Niaz, Wajeeha

2016-01-01

Water-related impacts due to change in climatic conditions ranging from water scarcity to intense floods and storms are increasing in developing countries like Pakistan. Water quality and waterborne diseases like hepatitis, cholera, typhoid, malaria and dengue fever are increasing due to chaotic urbanization, industrialization, poor hygienic conditions, and inappropriate water management. The morbidity rate is high due to lack of health care facilities, especially in developing countries. Organizations linked to the Government of Pakistan (e.g., Ministry of Environment, Ministry of Climate Change, Planning and Development, Ministry of Forest, Irrigation and Public Health, Pakistan Meteorological Department, National Disaster Management, Pakistan Agricultural Research Centre, Pakistan Council for Research in Water Resources, and Global Change Impact Study Centre), United Nation organizations, provincial government departments, non-governmental organizations (e.g., Global Facility and Disaster Reduction), research centers linked to universities, and international organizations (International Institute for Sustainable Development, Food and Agriculture, Global Climate Fund and World Bank) are trying to reduce the water-related impacts of climate change, but due to lack of public awareness and health care infrastructure, the death rate is steadily increasing. This paper critically reviews the scientific studies and reports both at national and at international level benefiting generalists concerned with environmental and public health challenges. The article underlines the urgent need for water conservation, risk management, and the development of mitigation measures to cope with the water-related impacts of climate change on agriculture and subsequently on public health. Novel solutions and bioremediation methods have been presented to control environmental pollution and to promote awareness among the scientific community. The focus is on diverse strategies to handle the forthcoming challenges associated with water resources management. PMID:27801802

[The waterpipe (shisha) - indoor air quality, human biomonitoring, and health effects].

PubMed

Fromme, Hermann; Schober, Wolfgang

2016-12-01

Waterpipe (WP) smoking, also known as shisha or hookah smoking, is growing in western countries as an alternative to cigarette smoking, especially in younger age groups. A majority of smokers mistakenly believe that shisha smoking is a social entertainment practice that leads to more social behavior and relaxation and that this type of smoking is safe or less harmful and less addictive than cigarette smoking.In reality, WP smokers are exposed to hundreds of toxic substances that include well-known carcinogens. High exposures to carbon monoxide and nicotine are major health threats. There is growing evidence that WP smoke causes adverse effects on the pulmonary and cardiovascular systems and there are indications that WP smoke is associated with cancer. Persons exposed to secondhand WP smoke are also at risk.More research on the health effects of WP is urgently needed and more preventive measures for public health protection. Moreover, public WP facilities should be implemented under specific nonsmoker protection laws and consequently controlled.This review summarizes recent data on exposure to WP smoking in indoor environments, the results of biomonitoring data, and the known health effects based on currently available toxicological or epidemiological studies.

Exploring bi-directional and SMS messaging for communications between Public Health Agencies and their stakeholders: a qualitative study.

PubMed

Revere, Debra; Calhoun, Rebecca; Baseman, Janet; Oberle, Mark

2015-07-08

Communication technologies that enable bi-directional/two-way communications and cell phone texting (SMS) between public health agencies and their stakeholders may improve public health surveillance, ensure targeted distribution of alerts to hard-to-reach populations, reduce mortality and morbidity in an emergency, and enable a crucial feedback loop between public health agencies and the communities they serve. Building on prior work regarding health care provider preferences for receiving one-way public health communications by email, fax or SMS, we conducted a formative, exploratory study to understand how a bi-directional system and the incorporation of SMS in that system might be used as a strategy to send and receive messages between public health agencies and community-based organizations which serve vulnerable populations, health care providers, and public health workers. Our research question: Under what conditions and/or situations might public health agencies utilize bi-directional and/or SMS messaging for disseminating time-sensitive public health information (alerts, advisories, updates, etc.) to their stakeholders? A mixed methods (qualitative and quantitative) study was conducted between April and July 2014. Data collection included a survey distributed to health care providers and semi-structured interviews with providers, community- and government-based organization leaders and directors, and public health agency internal workforce staff. Survey respondents and interviewees were asked about their exposure to public health messages, how these messages are received and how the information in these messages are handled, and in what situations (for example, a local vs. a national event, a pandemic or emergency vs. a health update) a bi-directional and/or SMS messaging system might improve communications between public health agencies and their stakeholder group. Interview and survey data were qualitatively analyzed. Thematic codes were quantitized into dichotomous variables of 0 or 1 on a per respondent basis to enumerate the presence or absence of each thematic code, enable quantitative analysis, and inform interpretation of findings. Five major themes emerged from synthesizing survey and interview results: 1) Regardless of situational context (emergency vs. non-urgent) and message recipient (stakeholder group), e-mail is a favored modality for receiving public health messages; 2) The decision to use bi-directional, SMS or multiple communication strategies is complex and public health agencies' need to manage messaging concerns/barriers and benefits for all parties; 3) Both public health agencies and their stakeholders share similar values/uses and concerns regarding two-way public health messaging and SMS; 4) Public health is highly trusted, thus thoughtful, effective messaging will ensure continuation of this goodwill; and 5) Information reciprocity between public health agencies and stakeholders who share their information is essential. Multiple communication strategies might be utilized but the choice of a specific strategy needs to balance message content (emergency vs. routine communications), delivery (one- vs. two-way), channel (SMS, email, etc.), and public health agency burden with stakeholder preferences and technical capabilities, all while mitigating the risk of message overload and disregard of important communications by recipients.

Role of Primary Health Care in Ensuring Access to Medicines

PubMed Central

Sambala, Evanson Z; Sapsed, Susan; Mkandawire, Mercy L

2010-01-01

To examine ways of ensuring access to health services within the framework of primary health care (PHC), since the goal of PHC to make universal health care available to all people has become increasingly neglected amid emerging themes of globalization, trade, and foreign policy. From a public health point of view, we argue that the premise of PHC can unlock barriers to health care services and contribute greatly to determining collective health through the promotion of universal basic health services. PHC has the most sophisticated and organized infrastructure, theories, and political principles, with which it can deal adequately with the issues of inequity, inequality, and social injustice which emerge from negative economic externalities and neo-liberal economic policies. Addressing these issues, especially the complex social and political influences that restrict access to medicines, may require the integration of different health initiatives into PHC. Based on current systems, PHC remains the only conventional health delivery service that can deal with resilient public health problems adequately. However, to strengthen its ability to do so, we propose the revitalization of PHC to incorporate scholarship that promotes human rights, partnerships, research and development, advocacy, and national drug policies. The concept of PHC can improve access; however, this will require the urgent interplay among theoretical, practical, political, and sociological influences arising from the economic, social, and political determinants of ill health in an era of globalization. PMID:20564760

Advancing the Use of Emergency Department Syndromic Surveillance Data, New York City, 2012-2016.

PubMed

Lall, Ramona; Abdelnabi, Jasmine; Ngai, Stephanie; Parton, Hilary B; Saunders, Kelly; Sell, Jessica; Wahnich, Amanda; Weiss, Don; Mathes, Robert W

The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa. The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters. For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak. Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.

Climate change and health: Why should India be concerned?

PubMed

Majra, J P; Gur, A

2009-04-01

Overwhelming evidence shows that climate change presents growing threats to public health security - from extreme weather-related disasters to wider spread of such vector-borne diseases as malaria and dengue. The impacts of climate on human health will not be evenly distributed around the world. The Third Assessment Report (Intergovernmental Panel on Climate Change-2001) concluded that vulnerability to climate change is a function of exposure, sensitivity, and adaptive capacity. Developing country populations, particularly in small island states, arid and high mountain zones, and in densely populated coastal areas are considered to be particularly vulnerable. India is a large developing country, with the Great Himalayas, the world's third largest ice mass in the north, 7500 km long, and densely populated coast line in the south. Nearly 700 million of her over one billion population living in rural areas directly depends on climate-sensitive sectors (agriculture, forests, and fisheries) and natural resources (such as water, biodiversity, mangroves, coastal zones, grasslands) for their subsistence and livelihoods. Heat wave, floods (land and coastal), and draughts occur commonly. Malaria, malnutrition, and diarrhea are major public health problems. Any further increase, as projected in weather-related disasters and related health effects, may cripple the already inadequate public health infrastructure in the country. Hence, there is an urgent need to respond to the situation. Response options to protect health from effects of climate change include mitigation as well as adaptation. Both can complement each other and together can significantly reduce the risks of climate change.

Water fluoridation: a critical review of the physiological effects of ingested fluoride as a public health intervention.

PubMed

Peckham, Stephen; Awofeso, Niyi

2014-01-01

Fluorine is the world's 13th most abundant element and constitutes 0.08% of the Earth crust. It has the highest electronegativity of all elements. Fluoride is widely distributed in the environment, occurring in the air, soils, rocks, and water. Although fluoride is used industrially in a fluorine compound, the manufacture of ceramics, pesticides, aerosol propellants, refrigerants, glassware, and Teflon cookware, it is a generally unwanted byproduct of aluminium, fertilizer, and iron ore manufacture. The medicinal use of fluorides for the prevention of dental caries began in January 1945 when community water supplies in Grand Rapids, United States, were fluoridated to a level of 1 ppm as a dental caries prevention measure. However, water fluoridation remains a controversial public health measure. This paper reviews the human health effects of fluoride. The authors conclude that available evidence suggests that fluoride has a potential to cause major adverse human health problems, while having only a modest dental caries prevention effect. As part of efforts to reduce hazardous fluoride ingestion, the practice of artificial water fluoridation should be reconsidered globally, while industrial safety measures need to be tightened in order to reduce unethical discharge of fluoride compounds into the environment. Public health approaches for global dental caries reduction that do not involve systemic ingestion of fluoride are urgently needed.

Water Fluoridation: A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention

PubMed Central

2014-01-01

Fluorine is the world's 13th most abundant element and constitutes 0.08% of the Earth crust. It has the highest electronegativity of all elements. Fluoride is widely distributed in the environment, occurring in the air, soils, rocks, and water. Although fluoride is used industrially in a fluorine compound, the manufacture of ceramics, pesticides, aerosol propellants, refrigerants, glassware, and Teflon cookware, it is a generally unwanted byproduct of aluminium, fertilizer, and iron ore manufacture. The medicinal use of fluorides for the prevention of dental caries began in January 1945 when community water supplies in Grand Rapids, United States, were fluoridated to a level of 1 ppm as a dental caries prevention measure. However, water fluoridation remains a controversial public health measure. This paper reviews the human health effects of fluoride. The authors conclude that available evidence suggests that fluoride has a potential to cause major adverse human health problems, while having only a modest dental caries prevention effect. As part of efforts to reduce hazardous fluoride ingestion, the practice of artificial water fluoridation should be reconsidered globally, while industrial safety measures need to be tightened in order to reduce unethical discharge of fluoride compounds into the environment. Public health approaches for global dental caries reduction that do not involve systemic ingestion of fluoride are urgently needed. PMID:24719570

Disasters related to droughts and public health - a review of the scientific literature.

PubMed

Alpino, Tais Ariza; de Sena, Aderita Ricarda Martins; de Freitas, Carlos Machado

2016-03-01

In Brazil, the history of droughts has been marked by constant social and health tragedies, with estimates of up to 3 million deaths from the early 19th century until the late 20th century. There is a record of nearly 32,000 events related to the above and more than 96 million people were affected between 1991 and 2010. Although droughts have historically brought disasters to Brazil, which was noted in the scientific expeditions of Arthur Neiva and Belisario Penna that documented these droughts, there have not been many studies on them. The objective of this paper is to present a revision of the scientific articles related to droughts and public health. The following databases were used: PubMed, the Preparation and Response to Disasters Portal from BVS and the Capes Periodical Portal. The descriptors drought and health were used to search titles and summaries of articles in English, Portuguese and Spanish. Among the repercussions related to health that were discovered: malnutrition and nutritional deficiencies, mental health problems, issues relating to water and air quality and commitments made concerning access to health services. As there is a trend for more intense droughts and a scarcity of water until 2030, there is an urgent need for more research and studies in these areas.

The Use of Research Evidence in Public Health Decision Making Processes: Systematic Review

PubMed Central

Orton, Lois; Lloyd-Williams, Ffion; Taylor-Robinson, David; O'Flaherty, Martin; Capewell, Simon

2011-01-01

Background The use of research evidence to underpin public health policy is strongly promoted. However, its implementation has not been straightforward. The objectives of this systematic review were to synthesise empirical evidence on the use of research evidence by public health decision makers in settings with universal health care systems. Methods To locate eligible studies, 13 bibliographic databases were screened, organisational websites were scanned, key informants were contacted and bibliographies of included studies were scrutinised. Two reviewers independently assessed studies for inclusion, extracted data and assessed methodological quality. Data were synthesised as a narrative review. Findings 18 studies were included: 15 qualitative studies, and three surveys. Their methodological quality was mixed. They were set in a range of country and decision making settings. Study participants included 1063 public health decision makers, 72 researchers, and 174 with overlapping roles. Decision making processes varied widely between settings, and were viewed differently by key players. A range of research evidence was accessed. However, there was no reliable evidence on the extent of its use. Its impact was often indirect, competing with other influences. Barriers to the use of research evidence included: decision makers' perceptions of research evidence; the gulf between researchers and decision makers; the culture of decision making; competing influences on decision making; and practical constraints. Suggested (but largely untested) ways of overcoming these barriers included: research targeted at the needs of decision makers; research clearly highlighting key messages; and capacity building. There was little evidence on the role of research evidence in decision making to reduce inequalities. Conclusions To more effectively implement research informed public health policy, action is required by decision makers and researchers to address the barriers identified in this systematic review. There is an urgent need for evidence to support the use of research evidence to inform public health decision making to reduce inequalities. PMID:21818262

Determinants of Demand in the Public Dental Emergency Service.

PubMed

Matsumoto, Maria Sa; Gatti, Marcia An; de Conti, Marta Hs; de Ap Simeão, Sandra F; de Oliveira Braga Franzolin, Solange; Marta, Sara N

2017-02-01

Although dental emergencies are primarily aimed at pain relief, in practice, dental emergency services have been overwhelmed by the massive inflow of patients with less complex cases, which could be resolved at basic levels of health care. They frequently become the main gateway to the system. We investigated the determinant factors of demand at the Central Dental Emergency Unit in Bauru, São Paulo, Brazil. The questionnaire was applied to 521 users to evaluate sociodemographic profile; factors that led users to seek the service at the central dental emergency; perception of service offered. About 80.4% of users went directly to the central dental emergency, even before seeking basic health units. The reasons were difficulty to be attended (34.6%) and incompatible time (9.8%). To the perception of the necessity of the service, responses were problem as urgent (78.3%) and pain was the main complaint (69.1%). The profile we found was unmarried (41.5%), male (52.2%), white (62.8%), aged 30 to 59 (52.2%), incomplete basic education (41.6%), family income up to 2 minimum wages (47.4%), and no medical/dental plan (88.9%). It was concluded that the users of central dental emergency come from all sectors of the city, due to difficult access to basic health units; they consider their complaint urgent; and they are satisfied with the service offered. To meet the profile of the user urgency's service so that it is not overloaded with demand that can be fulfilled in basic health units.

Trends in Prevalence, Awareness, Treatment and Control of Hypertension during 2001-2010 in an Urban Elderly Population of China.

PubMed

Wu, Lei; He, Yao; Jiang, Bin; Sun, Dongling; Wang, Jianhua; Liu, Miao; Yang, Shanshan; Wang, Yiyan

2015-01-01

As the most important risk factors of cardiovascular disease, pre-hypertension and hypertension are important public health challenges. Few studies have focused on the trends of pre-hypertension and hypertension specifically for the aging population in China. Given the anticipated growth of the elderly population in China, there is an urgent need to document the conditions of pre-hypertension and hypertension in this aging population. We conducted two cross-sectional surveys of Chinese adults aged ≥60 years in 2001 and 2010. A total of 2,272 (943 males, 1,329 females) and 2,074 (839 males, 1,235 females) participants were included in the two surveys, respectively. The age- and sex-standardized prevalence of hypertension significantly increased from 60.1% to 65.2% from the 2001 to the 2010 survey. Among the participants with hypertension, the awareness, treatment and control of hypertension all significantly increased from 69.8% to 74.5%, 50.3% to 63.7%, and 15.3% to 30.3%, respectively, from 2001 to 2010. A logistic regression showed that a higher education level, a higher BMI, a family history of hypertension and doctor-diagnosed cardiovascular disease were significantly associated with hypertension awareness and treatment. Hypertension prevalence increased rapidly between the years surveyed. Although the awareness, treatment and control of hypertension improved significantly, the values of these variables remained low. More attention should be given to the elderly because the population is aging worldwide, and urgent action, optimal treatment approaches and proper public health strategies must be taken to prevent and manage hypertension.

Community Perspectives on Factors That Influence Collaboration in Public Health Research

PubMed Central

Pinto, Rogério M.

2009-01-01

Community collaboration in research may lead to better methods, results, and dissemination of interventions. Little systematic research has examined specific factors that influence community-based organizations (CBOs) to collaborate in public health research. There is an urgent need to advance knowledge on this topic so that together, researchers and CBOs can minimize barriers to collaboration. This study advances a CBO-focused characterization of collaboration in HIV-prevention research. By focusing on the perspectives of 20 key informants in 10 HIV-prevention CBOs, qualitative data revealed factors that influenced their collaborations in four domains: (a) Researchers’ Characteristics (expertise, availability), (b) Collaborative Research Characteristics (ought to improve services and CBO infrastructure); (c) Community Partner–Researcher Relationships (resolving social and professional issues); and (d) Barriers to HIV-Prevention Research Collaboration (cultural and social disconnect between CBO and academia). To reduce barriers, researchers ought to enhance motivators that facilitate collaboration. To use the advantages of community-based research, prevention scientists and policy makers ought to embrace CBOs’ characterization of what makes health research genuinely collaborative. PMID:19196863

Ending AIDS as a public health threat by 2030: Scientific Developments from the 2016 INTEREST Conference in Yaoundé, Cameroon

PubMed Central

Hankins, Catherine A; Koulla-Shiro, Sinata; Kilmarx, Peter; Ferrari, Guido; Schechter, Mauro; Kane, Coumba Touré; Venter, François; Boucher, Charles AB; Ross, Anna-Laura; Zewdie, Debrework; Eholié, Serge Paul; Katabira, Elly

2017-01-01

The underpinning theme of the 2016 INTEREST Conference held in Yaoundé, Cameroon, 3–6 May 2016 was ending AIDS as a public health threat by 2030. Focused primarily on HIV treatment, pathogenesis and prevention research in resource-limited settings, the conference attracted 369 active delegates from 34 countries, of which 22 were in Africa. Presentations on treatment optimization, acquired drug resistance, care of children and adolescents, laboratory monitoring and diagnostics, implementation challenges, HIV prevention, key populations, vaccine and cure, hepatitis C, mHealth, financing the HIV response and emerging pathogens, were accompanied by oral, mini-oral and poster presentations. Spirited plenary debates on the UNAIDS 90-90-90 treatment cascade goal and on antiretroviral pre-exposure prophylaxis took place. Joep Lange career guidance sessions and grantspersonship sessions attracted early career researchers. At the closing ceremony, the Yaoundé Declaration called on African governments; UNAIDS; development, bilateral, and multilateral partners; and civil society to adopt urgent and sustained approaches to end HIV by 2030. PMID:28387654

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

PubMed

Munns, Craig F; Shaw, Nick; Kiely, Mairead; Specker, Bonny L; Thacher, Tom D; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary; Högler, Wolfgang

2016-02-01

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.

Tackling overweight and obesity: does the public health message match the science?

PubMed

Hafekost, Katherine; Lawrence, David; Mitrou, Francis; O'Sullivan, Therese A; Zubrick, Stephen R

2013-02-18

Despite the increasing understanding of the mechanisms relating to weight loss and maintenance, there are currently no validated public health interventions that are able to achieve sustained long-term weight loss or to stem the increasing prevalence of obesity in the population. We aimed to examine the models of energy balance underpinning current research about weight-loss intervention from the field of public health, and to determine whether they are consistent with the model provided by basic science. EMBASE was searched for papers published in 2011 on weight-loss interventions. We extracted details of the population, nature of the intervention, and key findings for 27 articles. Most public health interventions identified were based on a simple model of energy balance, and thus attempted to reduce caloric consumption and/or increase physical activity in order to create a negative energy balance. There appeared to be little consideration of homeostatic feedback mechanisms and their effect on weight-loss success. It seems that there has been a lack of translation between recent advances in understanding of the basic science behind weight loss, and the concepts underpinning the increasingly urgent efforts to reduce excess weight in the population. Public health weight-loss interventions seem to be based on an outdated understanding of the science. Their continued failure to achieve any meaningful, long-term results reflects the need to develop intervention science that is integrated with knowledge from basic science. Instead of asking why people persist in eating too much and exercising too little, the key questions of obesity research should address those factors (environmental, behavioral or otherwise) that lead to dysregulation of the homeostatic mechanism of energy regulation. There is a need for a multidisciplinary approach in the design of future weight-loss interventions in order to improve long-term weight-loss success.

Improving Community-Based Mental Health Care for Children: Translating Knowledge into Action

PubMed Central

Haine-Schlagel, Rachel; Brookman-Frazee, Lauren; Baker-Ericzen, Mary; Trask, Emily; Fawley-King, Kya

2013-01-01

There is urgent need for improvement in community-based mental health care for children and families. Multiple studies have documented serious limitations in the effectiveness of “usual care.” Fortunately, many empirically-supported strategies to improve care have been developed, and thus there is now a great deal of knowledge available to address this significant public health problem. The goal of this selective review is to highlight and synthesize that empirically-supported knowledge to stimulate and facilitate the needed translation of knowledge into action. The review provides a sound foundation for constructing improved services by consolidating descriptive data on the status quo in children’s mental health care, as well as evidence for an array of promising strategies to improve (a) Service access and engagement; (b) Delivery of evidence-based practices; and (c) Outcome accountability. A multi-level framework is used to highlight recommended care improvement targets. PMID:23212902

Health Economics of Dengue: A Systematic Literature Review and Expert Panel's Assessment

PubMed Central

Beatty, Mark E.; Beutels, Philippe; Meltzer, Martin I.; Shepard, Donald S.; Hombach, Joachim; Hutubessy, Raymond; Dessis, Damien; Coudeville, Laurent; Dervaux, Benoit; Wichmann, Ole; Margolis, Harold S.; Kuritsky, Joel N.

2011-01-01

Dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential financial and public health impact. We searched five databases (PubMed, EMBASE, LILAC, EconLit, and WHOLIS) to identify health economics studies of dengue. Forty-three manuscripts were identified that provided primary data: 32 report economic burden of dengue and nine are comparative economic analyses assessing various interventions. The remaining two were a willingness-to-pay study and a policymaker survey. An expert panel reviewed the existing dengue economic literature and recommended future research to fill information gaps. Although dengue is an important vector-borne disease, the economic literature is relatively sparse and results have often been conflicting because of use of inconsistent assumptions. Health economic research specific to dengue is urgently needed to ensure informed decision making on the various options for controlling and preventing this disease. PMID:21363989

Dental care as a vital service response for disaster victims.

PubMed

Mosca, Nicholas G; Finn, Emanuel; Joskow, Renée

2007-05-01

Hurricane Katrina's impact on the infrastructure of public health and the health care system in the affected areas was unprecedented in the United States. Many dental offices were flood-bound in New Orleans and over 60% of dental practices were partially or completely damaged in affected counties in Mississippi. Most needs assessments conducted during the initial recovery operations did not include questions about access to oral health care. However, the extent of the destruction of the health care infrastructure demonstrated the need for significant state and federal support to make dental treatment accessible to survivors and evacuees. The Katrina response is one of the few times that state and federal government agencies responded to provide dental services to victims as part of disaster response and recovery. The purpose of this paper is to share our experiences in Mississippi and the District of Columbia providing urgent dental care to disaster victims as part of a crisis response.

Perceptions of Ebola virus disease in Nigeria: Understanding the influence of imagination on health orientation.

PubMed

Oduyemi, Rachael O; Ayegboyin, Matthew; Salami, Kabiru K

2016-06-01

The 2014 Ebola virus disease (EVD) outbreak was officially declared in the West Africa region by the World Health Organization (WHO) on 23 March 2014. This first episode of EVD in Nigeria on 20 July 2014 raised more intense panic globally than the seven occurrences of the disease in Zaire. Although Nigeria was declared Ebola free by the WHO within 3 months, it is imperative to understand people's perceptions of the disease in the country. A discussion of peoples' perception of EVD in Nigeria is the aim of this article. This discussion paper complements secondary data with grey literature to explore how peoples' imagination and personification of thoughts influence their health orientation. Data are sourced from secondary information compiled from 'The Nation Newspaper, 2014'; 'Nairaland online forum, 2014' and 'Giftedgreen online magazine, 2014'. Ebola virus disease was perceived as a spiritual manipulation of witchcraft activities and described as biological terrorism and a means of creating a drug market, among other issues, in the country. Public health professionals should consider the sociocultural milieu to understand and offer health-care services in epidemics. Public health orientation work is urgently required in Nigeria to forestall future occurrence of EVD and other highly infectious diseases. © 2016 John Wiley & Sons Australia, Ltd.

Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap

PubMed Central

Rusch, Dana; Mehta, Tara G.; Lakind, Davielle

2015-01-01

Dissemination and implementation science (DI) has evolved as a major research model for children’s mental health in response to a longstanding call to integrate science and practice and bridge the elusive research to practice gap. However, to address the complex and urgent needs of the most vulnerable children and families, future directions for DI require a new alignment of ecological theory and public health to provide effective, sustainable, and accessible mental health services. We present core principles of ecological theory to emphasize how contextual factors impact behavior and allow for the reciprocal impact individuals have on the settings they occupy, and an alignment of these principles with a public health model to ensure that services span the prevention to intervention continuum. We provide exemplars from our ongoing work in urban schools, and a new direction for research to address the mental health needs of immigrant Latino families. Through these examples we illustrate how DI can expand its reach by embedding within natural settings to build on local capacity and indigenous resources, incorporating the local knowledge necessary to more substantively address long-standing mental health disparities. This paradigm shift for DI, away from an over-emphasis on promoting program adoption, calls for fitting interventions within settings that matter most to children’s healthy development, and utilizing and strengthening available community resources. In this way, we can meet the challenge of addressing our nation’s mental health burden by supporting the needs and values of families and communities within their own unique social ecologies. PMID:26155972

Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap.

PubMed

Atkins, Marc S; Rusch, Dana; Mehta, Tara G; Lakind, Davielle

2016-01-01

Dissemination and implementation science (DI) has evolved as a major research model for children's mental health in response to a long-standing call to integrate science and practice and bridge the elusive research to practice gap. However, to address the complex and urgent needs of the most vulnerable children and families, future directions for DI require a new alignment of ecological theory and public health to provide effective, sustainable, and accessible mental health services. We present core principles of ecological theory to emphasize how contextual factors impact behavior and allow for the reciprocal impact individuals have on the settings they occupy, and an alignment of these principles with a public health model to ensure that services span the prevention to intervention continuum. We provide exemplars from our ongoing work in urban schools and a new direction for research to address the mental health needs of immigrant Latino families. Through these examples we illustrate how DI can expand its reach by embedding within natural settings to build on local capacity and indigenous resources, incorporating the local knowledge necessary to more substantively address long-standing mental health disparities. This paradigm shift for DI, away from an overemphasis on promoting program adoption, calls for fitting interventions within settings that matter most to children's healthy development and for utilizing and strengthening available community resources. In this way, we can meet the challenge of addressing our nation's mental health burden by supporting the needs and values of families and communities within their own unique social ecologies.

Control of Infectious Diseases in the Era of European Clinical Microbiology Laboratory Consolidation: New Challenges and Opportunities for the Patient and for Public Health Surveillance.

PubMed

Vandenberg, Olivier; Kozlakidis, Zisis; Schrenzel, Jacques; Struelens, Marc Jean; Breuer, Judith

2018-01-01

Many new innovative diagnostic approaches have been made available during the last 10 years with major impact on patient care and public health surveillance. In parallel, to enhance the cost-effectiveness of the clinical microbiology laboratories (CMLs), European laboratory professionals have streamlined their organization leading to amalgamation of activities and restructuring of their professional relationships with clinicians and public health specialists. Through this consolidation process, an operational model has emerged that combines large centralized clinical laboratories performing most tests on one high-throughput analytical platform connected to several distal laboratories dealing locally with urgent analyses at near point of care. The centralization of diagnostic services over a large geographical region has given rise to the concept of regional-scale "microbiology laboratories network." Although the volume-driven cost savings associated with such laboratory networks seem self-evident, the consequence(s) for the quality of patient care and infectious disease surveillance and control remain less obvious. In this article, we describe the range of opportunities that the changing landscape of CMLs in Europe can contribute toward improving the quality of patient care but also the early detection and enhanced surveillance of public health threats caused by infectious diseases. The success of this transformation of health services is reliant on the appropriate preparation in terms of staff, skills, and processes that would be inclusive of stakeholders. In addition, rigorous metrics are needed to set out more concrete laboratory service performance objectives and assess the expected benefits to society in terms of saving lives and preventing diseases.

Rapid susceptibility testing of Mycobacterium avium complex and Mycobacterium tuberculosis isolated from AIDS patients

NASA Technical Reports Server (NTRS)

Dhople, Arvind M.

1994-01-01

In ominous projections issued by both U.S. Public Health Service and the World Health Organization, the epidemic of HIV infection will continue to rise more rapidly worldwide than predicted earlier. The AIDS patients are susceptible to diseases called opportunistic infections of which tuberculosis and Mycobacterium avium complex (MAC) infection are most common. This has created an urgent need to uncover new drugs for the treatment of these infections. In the seventies, NASA scientists at Goddard Space Flight Center, Greenbelt, MD, had adopted a biochemical indicator, adenosine triphosphate (ATP), to detect presence of life in extraterrestrial space. We proposed to develop ATP assay technique to determine sensitivity of antibacterial compounds against MAC and M. tuberculosis.

An Overview of Risk Factors Associated to Post-partum Depression in Asia.

PubMed

Mehta, Shubham; Mehta, Nidhi

2014-03-04

Post partum depression (PPD) is an important complication of child-bearing. It requires urgent interventions as it can have long-term adverse consequences if ignored, for both mother and child. If PPD has to be prevented by a public health intervention, the recognition and timely identification of its risk factors is must. We in this review have tried to synthesize the results of Asian studies examining the risk factors of PPD. Some risk factors, which are unique to Asian culture, have also been identified and discussed. We emphasize on early identification of these risk factors as most of these are modifiable and this can have significant implications in prevention of emergence of post partum depression, a serious health issue of Asian women.

Non-urgent accident and emergency department use as a socially shared custom: a qualitative study

PubMed Central

Keizer Beache, Simone; Guell, Cornelia

2016-01-01

Objective We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities. Methods In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach. Results In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare. Conclusions We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking. PMID:25841166

Analysis Of End-Of-Life Care, Out-Of-Pocket Spending, And Place Of Death In 16 European Countries And Israel.

PubMed

Orlovic, Martina; Marti, Joachim; Mossialos, Elias

2017-07-01

In Europe the aging of the population will pose considerable challenges to providing high-quality end-of-life care. The complexity of providing care and the large spectrum of actors involved make it difficult to understand the care pathways and how these are influenced by financial and institutional factors. We examined a large, multicountry data set with waves of data from the period 2006-13 to determine the differences in health care usage, out-of-pocket spending, and place of death in sixteen European countries and Israel. Our results reveal the importance of the funding mechanisms of long-term care. They also illuminate the effect of patients' characteristics on end-of-life care pathways. We found that in countries where public financing and organization of long-term care are particularly strong, patients at the end of life are more likely to have reduced hospitalizations and a higher share of out-of-hospital deaths. Understanding end-of-life care patterns is crucial to developing policies to address the urgent public health priority that this aspect of health care presents. Project HOPE—The People-to-People Health Foundation, Inc.

Translational research in cancer genetics: the road less traveled.

PubMed

Schully, S D; Benedicto, C B; Gillanders, E M; Wang, S S; Khoury, M J

2011-01-01

Gene discoveries in cancer have the potential for clinical and public health applications. To take advantage of such discoveries, a translational research agenda is needed to take discoveries from the bench to population health impact. To assess the current status of translational research in cancer genetics, we analyzed the extramural grant portfolio of the National Cancer Institute (NCI) from Fiscal Year 2007, as well as the cancer genetic research articles published in 2007. We classified both funded grants and publications as follows: T0 as discovery research; T1 as research to develop a candidate health application (e.g., test or therapy); T2 as research that evaluates a candidate application and develops evidence-based recommendations; T3 as research that assesses how to integrate an evidence-based recommendation into cancer care and prevention; and T4 as research that assesses health outcomes and population impact. We found that 1.8% of the grant portfolio and 0.6% of the published literature was T2 research or beyond. In addition to discovery research in cancer genetics, a translational research infrastructure is urgently needed to methodically evaluate and translate gene discoveries for cancer care and prevention. Copyright © 2009 S. Karger AG, Basel.

Visions Lost and Dreams Forgotten: Environmental Education, Systems Thinking, and Possible Futures in American Public Schools

ERIC Educational Resources Information Center

Cassell, John A.; Nelson, Thomas

2010-01-01

This article discusses the contributions to this special issue of "Teacher Education Quarterly." At the core of all the contributions is the compellingly urgent realization that humanity is facing, and must deal with, enormous ecological and social problems and challenges. This situation has created an urgent and compelling need centered…

Eliminating waste in US health care.

PubMed

Berwick, Donald M; Hackbarth, Andrew D

2012-04-11

The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste--overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse--the sum of the lowest available estimates exceeds 20% of total health care expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies.

Assessment of Risk of Cholera in Haiti following Hurricane Matthew.

PubMed

Khan, Rakib; Anwar, Rifat; Akanda, Shafqat; McDonald, Michael D; Huq, Anwar; Jutla, Antarpreet; Colwell, Rita

2017-09-01

Damage to the inferior and fragile water and sanitation infrastructure of Haiti after Hurricane Matthew has created an urgent public health emergency in terms of likelihood of cholera occurring in the human population. Using satellite-derived data on precipitation, gridded air temperature, and hurricane path and with information on water and sanitation (WASH) infrastructure, we tracked changing environmental conditions conducive for growth of pathogenic vibrios. Based on these data, we predicted and validated the likelihood of cholera cases occurring past hurricane. The risk of cholera in the southwestern part of Haiti remained relatively high since November 2016 to the present. Findings of this study provide a contemporary process for monitoring ground conditions that can guide public health intervention to control cholera in human population by providing access to vaccines, safe WASH facilities. Assuming current social and behavioral patterns remain constant, it is recommended that WASH infrastructure should be improved and considered a priority especially before 2017 rainy season.

[Reducing the burden of disease caused by alcohol use in Peru: evidence- based approaches].

PubMed

Fiestas, Fabián

2012-03-01

Alcohol use is one the most important risk factors for illness and early death in Peru. Measures aimed at decreasing or controlling the great impact caused by alcohol in the Peruvian society are urgently needed. This article identifies and promotes the implementation of public health measures supported by sound scientific evidence of effectiveness or, in some cases, cost-effectiveness. The 10 evidence-based public health measures identified and described here represent a set if measures with high probability of success if implemented, as they are supported by scientific evidence. We recommend that governments, at the national or local levels, apply these measures not individually, but in combination, arranging them into a plan or roadmap, where the framework in which they will be applied must be established according to each context. Considering the available resources, some of these measures could be implemented in the short and medium term while the others can be set in the long-term.

Informing public policy toward binational health insurance: Empirical evidence from California

PubMed Central

Fulton, Brent D; Galárraga, Omar; Dow, William H

2015-01-01

Objective To estimate reimbursement rate differences between Mexico and US based physicians reimbursed by a binational health insurance (BHI) plan and US payers, respectively; and show the relationship between plan benefit designs and health care utilization in Mexico. Materials and methods Data include 33 841 and 53 909 HMO enrollees in California from Sistemas Médicos Nacionales (SIMNSA) and Salud con Health Net, respectively. We use descriptive statistical methods. Results SIMNSA’s physician reimbursement rates averaged 50.7% (95% CI: 34.5%–67.0%) of Medi-Cal’s, 28.3% (95% CI: 19.6%–37.0%) of Medicare’s, and 22% of US private plans’. Each year, 99.4% of SIMNSA enrollees but only 0.1% of Salud con Health Net enrollees obtained care in Mexico. Conclusion SIMNSA only covers emergency and urgent care in the US, while Salud con Health Net covers comprehensive care with higher patient cost sharing than in Mexico. To realize potential savings, plans need strong incentives to increase utilization in Mexico. PMID:25153186

Measuring the performance of telephone-based disease surveillance systems in local health departments.

PubMed

Dausey, David J; Chandra, Anita; Schaefer, Agnes G; Bahney, Ben; Haviland, Amelia; Zakowski, Sarah; Lurie, Nicole

2008-09-01

We tested telephone-based disease surveillance systems in local health departments to identify system characteristics associated with consistent and timely responses to urgent case reports. We identified a stratified random sample of 74 health departments and conducted a series of unannounced tests of their telephone-based surveillance systems. We used regression analyses to identify system characteristics that predicted fast connection with an action officer (an appropriate public health professional). Optimal performance in consistently connecting callers with an action officer in 30 minutes or less was achieved by 31% of participating health departments. Reaching a live person upon dialing, regardless of who that person was, was the strongest predictor of optimal performance both in being connected with an action officer and in consistency of connection times. Health departments can achieve optimal performance in consistently connecting a caller with an action officer in 30 minutes or less and may improve performance by using a telephone-based disease surveillance system in which the phone is answered by a live person at all times.

Informing public policy toward binational health insurance: empirical evidence from California.

PubMed

Fulton, Brent D; Galárraga, Omar; Dow, William H

2013-01-01

To estimate reimbursement rate differences between Mexico and US based physicians reimbursed by a binational health insurance (BHI) plan and US payers, respectively; and show the relationship between plan benefit designs and health care utilization in Mexico. Data include 33,841 and 53,909 HMO enrollees in California from Sistemas Médicos Nacionales (SIMNSA) and Salud con Health Net, respectively. We use descriptive statistical methods. SIMNSA's physician reimbursement rates averaged 50.7% (95% CI: 34.5%-67.0%) of Medi-Cal's, 28.3% (95% CI: 19.6%-37.0%) of Medicare's, and 22% of US private plans'. Each year, 99.4% of SIMNSA enrollees but only 0.1% of Salud con Health Net enrollees obtained care in Mexico. SIMNSA only covers emergency and urgent care in the US, while Salud con Health Net covers comprehensive care with higher patient cost sharing than in Mexico. To realize potential savings, plans need strong incentives to increase utilization in Mexico.

Association between the use of biomass fuels on respiratory health of workers in food catering enterprises in Nairobi Kenya

PubMed Central

Keraka, Margaret; Ochieng, Carolyne; Engelbrecht, Jacobus; Hongoro, Charles

2013-01-01

Introduction Indoor air pollution from biomass fuel use has been found to be responsible for more than 1.6 million annual deaths and 2.7% of the global burden of disease. This makes it the second biggest environmental contributor to ill health, behind unsafe water and sanitation. Methods The main objective of this study was to investigate if there was any association between use of bio-fuels in food catering enterprises and respiratory health of the workers. A cross-sectional design was employed, and data collected using Qualitative and quantitative techniques. Results The study found significantly higher prevalence of respiratory health outcomes among respondents in enterprises using biomass fuels compared to those using processed fuels. Biomass fuels are thus a major public health threat to workers in this sub-sector, and urgent intervention is required. Conclusion The study recommends a switch from biomass fuels to processed fuels to protect the health of the workers. PMID:23898361

Association between the use of biomass fuels on respiratory health of workers in food catering enterprises in Nairobi Kenya.

PubMed

Keraka, Margaret; Ochieng, Carolyne; Engelbrecht, Jacobus; Hongoro, Charles

2013-01-01

Indoor air pollution from biomass fuel use has been found to be responsible for more than 1.6 million annual deaths and 2.7% of the global burden of disease. This makes it the second biggest environmental contributor to ill health, behind unsafe water and sanitation. The main objective of this study was to investigate if there was any association between use of bio-fuels in food catering enterprises and respiratory health of the workers. A cross-sectional design was employed, and data collected using Qualitative and quantitative techniques. The study found significantly higher prevalence of respiratory health outcomes among respondents in enterprises using biomass fuels compared to those using processed fuels. Biomass fuels are thus a major public health threat to workers in this sub-sector, and urgent intervention is required. The study recommends a switch from biomass fuels to processed fuels to protect the health of the workers.

State of malnutrition in hospitals of Ecuador.

PubMed

Gallegos Espinosa, Sylvia; Nicolalde Cifuentes, Marcelo; Santana Porbén, Sergio

2014-08-01

Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. The Ecuadorian Hospital Malnutrition Study was conducted between November 2011 and June 2012 with 5,355 patients (Women: 37.5%; Ages ≥ 60 years: 35.1%; Length of stay ≤ 15 days: 91.2%) admitted to 36 public hospitals located in the prominent cities of 22 out of the 24 provinces of the country. Malnutrition frequency was estimated by means of the Subjective Global Assessment survey. Malnutrition affected 37.1% of the surveyed patients. Malnutrition was dependent upon patient's age and education level; as well as the presence of cancer, sepsis, and chronic organic failure. Hospital areas showed different frequencies of hospital malnutrition. Health condition leading to hospital admission influenced negatively upon nutritional status. Malnutrition frequency increased as length of stay prolonged. Malnutrition currently affects an important proportion of patients hospitalized in public health institutions of Ecuador. Policies and actions are urgently required in order to successfully deal with this health problem and thus to ameliorate its negative impact upon quality of medical care. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

How urgent is urgent? Analysing urgent out-patient referrals to an adult psychiatric service.

PubMed

Cubbin, S; Llewellyn-Jones, S; Donnelly, P

2000-01-01

It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an ¤ urgent' referral. The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. ( Int J Psych Clin Pract 2000; 4: 233 - 235).

Studying modification of aminoglycoside antibiotics by resistance-causing enzymes via microarray.

PubMed

Disney, Matthew D

2012-01-01

Widespread bacterial resistance to antibiotics is a significant public health concern. To remain a step ahead of evolving bacteria, new methods to study resistance to antibacterials and to uncover novel antibiotics that evade resistance are urgently needed. Herein, microarray-based methods that have been developed to study aminoglycoside modification by resistance-causing enzymes are reviewed. These arrays can also be used to study the binding of aminoglycoside antibiotics to a mimic of their therapeutic target, the rRNA aminoacyl site (A-site), and how modification by resistance-causing enzymes affects their abilities to bind RNA.

Healthcare-associated infections: challenges to public health in Brazil

PubMed Central

Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco

2014-01-01

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges. PMID:26039403

"We need somewhere to smoke crack": An ethnographic study of an unsanctioned safer smoking room in Vancouver, Canada.

PubMed

McNeil, Ryan; Kerr, Thomas; Lampkin, Hugh; Small, Will

2015-07-01

Many cities around the globe have experienced substantial increases in crack cocaine use. Public health programmes have begun to address crack smoking, primarily through the distribution of safer crack use equipment, but their impacts have been limited. More comprehensive safer environmental interventions, specifically safer smoking rooms (SSR), have been implemented only in select European cities. However, none have been subjected to rigorous evaluation. This ethnographic study was undertaken at an 'unsanctioned' SSR operated by a drug user-led organization in Vancouver, Canada, to explore how this intervention shaped crack smoking practices, public crack smoking, and related harms. Ethnographic fieldwork was undertaken at this SSR from September to December 2011, and included approximately 50 hours of ethnographic observation and 23 in-depth interviews with people who smoke crack. Data were analyzed by drawing on the 'Risk Environment' framework and concepts of 'symbolic', 'everyday', and 'structural' violence. Our findings illustrate how a high demand for SSRs was driven by the need to minimize exposure to policing (structural violence), drug scene violence (everyday violence), and stigma (symbolic violence) that characterized unregulated drug use settings (e.g., public spaces). Although resource scarcity and social norms operating within the local drug scene (e.g., gendered power relations) perpetuated crack pipe-sharing within unregulated drug use settings, the SSR fostered harm reduction practices by reshaping the social-structural context of crack smoking and reduced the potential for health harms. Given the significant potential of SSRs in reducing health and social harms, there is an urgent need to scale up these interventions. Integrating SSRs into public health systems, and supplementing these interventions with health and social supports, has potential to improve the health and safety of crack-smoking populations. Copyright © 2015 Elsevier B.V. All rights reserved.

Urbanization and health in China, thinking at the national, local and individual levels.

PubMed

Li, Xinhu; Song, Jinchao; Lin, Tao; Dixon, Jane; Zhang, Guoqin; Ye, Hong

2016-03-08

China has the biggest population in the world, and has been experiencing the largest migration in history, and its rapid urbanization has profound and lasting impacts on local and national public health. Under these conditions, a systems understanding on the correlation among urbanization, environmental change and public health and to devise solutions at national, local and individual levels are in urgent need. In this paper, we provide a comprehensive review of recent studies which have examined the relationship between urbanization, urban environmental changes and human health in China. Based on the review, coupled with a systems understanding, we summarize the challenges and opportunities for promoting the health and wellbeing of the whole nation at national, local, and individual levels. Urbanization and urban expansion result in urban environmental changes, as well as residents' lifestyle change, which can lead independently and synergistically to human health problems. China has undergone an epidemiological transition, shifting from infectious to chronic diseases in a much shorter time frame than many other countries. Environmental risk factors, particularly air and water pollution, are a major contributing source of morbidity and mortality in China. Furthermore, aging population, food support system, and disparity of public service between the migrant worker and local residents are important contributions to China's urban health. At the national level, the central government could improve current environmental policies, food safety laws, and make adjustments to the health care system and to demographic policy. At the local level, local government could incorporate healthy life considerations in urban planning procedures, make improvements to the local food supply, and enforce environmental monitoring and management. At the individual level, urban residents can be exposed to education regarding health behaviour choices while being encouraged to take responsibility for their health and to participate in environmental monitoring and management.

[Migration, climate and health].

PubMed

Tellier, Siri; Carballo, Manuel; Calballo, Manuel

2009-10-26

Many tentative connections have been postulated between migration and climate. This article points to rural-urban migration, particularly into low elevation urban slums prone to flooding as an issue needing urgent attention by health professionals. It also notes the no-man's land in which environmental refugees find themselves and the consequences this may have. Finally, it points to the urgent need to reform health systems in both developing and developed countries to adapt to rapidly changing disease patterns and to become more responsive to them.

Turning health research into health promotion: a study of causality and 'critical insights' in a United Kingdom health campaign.

PubMed

Piggin, Joe

2012-10-01

This article examines how important decisions about health can alter between public health policy formulation and eventual marketing implementation. Specifically, the article traces the development and production of a major United Kingdom social marketing campaign named Change4Life, and examines how ideas about the causes of and solutions to the obesity epidemic are produced in differing ways throughout the health promotion process. This study examines a variety of United Kingdom health research, policy, marketing strategy and marketing messages between 2008 and 2011. This research demonstrates that claims about causality oscillate and alter throughout the research, policy and Change4Life marketing process. These oscillations are problematic, since the Department of Health described the original consumer research as 'critical'. Given both the importance of the health issues being addressed and the amount of funding dedicated to Change4Life, that 'critical' research was directly contradicted in the campaign requires urgent review. To conclude, the article discusses the utility of social marketing when considering causal claims in health promotion. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Burden of oral disease in the Middle East: Opportunities for dental public health.

PubMed

Morgano, S M; Doumit, M; Shammari, K F Al-; Al-Suwayed, A; Al-Suwaidi, A; Debaybo, D; Al-Mubarak, S

2010-06-01

A significant increase in the burden of oral-health related diseases in the Middle East has been observed recently. This increase has been largely the result of poor awareness concerning the importance of oral health and best practices towards achieving good oral hygiene. Contributing factors to this burden include but are not limited to: increased sugar consumption, inadequate oral hygiene practices and a high prevalence of smoking. All these factors are known to have considerable influence on the development of the most common oral diseases, such as dental caries, periodontal diseases, oral precancerous lesions and cancer. Although oral diseases represent a significant burden on the quality of life and healthcare economics of Middle Eastern countries, restorative and preventive dental care have not been given nearly enough attention. The prevention of dental diseases is critical to preserving not only oral health but also to maintaining general well being. This Supplement will address the need for oral disease preventative approaches with the use of epidemiological data, and will focus on the management and prevention of dental caries and periodontal disease, providing practical advice on for the management of plaque biofilm. There is a significant need for increased public awareness and regular surveillance of oral hygiene practices in the Middle East, as well as the complications associated with poor oral hygiene. In addition, development of guidelines, public health awareness programmess and dental community educational programmes are urgently needed. 2010 FDI/World Dental Press.

Global-to-local policy transfer in the introduction of new molecular tuberculosis diagnostics in South Africa.

PubMed

Colvin, C J; Leon, N; Wills, C; van Niekerk, M; Bissell, K; Naidoo, P

2015-11-01

Lack of innovation in diagnostics has contributed to tuberculosis (TB) remaining a global health challenge. It is critical to understand how new diagnostic technologies are translated into policies and how these are implemented. To examine policy transfer for two rapid molecular diagnostic tests, GenoType(®) MDRTBplus and Xpert(®) MTB/RIF, to understand policy development, uptake and implementation in South Africa. A policy transfer analysis framework integrating the key dimensions of policy transfer into one coherent model was used. Two phases of key informant interviews were undertaken with a wide range of stakeholders. Both tests were developed through innovative partnerships and responded to urgent public health needs. GenoType was introduced through a process that was more inclusive than that for Xpert. National policy and planning processes were opaque for both tests. Their implementation, maintenance and expansion suffered from poor communication and coordination, insufficient attention to resource implications, technical challenges and a lack of broader health systems thinking. Our analysis identified the risks and benefits of partnerships for technological innovation, the complex intersections between global and national actors and the impact of health systems on policy transfer, and the risks of rescue- and technology-focused thinking in addressing public health challenges.

Oral Health Status of Older Adults Attending Senior Centers and Congregate Meal Sites in New Hampshire.

PubMed

Anderson, Ludmila; Martin, Nancy R; Kelly, Stephanie M; Brown, Heather A

2016-04-01

This study assessed the oral health status of older adults in randomly selected New Hampshire senior centers and congregate meal sites for the purpose of future planning, implementation and evaluation of targeted public health programs. A cross-sectional surveillance project was developed. Registered dental hygienists visually assessed denture use, number of natural teeth, teeth mobility, untreated caries, root fragments, gingivitis, need for care and treatment urgency among randomly selected active older adults living within New Hampshire communities. Altogether, 610 adults 60 years old and older attending 25 senior centers and congregate meal sites participated. Sixteen percent were edentulous and 42% reported having a removable upper or lower denture. Among edentulous adults, 5% had no dentures at all. Among 513 dentate participants, 22% had untreated caries, 14% had root fragments, 9% had gingivitis and 7% presented with obviously mobile teeth. Overall, 19% required early or urgent dental care. Differences were detected by sex, age group, urban versus rural location of the site and by the participation in a federal nutritional program for older adults. Baseline information about oral health needs of older adults in New Hampshire was gathered. Overall needs as well as existing oral health disparities will be addressed through the collaboration of public and private partners. Copyright © 2016 The American Dental Hygienists’ Association.

The Opportunities of Crises and Emergency Risk Communication in Activities of Serbian Public Health Workforce in Emergencies

PubMed Central

Radović, V; Ćurčić, L

2012-01-01

Background: The aim of the study was a recommendation and establishment the concept of the appropriate communication between public health, other competent services and population in emergency as the corner stone which guarantee that all goals which are important for community life will be achieved. Methods: We used methodology appropriate for social science: analyses of documents, historical approach and comparative analysis. Results: The finding shows the urgent need for accepting of crises and emergency risk communication principles, or some similar concepts, in Serbia, and implementing effective two way communication especially in multiethnic region. The pragmatic value of the paper lays in information about the recent improvement of health workforce and emergency services in emergencies using new concept of communication and as source of numerous useful documents published in USA and few recent Serbian examples. Conclusion: Health workforce has significant role in the process of protection of population in emergencies. Policy makers should work on finding a way to improve their coordination and communication, creating new academic programs, providing of adequate training, and financial means in order to give them different role in society and provide visibility. From other side health workforce should build back to the citizen trust in what they are doing for society welfare using all their skills and abilities. PMID:23308348

Health impacts of wildfires.

PubMed

Finlay, Sarah Elise; Moffat, Andrew; Gazzard, Rob; Baker, David; Murray, Virginia

2012-11-02

Introduction Wildfires are common globally. Although there has been considerable work done on the health effects of wildfires in countries such as the USA where they occur frequently there has been relatively little work to investigate health effects in the United Kingdom. Climate change may increase the risk of increasing wildfire frequency, therefore there is an urgent need to further understand the health effects and public awareness of wildfires. This study was designed to review current evidence about the health effects of wildfires from the UK standpoint. Methods A comprehensive literature review of international evidence regarding wildfire related health effects was conducted in January 2012. Further information was gathered from authors' focus groups. Results A review of the published evidence shows that human health can be severely affected by wildfires. Certain populations are particularly vulnerable. Wood smoke has high levels of particulate matter and toxins. Respiratory morbidity predominates, but cardiovascular, ophthalmic and psychiatric problems can also result. In addition severe burns resulting from direct contact with the fire require care in special units and carry a risk of multi - organ complications. The wider health implications from spreading air, water and land pollution are of concern. Access to affected areas and communication with populations living within them is crucial in mitigating risk. Conclusion This study has identified factors that may reduce public health risk from wildfires. However more research is needed to evaluate longer term health effects from wildfires. An understanding of such factors is vital to ensure preparedness within health care services for such events.

Health Impacts of Wildfires

PubMed Central

Finlay, Sarah Elise; Moffat, Andrew; Gazzard, Rob; Baker, David; Murray, Virginia

2012-01-01

Introduction Wildfires are common globally. Although there has been considerable work done on the health effects of wildfires in countries such as the USA where they occur frequently there has been relatively little work to investigate health effects in the United Kingdom. Climate change may increase the risk of increasing wildfire frequency, therefore there is an urgent need to further understand the health effects and public awareness of wildfires. This study was designed to review current evidence about the health effects of wildfires from the UK standpoint. Methods A comprehensive literature review of international evidence regarding wildfire related health effects was conducted in January 2012. Further information was gathered from authors’ focus groups. Results A review of the published evidence shows that human health can be severely affected by wildfires. Certain populations are particularly vulnerable. Wood smoke has high levels of particulate matter and toxins. Respiratory morbidity predominates, but cardiovascular, ophthalmic and psychiatric problems can also result. In addition severe burns resulting from direct contact with the fire require care in special units and carry a risk of multi – organ complications. The wider health implications from spreading air, water and land pollution are of concern. Access to affected areas and communication with populations living within them is crucial in mitigating risk. Conclusion This study has identified factors that may reduce public health risk from wildfires. However more research is needed to evaluate longer term health effects from wildfires. An understanding of such factors is vital to ensure preparedness within health care services for such events. PMID:23145351

Awareness of nutrition problems among Vietnamese health and education professionals.

PubMed

Pham, Thi Hai Quynh; Worsley, Anthony; Lawrence, Mark; Marshall, Bernie

2017-10-01

Professionals who provide nutrition education and consulting to the public are encouraged to take into account the health, environmental and social contexts that influence health-related attitudes and behaviours in the population. This paper examined the awareness of shifts in population health outcomes associated with the nutrition transition in Vietnam among university nutrition lecturers, health professionals and school education professionals. Most of these professionals held accurate views of the current population health issues in Vietnam. However, they differed in their awareness of the seriousness of overweight and obesity. Although the majority indicated that the prevalence of obesity and non-communicable diseases (NCDs) had increased, nearly half believed that the government should complete its attempts to control undernutrition before trying to control obesity. More health professionals believed that food marketing was responsible for the growing prevalence of children's obesity, and more of them disapproved of the marketing of less healthy food to children. In contrast, the university nutrition lecturers were least aware of food marketing and the seriousness of obesity. Of the three groups, the university nutrition lecturers held less accurate perceptions of nutrition transition problems and their likely drivers. There is an urgent need for greater provision of public nutrition education for all three groups of professionals. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Climate change--the greatest public health threat of our time: seeing the wood, not just the trees.

PubMed

McFarlane, Gary J

2010-01-01

If asked to describe the key public health challenges of our time many practitioners might well cite issues such as health inequalities, obesity, smoking and poverty. However, with the greatest of respect to those agendas, they are not, in my view, the greatest priority at present. If we cannot learn to live within sustainable limits and damage beyond repair the essential life support systems that we depend on, they will fail catastrophically with horrific consequences for humanity. All credible, reliable scientific evidence suggests that without profound and significant change that is exactly where we are headed. However, there is time, albeit short, to avoid the very worst consequences of runaway climate change. But to do so requires collective and urgent action now! Public health practitioners have potentially so much to offer towards this effort. We have many of the skills and experience so critically needed to advocate for change--both political and behavioural; we have the ability to design creative, effective, and dynamic interventions to assist and facilitate communities and individuals make the journey; and equally importantly we have huge opportunities to do so. However to do so effectively means that we need to look at the problem through a different lens and make climate change a top public health priority. We need to see beyond many of the institutional and cultural barriers that exist, albeit not through deliberate design, within our organisations which can cause us to be focused on very specific agendas and see the whole wood, rather than individual trees within it. Climate change is not just an "environmental" problem and a priority therefore specifically for that sector. It is already costing lives and is life threatening on a scale that far surpasses current public health concerns and priorities. Equally critically, tackling climate change would and will significantly contribute towards addressing health inequalities. To use two well worn public health cliché's, climate change is everyone's business. And it must be a case of prevention because there will be, in this instance, no cure!

Systematic review of current efforts to quantify the impacts of climate change on undernutrition.

PubMed

Phalkey, Revati K; Aranda-Jan, Clara; Marx, Sabrina; Höfle, Bernhard; Sauerborn, Rainer

2015-08-18

Malnutrition is a challenge to the health and productivity of populations and is viewed as one of the five largest adverse health impacts of climate change. Nonetheless, systematic evidence quantifying these impacts is currently limited. Our aim was to assess the scientific evidence base for the impact of climate change on childhood undernutrition (particularly stunting) in subsistence farmers in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Fifteen manuscripts were reviewed. Few studies use primary data to investigate the proportion of stunting that can be attributed to climate/weather variability. Although scattered and limited, current evidence suggests a significant but variable link between weather variables, e.g., rainfall, extreme weather events (floods/droughts), seasonality, and temperature, and childhood stunting at the household level (12 of 15 studies, 80%). In addition, we note that agricultural, socioeconomic, and demographic factors at the household and individual levels also play substantial roles in mediating the nutritional impacts. Comparable interdisciplinary studies based on primary data at a household level are urgently required to guide effective adaptation, particularly for rural subsistence farmers. Systemization of data collection at the global level is indispensable and urgent. We need to assimilate data from long-term, high-quality agricultural, environmental, socioeconomic, health, and demographic surveillance systems and develop robust statistical methods to establish and validate causal links, quantify impacts, and make reliable predictions that can guide evidence-based health interventions in the future.

Systematic review of current efforts to quantify the impacts of climate change on undernutrition

PubMed Central

Phalkey, Revati K.; Aranda-Jan, Clara; Marx, Sabrina; Höfle, Bernhard; Sauerborn, Rainer

2015-01-01

Malnutrition is a challenge to the health and productivity of populations and is viewed as one of the five largest adverse health impacts of climate change. Nonetheless, systematic evidence quantifying these impacts is currently limited. Our aim was to assess the scientific evidence base for the impact of climate change on childhood undernutrition (particularly stunting) in subsistence farmers in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Fifteen manuscripts were reviewed. Few studies use primary data to investigate the proportion of stunting that can be attributed to climate/weather variability. Although scattered and limited, current evidence suggests a significant but variable link between weather variables, e.g., rainfall, extreme weather events (floods/droughts), seasonality, and temperature, and childhood stunting at the household level (12 of 15 studies, 80%). In addition, we note that agricultural, socioeconomic, and demographic factors at the household and individual levels also play substantial roles in mediating the nutritional impacts. Comparable interdisciplinary studies based on primary data at a household level are urgently required to guide effective adaptation, particularly for rural subsistence farmers. Systemization of data collection at the global level is indispensable and urgent. We need to assimilate data from long-term, high-quality agricultural, environmental, socioeconomic, health, and demographic surveillance systems and develop robust statistical methods to establish and validate causal links, quantify impacts, and make reliable predictions that can guide evidence-based health interventions in the future. PMID:26216952

Measurement equivalence: a glossary for comparative population health research.

PubMed

Morris, Katherine Ann

2018-03-06

Comparative population health studies are becoming more common and are advancing solutions to crucial public health problems, but decades-old measurement equivalence issues remain without a common vocabulary to identify and address the biases that contribute to non-equivalence. This glossary defines sources of measurement non-equivalence. While drawing examples from both within-country and between-country studies, this glossary also defines methods of harmonisation and elucidates the unique opportunities in addition to the unique challenges of particular harmonisation methods. Its primary objective is to enable population health researchers to more clearly articulate their measurement assumptions and the implications of their findings for policy. It is also intended to provide scholars and policymakers across multiple areas of inquiry with tools to evaluate comparative research and thus contribute to urgent debates on how to ameliorate growing health disparities within and between countries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Healthy people with nature in mind.

PubMed

Annerstedt van den Bosch, Matilda; Depledge, Michael H

2015-12-11

The global disease burden resulting from climate change is likely to be substantial and will put further strain on public health systems that are already struggling to cope with demand. An up- stream solution, that of preventing climate change and associated adverse health effects, is a promising approach, which would create win-win-situations where both the environment and human health benefit. One such solution would be to apply methods of behaviour change to prompt pro-environmentalism, which in turn benefits health and wellbeing. Based on evidence from the behavioural sciences, we suggest that, like many social behaviours, pro- environmental behaviour can be automatically induced by internal or external stimuli. A potential trigger for such automatic pro-environmental behaviour would be natural environments themselves. Previous research has demonstrated that natural environments evoke specific psychological and physiological reactions, as demonstrated by self-reports, epidemiological studies, brain imaging techniques, and various biomarkers. This suggests that exposure to natural environments could have automatic behavioural effects, potentially in a pro-environmental direction, mediated by physiological reactions. Providing access and fostering exposure to natural environments could then serve as a public health tool, together with other measures, by mitigating climate change and achieving sustainable health in sustainable ecosystems. However, before such actions are implemented basic research is required to elucidate the mechanisms involved, and applied investigations are needed to explore real world impacts and effect magnitudes. As environmental research is still not sufficiently integrated within medical or public health studies there is an urgent need to promote interdisciplinary methods and investigations in this critical field. Health risks posed by anthropogenic climate change are large, unevenly distributed, and unpredictable. To ameliorate negative impacts, pro-environmental behaviours should be fostered. Potentially this could be achieved automatically through exposure to favourable natural environments, with an opportunity for cost-efficient nature-based solutions that provide benefits for both the environment and public health.

Quantitative comparison of measurements of urgent care service quality.

PubMed

Qin, Hong; Prybutok, Victor; Prybutok, Gayle

2016-01-01

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

Overview of a public health approach to pediatric hearing impairment in the Pacific Islands.

PubMed

Kaspar, Annette; Kei, Joseph; Driscoll, Carlie; Swanepoel, De Wet; Goulios, Helen

2016-07-01

Childhood hearing impairment is a significant cause of disability in developing countries. Otitis media and meningitis are leading infectious causes of preventable hearing loss in children. It is estimated that the Pacific Islands have among the greatest global burden of childhood hearing impairment due to infectious causes, and yet there is currently very little in the research literature on pediatric hearing disorders in this region. (1) To review existing research literature on pediatric hearing impairment in the Pacific Islands, and (2) to present a public health approach to the development and improvement of childhood hearing services in the Pacific Islands. The primary tool was a comprehensive literature review. MEDLINE and ScienceDirect databases were searched for relevant journal articles. There was no limit on the date of publication. Any article reporting on hearing impairment in the Pacific Region was included. A total of 23 journal articles were found that satisfied the above inclusion criteria. The limited information available in the literature suggests that otitis media and vaccine-preventable infections are a significant cause of avoidable childhood hearing impairment in the Pacific Islands. Pediatric audiology services are limited in this region. Further research is required to develop effective public health programs that should reduce the burden of preventable childhood hearing loss in the Pacific Islands. There is limited information in the research literature on pediatric hearing impairment and audiology services in the Pacific Islands. Epidemiological data based on the WHO Ear and Hearing Disorders Survey Protocol are urgently needed, and the development of audiology services within the existing public and primary health care framework should reduce the burden of preventable hearing loss in the Pacific Islands. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

PubMed

Munns, Craig F; Shaw, Nick; Kiely, Mairead; Specker, Bonny L; Thacher, Tom D; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary; Högler, Wolfgang

2016-01-01

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. © 2016 S. Karger AG, Basel and The Endocrine Society.

Ethics, health policy, and Zika: From emergency to global epidemic?

PubMed

Jamrozik, Euzebiusz; Selgelid, Michael J

2018-05-01

Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation (PAHO), with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the PAHO ethics guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved. Zika raises traditional bioethical issues related to reproduction, prenatal diagnosis of serious malformations and unjust disparities in health outcomes. But the epidemic has also highlighted important issues of growing interest in public health ethics, such as the international spread of infectious disease; the central importance of reproductive healthcare in preventing maternal and neonatal morbidity and mortality; diagnostic and reporting biases; vector control and the links between vectors, climate change, and disparities in the global burden of disease. Finally, there are controversies regarding Zika vaccine research and eventual deployment. Zika virus was a neglected disease for over 50 years before the outbreak in Brazil. As it continues to spread, public health agencies should promote gender equity and disease control efforts in Latin America, while preparing for the possibility of a global epidemic. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

PubMed Central

Munns, Craig F.; Shaw, Nick; Kiely, Mairead; Specker, Bonny L.; Thacher, Tom D.; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M. Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A.; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M.; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary

2016-01-01

Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. PMID:26745253

Twenty-first century vaccinomics innovation systems: capacity building in the global South and the role of Product Development Partnerships (PDPs).

PubMed

Huzair, Farah; Borda-Rodriguez, Alexander; Upton, Mary

2011-09-01

The availability of sequence information from publicly available complete genomes and data intensive sciences, together with next-generation sequencing technologies offer substantial promise for innovation in vaccinology and global public health in the beginning of the 21st century. This article presents an innovation analysis for the nascent field of vaccinomics by describing one of the major challenges in this endeavor: the need for capacities in "vaccinomics innovation systems" to support the developing countries involved in the creation and testing of new vaccines. In particular, we discuss the need for understanding how institutional frameworks can enhance capacities as intrinsic to a systems approach to health technology development. We focus our attention on the global South, meaning the technically less advanced and developing nations in Africa, Asia, and Latin America. This focus is timely and appropriate because the challenge for innovation in postgenomics medicine is markedly much greater in these regions where basic infrastructures are often underresourced and new or the anticipated institutional relationships can be fragile. Importantly, we examine the role of Product Development Partnerships (PDPs) as a 21st century organizational innovation that contributes to strengthening fragile institutions and capacity building. For vaccinomics innovation systems to stand the test of time in a context of global public health, local communities, knowledge, and cultures need to be collectively taken into account at all stages in programs for vaccinomics-guided vaccine development and delivery in the global South where the public health needs for rational vaccine development are urgent.

Exploring the Public Health Impacts of Private Security Guards on People Who Use Drugs: a Qualitative Study.

PubMed

Markwick, Nicole; McNeil, Ryan; Small, Will; Kerr, Thomas

2015-12-01

Private security guards occupy an increasingly prominent role in the policing of private and public spaces. There are growing concerns regarding security guards' potential to shape violence, discrimination, and adverse health outcomes among vulnerable populations, including people who use drugs (PWUD). This is relevant in Vancouver, Canada, where private security guards have increasingly been employed by private organizations to manage public and private spaces, including those within urban drug scenes. This qualitative study sought to understand interactions between PWUD and private security guards and explore their impacts on health care access, risks, and harms among PWUD. Semi-structured interviews were conducted with 30 PWUD recruited from two ongoing prospective cohort studies. Interviews were transcribed and analyzed using a coding framework comprised of a priori and emergent categories. Study data indicate that participants experience pervasive, discriminatory profiling and surveillance by security guards, which exacerbates existing social marginalization and structural vulnerability, particularly among PWUD of Aboriginal ancestry. Participants reported that security guards restrict PWUD's access to public and private spaces, including pharmacies and hospitals. PWUD also reported that their interactions with security guards often involved interpersonal violence and aggression, experiences that served to increase their vulnerability to subsequent risks and harms. Our findings highlight that private security forces contribute significantly to the everyday violence experienced by PWUD within drug scenes and elsewhere and do so in a manner very similar to that of traditional police forces. These findings point to the urgent need for greater oversight and training of private security guards in order to protect the health and safety of PWUD.

Tourist health as a new branch of public health.

PubMed

Pasini, W

1989-01-01

Tourism has been steadily expanding in recent years and continues to do so, with the result that the health and social problems related to this new mass phenomenon are growing likewise. Urgent and serious attention to the various implications is now required on the part of relevant national and international bodies and of all sectors interested in the health and wellbeing of tourists, both in their place of origin and at their destination. Tourist health is a new branch of public health concerned with the protection and promotion of the health of tourists. The traditional role of medicine has always been to deal with the health aspects of the most important of life's activities, such as work and sport. The medical profession cannot therefore neglect a leisure-time pursuit such as tourism, in view of its wide-ranging health implications. The Italian Association for Tourist Medicine (IATM) and the Tourist Health Centre, with headquarters in Rimini, were founded in 1983 to assist in the creation of tourist health as a discipline and to promote its development. An international meeting on Prevention and control of infections in tourists in the Mediterranean area, organized in close collaboration with the World Health Organization (WHO) and the World Tourism Organization (WTO) was held in Rimini on 8-11 February 1988. The meeting recommended that the IATM act as focal point in the promotion of tourist health and tourist medicine, especially for countries in the Mediterranean area. In December 1988, the Tourist Health Centre, Rimini was designated as a WHO collaborating centre for tourist health and tourist medicine.(ABSTRACT TRUNCATED AT 250 WORDS)

Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People.

PubMed

Costa, Angelo Brandelli; da Rosa Filho, Heitor Tome; Pase, Paola Fagundes; Fontanari, Anna Martha Vaitses; Catelan, Ramiro Figueiredo; Mueller, Andressa; Cardoso, Dhiordan; Soll, Bianca; Schwarz, Karine; Schneider, Maiko Abel; Gagliotti, Daniel Augusto Mori; Saadeh, Alexandre; Lobato, Maria Inês Rodrigues; Nardi, Henrique Caetano; Koller, Silvia Helena

2018-02-01

Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.

Agricultural Applications for Antimicrobials. A Danger to Human Health: An Official Position Statement of the Society of Infectious Diseases Pharmacists.

PubMed

Aitken, Samuel L; Dilworth, Thomas J; Heil, Emily L; Nailor, Michael D

2016-04-01

The use of antibiotics in agriculture, particularly in food-producing animals, is pervasive and represents the overwhelming majority of antibiotic use worldwide. The link between antibiotic use in animals and antibiotic resistance in humans is unequivocal. Transmission can occur by ingesting undercooked meats harboring resistant bacteria, by direct contact of animals by animal handlers, and by various other means. Antibiotics used in aquaculture and antifungals used in horticulture are also an evolving threat to human health. Regulations aimed at decreasing the amount of antibiotics used in food production to limit the development of antibiotic resistance have recently been implemented. However, further action is needed to minimize antibiotic use in agriculture. This article describes the extent of this current problem and serves as the official position of the Society of Infectious Diseases Pharmacists on this urgent threat to human health. © 2016 Pharmacotherapy Publications, Inc.

Control of Infectious Diseases in the Era of European Clinical Microbiology Laboratory Consolidation: New Challenges and Opportunities for the Patient and for Public Health Surveillance

PubMed Central

Vandenberg, Olivier; Kozlakidis, Zisis; Schrenzel, Jacques; Struelens, Marc Jean; Breuer, Judith

2018-01-01

Many new innovative diagnostic approaches have been made available during the last 10 years with major impact on patient care and public health surveillance. In parallel, to enhance the cost-effectiveness of the clinical microbiology laboratories (CMLs), European laboratory professionals have streamlined their organization leading to amalgamation of activities and restructuring of their professional relationships with clinicians and public health specialists. Through this consolidation process, an operational model has emerged that combines large centralized clinical laboratories performing most tests on one high-throughput analytical platform connected to several distal laboratories dealing locally with urgent analyses at near point of care. The centralization of diagnostic services over a large geographical region has given rise to the concept of regional-scale “microbiology laboratories network.” Although the volume-driven cost savings associated with such laboratory networks seem self-evident, the consequence(s) for the quality of patient care and infectious disease surveillance and control remain less obvious. In this article, we describe the range of opportunities that the changing landscape of CMLs in Europe can contribute toward improving the quality of patient care but also the early detection and enhanced surveillance of public health threats caused by infectious diseases. The success of this transformation of health services is reliant on the appropriate preparation in terms of staff, skills, and processes that would be inclusive of stakeholders. In addition, rigorous metrics are needed to set out more concrete laboratory service performance objectives and assess the expected benefits to society in terms of saving lives and preventing diseases. PMID:29457001

Emerging infectious diseases not covered by routine vaccination in Europe in 2010-2015--the review of WHO and ECDC notifications for the National IHR Focal Point in Poland.

PubMed

Henszel, Łukasz; Janiec, Janusz; Izdebski, Radosław; Radziszewski, Franciszek; Polański, Piotr

2015-01-01

The National IHR Focal Point is a center set up by each Member State of the World Health Organization (WHO) in accordance with the International Health Regulations (2005). The International Health Regulations (IHR) were adopted on 23 May 2005 at the World Health Assembly and entered into force since 15 June 2007 as the legal instrument designed to help protect all countries from uncontrolled international spread of diseases and other urgent public health threats. According to Article 2 of IHR the purpose and scope of these Regulations are to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. Primarily, the scope of IHR is to establish a system of early warning (in accordance with Article 6 and 7) with the functioning in each country National IHR Focal Point which is available at any time to communicate with WHO IHR Contact Points and other entities. The tasks of the National IHR Fo- cal Point in Poland which was appointed by the Minister of Health and runs in the Department of Epidemiology, National Institute of Public Health--National Institute of Hygiene from 1 September 2007 are the notification of events that may constitute a public health emergency of international concern occurring in Poland or abroad and the dissemination of this information to the WHO, other National IHR Focal Points or competent authorities responsible for public health. The task of the National IHR Focal Point in Poland is also the dissemination of WHO and ECDC notifications, including recommendation and risk assessment documents. The aim of this work is the review of WHO and ECDC notifications received by National IHR Focal Point in Poland in the period from 2010 to 2015 which were related to emerging infectious diseases not covered by routine vaccination programs or for which there are no effective vaccines that have occurred in the WHO European Region. The review includes verotoxin-producing Escherichia coli O104: H4 infections, MERS-CoV infections, Ebola virus disease, malaria, dengue fever, West Nile fever, chikungunya and cholera.

ERISA failures and the erosion of workers' rights: the urgent need to protect private & public workers' pension and benefits.

PubMed

Allen, James P; Bales, Richard A

On March 11, 2011, Governor Scott Walker of Wisconsin signed into law a bill that eliminated most collective bargaining rights for the state's public-sector workers. Many other cash-strapped states followed Wisconsin's lead and introduced or enacted similar restraints on the rights of their workers. Thousands of public workers, whose only means of protecting their rights rested in their ability to collectively bargain, suddenly found their retirement benefits in jeopardy. This truth highlighted the lack of protections for public worker benefits similar to those of the private sector. However, the Employee Retirement Income Security Act, enacted for that purpose, has failed to secure these benefits. This article seeks to provide a broad overview of the crisis facing the pension and benefits system in the United States and offers some possible solutions. More importantly, the goal is to spur discourse on the urgent need to protect the benefits of all workers, public and private.

The Economic Burden of Visceral Leishmaniasis in Sudan: An Assessment of Provider and Household Costs

PubMed Central

Meheus, Filip; Abuzaid, Abuzaid A.; Baltussen, Rob; Younis, Brima M.; Balasegaram, Manica; Khalil, Eltahir A. G.; Boelaert, Marleen; Musa, Ahmed M.

2013-01-01

Visceral leishmaniasis (VL) is a neglected parasitic disease that is fatal if left untreated and is endemic in eastern Sudan. We estimated the direct and indirect costs of treatment of VL from the perspective of the provider and the household at three public hospitals in Gedaref State. The median total cost for one VL episode was estimated to be US$450. Despite the free provision of VL drugs at public hospitals, households bore 53% of the total cost of VL with one episode of VL representing 40% of the annual household income. More than 75% of households incurred catastrophic out-of-pocket expenditures. The length of treatment of 30 days led to important costs for both health providers and households. Alternative treatment regimens that reduce the duration of treatment are urgently needed. PMID:24189368

Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies.

PubMed

Pillemer, Karl; Burnes, David; Riffin, Catherine; Lachs, Mark S

2016-04-01

Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, and the general public. In this article, we provide an overview of global issues in the field of elder abuse, with a focus on prevention. This article provides a scoping review of key issues in the field from an international perspective. By drawing primarily on population-based studies, this scoping review provided a more valid and reliable synthesis of current knowledge about prevalence and risk factors than has been available. Despite the lack of scientifically rigorous intervention research on elder abuse, the review also identified 5 promising strategies for prevention. The findings highlight a growing consensus across studies regarding the extent and causes of elder mistreatment, as well as the urgent need for efforts to make elder mistreatment prevention programs more effective and evidence based. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Length of unemployment and health-related outcomes: a life-course analysis.

PubMed

Janlert, Urban; Winefield, Anthony H; Hammarström, Anne

2015-08-01

Most previous studies on the effects of length of unemployment on health have focused on the duration of continuous spells of unemployment rather than on the cumulative length of intermittent spells. This study analysed the relationship between the cumulative length of intermittent spells of unemployment and different health-related outcomes using data from a longitudinal study of school leavers. All pupils who completed compulsory schooling in 1981 in a medium-sized town in northern Sweden (N = 1083) were followed for 14 years with repeated questionnaires including questions about unemployment, health and health behaviour. Men tended to react with a steady state or a levelling off of health symptoms with increased unemployment, whereas women showed deteriorating health symptoms. For health behaviour the reverse occurred. Women's health behaviour was less connected with increased unemployment while men's health behaviour tended to deteriorate. Cumulative length of unemployment is correlated with deteriorated health and health behaviour. Long-term unemployment, even as a result of cumulated shorter employment spells over a number of years should be an urgent target for policy makers. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

National Training and Education Standards for Health and Wellness Coaching: The Path to National Certification

PubMed Central

Wolever, Ruth Q.; Lawson, Karen; Moore, Margaret

2015-01-01

The purpose of this article is twofold: (1) to announce the findings of the job task analysis as well as national training and education standards for health and wellness coaching (HWC) that have been developed by the large-scale, collaborative efforts of the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC) and (2) to invite commentary from the public. The rapid proliferation of individuals and organizations using the terms of health and/or wellness coaches and the propagation of private industry and academic coach training and education programs endeavoring to prepare these coaches has created an urgent and pressing need for national standards for use of the term health and wellness coach, as well as minimal requirements for training, education, and certification. Professionalizing the field with national standards brings a clear and consistent definition of health and wellness coaching and accepted practice standards that are uniform across the field. In addition, clear standards allow for uniform curricular criteria to ensure a minimal benchmark for education, training, and skills and knowledge evaluation of professional health and wellness coaches. PMID:25984418

A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota

PubMed Central

Cantas, L.; Shah, Syed Q. A.; Cavaco, L. M.; Manaia, C. M.; Walsh, F.; Popowska, M.; Garelick, H.; Bürgmann, H.; Sørum, H.

2013-01-01

The discovery and introduction of antimicrobial agents to clinical medicine was one of the greatest medical triumphs of the 20th century that revolutionized the treatment of bacterial infections. However, the gradual emergence of populations of antimicrobial-resistant pathogenic bacteria resulting from use, misuse, and abuse of antimicrobials has today become a major global health concern. Antimicrobial resistance (AMR) genes have been suggested to originate from environmental bacteria, as clinically relevant resistance genes have been detected on the chromosome of environmental bacteria. As only a few new antimicrobials have been developed in the last decade, the further evolution of resistance poses a serious threat to public health. Urgent measures are required not only to minimize the use of antimicrobials for prophylactic and therapeutic purposes but also to look for alternative strategies for the control of bacterial infections. This review examines the global picture of antimicrobial resistance, factors that favor its spread, strategies, and limitations for its control and the need for continuous training of all stake-holders i.e., medical, veterinary, public health, and other relevant professionals as well as human consumers, in the appropriate use of antimicrobial drugs. PMID:23675371

How evidence-based medicine is failing due to biased trials and selective publication.

PubMed

Every-Palmer, Susanna; Howick, Jeremy

2014-12-01

Evidence-based medicine (EBM) was announced in the early 1990s as a 'new paradigm' for improving patient care. Yet there is currently little evidence that EBM has achieved its aim. Since its introduction, health care costs have increased while there remains a lack of high-quality evidence suggesting EBM has resulted in substantial population-level health gains. In this paper we suggest that EBM's potential for improving patients' health care has been thwarted by bias in the choice of hypotheses tested, manipulation of study design and selective publication. Evidence for these flaws is clearest in industry-funded studies. We argue EBM's indiscriminate acceptance of industry-generated 'evidence' is akin to letting politicians count their own votes. Given that most intervention studies are industry funded, this is a serious problem for the overall evidence base. Clinical decisions based on such evidence are likely to be misinformed, with patients given less effective, harmful or more expensive treatments. More investment in independent research is urgently required. Independent bodies, informed democratically, need to set research priorities. We also propose that evidence rating schemes are formally modified so research with conflict of interest bias is explicitly downgraded in value. © 2014 John Wiley & Sons, Ltd.

Addressing the challenges of cross-jurisdictional data linkage between a national clinical quality registry and government-held health data.

PubMed

Andrew, Nadine E; Sundararajan, Vijaya; Thrift, Amanda G; Kilkenny, Monique F; Katzenellenbogen, Judith; Flack, Felicity; Gattellari, Melina; Boyd, James H; Anderson, Phil; Grabsch, Brenda; Lannin, Natasha A; Johnston, Trisha; Chen, Ying; Cadilhac, Dominique A

2016-10-01

To describe the challenges of obtaining state and nationally held data for linkage to a non-government national clinical registry. We reviewed processes negotiated to achieve linkage between the Australian Stroke Clinical Registry (AuSCR), the National Death Index, and state held hospital data. Minutes from working group meetings, national workshop meetings, and documented communications with health department staff were reviewed and summarised. Time from first application to receipt of data was more than two years for most state data-sets. Several challenges were unique to linkages involving identifiable data from a non-government clinical registry. Concerns about consent, the re-identification of data, duality of data custodian roles and data ownership were raised. Requirements involved the development of data flow methods, separating roles and multiple governance and ethics approvals. Approval to link death data presented the fewest barriers. To our knowledge, this is the first time in Australia that person-level data from a clinical quality registry has been linked to hospital and mortality data across multiple Australian jurisdictions. Implications for Public Health: The administrative load of obtaining linked data makes projects such as this burdensome but not impossible. An improved national centralised strategy for data linkage in Australia is urgently needed. © 2016 Public Health Association of Australia.

The global burden of oral diseases and risks to oral health.

PubMed Central

Petersen, Poul Erik; Bourgeois, Denis; Ogawa, Hiroshi; Estupinan-Day, Saskia; Ndiaye, Charlotte

2005-01-01

This paper outlines the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles (i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries. PMID:16211157

Assessment of screening practices for gestational hyperglycaemia in public health facilities: a descriptive study in bangalore, India.

PubMed

Babu, Giridhara R; Tejaswi, B; Kalavathi, M; Vatsala, G M; Murthy, G V S; Kinra, Sanjay; Neelon, Sara E Benjamin

2015-02-20

Screening and timely treatment of gestational hyperglycaemia (GH) is proved to be beneficial and improves maternal and foetal health outcomes. To understand screening practices, we explored the knowledge and perceptions of doctors working in public health facilities in Bangalore, India. We also studied participation factors by examining whether undergoing glucose estimation tests affects morning sickness in pregnant women. We aimed to understand the screening practices and knowledge of doctors. A semi-structured questionnaire was self-administered by the 50 participant doctors, selected from the sampling frame comprising of all the doctors working in public health facilities. We included 105 pregnant women for baseline assessment, in whom a well-structured questionnaire was used. We reported that gestational diabetes mellitus (GDM) screening was done in nearly all the health centres (96%). However, only 12% of the doctors could provide all components of GDM diagnosis and management correctly and 46% would diagnose by using a random blood glucose test. A majority (92%) of the doctors had poor knowledge (68%) about the cut-off values of glucose tests. More than 80% of pregnant women experienced some discomfort mostly due to rapid ingestion glucose in short span of time. Our study established that screening for GH is done in most public health facilities. Nonetheless, knowledge of doctors on the glucose tests and their interpretation needs improvement. Re-orientation trainings of the doctors can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning prior to the tests can aid successful completion of them. Significance for public healthRising burden of hyperglycaemia in pregnancy is a cause for concern and is associated with short and long term deleterious consequences for mother and offspring. Hence, there is an urgent need to explore the screening practices for gestational hyperglycaemia (GH). The current study considers patient and doctors' perspectives regarding GH screening. The results from our study indicate several issues during screening of gestational hyperglycaemia in public health facilities in Bangalore, India. These included low awareness levels among doctors, lack of standard operating procedures and lack of adequate care and attention provided to pregnant women. Re-orientation trainings of the doctors within public health facilities can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning and preparation of the patient prior to the tests can help ensure successful completion of the tests. The findings of the study are comparable with the practices of public health hospitals in India.

Paradise lost: an introduction to the geography of water pollution in Puerto Rico.

PubMed

Hunter, J M; Arbona, S I

1995-05-01

Rapid industrialization has transformed the agricultural economy of Puerto Rico, creating employment opportunities and raising standards of living. Success, however, is marred by widespread pollution that outstrips the infrastructural capacity necessary for the preservation of environmental quality and of human health. The result today is a landfill crisis, a heritage of toxic dumps, and an advancing tide of pollution. Rivers and reservoirs are nearly ubiquitously affected and groundwaters, long thought to be naturally protected, show evidence of increasing contamination. Limestone aquifers are at particular risk. Public awareness and inter-sectoral political leadership are urgently needed to reverse the trend towards environmental deterioration.

The need to support students with autism at university.

PubMed

Mulder, Ann M; Cashin, Andrew

2014-09-01

Publicity surrounds the increased prevalence of autism. However, in contrast to support in primary and secondary schools, there exists little focus on supporting students with autism at university. Mental health nurses are well placed to facilitate support programmes for students with autism who have the capacity for higher education. This article examines the international literature around the support needs for these students and discusses opportunities that exist to support these students, their families, and higher education staff. Research is urgently needed to evaluate the success of such interventions, particularly in light of the low participation rates in study and work for people with autism.

Cryptosporidiosis Drug Discovery: Opportunities and Challenges.

PubMed

Manjunatha, Ujjini H; Chao, Alexander T; Leong, F Joel; Diagana, Thierry T

2016-08-12

The apicomplexan parasite Cryptosporidium is the second most important diarrheal pathogen causing life-threatening diarrhea in children, which is also associated with long-term growth faltering and cognitive deficiency. Cryptosporidiosis is a parasitic disease of public health concern caused by Cryptosporidium parvum and Cryptosporidium hominis. Currently, nitazoxanide is the only approved treatment for cryptosporidium infections. Unfortunately, it has limited efficacy in the most vulnerable patients, thus there is an urgent need for a safe and efficacious cryptosporidiosis drug. In this work, we present our current perspectives on the target product profile for novel cryptosporidiosis therapies and the perceived challenges and possible mitigation plans at different stages in the cryptosporidiosis drug discovery process.

Drug supply strategies, constraints and prospects in Nigeria.

PubMed

Yusuff, K B; Tayo, F

2004-12-01

The study set out to identify the strategies for public drug supply in Nigeria, assess its functionality, and recommend appropriate means to ensure regular availability of safe, efficacious, good quality and affordable essential drugs at public health facilities. The investigation was carried out at the Directorate of Pharmaceutical services, Federal Ministry of Health (F.M.O.H) Abuja and Federal Medical Stores, Oshodi, Lagos. Semi-structured interview was conducted with key informants at the Department of Food & Drugs, Drug procurement unit and Central Medical store using structured questionnaires and direct informants answers. Our study shows that public drug supply in Nigeria is governed by a National Drug Policy (NDP) which was introduced in 1990 and it is yet to be reviewed after ten years. We also identified the Central Medical Store (CMS) system as the current public drug supply strategy in Nigeria. Public drug supply is mainly financed by governments and this is inadequate to ensure sustained availability of essential drugs. The major procurement methods in use are open tender and direct procurement. These methods as presently operated suffer from late order placement, delay in payment and poor supplier lead-time mainly attributable to lateness in payment for previous drug supplies. These have contributed to stock out of essential drugs at public health facilities. Major losses due to expiration and spoilage are recorded at both central and peripheral storage points despite adequacy of storage facilities and personnel. Road transportation was the major mode of drug distribution from central to peripheral storage points and shortage of vehicle was a key factor affecting drug distribution. There was an apparent lack of a functioning drug management information system to effectively coordinate public drug supply and there are no definite systems that monitor and evaluate staff performance. The CMS strategy currently used for public drug supply in Nigeria has not ensured regular availability of essential drugs at public health facilities. Our study suggests that this is more of an administrative failure. Public drug supply in Nigeria is therefore in need of urgent reforms and this could be achieved through the use of an autonomous drug supply agency to assure efficiency and sustainability.

Public perspective towards marine litter in West Aceh City

NASA Astrophysics Data System (ADS)

Kusumawati, I.; Setyowati, M.; Riana, E.; Prartono, T.

2018-03-01

Marine litter or marine debris is a man-made solid material discarded, abandoned or lost in coastline or into the sea. To reduce the amount of marine litter in the ocean, raising public awareness is an important way. One of the contributing factors on marine litter is the lack of understanding within the community, but to identify how people notice the problem is required adequate research literature. The purpose of this study is to examine the awareness of West Aceh community on marine litter along western coastal area. The research objectives; 1) to evaluate societal perception towards marine litter; 2) to examine the urgent indicator of public awareness in West Aceh City. This study will employ a survey approach by distributing questionnaires to 383 respondents. It was found that respondents show low awareness on marine litter according to statistical data, but there are some rooms to manage in order to raise the level of public awareness. It concludes that sense of responsibility could be enhanced by involving public in any activities for preventing and eradicating marine litter. Education aspect is also important to increase public understanding about the threats of marine debris on environment, human health and economic income.

Non-urgent accident and emergency department use as a socially shared custom: a qualitative study.

PubMed

Keizer Beache, Simone; Guell, Cornelia

2016-01-01

We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities. In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach. In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare. We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa.

PubMed

Levitt, Naomi S; Puoane, Thandi; Denman, Catalina A; Abrahams-Gessel, Shafika; Surka, Sam; Mendoza, Carlos; Khanam, Masuma; Alam, Sartaj; Gaziano, Thomas A

2015-01-01

We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.

Associations Between Perceived Weight Discrimination and the Prevalence of Psychiatric Disorders in the General Population

PubMed Central

Hatzenbuehler, Mark L.; Keyes, Katherine M.; Hasin, Deborah S.

2013-01-01

Despite the increased prevalence of weight discrimination, few studies have examined the association between perceived weight discrimination and the prevalence of current psychiatric disorders in the general population. This study utilized a subsample of overweight and obese individuals (N = 22,231) from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional nationally representative study of noninstitutionalized US adults. Perceived weight discrimination is associated with substantial psychiatric morbidity and comorbidity. These results remained significant after adjusting for a potential confound, perceived stress. Moreover, social support did not buffer against the adverse effects of perceived weight discrimination on mental health. Controlling for BMI did not diminish the associations, indicating that perceived weight discrimination is potentially harmful to mental health regardless of weight. These results highlight the urgent need for a multifaceted approach to address this important public health issue, including interventions to assist overweight individuals in coping with the mental health sequelae of perceived weight discrimination. PMID:19390520

Current trends in health insurance systems: OECD countries vs. Japan.

PubMed

Sasaki, Toshiyuki; Izawa, Masahiro; Okada, Yoshikazu

2015-01-01

Over the past few decades, the longest extension in life expectancy in the world has been observed in Japan. However, the sophistication of medical care and the expansion of the aging society, leads to continuous increase in health-care costs. Medical expenses as a part of gross domestic product (GDP) in Japan are exceeding the current Organization for Economic Co-operation and Development (OECD) average, challenging the universally, equally provided low cost health care existing in the past. A universal health insurance system is becoming a common system currently in developed countries, currently a similar system is being introduced in the United States. Medical care in Japan is under a social insurance system, but the injection of public funds for medical costs becomes very expensive for the Japanese society. In spite of some urgently decided measures to cover the high cost of advanced medical treatment, declining birthrate and aging population and the tendency to reduce hospital and outpatients' visits numbers and shorten hospital stays, medical expenses of Japan continue to be increasing.

Implementing falls prevention research into policy and practice: an overview of a new National Health and Medical Research Council Partnership Grant.

PubMed

Lord, Stephen R; Delbaere, Kim; Tiedemann, Anne; Smith, Stuart T; Sturnieks, Daina L

2011-06-01

Preventing falls and fall-related injuries among older people is an urgent public health challenge. This paper provides an overview of the background to and research planned for a 5-year National Health and Medical Research Council Partnership Grant on implementing falls prevention research findings into policy and practice. This program represents a partnership between key Australian falls prevention researchers, policy makers and information technology companies which aims to: (1) fill gaps in evidence relating to the prevention of falls in older people, involving new research studies of risk factor assessment and interventions for falls prevention; (2) translate evidence into policy and practice, examining the usefulness of new risk-identification tools in clinical practice; and (3) disseminate evidence to health professionals working with older people, via presentations, new evidence-based guidelines, improved resources and learning tools, to improve the workforce capacity to prevent falls and associated injuries in the future.

Addressing physical inactivity in Omani adults: perceptions of public health managers.

PubMed

Mabry, Ruth M; Al-Busaidi, Zakiya Q; Reeves, Marina M; Owen, Neville; Eakin, Elizabeth G

2014-03-01

To explore barriers and solutions to addressing physical inactivity and prolonged sitting in the adult population of Oman. Qualitative study involving semi-structured interviews that took place from October 2011 to January 2012. Participants were recruited through purposive sampling. Data collection and analysis was an iterative process; later interviews explored emerging themes. Interviews were audio-recorded and transcribed and continued until data saturation; this occurred by the tenth interviewee. Thematic content analysis was carried out, guided by an ecological model of health behaviour. Muscat, Oman. Ten mid-level public health managers. Barriers for physical inactivity were grouped around four themes: (i) intrapersonal (lack of motivation, awareness and time); (ii) social (norms restricting women's participation in outdoor activity, low value of physical activity); (iii) environment (lack of places to be active, weather); and (iv) policy (ineffective health communication, limited resources). Solutions focused on culturally sensitive interventions at the environment (building sidewalks and exercise facilities) and policy levels (strengthening existing interventions and coordinating actions with relevant sectors). Participants' responses regarding sitting time were similar to, but much more limited than those related to physical inactivity, except for community participation and voluntarism, which were given greater emphasis as possible solutions to reduce sitting time. Given the increasing prevalence of chronic disease in Oman and the Arabian Gulf, urgent action is required to implement gender-relevant public health policies and programmes to address physical inactivity, a key modifiable risk factor. Additionally, research on the determinants of physical inactivity and prolonged sitting time is required to guide policy makers.

A comparative study on the level of satisfaction among regular and contractual health-care workers in a Northern city of India

PubMed Central

Dixit, Jyoti; Goel, Sonu; Sharma, Vijaylakshmi

2017-01-01

Introduction: Job satisfaction greatly determines the productivity and efficiency of human resources for health. The current study aims to assess the level of satisfaction and factors influencing the job satisfaction among regular and contractual health-care workers. Materials and Methods: A cross-sectional quantitative study was conducted from January to June 2015 among health care workers (n = 354) at all levels of public health-care facilities of Chandigarh. The correlation between variables with overall level of satisfaction was computed for regular and contractual health-care workers. Stepwise multiple linear regression was done to elucidate the major factors influencing job satisfaction. Results: Majority of the regular health-care staff was highly satisfied (86.9%) as compared to contractual staff (10.5%), which however was moderately satisfied (55.9%). Stepwise regression model showed that work-related matters (β = 1.370, P < 0.01), organizational facilities (β = 1.586, P < 0.01), privileges attached to the job (β = 0.530, P < 0.01), attention to the suggestions (β = 0.515, P < 0.01), chance of promotion (β = 0.703, P < 0.01), and human resource issues (β = 1.0721, P < 0.01) are strong predictors of overall satisfaction level. Conclusion: Under the National Rural Health Mission, contract appointments have improved the overall availability of health-care staff at all levels of public health facilities. However, there are concerns regarding their level of motivation with various aspects related to the job, which need to be urgently addressed so as to improve the effectiveness and efficiency of health services. PMID:29302557

A comparative study on the level of satisfaction among regular and contractual health-care workers in a Northern city of India.

PubMed

Dixit, Jyoti; Goel, Sonu; Sharma, Vijaylakshmi

2017-01-01

Job satisfaction greatly determines the productivity and efficiency of human resources for health. The current study aims to assess the level of satisfaction and factors influencing the job satisfaction among regular and contractual health-care workers. A cross-sectional quantitative study was conducted from January to June 2015 among health care workers ( n = 354) at all levels of public health-care facilities of Chandigarh. The correlation between variables with overall level of satisfaction was computed for regular and contractual health-care workers. Stepwise multiple linear regression was done to elucidate the major factors influencing job satisfaction. Majority of the regular health-care staff was highly satisfied (86.9%) as compared to contractual staff (10.5%), which however was moderately satisfied (55.9%). Stepwise regression model showed that work-related matters (β = 1.370, P < 0.01), organizational facilities (β = 1.586, P < 0.01), privileges attached to the job (β = 0.530, P < 0.01), attention to the suggestions (β = 0.515, P < 0.01), chance of promotion (β = 0.703, P < 0.01), and human resource issues (β = 1.0721, P < 0.01) are strong predictors of overall satisfaction level. Under the National Rural Health Mission, contract appointments have improved the overall availability of health-care staff at all levels of public health facilities. However, there are concerns regarding their level of motivation with various aspects related to the job, which need to be urgently addressed so as to improve the effectiveness and efficiency of health services.

E-health: an overview of the uses of the Internet, social media, apps, and websites for mood disorders.

PubMed

Parikh, Sagar V; Huniewicz, Paulina

2015-01-01

The current article defines and surveys E-health: Internet and technology-guided interventions and tools useful for mood disorders. E-health encompasses many categories, including computerized self-help strategies, online psychotherapy, websites that provide information, social media approaches including Facebook, Internet forums for health discussions, personal blogs, and videogames. Multiple tools exist to assess and document symptoms, particularly mood charts. Although all of these approaches are popular, only online psychotherapy and videogames have actually been evaluated in studies to evaluate both validity and efficacy. The face validity of social communication strategies including social media and blogs is strong, with clear implications for stigma reduction and peer support. Informational websites continue to be primary sources of psychoeducation on mental disorders. Social media sites have widespread use by the public and a profusion of health discussions and tools, but without published research evaluation of efficacy. E-health strategies, particularly online psychotherapy and tools to document symptoms, are useful and likely effective. Social communication strategies show enormous popularity, but urgently require research evaluation for impact.

Non-Accidental Health Impacts of Wildfire Smoke

PubMed Central

Youssouf, Hassani; Liousse, Catherine; Roblou, Laurent; Assamoi, Eric-Michel; Salonen, Raimo O.; Maesano, Cara; Banerjee, Soutrik; Annesi-Maesano, Isabella

2014-01-01

Wildfires take a heavy toll on human health worldwide. Climate change may increase the risk of wildfire frequency. Therefore, in view of adapted preventive actions, there is an urgent need to further understand the health effects and public awareness of wildfires. We conducted a systematic review of non-accidental health impacts of wildfire and incorporated lessons learned from recent experiences. Based on the literature, various studies have established the relationship between one of the major components of wildfire, particulate matter (particles with diameter less than 10 µm (PM10) and less than 2.5 µm (PM2.5)) and cardiorespiratory symptoms in terms of Emergency Rooms visits and hospital admissions. Associations between wildfire emissions and various subclinical effects have also been established. However, few relationships between wildfire emissions and mortality have been observed. Certain segments of the population may be particularly vulnerable to smoke-related health risks. Among them, people with pre-existing cardiopulmonary conditions, the elderly, smokers and, for professional reasons, firefighters. Potential action mechanisms have been highlighted. Overall, more research is needed to better understand health impact of wildfire exposure. PMID:25405597

Non-accidental health impacts of wildfire smoke.

PubMed

Youssouf, Hassani; Liousse, Catherine; Roblou, Laurent; Assamoi, Eric-Michel; Salonen, Raimo O; Maesano, Cara; Banerjee, Soutrik; Annesi-Maesano, Isabella

2014-11-14

Wildfires take a heavy toll on human health worldwide. Climate change may increase the risk of wildfire frequency. Therefore, in view of adapted preventive actions, there is an urgent need to further understand the health effects and public awareness of wildfires. We conducted a systematic review of non-accidental health impacts of wildfire and incorporated lessons learned from recent experiences. Based on the literature, various studies have established the relationship between one of the major components of wildfire, particulate matter (particles with diameter less than 10 µm (PM10) and less than 2.5 µm (PM2.5)) and cardiorespiratory symptoms in terms of Emergency Rooms visits and hospital admissions. Associations between wildfire emissions and various subclinical effects have also been established. However, few relationships between wildfire emissions and mortality have been observed. Certain segments of the population may be particularly vulnerable to smoke-related health risks. Among them, people with pre-existing cardiopulmonary conditions, the elderly, smokers and, for professional reasons, firefighters. Potential action mechanisms have been highlighted. Overall, more research is needed to better understand health impact of wildfire exposure.

Improving outcomes in cancer diagnosis, prevention and control: barriers, facilitators and the need for health literacy in Ibadan Nigeria.

PubMed

Adedimeji, Adebola A; Lounsbury, David; Popoola, Oluwafemi; Asuzu, Chioma; Lawal, Akinmayowa; Oladoyin, V; Crifase, Cassandra; Agalliu, Ilir; Shankar, Viswanathan; Adebiyi, Akindele

2017-10-01

Cancers constitute a significant public health problem in Nigeria. Breast, cervix and prostate cancers are leading causes of cancer-related deaths. Changing diets, lifestyles, HIV/AIDS and macro-structural factors contribute to cancer morbidity and mortality. Poor health information linking cancer risk to individual behaviors, environmental pollutants and structural barriers undermine prevention/control efforts. Studies suggest increasing health literacy and empowering individuals to take preventive action will improve outcomes and mitigate impact on a weak health system. We obtained qualitative data from 80 men, women, and young adults in 11 focus groups to assess beliefs, risk-perceptions, preventive behaviors and perceptions of barriers and facilitators to cancer control in Ibadan, Nigeria and conducted thematic analysis. Participants demonstrated awareness of cancers and mentioned several risk factors related to individual behaviors and the environment. Nonetheless, myths and misconceptions as well as micro, meso and macro level barriers impede prevention and control efforts. Developing and implementing comprehensive context-relevant health literacy interventions in community settings are urgently needed.Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Getting Australia more active: challenges and opportunities for health promotion.

PubMed

Hills, A P; Street, S J; Harris, N

2014-04-01

A growing body of evidence demonstrates that regular physical activity promotes health and assists in the prevention of non-communicable diseases but this is presently curtailed by low and unhealthy participation rates in Australia and comparable industrialised countries. Compounding the problem is knowledge that physical inactivity is independently associated with poor health outcomes. Despite physical activity being described as public health's 'best bet' or 'best buy', motivating individuals and groups to adopt and maintain physical activity continues to be a major challenge for health professionals. Global advocacy for prevention efforts must be operationalised through national to local strategies to promote and support physical activity in multiple settings including the home, schools and workplace. The Australian health promotion community has and continues to play a leadership role in physical activity promotion. However, there is an urgent need to continue to promote the importance of physical activity, along with its pivotal role in the prevention of non-communicable diseases, alongside related agendas including healthy diets, tobacco control and environmental sustainability. This commentary overviews the contemporary status of physical activity promotion in Australia and identifies key challenges and opportunities moving forward.

The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement.

PubMed

McClelland, Mark Stephen; Lazar, Danielle; Sears, Vickie; Wilson, Marcia; Siegel, Bruce; Pines, Jesse M

2011-12-01

Over the past decade, emergency departments (ED) have encountered major challenges due to increased crowding and a greater public focus on quality measurement and quality improvement. Responding to these challenges, many EDs have worked to improve their processes and develop new and innovative models of care delivery. Urgent Matters has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States. Recognizing that EDs across the country are struggling with many of the same issues, Urgent Matters-a program funded by the Robert Wood Johnson Foundation (RWJF)-has sought to identify, develop, and disseminate innovative approaches, interventions, and models to improve ED flow and quality. Using a variety of techniques, such as learning networks (collaboratives), national conferences, e-newsletters, webinars, best practices toolkits, and social media, Urgent Matters has served as a thought leader and innovator in ED quality improvement initiatives. The Urgent Matters Seven Success Factors were drawn from the early work done by program participants and propose practical guidelines for implementing and sustaining ED improvement activities. This article chronicles the history, activities, lessons learned, and future of the Urgent Matters program. © 2011 by the Society for Academic Emergency Medicine.

Power, Politics, and Health: A New Public Health Practice Targeting the Root Causes of Health Equity.

PubMed

Iton, Anthony; Shrimali, Bina Patel

2016-08-01

Purpose Understanding the WHY, WHAT, and HOW of place-based work in maternal and child health (MCH) is critical to examining the components of the environment that shape health opportunity through the relationship between life expectancy and neighborhood residence. Description On September 18, 2014, during the CityMatCH Leadership and MCH Epidemiology Conference, Dr. Anthony Iton provided the Keynote Address focused on the root causes of health inequities. Assessment The address focused on issues of equity in California and initiatives designed to mitigate and prevent disparities, including the Bay Area Regional Health Equities Initiative framework. Dr. Iton presented information on how the framework translated into investment strategies and a policy and systems change approach to place-based work. Conclusion The field of MCH, because of its focus on supporting health during critical periods of development, is poised to play a significant role in reducing health inequities. Recognizing that human health suffers when low income communities are passive, disenfranchised and disorganized, in order to change this status quo, understanding that human capital is the greatest asset is the urgent challenge to the field of MCH.

Integrated e-Health approach based on vascular ultrasound and pulse wave analysis for asymptomatic atherosclerosis detection and cardiovascular risk stratification in the community.

PubMed

Santana, Daniel Bia; Zócalo, Yanina A; Armentano, Ricardo L

2012-03-01

New strategies are urgently needed to identify subjects at increased risk of atherosclerotic cardiovascular disease (ACVD) development or complications. A National Public University Center (CUiiDARTE) was created in Uruguay, based on six main pillars: 1) integration of experts in different disciplines and creation of multidisciplinary teams, 2) incidence in public and professional education programs to give training in the use of new technologies and to shift the focus from ACVD treatment to disease prevention, 3) implementation of free vascular studies in the community (distributed rather than centralized healthcare), 4) innovation and application of e-Health and noninvasive technology and approaches, 5) design and development of a biomedical approach to determine the target population and patient workflow, and 6) improvement in individual risk estimation and differentiation between aging and ACVD-related arterial changes using population-based epidemiological and statistical patient-specific models. This work describes main features of CUiiDARTE project implementation, the scientific and technological steps and innovations done for individual risk stratification, and sub-clinical ACVD diagnosis. © 2012 IEEE

High Prevalence of Metabolic Syndrome among Kuwaiti Adults —A Wake-Up Call for Public Health Intervention

PubMed Central

Al Zenki, Sameer; Al Omirah, Husam; Al Hooti, Suad; Al Hamad, Nawal; Jackson, Robert T.; Rao, Aravinda; Al Jahmah, Nasser; Al Obaid, Ina'am; Al Ghanim, Jameela; Al Somaie, Mona; Zaghloul, Sahar; Al Othman, Amani

2012-01-01

The socio-economic development which followed the discovery of oil resources brought about considerable changes in the food habits and lifestyle of the Kuwaiti population. Excessive caloric intake and decreased energy expenditure due to a sedentary lifestyle have led to a rapid increase in obesity, diabetes and other non-communicable chronic diseases in the population. In this paper, we examine the prevalence of the Metabolic Syndrome (MetS) among Kuwaiti adults (≥20 years) using data from the first national nutrition survey conducted between July 2008 and November 2009. The prevalence of MetS was 37.7% in females and 34.2% in males by NCEP criteria, whereas the values were 40.1% in females and 41.7% in males according to IDF criteria. Prevalence of MetS increased with age and was higher in females than males. The high prevalence of the MetS in Kuwaiti adults warrants urgent public health measures to prevent morbidity and mortality due to cardiovascular complications in the future. PMID:22754486

Meta-analysis in evidence-based healthcare: a paradigm shift away from random effects is overdue.

PubMed

Doi, Suhail A R; Furuya-Kanamori, Luis; Thalib, Lukman; Barendregt, Jan J

2017-12-01

Each year up to 20 000 systematic reviews and meta-analyses are published whose results influence healthcare decisions, thus making the robustness and reliability of meta-analytic methods one of the world's top clinical and public health priorities. The evidence synthesis makes use of either fixed-effect or random-effects statistical methods. The fixed-effect method has largely been replaced by the random-effects method as heterogeneity of study effects led to poor error estimation. However, despite the widespread use and acceptance of the random-effects method to correct this, it too remains unsatisfactory and continues to suffer from defective error estimation, posing a serious threat to decision-making in evidence-based clinical and public health practice. We discuss here the problem with the random-effects approach and demonstrate that there exist better estimators under the fixed-effect model framework that can achieve optimal error estimation. We argue for an urgent return to the earlier framework with updates that address these problems and conclude that doing so can markedly improve the reliability of meta-analytical findings and thus decision-making in healthcare.

Health impact of the Buncefield oil depot fire, December 2005: study of accident and emergency case records.

PubMed

Hoek, M R; Bracebridge, S; Oliver, I

2007-09-01

On Sunday 11th of December 2005, an explosion occurred at the Buncefield oil depot, Hertfordshire, resulting in a large fire that blazed for several days. Two Accident and Emergency (A&E) departments were placed on stand-by to receive casualties. A simple surveillance system was put in place during the acute phase of the incident, but this was not adequate to fully examine the health impact of the fire. Retrospective study of A&E records at Hemel Hempstead and Watford A&E departments for the period that the fire burnt. Two hundred and forty-four people attended A&E as a result of the fire: 187 were members of the emergency services; 17 were oil depot workers; and 40 were members of the public. The most common presenting complaints were respiratory symptoms (n = 66) and injuries (n = 38). Twenty-five (21%) individuals were referred for medical follow-up. There were no fatalities. There was a significant impact on local health services, with many emergency service personnel attending A&E asymptomatically. Alternative health service provision for these individuals, possibly near to the scene of the incident, should be considered. This incident has also highlighted an urgent need to develop surveillance systems that enable real-time monitoring of the acute public health impact of major incidents.

42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... means of transportation would endanger the beneficiary's health. (b) Emergency and urgently needed... temporarily absent from the MA plan's service (or, if applicable, continuation) area (or, under unusual and... organization's provider network is temporarily unavailable or inaccessible) when the services are medically...

Three decades of disasters: a review of disaster-specific literature from 1977-2009.

PubMed

Smith, Erin; Wasiak, Jason; Sen, Ayan; Archer, Frank; Burkle, Frederick M

2009-01-01

The potential for disasters exists in all communities. To mitigate the potential catastrophes that confront humanity in the new millennium, an evidence-based approach to disaster management is required urgently. This study moves toward such an evidence-based approach by identifying peer-reviewed publications following a range of disasters and events over the past three decades. Peer-reviewed, event-specific literature was identified using a comprehensive search of the electronically indexed database, MEDLINE (1956-January 2009). An extended comprehensive search was conducted for one event to compare the event-specific literature indexed in MEDLINE to other electronic databases (EMBASE, CINAHL, AMED, CENTRAL, Psych Info, Maternity and Infant Care, EBM Reviews). Following 25 individual disasters or overwhelming crises, a total of 2,098 peer-reviewed, event-specific publications were published in 789 journals (652 publications following disasters/events caused by natural hazards, 966 following human-made/technological disasters/events, and 480 following conflict/complex humanitarian events).The event with the greatest number of peer-reviewed, event-specific publications was the 11 September 2001 terrorist attacks (686 publications). Prehospital and Disaster Medicine published the greatest number of peer-reviewed, event-specific publications (54), followed by Journal of Traumatic Stress (42), Military Medicine (40), and Psychiatric Services (40). The primary topics of event-specific publications were mental health, medical health, and response. When an extended, comprehensive search was conducted for one event, 75% of all peer-reviewed, event-specific publications were indexed in MEDLINE. A broad range of multi-disciplinary journals publish peer reviewed, event-specific publications. While the majority of peer-reviewed, event-specific literature is indexed in MEDLINE, comprehensive search strategies should include EMBASE to increase yield.

Domestic violence against children and adolescents: social support network perspectives.

PubMed

Carlos, Diene Monique; Pádua, Elisabete Matallo Marchesini De; Fernandes, Maria Isabel Domingues; Leitão, Maria Neto da Cruz; Ferriani, Maria das Graças Carvalho

2017-07-20

To identify and analyze the social support network of families involved in violence against children and adolescents, from the perspective of health professionals and families in a municipality of the state of São Paulo, Brazil. This was a qualitative strategic social study, anchored in the paradigm of complexity. Data were collected from 41 health professionals and 15 families using institutional or personal network maps, and semi-structured interviews. Analysis was conducted by organizing the data, constructing theoretical frameworks, and categorizing resulting information. The category "weaving the network" was unveiled, with family experiences and professionals focused on a logic of fragmentation of care. The creation and implementation of public policy are urgently needed to address the needs of this population, by empowering families and communities and developing research that respects the multidimensional nature of the phenomenon.

Not Missing the Future: A Call to Action for Investigating the Role of Regenerative Medicine Therapies in Pediatric/Adolescent Sports Injuries.

PubMed

Best, Thomas M; Caplan, Arnold; Coleman, Michael; Goodrich, Laurie; Hurd, Jason; Kaplan, Lee D; Noonan, Ben; Schoettle, Philip; Scott, Christopher; Stiene, Henry; Huard, Johnny

In August 2016, a group including sport medicine clinicians, researchers, and a bioethicist met in Vail, Colorado to discuss regenerative medicine and its potential role in youth sports injuries. There was consensus that a call to action is urgently needed to understand the current evidence base, the risks and rewards, and future directions of research and clinical practice for regenerative medicine therapies in youth sports. We present here a summary of our meeting, which was supported by the National Youth Sports Health and Safety Institute (NYSHSI), a partnership between the American College of Sports Medicine (ACSM) and Sanford Health. The group's goal is to educate practitioners and the public, and to pioneer a means of accumulating meaningful clinical data on regenerative medicine therapies in pediatric and adolescent athletes.

Commentary: the role of epidemiologists in funding biomedical education and research.

PubMed

Perry, Melissa J

2016-09-01

Melissa Perry served as the president of the American College of Epidemiology from September 2014 to September 2015. This is a written version of her Presidential Address at the 2015 Annual Meeting. Her speech was inspired by a 2014 Wall Street Journal commentary by Dr. Ferric Fang of the Washington University School of Medicine and Dr. Arturo Casadevall of the Albert Einstein College of Medicine of Yeshiva University. They likened the process of submitting a research proposal to the National Institutes of Health to playing the Powerball lottery. In her speech, Dr. Perry argued for the urgent need for epidemiology researchers to reach out to policymakers and the public in support of our field to ensure the continuation of research projects that can help improve the health of citizens everywhere. Copyright © 2016 Elsevier Inc. All rights reserved.

Combating poor-quality anti-malarial medicines: a call to action.

PubMed

Bassat, Quique; Tanner, Marcel; Guerin, Philippe J; Stricker, Kirstin; Hamed, Kamal

2016-06-01

The circulation of poor-quality medicines continues to undermine the fight against many life-threatening diseases. Anti-malarial medicines appear to have been particularly compromised and present a major public health threat in malaria-endemic countries, negatively affecting individuals and their communities. Concerted collaborative efforts are required from global, regional and national organizations, involving the public and private sectors, to address the problem. While many initiatives are underway, a number of unmet needs deserve urgent and increased multisector attention. At the global level, there is a need for an international public health legal framework or treaty on poor-quality medicines, with statutes suitable for integration into national laws. In addition, increased international efforts are required to strengthen the governance of global supply chains and enhance cooperation between national medicine regulation authorities and law enforcement bodies. Increased investment is needed in innovative technologies that will enable healthcare teams to detect poor-quality medicines at all levels of the supply chain. At the regional level, a number of initiatives would be beneficial-key areas are standardization, simplification, and reciprocal recognition of registration processes and development of quality control capacity in regional centres of excellence that are better aligned with public health needs; improved surveillance methods and creation of a framework for compulsory and transparent reporting of poor-quality medicines; additional support for national medicine regulation authorities and other national partner authorities; and an increase in support for regional laboratories to boost their capabilities in detecting poor-quality medicines. It is vital that all stakeholders involved in efforts against poor-quality anti-malarial medicines extend and strengthen their actions in these critical areas and thus effectively support global health development and malaria elimination programmes.

Current challenges and possible solutions to improve access to care and treatment for hepatitis C infection in Vietnam: a systematic review.

PubMed

Berto, Alessandra; Day, Jeremy; Van Vinh Chau, Nguyen; Thwaites, Guy E; My, Ngoc Nghiem; Baker, Stephen; Darton, Thomas C

2017-04-11

Hepatitis C infection is a major public health concern in low- and middle-income countries where an estimated 71.1 million individuals are living with chronic infection. The World Health Organization (WHO) has recently released new guidance for hepatitis C virus (HCV) treatment programs, which include improving the access to new direct-acting antiviral agents. In Vietnam, a highly populated middle-income country, the seroprevalence of HCV infection is approximately 4% and multiple genotypes co-circulate in the general population. Here we review what is currently known regarding the epidemiology of HCV in Vietnam and outline options for reducing the significant burden of morbidity and mortality in our setting. We performed a systematic review of the currently available literature to evaluate what has been achieved to date with efforts to control HCV infection in Vietnam. This search retrieved few publications specific to Vietnam indicating a significant gap in baseline epidemiological and public health data. Key knowledge gaps identified included an understanding of the prevalence in specific high-risk groups, characterization of circulating HCV genotypes in the population and likely response to treatment, and the extent to which HCV treatment is available, accessed and utilized. We conclude that there is an urgent need to perform up to date assessments of HCV disease burden in Vietnam, especially in high-risk groups, in whom incidence is high and cross infection with multiple genotypes is likely to be frequent. Coordinating renewed surveillance measures with forthcoming HCV treatment studies should initiate the traction required to achieve the WHO goal of eliminating HCV as a public health threat by 2030, at least in this region.

Key Aspects of a Sustainable Health Insurance System in Germany.

PubMed

Pelster, Matthias; Hagemann, Vera; Laporte Uribe, Franziska

2016-06-01

The main goals of health-care systems are to improve the health of the population they serve, respond to people's legitimate expectations, and offer fair financing. As a result, the health system in Germany is subject to continuous adaption as well as public and political discussions about its design. This paper analyzes the key challenges for the German health-care system and the underlying factors driving these challenges. We aim to identify possible solutions to put the German health-care system in a better position to face these challenges. We utilize a broad array of methods to answer these questions, including a review of the published and grey literature on health-care planning in Germany, semi-structured interviews with stakeholders in the system, and an online questionnaire. We find that the most urgent (and manageable) aspects that merit attention are holistic hospital planning, initiatives to increase (administrative) innovation in the health-care system, incentives to increase prevention, and approaches to increase analytical quality assurance. We found that hospital planning, innovation, quality control, and prevention, are considered to be the topics most in need of attention in the German health system.

Provision and Use of Maternal Health Services among Urban Poor Women in Kenya: What Do We Know and What Can We Do?

PubMed Central

Ezeh, Alex; Oronje, Rose

2008-01-01

In sub-Saharan Africa, the unprecedented population growth that started in the second half of the twentieth century has evolved into unparalleled urbanization and an increasing proportion of urban dwellers living in slums and shanty towns, making it imperative to pay greater attention to the health problems of the urban poor. In particular, urgent efforts need to focus on maternal health. Despite the lack of reliable trend data on maternal mortality, some investigators now believe that progress in maternal health has been very slow in sub-Saharan Africa. This study uses a unique combination of health facility- and individual-level data collected in the slums of Nairobi, Kenya to: (1) describe the provision of obstetric care in the Nairobi informal settlements; (2) describe the patterns of antenatal and delivery care, notably in terms of timing, frequency, and quality of care; and (3) draw policy implications aimed at improving maternal health among the rapidly growing urban poor populations. It shows that the study area is deprived of public health services, a finding which supports the view that low-income urban residents in developing countries face significant obstacles in accessing health care. This study also shows that despite the high prevalence of antenatal care (ANC), the proportion of women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy remains low compared to Nairobi as a whole and, more importantly, compared to rural populations. Bivariate analyses show that household wealth, education, parity, and place of residence were closely associated with frequency and timing of ANC and with place of delivery. Finally, there is a strong linkage between use of antenatal care and place of delivery. The findings of this study call for urgent attention by Kenya’s Ministry of Health and local authorities to the void of quality health services in poor urban communities and the need to provide focused and sustained health education geared towards promoting use of obstetric services. PMID:18389376

Situational Analysis of Essential Surgical Care Management in Iran Using the WHO Tool

PubMed Central

Kalhor, Rohollah; Keshavarz Mohamadi, Nastaran; Khalesi, Nader; Jafari, Mehdi

2016-01-01

Background: Surgery is an essential component of health care, yet it has usually been overlooked in public health across the world. Objectives: This study aimed to perform a situational analysis of essential surgical care management at district hospitals in Iran. Materials and Methods: This research was a descriptive and cross-sectional study performed at 42 first-referral district hospitals of Iran in 2013. The World Health Organization (WHO) Tool for the situational analysis of emergency and essential care was used for data collection in four domains of facilities and equipment, human resources, surgical interventions, and infrastructure. Data analysis was conducted using simple descriptive statistical methods. Results: In this study, 100% of the studied hospitals had oxygen cylinders, running water, electricity, anesthesia machines, emergency departments, archives of medical records, and X-ray machines. In 100% of the surveyed hospitals, specialists in surgery, anesthesia, and obstetrics and gynecology were available as full-time staff. Life-saving procedures were performed in the majority of the hospitals. Among urgent procedures, neonatal surgeries were conducted in 14.3% of the hospitals. Regarding non-urgent procedures, acute burn management was conducted in 38.1% of the hospitals. Also, a few other procedures such as cricothyrotomy and foreign body removal were performed in 85.7% of the hospitals. Conclusions: The results indicated that suitable facilities and equipment, human resources, and infrastructure were available in the district hospitals in Iran. These findings showed that there is potential for the district hospitals to provide care in a wider spectrum. PMID:27437121

Epilepsy and the law--a view from Thailand.

PubMed

Locharernkul, Chaichon

2007-03-01

Patients with epilepsy often suffer social injustice in many societies. This is a review of current laws dealing with epilepsy and the consequences of this complex disease. The author looked at reported unjust legal and social acts resulting from epileptic seizures and their results. The author found that accusation of criminal acts, accidents while driving, and job loss are relatively common experiences for epileptics. Such events reflect lack of public understanding. There is inadequate legislation to protect epileptics. Most disturbing areas are ictal behavior misinterpreted as crime, driving while experiencing a seizure, and social discrimination. There is no law dealing with epilepsy in Thailand while considerable progress in this field has been made in Western countries. Epilepsy patients are inadequately protected by Thai law. There is an urgent need for education and campaigns for their rights focused on the public, the legal profession, and the health care professionals.

International Alzheimer's Disease Research Portfolio (IADRP) aims to capture global Alzheimer's disease research funding.

PubMed

Liggins, Charlene; Snyder, Heather M; Silverberg, Nina; Petanceska, Suzana; Refolo, Lorenzo M; Ryan, Laurie; Carrillo, Maria C

2014-05-01

Alzheimer's disease (AD) is a recognized international public health crisis. There is an urgent need for public and private funding agencies around the world to coordinate funding strategies and leverage existing resources to enhance and expand support of AD research. To capture and compare their existing investments in AD research and research-related resources, major funding organizations are starting to utilize the Common Alzheimer's Disease Research Ontology (CADRO) to categorize their funding information. This information is captured in the International Alzheimer's Disease Research Portfolio (IADRP) for further analysis. As of January, 2014, over fifteen organizations from the US, Canada, Europe and Australia have contributed their information. The goal of the IADRP project is to enable funding organizations to assess the changing landscape of AD research and coordinate strategies, leverage resources, and avoid duplication of effort. Copyright © 2014. Published by Elsevier Inc.

Need for improved methods to collect and present spatial epidemiologic data for vectorborne diseases.

PubMed

Eisen, Lars; Eisen, Rebecca J

2007-12-01

Improved methods for collection and presentation of spatial epidemiologic data are needed for vectorborne diseases in the United States. Lack of reliable data for probable pathogen exposure site has emerged as a major obstacle to the development of predictive spatial risk models. Although plague case investigations can serve as a model for how to ideally generate needed information, this comprehensive approach is cost-prohibitive for more common and less severe diseases. New methods are urgently needed to determine probable pathogen exposure sites that will yield reliable results while taking into account economic and time constraints of the public health system and attending physicians. Recent data demonstrate the need for a change from use of the county spatial unit for presentation of incidence of vectorborne diseases to more precise ZIP code or census tract scales. Such fine-scale spatial risk patterns can be communicated to the public and medical community through Web-mapping approaches.

A New Foundation for the Delivery and Financing of American Health Care.

PubMed

Saultz, John W; Jones, Samuel M; McDaniel, Susan H; Bagley, Bruce; McCormally, Terence; Marker, Jason E; Weida, Jane A; Green, Larry A

2015-09-01

For the past decade, primary care practices across America have worked to implement a practice model called the Patient-Centered Medical Home (PCMH) to revitalize practice, better support clinicians and patients, improve efficiency, and facilitate growth in primary care capacity. In spite of substantial progress, this work has not been matched by sufficient change in the payment system to allow these goals to be accomplished. Nevertheless, improving the quality and availability of primary care remains essential to achieving the goals of the Triple Aim (better health care, better population health, and containment of health care costs). For this to occur, the PCMH model of care must be further refined, and the payment system for primary care must be completely restructured. The need for these changes is urgent. In October 2014, the discipline of family medicine announced a comprehensive strategic plan called Family Medicine for America's Health (FMAHealth). FMAHealth proposes to expand the PCMH care model by fully integrating our nation's behavioral/mental health, public health, and primary care systems to create a new foundation for American health care. Accomplishing these ambitious goals will require a broad coalition of private and public interests across the health care disciplines as well as patients, communities, government, and businesses. These changes require additional infrastructure that existing financing systems do not adequately support, so comprehensive payment reform is essential for large-scale dissemination and sustainability of this model. The new payment model must reward value rather than volume of service and must provide a secure financial foundation for practices designed to care for patients and communities at affordable costs.

Inequity in access to dental care services explains current socioeconomic disparities in oral health: the Swedish National Surveys of Public Health 2004-2005.

PubMed

Wamala, Sarah; Merlo, Juan; Boström, Gunnel

2006-12-01

To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health. Design, setting and outcomes: Cross-sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self-rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index (SDI) was developed, consisting of social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves. Swedish population-based sample of 17 362 men and 20 037 women. Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services. After adjusting for age, men with a mild SDI compared with those with no SDI had 2.7 (95% confidence interval (CI) 2.5 to 3.0) times the odds for self-rated poor oral health, whereas odds related to severe SDI were 6.8 (95% CI 6.2 to 7.5). The corresponding values among women were 2.3 (95% CI 2.1 to 2.5) and 6.8 (95% CI 6.3 to 7.5). Nevertheless, people with severe socioeconomic disparities were 7-9 times as likely to refrain from seeking the required dental treatment. These associations persisted even after controlling for living alone, education, occupational status and lifestyle factors. Lifestyle factors explained only 29% of the socioeconomic differences in poor oral health among men and women, whereas lack of access to dental care services explained about 60%. The results of the multilevel regression analysis indicated no additional effect of the administrative boundaries of counties or of municipalities in Sweden. Results call for urgent public health interventions to increase equitable access to dental care services.

Regional Climate Change and Development of Public Health Decision Aids

NASA Astrophysics Data System (ADS)

Hegedus, A. M.; Darmenova, K.; Grant, F.; Kiley, H.; Higgins, G. J.; Apling, D.

2011-12-01

According to the World Heath Organization (WHO) climate change is a significant and emerging threat to public health, and changes the way we must look at protecting vulnerable populations. Worldwide, the occurrence of some diseases and other threats to human health depend predominantly on local climate patterns. Rising average temperatures, in combination with changing rainfall patterns and humidity levels, alter the lifecycle and regional distribution of certain disease-carrying vectors, such as mosquitoes, ticks and rodents. In addition, higher surface temperatures will bring heat waves and heat stress to urban regions worldwide and will likely increase heat-related health risks. A growing body of scientific evidence also suggests an increase in extreme weather events such as floods, droughts and hurricanes that can be destructive to human health and well-being. Therefore, climate adaptation and health decision aids are urgently needed by city planners and health officials to determine high risk areas, evaluate vulnerable populations and develop public health infrastructure and surveillance systems. To address current deficiencies in local planning and decision making with respect to regional climate change and its effect on human health, our research is focused on performing a dynamical downscaling with the Weather Research and Forecasting (WRF) model to develop decision aids that translate the regional climate data into actionable information for users. WRF model is initialized with the Max Planck Institute European Center/Hamburg Model version 5 (ECHAM5) General Circulation Model simulations forced with the Special Report on Emissions (SRES) A1B emissions scenario. Our methodology involves development of climatological indices of extreme weather, quantifying the risk of occurrence of water/rodent/vector-borne diseases as well as developing various heat stress related decision aids. Our results indicate that the downscale simulations provide the necessary detailed output required by state and local governments and the private sector to develop climate adaptation plans with respect to human health.

Civil Society Organizations and medicines policy change: a case study of registration, procurement, distribution and use of misoprostol in Uganda.

PubMed

Atukunda, Esther Cathyln; Brhlikova, Petra; Agaba, Amon Ganafa; Pollock, Allyson M

2015-04-01

Misoprostol use for postpartum haemorrhage (PPH) has been promoted by Civil Society Organizations (CSOs) since the early 2000s. Yet, CSOs' role in improving access to misoprostol and shaping health policy at global and national levels is not well understood. We document the introduction of misoprostol in Uganda in 2008 from its registration, addition to treatment guidelines and national Essential Medicines List (EML), to its distribution and use. We then analyse the contribution of CSOs to this health policy change and service provision. Policy documents, procurement data and 82 key informant interviews with government officials, healthcare providers, and CSOs in four Ugandan districts of Kampala, Mbarara, Apac, Bundibugyo were collected between 2010 and 2013. Five key CSOs promoted and accelerated the rollout of misoprostol in Uganda. They supported the registration of misoprostol with the National Drug Authority, the development of clinical guidelines, and the piloting and training of health care providers. CSOs and National Medical Stores were procuring and distributing misoprostol country-wide to health centres two years before it was added to the clinical guidelines and EML of Uganda and in the absence of good evidence. The evidence suggests an increasing trend of misoprostol procurement and availability over the medicine of choice, oxytocin. This shift in national priorities has serious ramifications for maternal health care that need urgent evaluation. The absence of clinical guidelines in health centres and the lack of training preclude rational use of misoprostol. CSOs shifted their focus from the public to the private sector, where some of them continue to promote its use for off-label indications including induction of labour and abortion. There is an urgent need to build capacity to improve the robustness of the national and local institutions in assessing the safety and effectiveness of all medicines and their indications in Uganda. Copyright © 2015 Elsevier Ltd. All rights reserved.

Paediatric mental and physical health presentations to emergency departments, Victoria, 2008-15.

PubMed

Hiscock, Harriet; Neely, Rachel J; Lei, Shaoke; Freed, Gary

2018-05-07

To identify trends in presentations to Victorian emergency departments (EDs) by children and adolescents for mental and physical health problems; to determine patient characteristics associated with these presentations; to assess the relative clinical burdens of mental and physical health presentations. Secondary analysis of Victorian Emergency Minimum Dataset (VEMD) data. Participants, setting: Children and young people, 0-19 years, who presented to public EDs in Victoria, 2008-09 to 2014-15. Absolute numbers and proportions of mental and physical health presentations; types of mental health diagnoses; patient and clinical characteristics associated with mental and physical health presentations. Between 2008-09 and 2014-15, the number of mental health presentations increased by 6.5% per year, that of physical health presentations by 2.1% per year; the proportion of mental health presentations rose from 1.7% to 2.2%. Self-harm accounted for 22.5% of mental health presentations (11 770 presentations) and psychoactive substance use for 22.3% (11 694 presentations); stress-related, mood, and behavioural and emotional disorders together accounted for 40.3% (21 127 presentations). The rates of presentations for self-harm, stress-related, mood, and behavioural and emotional disorders each increased markedly over the study period. Patients presenting with mental health problems were more likely than those with physical health problems to be triaged as urgent (2014-15: 66% v 40%), present outside business hours (36% v 20%), stay longer in the ED (65% v 82% met the National Emergency Access Target), and be admitted to hospital (24% v 18%). The number of children who presented to Victorian public hospital EDs for mental health problems increased during 2008-2015, particularly for self-harm, depression, and behavioural disorders.

Accounting for Sitting and Moving: An Analysis of Sedentary Behavior in Mass Media Campaigns.

PubMed

Knox, Emily; Biddle, Stuart; Esliger, Dale W; Piggin, Joe; Sherar, Lauren

2015-09-01

Mass media campaigns are an important tool for promoting health-related physical activity. The relevance of sedentary behavior to public health has propelled it to feature prominently in health campaigns across the world. This study explored the use of messages regarding sedentary behavior in health campaigns within the context of current debates surrounding the association between sedentary behavior and health, and messaging strategies to promote moderate-to-vigorous physical activity (MVPA). A web-based search of major campaigns in the United Kingdom, United States, Canada, and Australia was performed to identify the main campaign from each country. A directed content analysis was then conducted to analyze the inclusion of messages regarding sedentary behavior in health campaigns and to elucidate key themes. Important areas for future research were illustrated. Four key themes from the campaigns emerged: clinging to sedentary behavior guidelines, advocating reducing sedentary behavior as a first step on the activity continuum and the importance of light activity, confusing the promotion of MVPA, and the demonization of sedentary behavior. Strategies for managing sedentary behavior as an additional complicating factor in health promotion are urgently required. Lessons learned from previous health communication campaigns should stimulate research to inform future messaging strategies.

Building peace through participatory health training: a case from Cambodia.

PubMed

Ui, S; Leng, K; Aoyama, A

2007-01-01

This qualitative study examines the significance and effectiveness of participatory health training as a tool for peace building. It does so by analysing a case of training for 'health promoters' run by a Cambodian government health agency. The authors observed participants during the training and interviewed those involved in the courses. A developing capacity for coexistence and reconciliation between individuals who had been on opposite sides during the years of Khmer Rouge terror and continuous internal war was observed among both participants and trainers. Factors embodied in the training that facilitated favourable changes in self and in relations with others were identified as: (1) 'space for dialogue' was created by concrete common public health interests and urgent needs; (2) training took place 'live-in' style in a rural setting; (3) course contents and methods were consistent with peace education; (4) trainers had a conscious function as role models; and (5) there was continuity of effort and consequent accumulation of experience. To build peace, as well as conducting training directly on a technical topic, these essential factors need to be incorporated in the training programmes.

Health system challenges of NCDs in Tunisia.

PubMed

Ben Romdhane, Habiba; Tlili, Faten; Skhiri, Afef; Zaman, Shahaduz; Phillimore, Peter

2015-01-01

The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.

Ask not what nature can do for you: A critique of ecosystem services as a communication strategy

USGS Publications Warehouse

Bekessy, Sarah A.; Runge, Michael C.; Kusmanoff, Alex; Keith, David A.; Wintle, Brendan A.

2018-01-01

Given the urgent need to raise public awareness on biodiversity issues, we review the effectiveness of “ecosystem services” as a frame for promoting biodiversity conservation. Since its inception as a communications tool in the 1970s, the concept of ecosystem services has become pervasive in biodiversity policy. While the goal of securing ecosystem services is absolutely legitimate, we argue that it has had limited success as a vehicle for securing public interest and support for nature, which is crucial to securing long-term social mandates for protection. Emerging evidence suggests that focusing on ecosystem services rather than the intrinsic value of nature is unlikely to be effective in bolstering public support for nature conservation. Theory to guide effective communication about nature is urgently needed. In the mean-time, communicators should reflect on their objectives and intended audience and revisit the way nature is framed to ensure maximum resonance.

Mental health stigma: what is being done to raise awareness and reduce stigma in South Africa?

PubMed

Kakuma, R; Kleintjes, S; Lund, C; Drew, N; Green, A; Flisher, A J

2010-05-01

Stigma plays a major role in the persistent suffering, disability and economic loss associated with mental illnesses. There is an urgent need to find effective strategies to increase awareness about mental illnesses and reduce stigma and discrimination. This study surveys the existing anti-stigma programmes in South Africa. The World Health Organization's Assessment Instrument for Mental Health Systems Version 2.2 and semi-structured interviews were used to collect data on mental health education programmes in South Africa. Numerous anti-stigma campaigns are in place in both government and non-government organizations across the country. All nine provinces have had public campaigns between 2000 and 2005, targeting various groups such as the general public, youth, different ethnic groups, health care professionals, teachers and politicians. Some schools are setting up education and prevention programmes and various forms of media and art are being utilized to educate and discourage stigma and discrimination. Mental health care users are increasingly getting involved through media and talks in a wide range of settings. Yet very few of such activities are systematically evaluated for the effectiveness and very few are being published in peer-review journals or in reports where experiences and lessons can be shared and potentially applied elsewhere. A pool of evidence for anti-stigma and awareness-raising strategies currently exists that could potentially make a scientific contribution and inform policy in South Africa as well as in other countries.

76 FR 35000 - Award of an Urgent Single-Source Grant to Heartland Alliance, Chicago, IL

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-15

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Refugee Resettlement Award of an Urgent Single-Source Grant to Heartland Alliance, Chicago, IL AGENCY: Office of Refugee Resettlement, ACF, HHS. ACTION... technical assistance on incoming Lesbian, Gay, Bi- Sexual and Transgender (LGBT) refugee cases to Heartland...

Redesigning the Regulatory Framework for Ambulatory Care Services in New York

PubMed Central

Chokshi, Dave A; Rugge, John; Shah, Nirav R

2014-01-01

Context While hospitals remain important centers of gravity in the health system, services are increasingly being delivered through ambulatory care. This shift to ambulatory care is giving rise to new delivery structures, such as retail clinics and urgent care centers, as well as reinventing existing ambulatory care capacity, as seen with the patient-centered medical home model and the movement toward team-based care. To protect the public's interests, oversight of ambulatory care services must keep pace with these rapid changes. With this purpose, in January 2013 the New York Public Health and Health Planning Council undertook a redesign of the regulatory framework for the state's ambulatory care services. This article describes the principles undergirding the framework as well as the regulatory recommendations themselves. Methods We explored and analyzed the regulation of ambulatory care services in New York in accordance with the available gray and peer-reviewed literature and legislative documents. The deliberations of the Public Health and Health Planning Council informed our review. Findings The vision of high-performing ambulatory care should be rooted in the Triple Aim (better health, higher-quality care, lower costs), with a particular emphasis on continuity of care for patients. There is a pressing need to better define the taxonomy of ambulatory care services. From the state government's perspective, this clarification requires better reporting from new health care entities (eg, retail clinics), connections with regional and state health information technology hubs, and coordination among state agencies. A uniform nomenclature also would improve consumers’ understanding of rights and responsibilities. Finally, the regulatory mechanisms employed—from mandatory reporting to licensure to regional planning to the certificate of need—should remain flexible and match the degree of consensus regarding the appropriate regulatory path. Conclusions Few other states have embarked on a wide-ranging assessment of their regulation of ambulatory care services. By moving toward adopting the regulatory approach described here, New York aims to balance sound oversight with pluralism and innovation in health care delivery. PMID:25492604

Wife abuse among women of childbearing age in Nicaragua.

PubMed Central

Ellsberg, M C; Peña, R; Herrera, A; Liljestrand, J; Winkvist, A

1999-01-01

OBJECTIVES: This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Nicaragua. METHODS: A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age. RESULTS: The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation. CONCLUSIONS: Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims. PMID:9949757

Zika Virus: Recent Advances towards the Development of Vaccines and Therapeutics.

PubMed

McArthur, Monica A

2017-06-13

Zika is a rapidly emerging public health threat. Although clinical infection is frequently mild, significant neurological manifestations have been demonstrated in infants born to Zika virus (ZIKV) infected mothers. Due to the substantial ramifications of intrauterine infection, effective counter-measures are urgently needed. In order to develop effective anti-ZIKV vaccines and therapeutics, improved animal models and a better understanding of immunological correlates of protection against ZIKV are required. This review will summarize what is currently known about ZIKV, the clinical manifestations and epidemiology of Zika as well as, the development of animal models to study ZIKV infection, host immune responses against ZIKV, and the current state of development of vaccines and therapeutics against ZIKV.

Firm-Level Perspectives on Public Sector Engagement with Private Healthcare Providers: Survey Evidence from Ghana and Kenya

PubMed Central

Sood, Neeraj; Burger, Nicholas; Yoong, Joanne; Kopf, Dan; Spreng, Connor

2011-01-01

Background Health systems in Sub-Saharan Africa (SSA) are in urgent need of improvement. The private health sector is a major provider of care in the region and it will remain a significant actor in the future. Any efforts by SSA governments to improve health systems performance therefore has to account for the private health sector. Regional and international actors increasingly recognize importance of effectively engaging with the private health sector, and initiatives to improve engagement are underway in several countries. However, there is little systematic analysis of private health providers' view and experience with engagement. Methodology/Principal Findings In this study we surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is “command-and-control” type regulations to improve the quality of care. There is little attention paid to building the capacity of health care businesses through either technical or financial assistance. The vast majority of these facilities also receive no government assistance in meeting public health and social goals. Finally, government engagement with private pharmacies is often neglected and clinics receive a disproportionate share of government assistance. Conclusions/Significance Overall, our findings suggest that there may be considerable untapped potential for greater engagement with private health facilities—particularly pharmacies. Improving engagement will likely help governments with limited resources to better take advantage of the private sector capacity to meet access and equity objectives and to accelerate the achievement of the Millennium Development Goals. PMID:22132092

“They see you as a different thing”: The Experiences of Men Who Have Sex with Men with Health Care Workers in South African Township Communities

PubMed Central

Lane, Tim; Mogale, Thomas; Struthers, Helen; McIntyre, James; Kegeles, Susan M.

2009-01-01

Objectives To describe interactions between men who have sex with men (MSM) and health care workers (HCWs) in peri-urban township communities in South Africa. Method Qualitative study using semistructured in-depth interviews and focus group discussions in the Gauteng province townships of Soweto and Mamelodi. We purposively sampled 32 MSM for in-depth interviews and 15 for focus group discussions. Topics explored included identity, sexuality, community life, use of health services, and experiences of stigma and discrimination. Results MSM felt their options for non-stigmatizing sexual health care services were limited by homophobic verbal harassment by HCWs. Gay-identified men sought out clinics with reputations for employing HCWs who respected their privacy and their sexuality, and challenged those HCWs who mistreated them. Non-gay identified MSM presented masculine, heterosexual identities when presenting for sexual health problems, and avoided discussing their sexuality with HCWs. Conclusions The strategies MSM employ to confront or avoid homophobia from HCWs may not be conducive to sexual health promotion in this population. Interventions that increase the capacity of public sector HCWs to provide appropriate sexual health services to MSM are urgently needed. PMID:19028941

Do Health Beliefs and Behaviors Differ According to Severity of Obesity? A Qualitative Study of Australian Adults

PubMed Central

Lewis, Sophie; Thomas, Samantha L.; Blood, R. Warwick; Hyde, Jim; Castle, David J.; Komesaroff, Paul A.

2010-01-01

Public responses to obesity have focused on providing standardized messages and supports to all obese individuals, but there is limited understanding of the impact of these messages on obese adults. This descriptive qualitative study using in-depth interviews and a thematic method of analysis, compares the health beliefs and behaviors of 141 Australian adults with mild to moderate (BMI 30−39.9) and severe (BMI ≥ 40) obesity. Mildly obese individuals felt little need to change their health behaviors or to lose weight for health reasons. Most believed they could “lose weight” if they needed to, distanced themselves from the word obesity, and stigmatized those “fatter” than themselves. Severely obese individuals felt an urgent need to change their health behaviors, but felt powerless to do so. They blamed themselves for their weight, used stereotypical language to describe their health behaviors, and described being “at war” with their bodies. Further research, particularly about the role of stigma and stereotyping, is needed to fully understand the impact of obesity messaging on the health beliefs, behaviors, and wellbeing of obese and severely obese adults. PMID:20616984

International Standards for Tuberculosis Care: revisiting the cornerstones of tuberculosis care and control.

PubMed

Fair, Elizabeth; Hopewell, Philip C; Pai, Madhukar

2007-02-01

Tuberculosis (TB) remains an enormous global health problem. There are 8-9 million new cases and 2 million deaths from TB annually. Despite the overwhelming burden of disease, the basic principles of care for persons with, or suspected of having, TB are the same worldwide: a diagnosis should be established promptly and accurately, standardized treatment regimens of proven efficacy should be used together with appropriate treatment support and supervision, the response to treatment should be monitored, and the essential public health responsibilities must be carried out. As an approach to improving the care of patients with TB, an evidence-based document, the International Standards for Tuberculosis Care (ISTC) was developed and has been endorsed by more than 30 international and national agencies. This special report introduces the ISTC and discusses the fact that accurate diagnosis and effective treatment are not only essential for good patient care, they are the key elements in the public health response to TB and are the cornerstone of TB control. With the recent emergence of extensively drug-resistant TB, there is an urgent need to ensure globally that standards of TB care are based on rigorous scientific findings, are clear and well understood, and are accessible to and applied by all types of healthcare providers in all corners of the world.

Pesticide poisoning in nonfatal, deliberate self-harm: A public health issue

PubMed Central

Chowdhary, A. N.; Banerjee, Sohini; Brahma, Arabinda; Biswas, M. K.

2007-01-01

Background: Nonfatal, deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture and these agents are most frequently used in DSH. Aim: This study sought to identify the nature of methods and agents used in nonfatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal. Materials and Methods: Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres (BPHCs') admission registers were analysed. Focus Group Discussions (FGDs) were conducted with the Panchayat Samithy of each block to elicit their perception about the problem of pesticide-related DSH or suicide in the region. Results: Five thousand, one hundred and seventy-eight (1,887 male and 3,291 female) subjects were admitted in the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning prevention program with a special focus on improving clinical services as well as initiating farmers' education programs focusing on safe pesticide practices at the primary care level. PMID:20711394

The growing epidemic of water pipe smoking: health effects and future needs.

PubMed

Bou Fakhreddine, Hisham M; Kanj, Amjad N; Kanj, Nadim A

2014-09-01

Water pipe smoking (WPS), an old method of tobacco smoking, is re-gaining widespread popularity all over the world and among various populations. Smoking machine studies have shown that the water pipe (WP) mainstream smoke (MSS) contains a wide array of chemical substances, many of which are highly toxic and carcinogenic for humans. The concentrations of some substances exceed those present in MSS of cigarettes. Despite being of low grade, current evidence indicates that WPS is associated with different adverse health effects, not only on the respiratory system but also on the cardiovascular, hematological, and reproductive systems, including pregnancy outcomes. In addition, association between WPS and malignancies, such as lung, oral and nasopharyngeal cancer, has been suggested in different studies and systematic reviews. Despite its long standing history, WPS research still harbors a lot of deficiencies. The magnitude of toxicants and carcinogen exposures, effects on human health, as well as the addiction and dependence potentials associated with WPS need to be studied in well-designed prospective trials. Unfortunately, many of the tobacco control and clean indoor policies have exempted water pipes. World wide awareness among the public, smokers, and policymakers about the potential health effects of WPS is urgently required. Furthermore, stringent policies and laws that control and ban WPS in public places, similar to those applied on cigarettes smoking need to be implemented. Copyright © 2014 Elsevier Ltd. All rights reserved.

Who will take responsibility for obesity in Australia?

PubMed

Stanton, R

2009-03-01

Obesity is increasing throughout the world. With its strong links to many health problems, the costs associated with obesity will strain future health budgets. Urgent action on obesity is needed and this needs to extend beyond treatment. Diets may work in the short term but their long-term success is poor. Bariatric surgery can be effective, but it is expensive and its long-term effects are unknown. Common sense dictates that attention should be focused on preventing obesity. Experience with other public health measures, such as reducing cigarette smoking, indicates that government intervention will be essential for success in preventing obesity. In practice, however, governments are reluctant to take responsibility for this multi-factorial problem that is exacerbated by modern lifestyles because it involves standing up to vested interests. The real need is to take action to alter food consumption patterns, change transport options and reform urban planning (including housing and workplace environments), so that healthy choices are easy and physical activity returns to being a normal part of everyday life.

Noise as a Health Hazard for Children, Time to Make a Noise about it.

PubMed

Thakur, Neha; Batra, Prerna; Gupta, Piyush

2016-02-01

Noise, a modern day curse of advancing infrastructure and technology, has emerged as an important public health problem. Exposure to noise during pregnancy may result in high-frequency hearing loss in newborns, growth retardation, cochlear damage, prematurity and birth defects. Newborns exposed to sound above 45 decibels may experience increase in blood pressure, heart rate, respiratory rate; decreased oxygen saturation; and increased caloric consumption. Noise exposure in older children may result in learning disabilities, attention difficulties, insulin resistance, hypertension, stress ulcers and cardiovascular diseases. Sudden exposure to loud noise can lead to rupture of eardrum. The damaging effects of noise pollution are more noticeable in large metropolitan cities, the hubs of urban settlements and industrial growth. Another concern is noise pollution inside the hospitals (particularly intensive care areas) that can lead to serious health consequences both for caregivers and for children. The issue needs to be addressed by both researchers and policy makers on an urgent basis.

Role of public-private partnership in micronutrient food fortification.

PubMed

Mannar, M G Venkatesh; van Ameringen, Marc

2003-12-01

Iron, iodine, and vitamin A deficiencies prevent 30% of the world's population from reaching full physical and mental potential. Fortification of commonly eaten foods with micronutrients offers a cost-effective solution that can reach large populations. Effective and sustainable fortification will be possible only if the public sector (which has the mandate and responsibility to improve the health of the population), the private sector (which has experience and expertise in food production and marketing), and the social sector (which has grass-roots contact with the consumer) collaborate to develop, produce, and promote micronutrient-fortified foods. Food fortification efforts must be integrated within the context of a country's public health and nutrition situation as part of an overall micronutrient strategy that utilizes other interventions as well. Identifying a set of priority actions and initiating a continuous dialogue between the various sectors to catalyze the implementation of schemes that will permanently eliminate micronutrient malnutrition are urgently needed. The partners of such a national alliance must collaborate closely on specific issues relating to the production, promotion, distribution, and consumption of fortified foods. Such collaboration could benefit all sectors: National governments could reap national health, economic, and political benefits; food companies could gain a competitive advantage in an expanding consumer marketplace; the scientific, development, and donor communities could make an impact by achieving global goals for eliminating micronutrient malnutrition; and by demanding fortified foods, consumers empower themselves to achieve their full social and economic potential.

Federal immunization policy and funding: a history of responding to crises.

PubMed

Johnson, K A; Sardell, A; Richards, B

2000-10-01

This article outlines the history of federal immunization policy and funding, with a focus on discretionary federal funding under Section 317 of the Public Health Service Act, paying particular attention to the role of Congress in shaping the program in the past 2 decades. This review of funding trends and initiatives indicates that when both a presidential administration and key congressional actors viewed immunization as a priority and made sufficient funds available to support the public health delivery system and its infrastructure, coverage levels would continue to rise and disease levels continue to decline. From the beginning, immunization financing was explicitly structured as a federal-state-private-sector partnership. Section 317 program's statute has not changed much in 35 years, despite significant changes to the health care delivery system, other federal immunization activities, and rates of immunization coverage. Although the creation and implementation of the Vaccines for Children (VFC) program in the mid-1990s resulted in some congressional deliberations over immunization policies, no explicit restructuring of the 317 program occurred as a result. The Section 317 program retains its traditional authority and mission to address urgent needs, sustain public delivery systems, and provide funds for purchase of vaccines. The question remains whether the resources to sustain progress in immunization can be secured during times with no crisis, to ensure constant "readiness" in immunization (as in defense), or whether another epidemic must occur before the federal government is willing to commit optimal resources.

[Current problems in determining children's nutritional needs].

PubMed

Koletzko, B; Toschke, A M; Von Kries, R

2004-03-01

Meeting children's nutritional needs is of fundamental importance for their immediate and later health, well-being, and performance. Age-adapted reference values of nutrient intake form the basis for analysis of the current situation and for policy planning, but for many nutrients they cannot be precisely defined due to inadequate scientific data. Therefore, such values are often extrapolated from adult reference values based on age-adapted mean body weight or body surface data, although such extrapolation does not reflect age-related physiological changes. There are considerable differences between various expert recommendations, in part also due to differences in definitions and underlying concepts for deriving reference values. Improvements and international harmonization are urgently needed. Nutritional needs of many children and adolescents are not adequately met at present. A particularly obvious indication is the epidemic-like increase of pediatric overweight and obesity, which could result in markedly increased prevalences of later metabolic syndrome, diabetes, and cardiovascular diseases. Contributing to increasing childhood obesity are low physical activity, changing eating culture and behavior, frequent consumption of high-fat foods with high energy density, and increasing portion sizes. Changes are urgently needed and might be achievable with close collaboration between scientists, public institutions, and industry.

76 FR 53913 - Award of an Urgent Single-Source Grant to Survivors of Torture International (SOTI) in San Diego...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Refugee Resettlement Award of an Urgent Single-Source Grant to Survivors of Torture International (SOTI) in San Diego, CA; Correction AGENCY: Office of... (SOTI), San Diego, CA. The document contained incorrect information in citing the statutory authority...

The Lorenzini Foundation in a changing scenario of patient management.

PubMed

Peracino, A; Paoletti, R

2009-06-10

The loss of life, disability, and economic burden attributed to cardiovascular disease (CVD) in Europe has created an urgent need for all stakeholders in CVD prevention to partner together to address the barriers in local health policy and produce effective programs in individual and population risk reduction and rational use of health services. Countries have a legal and moral obligation to achieve the highest standard of CV health care for citizens and to improve national health care systems accordingly. As part of a vision for future potential opportunities in CVD prevention, the Lorenzini Foundation would like to raise awareness of several key areas among the European authorities: Integration of interventions aimed at several risk factors within an individual country's health care system; implementation of a comprehensive approach combining policy development, capacity building, partnership and information support at all levels; promotion of transversal health policies, including coordinated action outside of the health sector to address major determinants of ill health; a combination of health policy and high-risk strategies to link health promotion, public health services, primary care, and hospital care; and, finally, reduction in ethnic, cultural, socioeconomic, and gender inequalities to multiple risk factor management among and within countries through use of cost-effective medications and medical technologies.

Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa

PubMed Central

Levitt, Naomi S.; Puoane, Thandi; Denman, Catalina A.; Abrahams-Gessel, Shafika; Surka, Sam; Mendoza, Carlos; Khanam, Masuma; Alam, Sartaj; Gaziano, Thomas A.

2015-01-01

Background We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Design Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Results Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. Conclusions The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment. PMID:25854780

The impact of health system governance and policy processes on health services in Iraqi Kurdistan.

PubMed

Tawfik-Shukor, Ali; Khoshnaw, Hiro

2010-06-08

Relative to the amount of global attention and media coverage since the first and second Gulf Wars, very little has been published in the health services research literature regarding the state of health services in Iraq, and particularly on the semi-autonomous region of Kurdistan. Building on findings from a field visit, this paper describes the state of health services in Kurdistan, analyzes their underlying governance structures and policy processes, and their overall impact on the quality, accessibility and cost of the health system, while stressing the importance of reinvesting in public health and community-based primary care. Very little validated, research-based data exists relating to the state of population health and health services in Kurdistan. What little evidence exists, points to a region experiencing an epidemiological polarization, with different segments of the population experiencing rapidly-diverging rates of morbidity and mortality related to different etiological patterns of communicable, non-communicable, acute and chronic illness and disease. Simply put, the rural poor suffer from malnutrition and cholera, while the urban middle and upper classes deal with issues of obesity and Type 2 diabetes. The inequity is exacerbated by a poorly governed, fragmented, unregulated, specialized and heavily privatized system, that not only leads to poor quality of care and catastrophic health expenditures, but also threatens the economic and political stability of the region. There is an urgent need to revisit and clearly define the core values and goals of a future health system, and to develop an inclusive governance and policy framework for change, towards a more equitable and effective primary care-based health system, with attention to broader social determinants of health and salutogenesis. This paper not only frames the situation in Kurdistan in terms of a human rights or special political issue of a minority population, but provides important generalizable lessons for other constituencies, highlighting the need for political action before effective public health policies can be implemented - as embodied by Rudolf Virchow, the father of European public health and pathology, in his famous quote "politics is nothing but medicine at a larger scale".

Pathogens and parasites: strategies and challenges

PubMed Central

2000-01-01

The threat of emerging infections grows with the swelling tide of the human population and the continued disregard for the health of the environment. One of our most urgent challenges in public health is to understand the evolution and natural history of pathogens and parasites and how a sudden shift in virulence or in targeted host population may occur without warning. Viruses call for especially close watching. They are mostly genes and have mastered the art of manipulating other genes. Some are planktonic in the world's oceans, numbering 10 billion per liter of seawater; some are planktonic in our blood; some lie low inside cells; some take over a cell's replication machinery and explode the cell with new copies of themselves; and some splice their genes seamlessly into our chromosomes. The twin themes of genetic diversity and natural selection are explored in this review, with their relevance to viruses, the vertebrate immune system, virulence, and communicable disease epidemiology. PMID:16389321

Data-protection standards and confidentiality of HIV/AIDS status in the workplace - a South African case study.

PubMed

Muskat-Gorska, Zuzanna

2008-11-01

The article contextualises an emerging new regime for information privacy in South Africa (i.e. the draft Protection of Personal Information Bill). Subsequently, it discusses the possibility of successful implementation of international data-protection standards in an environment where there is an urgent need to balance HIV/AIDS confidentiality rights with public health requirements. Also, the article presents a preliminary assessment of the possible impact of professionalisation (and outsourcing) of workplace HIV/AIDS management on workplace data-protection practices, and it identifies some spaces for social dialogue on HIV/AIDS-data treatment in South Africa. The study methods comprise an analysis of legal documents (concerning international data-protection standards and the development of law governing data protection and HIV/AIDS confidentiality in South Africa) and interviews conducted with workplace health managers and trade union representatives, in Johannesburg, in 2007.

Sugar-free medicines are counterproductive.

PubMed

Sundar, S

2012-09-01

Sugar in food and drinks is responsible for the poor dental health of many children and adults. On the other hand, there is no evidence that the small amount of sugar in medicines has been responsible for any dental problems. A recent British Heart Foundation survey found that nearly one in three UK children are eating sweets, chocolate and crisps three or more times a day. Hence it is futile administering sugar-free medicine to a child consuming lot of sweets. Moreover, sugar in medicines makes them palatable and bitter medicines inevitably affect compliance with the prescribed treatment. Poor compliance leads to inadequate treatment of illness and consequently increases the risk of complications from illness. Hence sugar-free medicines promoted as a public health policy could have actually caused more harm than any meaningful net benefit. There is an urgent need for a healthy debate and a fresh look at the policy of promoting sugar-free medicines.

Molecular genotyping of Echinococcus granulosus from dromedaries (Camelus dromedarius) in eastern Iran.

PubMed

Moghaddas, E; Borji, H; Naghibi, A; Shayan, P; Razmi, G R

2015-01-01

With the aim of genotyping Echinococcus granulosus cysts found in Iranian dromedaries (Camelus dromedarius), 50 cysts of E. granulosus were collected from five geographical regions in Iran. Cysts were characterized using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of the internal transcribed spacer 1 (ITS1) gene and sequencing fragments of the genes coding for mitochondrial cytochrome c oxidase subunit 1 (cox1). Morphological criteria using rostellar hook dimensions were also undertaken. The present results have shown that 27 out of 50 E. granulosus cysts (54%) were determined as the G1 strain, and the other (46%) were determined as the G6 strain. The molecular analysis of the ITS1 region of ribosomal DNA corresponded with the morphological findings. Because of its recognized infectivity in humans, the G1 genotype is a direct threat to human health and its presence in Iranian dromedaries is of urgent public health importance.

THE IMPORTANCE OF MOSQUITO BEHAVIOURAL ADAPTATIONS TO MALARIA CONTROL IN AFRICA

PubMed Central

Gatton, Michelle L; Chitnis, Nakul; Churcher, Thomas; Donnelly, Martin J; Ghani, Azra C; Godfray, H Charles J; Gould, Fred; Hastings, Ian; Marshall, John; Ranson, Hilary; Rowland, Mark; Shaman, Jeff; Lindsay, Steve W; Meagher, T

2013-01-01

Over the past decade the use of long-lasting insecticidal nets (LLINs), in combination with improved drug therapies, indoor residual spraying (IRS), and better health infrastructure, has helped reduce malaria in many African countries for the first time in a generation. However, insecticide resistance in the vector is an evolving threat to these gains. We review emerging and historical data on behavioral resistance in response to LLINs and IRS. Overall the current literature suggests behavioral and species changes may be emerging, but the data are sparse and, at times unconvincing. However, preliminary modeling has demonstrated that behavioral resistance could have significant impacts on the effectiveness of malaria control. We propose seven recommendations to improve understanding of resistance in malaria vectors. Determining the public health impact of physiological and behavioral insecticide resistance is an urgent priority if we are to maintain the significant gains made in reducing malaria morbidity and mortality. PMID:23550770

A cornerstone of healthy aging: do we need to rethink the concept of adherence in the elderly?

PubMed

Giardini, Anna; Maffoni, Marina; Kardas, Przemyslaw; Costa, Elisio

2018-01-01

Worldwide, the population is aging and this trend will increase in the future due to medical, technological and scientific advancements. To take care of the elderly is highly demanding and challenging for the health care system due to their frequent condition of chronicity, multimorbidity and the consequent complex management of polypharmacy. Nonadherence to medications and to medical plans is a well-recognized public health problem and a very urgent issue in this population. For this reason, some considerations to identify a new shared approach to integrated care of older people are described. The concept of adherence should be considered as a complex and continuous process where family, caregivers and patients' beliefs come into play. Moreover, a new culture of adherence should contemplate the complexity of multimorbidity, as well as the necessity to renegotiate the medication regimen on the basis of each patient's needs.

Bariatric embolization of the gastric arteries for the treatment of obesity.

PubMed

Weiss, Clifford R; Gunn, Andrew J; Kim, Charles Y; Paxton, Ben E; Kraitchman, Dara L; Arepally, Aravind

2015-05-01

Obesity is a public health epidemic in the United States that results in significant morbidity, mortality, and cost to the health care system. Despite advancements in therapeutic options for patients receiving bariatric procedures, the number of overweight and obese individuals continues to increase. Therefore, complementary or alternative treatments to lifestyle changes and surgery are urgently needed. Embolization of the left gastric artery, or bariatric arterial embolization (BAE), has been shown to modulate body weight in animal models and early clinical studies. If successful, BAE represents a potential minimally invasive approach offered by interventional radiologists to treat obesity. The purpose of the present review is to introduce the interventional radiologist to BAE by presenting its physiologic and anatomic bases, reviewing the preclinical and clinical data, and discussing current and future investigations. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Right and access to healthcare for undocumented children: addressing the gap between international conventions and disparate implementations in North America and Europe.

PubMed

Ruiz-Casares, Mónica; Rousseau, Cécile; Derluyn, Ilse; Watters, Charles; Crépeau, François

2010-01-01

Limited access to healthcare for vulnerable immigrant children in Europe and North America is increasingly worrisome as immigration policies harden. This paper analyzes the gap between States' obligations under international human rights law and the disparate local implementations in diverse countries. Studies that are both multidisciplinary and incorporate micro and macro level indicators are needed to reveal discrepancies between entitlements and access. It is argued that the lack of available data on the magnitude of the problem and on its individual and public health consequences stems from the conflicting situation faced by health institutions required to simultaneously protect the best interest of each child and allocate limited resources. Collaboration in research is urgently needed to assist policy-makers and institutions make informed decisions. Copyright 2009 Elsevier Ltd. All rights reserved.

The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings.

PubMed

Gebreyes, Wondwossen A; Dupouy-Camet, Jean; Newport, Melanie J; Oliveira, Celso J B; Schlesinger, Larry S; Saif, Yehia M; Kariuki, Samuel; Saif, Linda J; Saville, William; Wittum, Thomas; Hoet, Armando; Quessy, Sylvain; Kazwala, Rudovick; Tekola, Berhe; Shryock, Thomas; Bisesi, Michael; Patchanee, Prapas; Boonmar, Sumalee; King, Lonnie J

2014-01-01

Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec) Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011) and the second congress (Porto de Galinhas, Brazil, 2013) were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1) development of adequate science-based risk management policies, (2) skilled-personnel capacity building, (3) accredited veterinary and public health diagnostic laboratories with a shared database, and (4) improved use of existing natural resources and implementation. The aim of this review is to highlight advances in key zoonotic disease areas and the One Health capacity needs.

The Global One Health Paradigm: Challenges and Opportunities for Tackling Infectious Diseases at the Human, Animal, and Environment Interface in Low-Resource Settings

PubMed Central

Gebreyes, Wondwossen A.; Dupouy-Camet, Jean; Newport, Melanie J.; Oliveira, Celso J. B.; Schlesinger, Larry S.; Saif, Yehia M.; Kariuki, Samuel; Saif, Linda J.; Saville, William; Wittum, Thomas; Hoet, Armando; Quessy, Sylvain; Kazwala, Rudovick; Tekola, Berhe; Shryock, Thomas; Bisesi, Michael; Patchanee, Prapas; Boonmar, Sumalee; King, Lonnie J.

2014-01-01

Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec) Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011) and the second congress (Porto de Galinhas, Brazil, 2013) were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1) development of adequate science-based risk management policies, (2) skilled-personnel capacity building, (3) accredited veterinary and public health diagnostic laboratories with a shared database, and (4) improved use of existing natural resources and implementation. The aim of this review is to highlight advances in key zoonotic disease areas and the One Health capacity needs. PMID:25393303

Taking forward a 'One Health' approach for turning the tide against the Middle East respiratory syndrome coronavirus and other zoonotic pathogens with epidemic potential.

PubMed

Zumla, Alimuddin; Dar, Osman; Kock, Richard; Muturi, Matthew; Ntoumi, Francine; Kaleebu, Pontiano; Eusebio, Macete; Mfinanga, Sayoki; Bates, Matthew; Mwaba, Peter; Ansumana, Rashid; Khan, Mishal; Alagaili, Abdulaziz N; Cotten, Matthew; Azhar, Esam I; Maeurer, Markus; Ippolito, Giuseppe; Petersen, Eskild

2016-06-01

The appearance of novel pathogens of humans with epidemic potential and high mortality rates have threatened global health security for centuries. Over the past few decades new zoonotic infectious diseases of humans caused by pathogens arising from animal reservoirs have included West Nile virus, Yellow fever virus, Ebola virus, Nipah virus, Lassa Fever virus, Hanta virus, Dengue fever virus, Rift Valley fever virus, Crimean-Congo haemorrhagic fever virus, severe acute respiratory syndrome coronavirus, highly pathogenic avian influenza viruses, Middle East Respiratory Syndrome Coronavirus, and Zika virus. The recent Ebola Virus Disease epidemic in West Africa and the ongoing Zika Virus outbreak in South America highlight the urgent need for local, regional and international public health systems to be be more coordinated and better prepared. The One Health concept focuses on the relationship and interconnectedness between Humans, Animals and the Environment, and recognizes that the health and wellbeing of humans is intimately connected to the health of animals and their environment (and vice versa). Critical to the establishment of a One Health platform is the creation of a multidisciplinary team with a range of expertise including public health officers, physicians, veterinarians, animal husbandry specialists, agriculturalists, ecologists, vector biologists, viral phylogeneticists, and researchers to co-operate, collaborate to learn more about zoonotic spread between animals, humans and the environment and to monitor, respond to and prevent major outbreaks. We discuss the unique opportunities for Middle Eastern and African stakeholders to take leadership in building equitable and effective partnerships with all stakeholders involved in human and health systems to take forward a 'One Health' approach to control such zoonotic pathogens with epidemic potential. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Home health nursing care services in Greece during an economic crisis.

PubMed

Adamakidou, T; Kalokerinou-Anagnostopoulou, A

2017-03-01

The purpose of this review was to describe public home healthcare nursing services in Greece. The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided. © 2016 International Council of Nurses.

Analysis and interpretation of cost data in randomised controlled trials: review of published studies

PubMed Central

Barber, Julie A; Thompson, Simon G

1998-01-01

Objective To review critically the statistical methods used for health economic evaluations in randomised controlled trials where an estimate of cost is available for each patient in the study. Design Survey of published randomised trials including an economic evaluation with cost values suitable for statistical analysis; 45 such trials published in 1995 were identified from Medline. Main outcome measures The use of statistical methods for cost data was assessed in terms of the descriptive statistics reported, use of statistical inference, and whether the reported conclusions were justified. Results Although all 45 trials reviewed apparently had cost data for each patient, only 9 (20%) reported adequate measures of variability for these data and only 25 (56%) gave results of statistical tests or a measure of precision for the comparison of costs between the randomised groups. Only 16 (36%) of the articles gave conclusions which were justified on the basis of results presented in the paper. No paper reported sample size calculations for costs. Conclusions The analysis and interpretation of cost data from published trials reveal a lack of statistical awareness. Strong and potentially misleading conclusions about the relative costs of alternative therapies have often been reported in the absence of supporting statistical evidence. Improvements in the analysis and reporting of health economic assessments are urgently required. Health economic guidelines need to be revised to incorporate more detailed statistical advice. Key messagesHealth economic evaluations required for important healthcare policy decisions are often carried out in randomised controlled trialsA review of such published economic evaluations assessed whether statistical methods for cost outcomes have been appropriately used and interpretedFew publications presented adequate descriptive information for costs or performed appropriate statistical analysesIn at least two thirds of the papers, the main conclusions regarding costs were not justifiedThe analysis and reporting of health economic assessments within randomised controlled trials urgently need improving PMID:9794854

Veterinary public health in India: current status and future needs.

PubMed

Ghatak, S; Singh, B B

2015-12-01

Veterinary public health (VPH) assumes huge significance in developing countries such as India. However, the implementation of VPH services throughout the country is still in its infancy. From 1970 onwards, many institutes, national and international organisations, professional societies, policies and personalities have contributed towards the development of VPH in India. Nevertheless, there is an urgent need to develop VPH still further as there are many issues, such as high population density, the re-emergence of zoonotic pathogens, environmental pollution and antimicrobial resistance, that require attention. The time has surely come to involve all stakeholders, ranging from primary producers (e.g., farmers) to policy-makers, so as to garner support for the holistic implementation of VPH services in India. To improve VPH activities and services, science-based policies enforced through stringent regulation are required to improve human, animal and environmental health. The emergence of the 'One Health' concept has ushered in new hopes for the resurrection of VPH in India. Applying tools such as the World Organisation for Animal Health (OlE) Day One Competencies and the OlE Tool for the Evaluation of Performance of Veterinary Services (PVS Tool) is essential to improve the quality of national Veterinary Services and to identify gaps and weaknesses in service provision, which can be remedied to comply with the OlE international standards. VPH initiatives started modestly but they continue to grow. The present review is focused on the current status and future needs of VPH in India.

Public insurance program impact on catastrophic health expenditure on acute myocardial infarction.

PubMed

Martínez-García, M; Vargas-Barrón, J; Bañuelos-Téllez, F; González-Pacheco, H; Fresno, C; Hernández-Lemus, E; Martínez-Ríos, M A; Vallejo, M

2018-05-01

ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. Retrospective data analysis. STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence). Descriptive statistical analyses, Kaplan-Meier survival and Support Vector Machine models were used accordingly. Treatment costs were higher for PI-covered individuals (P=0.022) and only 1.89% of them remained in debt, in contrast to 16.15% of those without PI. Statistically significant differences were found in relation to days in hospital wards (P<0.001), imaging studies (P<0.001) and surgical materials (P=0.04). Survival analysis (P=0.44) and therapeutic adherence (P=0.38) showed no differences. Hospital readmission was predicted with an 81.97% accuracy. The most important predictive variables included were stent type, number of days at the coronary care unit and hospital wards. The PI has proven to be a successful program where no differences were found in terms of health care and survival, whereas it provides timely financial support for families facing catastrophic health challenging events. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

[Towards universal nomenclature for urgent surgical care].

PubMed

Liakhovs'kyĭ, V I; Dem'ianiuk, D H; Kravtsiv, M I; Borkunov, A L; Sapun, L V

2013-06-01

In a modern professional literature the diseases, which undoubtedly threaten the patient's health and life, are called an urgent, special, emergent, fixed-date, etc. Not rare these terms are used simultaneously. Such a plurality of names of a quite dangerous state causes sometimes in these conditions uncertainty to seek help of a specialists and loss of a time. Modern dictionaries of a foreign languages words, of a foreign languages words in Ukrainian language, medical, big explanatory dictionary of a modern Ukrainian language definitely explains, that these terms are synonyms. All of them mean unconditional, timing. And every expression may be used in this context. The above mentioned suggestions and thoughts do not promote a secure fixing in the citizens consciousness the undoubtedness, the disease consequences danger, a threat to health and life. To deposit this in their awareness it is possible not by amorphous depiction, but using a singular, brief, firm term - an urgent.

The carcinogenic effects of aspartame: The urgent need for regulatory re-evaluation.

PubMed

Soffritti, Morando; Padovani, Michela; Tibaldi, Eva; Falcioni, Laura; Manservisi, Fabiana; Belpoggi, Fiorella

2014-04-01

Aspartame (APM) is an artificial sweetener used since the 1980s, now present in >6,000 products, including over 500 pharmaceuticals. Since its discovery in 1965, and its first approval by the US Food and Drugs Administration (FDA) in 1981, the safety of APM, and in particular its carcinogenicity potential, has been controversial. The present commentary reviews the adequacy of the design and conduct of carcinogenicity bioassays on rodents submitted by G.D. Searle, in the 1970s, to the FDA for market approval. We also review how experimental and epidemiological data on the carcinogenic risks of APM, that became available in 2005 motivated the European Commission (EC) to call the European Food and Safety Authority (EFSA) for urgent re-examination of the available scientific documentation (including the Searle studies). The EC has further requested that, if the results of the evaluation should suggest carcinogenicity, major changes must be made to the current APM specific regulations. Taken together, the studies performed by G.D. Searle in the 1970s and other chronic bioassays do not provide adequate scientific support for APM safety. In contrast, recent results of life-span carcinogenicity bioassays on rats and mice published in peer-reviewed journals, and a prospective epidemiological study, provide consistent evidence of APM's carcinogenic potential. On the basis of the evidence of the potential carcinogenic effects of APM herein reported, a re-evaluation of the current position of international regulatory agencies must be considered an urgent matter of public health. © 2014 Wiley Periodicals, Inc.

Current Trends in Health Insurance Systems: OECD Countries vs. Japan

PubMed Central

SASAKI, Toshiyuki; IZAWA, Masahiro; OKADA, Yoshikazu

2015-01-01

Over the past few decades, the longest extension in life expectancy in the world has been observed in Japan. However, the sophistication of medical care and the expansion of the aging society, leads to continuous increase in health-care costs. Medical expenses as a part of gross domestic product (GDP) in Japan are exceeding the current Organization for Economic Co-operation and Development (OECD) average, challenging the universally, equally provided low cost health care existing in the past. A universal health insurance system is becoming a common system currently in developed countries, currently a similar system is being introduced in the United States. Medical care in Japan is under a social insurance system, but the injection of public funds for medical costs becomes very expensive for the Japanese society. In spite of some urgently decided measures to cover the high cost of advanced medical treatment, declining birthrate and aging population and the tendency to reduce hospital and outpatients’ visits numbers and shorten hospital stays, medical expenses of Japan continue to be increasing. PMID:25797778

Health policy analysis for prevention and control of cardiovascular diseases and diabetes mellitus in Turkey.

PubMed

Kilic, Bulent; Kalaca, Sibel; Unal, Belgin; Phillimore, Peter; Zaman, Shahaduz

2015-01-01

Current capacity of the Turkish health system is reviewed to evaluate and develop appropriate policies for cardiovascular diseases (CVD), diabetes mellitus (DM) and related risk factors. This paper qualitatively evaluates existing policies; interviews with key informants (KIs); and rapid appraisal fieldwork in clinical settings about CVD-DM through the framework of Walt and Gilson (Health Policy Plan 9:353-370, 1994). Document review shows that prevention and control of CVD-DM were strongly addressed in Turkey, yet no document mentioned country-wide early detection or screening programs. KIs indicated over-fragmented management of CVD-DM by the Ministry of Health (MoH). Coordination among the MoH, organizational structure at provincial level and civil society organizations are poor where mutual trust is a significant problem according to KIs. Clinical setting findings point to a complete lack of a referral structure and a lack of follow-up, compounding the absence of functioning health information systems for patient records. Primary care services for CVD-DM require urgent attention, focusing particularly on the training of staff in public facilities, the integration of patient data, referrals and follow-up across all levels of the health system.

Health Effects of Environmental Exposures, Occupational Hazards and Climate Change in Ethiopia: Synthesis of Situational Analysis, Needs Assessment and the Way Forward.

PubMed

Berhane, Kiros; Kumie, Abera; Samet, Jonathan

2016-01-01

The burden of diseases caused by environmental and occupational health hazards and the effects of global climate change are of growing concerns in Ethiopia. However, no adequate information seems to be available on the current situation. This means there is a critical gap in research, policy framework and implementation in the country. The purpose of this paper was to synthesize evidence from a systematic situational analysis and needs assessment to help establish a hub for research and training on three major themes and their related policy frameworks: air pollution and health, occupational health and safety and climate change and health. The methods used in this work include a systematic review of secondary data from peer-reviewed literature, thesis reports from academia, government and national statistical reports. Limited primary data based on key informant interviews held with major stakeholders were also used as sources of data. Exposures to high levels of indoor and outdoor air pollutants were found to be major sources of public health challenges. Lack of occupational safety and health due to agricultural activities and exposure to industries was found to be substantial. Worse is the growing fear that climate change will pose increasingly significant multidimensional challenges to the environment and public health. Across all three areas of focus, there was a paucity of information on local scientific evidence. There is also very limited trained skilled manpower and physical infrastructure to monitor the environment and enforce regulatory guidelines. Research, policy frameworks and regulatory mechanisms were among the cross-cutting issues that needed urgent attention. Critical gaps were observed in research and training across the three themes. Also, there is a limitation in implementing the link between policy and related regulations in the environment and health.

The prices people pay for medicines in Zimbabwe.

PubMed

Gavaza, P; Simoyi, T; Makunike, B; Maponga, C C

2009-01-01

To collect, analyse and compare prices of medicines in different sectors and parts of the country and to compare them with the medicine prices in other countries. A prospective cross sectional study. Pharmacy outlets in Zimbabwe comprising 27 retail pharmacies, 23 dispensing doctors, eight public hospital pharmacies and seven municipal clinics. Median price ratios, 25th percentiles and 75th percentiles. Innovator brands in the private sector were priced 10 times the International References Prices (IRP) and more than three times the price of generic medicines. Dispensing doctors were charging the highest prices for medicines and the public sector had the least prices. The national procurement agency, NatPharm, procured medicines at prices slightly below the Management Sciences for Health (MSH) prices. Prices of medicines in the public sector were higher than average prices for medicines from seven other African countries. Medicine prices in Zimbabwe are high, a scenario that may compromise affordability and accessibility to medicines especially by the poor. Urgent steps are needed to reduce the level and effect of the high prices on the population, especially the poor.

Exposure to and actions against passive smoking in non-smoking pregnant women in Guangzhou, China.

PubMed

Loke, A Y; Lam, T H; Pan, S C; Li, S Y; Gao, X J; Song, Y Y

2000-11-01

The objective was to describe the extent of passive smoking exposure and preventive actions against passive smoking in non-smoking pregnant women and to analyze factors associated with preventive actions. This was a cross-sectional survey on 1449 never-smoking pregnant women who made their first prenatal visit to the Women and Children's Hospital of Guangzhou, China during 1996-97. 60.2% (95% Confidence Interval 57.7%-62.7%) of the never-smoking pregnant women had a husband who currently smoked. Women with smoking husbands (n=872) were more exposed to ETS than those with non-smoking husbands (n=577) at home (71% vs. 33%), in public places (77% vs. 66%) and at work (60% vs. 50% of working women), and they took less actions against passive smoking in public places. Women with better education and knowledge on smoking and passive smoking had stronger preventive actions. Non-smoking pregnant women in China are often exposed to passive smoking and their preventive actions are weak. Passive smoking is an important obstetric and public health problem in developing countries and deserves urgent international attention.

The Assault on Public Education: Confronting the Politics of Corporate School Reform

ERIC Educational Resources Information Center

Watkins, William H., Ed.

2011-01-01

In this timely interdisciplinary volume, William Watkins has brought together leading scholars and activists to address some of the most urgent issues facing public education. What is underneath and behind the language of choice, efficiency, and improvement in current neoliberal discourse? How will urban and poor populations be affected? Will…

Writing against Harassment: Public Writing Pedagogy and Online Hate

ERIC Educational Resources Information Center

Gruwell, Leigh

2017-01-01

Of the 40% of internet users who have faced harassment online, young adults, women, and racial minorities are especially vulnerable, experiencing more severe harassment and experiencing it more often. This article attempts to reconcile the increasingly urgent calls for students to compose in public spaces online with the reality of potential…

Shaping the Public Narrative about Teaching and Learning

ERIC Educational Resources Information Center

Sullivan, Patrick

2017-01-01

An urgent crisis is before us. A huge gap has appeared between how the public perceives higher education and what academics and researchers at colleges and universities know to be true. It is imperative that scholars and educators take the lead in closing this dangerous--and highly politicized--gap. This article discusses the politicization of…

Fair ranking of researchers and research teams.

PubMed

Vavryčuk, Václav

2018-01-01

The main drawback of ranking of researchers by the number of papers, citations or by the Hirsch index is ignoring the problem of distributing authorship among authors in multi-author publications. So far, the single-author or multi-author publications contribute to the publication record of a researcher equally. This full counting scheme is apparently unfair and causes unjust disproportions, in particular, if ranked researchers have distinctly different collaboration profiles. These disproportions are removed by less common fractional or authorship-weighted counting schemes, which can distribute the authorship credit more properly and suppress a tendency to unjustified inflation of co-authors. The urgent need of widely adopting a fair ranking scheme in practise is exemplified by analysing citation profiles of several highly-cited astronomers and astrophysicists. While the full counting scheme often leads to completely incorrect and misleading ranking, the fractional or authorship-weighted schemes are more accurate and applicable to ranking of researchers as well as research teams. In addition, they suppress differences in ranking among scientific disciplines. These more appropriate schemes should urgently be adopted by scientific publication databases as the Web of Science (Thomson Reuters) or the Scopus (Elsevier).

Ageing in India: Financial hardship from health expenditures.

PubMed

Lee, Ting-Hsuan J; Saran, Indrani; Rao, Krishna D

2018-04-01

India's rapidly ageing population raises concerns about the burden of health care payments among older individuals who may have both limited income and greater health care needs. Using a nationally representative household survey, we investigate the association between age and financial hardship due to health expenditures. We find that both the probability of experiencing health problems and mean total out-of-pocket health expenditures increase with age. Second, the probability of households experiencing catastrophic health expenditures increases with each additional member aged 60 and above-33% of households with one 60+ member and 38% of households with 2 or more 60+ members experienced catastrophic health expenditures, compared to only 20% in households with all members under the age of 60 years. Lastly, we show that individuals aged 60 and above had a much higher probability of becoming impoverished as a result of health expenditures-the probability of impoverishment for 60+ individuals was 3 percentage points higher than for individuals under the age of 60. Overall, around 4.8% of the older population, representing 4.1 million people, fell into poverty. The results suggest that there is an urgent need for public investments in financial protection programs for older people in India. Copyright © 2017 John Wiley & Sons, Ltd.

Advanced primary care in San Antonio: linking practice and community strategies to improve health.

PubMed

Ferrer, Robert L; Gonzalez Schlenker, Carolina; Lozano Romero, Raquel; Poursani, Ramin; Bazaldua, Oralia; Davidson, DeWayne; Ann Gonzales, Melissa; Dehoyos, Janie; Castilla, Martha; Corona, Betty A; Tysinger, James; Alsip, Bryan; Trejo, Jonathan; Jaén, Carlos Roberto

2013-01-01

Improving health among people living in poverty often transcends narrowly focused illness care. Meaningful success is unlikely without confronting the complex social origins of illness. We describe an emerging community of solution to improve health outcomes for a population of 6000 San Antonio, Texas, residents enrolled in a county health care program. The community of solution comprises a county health system, a family medicine residency program, a metropolitan public health department, and local nonprofit organizations and businesses. Community-based activities responding to the needs of individuals and their neighborhoods are driven by a cohort of promotores (community health workers) whose mission encompasses change at both the individual and community levels. Centered on patients' functional goals, promotores mobilize family and community resources and consider what community-level action will address the social determinants of health. On the clinical side, care teams implement population-based risk assessment and nurse care management with a focus on care transitions as well as other measures to meet the needs of patients with high morbidity and high use of health care. Population-based outcome metrics include reductions in hospitalizations, emergency department and urgent care visits, and the associated charges. Promotores also assess patients' progress along the trajectory of their selected functional goals.

Patient-provider communication and reproductive health among HIV-positive women in Rio de Janeiro, Brazil.

PubMed

Malta, Monica; Todd, Catherine S; Stibich, Mark A; Garcia, Thais; Pacheco, Diego; Bastos, Francisco I

2010-12-01

To qualitatively assess the influence of patient-provider communication on contraceptive choice among HIV-positive women in the context of universal antiretroviral therapy (ART) access. Focus group discussions (FGD; n=3), in-depth (IDI; n=15) and freelist interviews (FLI; n=36) were conducted with HIV-positive women aged 18-40 years recruited from public health units in Rio de Janeiro/Brazil. Of 70 participants, 49 used ART and the median time since HIV diagnosis was 6 years (range: 1-18). The majority of participants (71.4%) reported some degree of dissatisfaction with their health providers (usually lack of open dialogue) and a few reported experiences of stigma/prejudice during appointments. Intra, interpersonal and social factors modulated behaviors and reproductive health decisions, and those issues were rarely addressed by providers during HIV clinical care. Despite dramatic increases in survival and life quality after universal ART implementation in Brazil, reproductive health issues are neglected by multiple cadres of HIV health providers. Communication on reproductive health issues remains fragmented and potentially contradictory, compromising care in these settings. Adequate provider training to address reproductive health-related issues in a comprehensive, culturally sensitive manner and improved integration of HIV and reproductive health care are urgently needed in this setting. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Smoking Cessation Intervention for Female Prisoners: Addressing an Urgent Public Health Need

PubMed Central

Eldridge, Gloria; Weaver, Michael; Villalobos, Gabriela; Stitzer, Maxine; Best, Al

2008-01-01

Objectives. We tested the efficacy of a combined pharmacologic and behavioral smoking cessation intervention among women in a state prison in the southern United States. Methods. The study design was a randomized controlled trial with a 6-month waitlist control group. The intervention was a 10-week group intervention combined with nicotine replacement therapy. Two hundred and fifty participants received the intervention, and 289 were in the control group. Assessments occurred at baseline; end of treatment; 3, 6, and 12 months after treatment; and at weekly sessions for participants in the intervention group. Results. The intervention was efficacious compared with the waitlist control group. Point prevalence quit rates for the intervention group were 18% at end of treatment, 17% at 3-month follow-up, 14% at 6-month follow-up, and 12% at 12-month follow-up, quit rates that are consistent with outcomes from community smoking-cessation interventions. Conclusions. Female prisoners are interested in smoking cessation interventions and achieved point-prevalence quit rates similar to community samples. Augmenting tobacco control policies in prison with smoking cessation interventions has the potential to address a significant public health need. PMID:18703440

Patterns of Health Expenditures and Financial Protections in Vietnam 1992-2012.

PubMed

Hoang, Van Minh; Oh, Juhwan; Tran, Tuan Anh; Tran, Thi Giang Huong; Ha, Anh Duc; Luu, Ngoc Hoat; Nguyen, Thi Kim Phuong

2015-11-01

Health financing has been considered as an important building block of a health system and has a key role in promoting universal health coverage in the Vietnam. This paper aims to describe the pattern of health expenditure, including total health expenditure and composition of health expenditure, over the last two decades in Vietnam. The paper mainly uses the data from Vietnam National Health Account and Vietnam Living Standards Survey. We also included data from other relevant published literature, reports and statistics about health care expenditure in Vietnam. The per capita health expenditure in Vietnam increased from US$ 14 in 1995 to US$ 86 in 2012. The total health expenditure as a share of GDP also rose from 5.2% in 1995 to 6.9% in 2012. Public health expenditure as percentage of government expenditure rose from 7.4% in 1995 to nearly 10% in 2012. The coverage of health insurance went up from 10% in 1995 to 68.5% in 2012. However, health financing in Vietnam was depending on private expenditures (57.4% in 2012). As a result, the proportion of households with catastrophic expenditure in 2012 was 4.2%. The rate of impoverishment in 2012 was 2.5%. To ensure equity and efficient goal of health system, policy actions for containing the health care out-of-pocket payments and their poverty impacts are urgently needed in Vietnam.

High prevalence of overweight and obesity among a representative sample of Puerto Rican children.

PubMed

Elías-Boneta, Augusto R; Toro, Milagros J; Garcia, Omar; Torres, Roxana; Palacios, Cristina

2015-03-05

The prevalence of childhood overweight and obesity has become a public health problem worldwide. The objectives of the study were: 1) to establish the BMI prevalence in 12-year olds residing in Puerto Rico, and 2) to determine BMI differences by sex, public-private school type, and geographic regions. Data was obtained from an island-wide probabilistic stratified sample of 1,582 twelve-year-olds (53% girls and 47% boys). The BMI was determined using the National Health and Nutrition Examination Survey procedures. Children were categorized as underweight, healthy weight, overweight or obese using the Center for Disease Control and Prevention's age and gender specific growth charts. A logistic regression model was used to estimate BMI category prevalence. Odds ratios were calculated using a multinomial regression. In this study, 18.8% of the children were overweight and 24.3% were obese. A higher prevalence of obesity was observed in boys as compared to girls, 28.2% vs. 20.2%, respectively. The estimated prevalence of overweight and obesity in children from public schools was lower than for those from private schools. After adjusting for type of school and region, boys had a significantly higher risk of being obese (64%) as compared to girls. In public schools, boys had a lower prevalence of being overweight while girls had a higher prevalence compared to children attending private schools. Girls attending private schools had a higher obesity prevalence (27.8%) compared to girls from public schools (19.8%). The prevalence of underweight (2.7%) is slightly lower than in the United States. The prevalence of overweight and obesity of 12-year-olds residing in PR was 18.8% and 24.3%, respectively; higher than in the U.S. (by groups). Boys were at higher risk of obesity than girls. There is an urgent need to implement public health policies/programs to reduce the prevalence of overweight and obesity in children in PR.

A comparison of private and public sector intensive care unit infrastructure in South Africa.

PubMed

Mahomed, S; Sturm, A W; Moodley, P

2017-11-27

Intensive care units (ICUs) are designed to care for patients who are often at increased risk of acquiring healthcare-associated infections. The structure of ICUs should be optimally designed to facilitate the care of these critically ill patients, and minimise their risk of infection. National regulations (R158) were developed to govern the building and registration of private hospitals, and until recently equivalent regulations were not available for public hospitals. To assess and compare the compliance of ICUs in the private and public sectors with the R158 regulations. A cross-sectional study design was used to assess the infrastructure of 25 private sector and 6 public sector ICUs in eThekwini Health District, KwaZulu-Natal Province, South Africa. We used the R158 checklist, which was developed by the KwaZulu-Natal Department of Health Private Licensing Unit and Infection Prevention and Control Unit. The aspects covered in the R158 checklist were categorised into the design, general safety and patient services of the ICUs. Most of the ICUs in both sectors met the general safety requirements. There were varying levels of compliance with the design criteria. Only 7 (28.0%) and 1 (16.7%) of the private and public ICUs, respectively, had sufficient space around the beds. Twenty-two private ICUs (88.0%) and 4 public ICUs (66.7%) had isolation rooms, but only some of these isolation rooms (15 private and 2 public) had appropriate mechanical ventilation. None of the ICUs had clinical hand-wash basins in the nurse stations and dirty utility rooms. The majority of the ICUs had the required number of oxygen and electric outlets at the bedside. None of the public ICUs met the light intensity requirement over the bed area. Adequate spacing in ICUs is an issue in many cases. Interventions need to be put in place to ensure that ICUs meet the relevant design standards. There is an urgent need to revise the R158 regulations to reflect current best practices, particularly with regard to infection control. The same standards should be applied to ICUs in the private and public health sectors to maintain quality of care to patients.

The duty to care in an influenza pandemic: a qualitative study of Canadian public perspectives.

PubMed

Bensimon, Cécile M; Smith, Maxwell J; Pisartchik, Dmitri; Sahni, Sachin; Upshur, Ross E G

2012-12-01

Ever since the emergence of SARS, when we were reminded that the nature of health care practitioners' duty to care is greatly contested, it has remained a polarizing issue. Discussions on the nature and limits of health care practitioners' duty to care during disasters and public health emergencies abounds the literature, ripe with arguments seeking to ground its foundations. However, to date there has been little public engagement on this issue. This study involved three Townhall meetings held between February 2008 and May 2010 in three urban settings in Canada in order to probe lay citizens' views about ethical issues related to pandemic influenza, including issues surrounding the duty to care. Participants included Canadian residents aged 18 and over who were fluent in English. Data were collected through day-long facilitated group discussions using case scenarios and focus group guides. Participant's views were organized according to several themes, including the following main themes (and respective sub-themes): 1. Legitimate limits; a) competing obligations; and b) appeal to personal choice; and 2. Legitimate expectations; a) reciprocity; and b) enforcement and planning. Our findings show that participants moved away from categorical notions of the duty to care towards more equivocal and often normative views throughout deliberations. Our analysis contributes a better understanding of the constitutive nature of the duty to care, defined in part by taking account of public views. This broadened understanding can further inform the articulation of acceptable norms of duty to care and policy development efforts. What is more, it illustrates the urgent need for policy-makers and regulators to get clarity on obligations, responsibilities, and accountability in the execution of HCPs' duty to care during times of universal vulnerability. Copyright © 2012 Elsevier Ltd. All rights reserved.

A review of radiation countermeasures focusing on injury-specific medicinals and regulatory approval status: part II. Countermeasures for limited indications, internalized radionuclides, emesis, late effects, and agents demonstrating efficacy in large animals with or without FDA IND status.

PubMed

Singh, Vijay K; Garcia, Melissa; Seed, Thomas M

2017-09-01

The threat of a radiological/nuclear event is a critical concern for all government agencies involved in national security and public health preparedness. Countermeasures that are safe, easily administered, and effective at diminishing or eliminating adverse health effects to individuals and the overall public health impact of radiation exposure are urgently needed. Radiation countermeasures included in this three-part series have been classified under various subheadings based specifically on their developmental stages for United States Food and Drug Administration (FDA) approval. We have included FDA-approved agents for acute radiation syndrome (ARS) in part I. This is part II in which we have reviewed FDA-approved agents for limited indications, internalized radionuclides, emesis, late effects, radiomitigators available in the strategic national stockpile (SNS), agents with FDA investigational new drug (IND) status, and those with NHP efficacy data without FDA IND. Agents discussed in part III are those agents that have been peer reviewed, published, and have demonstrated significant survival benefits in animal models of ARS. Agents investigated in in vitro models only or studied in animal models without peer-reviewed publications have not been included. The dearth of FDA-approved radiation countermeasures has prompted intensified research for a new generation of radiation countermeasures. A number of promising radiation countermeasures are currently moving forward with continued support and effort by both governmental agencies and by publicly and privately held pharmaceutical companies. There is a limited number of countermeasures which are progressing well following the Animal Rule and may get approved in the near future, thus serving to close the gap of this critically important, unmet radiobiomedical need.

Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services

PubMed Central

Leslie, Hannah H; Regan, Mathilda; Nambiar, Devaki; Kruk, Margaret E

2018-01-01

Objectives To assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states. Design Cross-sectional study. Setting Data from the nationally representative 2012–2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India. Participants 8536 PHCs and 4810 CHCs. Outcome measures We developed a summative index of 33 structural and process capacity items matching the Indian Public Health Standards for PHCs as a metric of minimum facility capacity for intrapartum care. We assessed differences in performance on this index across facility type and location. Results About 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low: median monthly delivery volume was 8 (IQR=13) in PHCs and 41 (IQR=73) in CHCs. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. Mean facility capacity was low in PHCs in both urban (0.64) and rural (0.63) areas, while in CHCs, capacity was slightly higher in urban areas (0.77vs0.74). Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index (<0.70), compared with 21% of districts otherwise. Conclusions Basic intrapartum care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes. Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and quality improvement. Policies to address deficits in skilled providers and emergency service availability are urgently required. PMID:29866726

Can India's primary care facilities deliver? A cross-sectional assessment of the Indian public health system's capacity for basic delivery and newborn services.

PubMed

Sharma, Jigyasa; Leslie, Hannah H; Regan, Mathilda; Nambiar, Devaki; Kruk, Margaret E

2018-06-04

To assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states. Cross-sectional study. Data from the nationally representative 2012-2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India. 8536 PHCs and 4810 CHCs. We developed a summative index of 33 structural and process capacity items matching the Indian Public Health Standards for PHCs as a metric of minimum facility capacity for intrapartum care. We assessed differences in performance on this index across facility type and location. About 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low: median monthly delivery volume was 8 (IQR=13) in PHCs and 41 (IQR=73) in CHCs. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. Mean facility capacity was low in PHCs in both urban (0.64) and rural (0.63) areas, while in CHCs, capacity was slightly higher in urban areas (0.77vs0.74). Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index (<0.70), compared with 21% of districts otherwise. Basic intrapartum care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes. Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and quality improvement. Policies to address deficits in skilled providers and emergency service availability are urgently required. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Outcome Measures of Health Programs: What and How?

ERIC Educational Resources Information Center

Chen, Martin K.

With the proliferation of new health programs, such as Health Maintenance Organizations (HMO's) and Professional Service Review Organizations (PSRO's), the task of evaluating the impact of such programs on the health delivery systems and on the health of the American people becomes more urgent. Thus far no experimental or quasi-experimental…

[Urgent retinal detachment management by the National Health System of Spain. Project Retina 2].

PubMed

Rojas, J; Fernández, I; Pastor, J C; Gómez-Ulla, F; Piñero, A

2007-05-01

To identify problems in the urgent management of retinal detachments (RD) in hospitals of the Spanish National Health System (NHS). A questionnaire was submitted confidentially to the heads of Ophthalmic Departments of 217 hospitals of the NHS to obtain information on the management of urgent RD during the last year. Data was stored in a Microsoft Access database and statistically analyzed by Excel and Statgraphics. Qualitative variables were analyzed by Chi-Square and Fisher exact tests and quantitative variables by the Kruskall-Wallis test. A global response rate of 54.8% was achieved with higher participation of the Teaching Hospitals (TH). District Hospital and non-Teaching Hospital responses were similar and grouped as non-TH. Eighteen percent of centers, mostly non-TH, had no ophthalmologist on duty. Thirty-six percent had a vitreoretinal specialist on call. Eighty percent of centres admitted to have problems handling urgent RD during weekends. Twenty-four had no ophthalmic surgical theatre available. Fifty percent referred to have problems having an anaesthesiologist available and only 22% had ophthalmic trained personnel (nurses) available. Sixty-four percent of centres performed pars plana vitrectomy (PPV) and 77% of those were able to perform an urgent PPV. Ninety percent admitted that a patient with a macula-threatening RD occurring at the beginning of the week-end would not be treated until at least 24 hours had elapsed, although 84% considered this to be inadequate. Despite the methodological problems and bias of this questionnaire, we did identify several important problems in the management of urgent RD by NHS hospitals. The data obtained provides useful information to enable the quality of the NHS care of RD to be improved, particularly that available at the week-end.

Triple burden of disease and out of pocket healthcare expenditure of women in India

PubMed Central

Ladusingh, Laishram; Mohanty, Sanjay Kumar

2018-01-01

Aim Women, unlike men, are subjected to triple burden of disease, namely, non-communicable and communicable diseases and reproductive health related diseases. To assess prevalence of triple burden of disease of currently married women and to contrast out of pocket maternal care expenditure of these diseases in India. Subject and methods This study uses nationally representative unit level data from the 71st round (2014) of the National Sample Survey Organisation. Descriptive statistics and bivariate analysis are employed to assess triple burden of diseases by background of currently married women. Mean out of pocket (OOP) expenditure for healthcare care by demographic and household characteristics of women are also compared by type of diseases. Two parts model is adopted for assessment of determents of out of pocket healthcare expenditure of women. Results Overall medical and non-medical expenses of non–communicable disease are much higher than those of other disease and disability, reproductive health related and communicable diseases. OOP expenditure for treatment of non-communicable diseases, reproductive health and related diseases and other disease and disability are significantly higher than the inpatient treatment of communicable diseases and the differences are statistically significant. Conclusion Out of pocket expenditure for treatment of non-communicable diseases is the highest, followed by that of other diseases & disability, then reproductive health related diseases and the least is for communicable diseases. OOP expenditures for maternal healthcare in private health facilities are much higher than in public health facilities regardless of types of disease. Women from households having insurance of any member spent less than that of women from households not having health insurance. There is an urgent need to expand the outreach of the public health system in India to rural areas. PMID:29746506

Health communication and consumer behavior on meat in Belgium: from BSE until dioxin.

PubMed

Verbeke, W; Viaene, J; Guiot, O

1999-01-01

This article focuses on the impact of mass media meat-health information on consumer perception, attitude, and behavior toward fresh meat in Belgium. In a situation similar to that which occurred in most other European countries, Belgian fresh meat consumption fell considerably during 1995-1999. A multitude of messages linking meat consumption to human health risks were reported by mass media. Bovine Spongiform Encephalopathy (BSE) since 1996 and dioxin in 1999 constituted the major issues. Empirical research, conducted in April 1998, revealed the tremendous negative impact of mass media coverage of meat-health issues on consumer risk perception, health concern, and attitude and behavior toward fresh meat. Oppositely, personal communication through butchers had only a small effect on consumer decision-making in this era dominated by alarming meat-health press. Implications are threefold. First, mass media should be aware of its social responsibilities, which include spreading reliable and correct information to the society. This is especially the case as human health risks are involved. Second, the meat industry urgently needs to reorient itself toward quality, safety, and transparency. Finally, future communication dealing with similar crises situations requires cooperation across the meat chain, government, and those who are responsible for public health promotion and communication.

Brazilians have different views on when abortion should be legal, but most do not agree with imprisoning women for abortion.

PubMed

Faúndes, Aníbal; Duarte, Graciana Alves; de Sousa, Maria Helena; Soares Camargo, Rodrigo Paupério; Pacagnella, Rodolfo Carvalho

2013-11-01

Unsafe abortions remain a major public health problem in countries with very restrictive abortion laws. In Brazil, parliamentarians - who have the power to change the law - are influenced by "public opinion", often obtained through surveys and opinion polls. This paper presents the findings from two studies. One was carried out in February-December 2010 among 1,660 public servants and the other in February-July 2011 with 874 medical students from three medical schools, both in São Paulo State, Brazil. Both groups of respondents were asked two sets of questions to obtain their opinion about abortion: 1) under which circumstances abortion should be permitted by law, and 2) whether or not women in general and women they knew who had had an abortion should be punished with prison, as Brazilian law mandates. The differences in their answers were enormous: the majority of respondents were against putting women who have had abortions in prison. Almost 60% of civil servants and 25% of medical students knew at least one woman who had had an illegal abortion; 85% of medical students and 83% of civil servants thought this person(s) should not be jailed. Brazilian parliamentarians who are currently reviewing a reform in the Penal Code need to have this information urgently. Copyright © 2013 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

The impact of an emergency fee increase on the composition of patients visiting emergency departments.

PubMed

Jung, Hyemin; Do, Young Kyung; Kim, Yoon; Ro, Junsoo

2014-11-01

This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.

Clinical management of resistance evolution in a bacterial infection: A case study.

PubMed

Woods, Robert J; Read, Andrew F

2015-10-10

We report the case of a patient with a chronic bacterial infection that could not be cured. Drug treatment became progressively less effective due to antibiotic resistance, and the patient died, in effect from overwhelming evolution. Even though the evolution of drug resistance was recognized as a major threat, and the fundamentals of drug resistance evolution are well understood, it was impossible to make evidence-based decisions about the evolutionary risks associated with the various treatment options. We present this case to illustrate the urgent need for translational research in the evolutionary medicine of antibiotic resistance. © The Author(s) 2015. Published by Oxford University Press on behalf of the Foundation for Evolution, Medicine, and Public Health.

Hospital bed occupancy: more than queuing for a bed.

PubMed

Keegan, Andrew D

2010-09-06

Timely access to safe hospital care remains a major concern. Target bed-occupancy rates have been proposed as a measure of the ability of a hospital to function safely and effectively. High bed-occupancy rates have been shown to be associated with greater risks of hospital-associated infection and access block and to have a negative impact on staff health. Clinical observational data have suggested that bed occupancies above 85% could adversely affect safe, effective hospital function. Using this figure, at least initially, would be of value in the planning and operational management of public hospital beds in Australia. There is an urgent need to develop meaningful outcome measures of patient care that could replace the process measures currently in use.

Zika Virus: Recent Advances towards the Development of Vaccines and Therapeutics

PubMed Central

McArthur, Monica A.

2017-01-01

Zika is a rapidly emerging public health threat. Although clinical infection is frequently mild, significant neurological manifestations have been demonstrated in infants born to Zika virus (ZIKV) infected mothers. Due to the substantial ramifications of intrauterine infection, effective counter-measures are urgently needed. In order to develop effective anti-ZIKV vaccines and therapeutics, improved animal models and a better understanding of immunological correlates of protection against ZIKV are required. This review will summarize what is currently known about ZIKV, the clinical manifestations and epidemiology of Zika as well as, the development of animal models to study ZIKV infection, host immune responses against ZIKV, and the current state of development of vaccines and therapeutics against ZIKV. PMID:28608813

Typhoid fever: misuse of Widal test in Libya.

PubMed

Zorgani, Abdulaziz; Ziglam, Hisham

2014-06-11

The worldwide gold standard of diagnosing of enteric fever depends on the isolation of Salmonella enterica serovar Typhi from a patient's bone marrow and/or blood culture. In Libya clinicians are heavily dependent on the Widal test for diagnosis of enteric fever which has been used without determining the locally appropriate threshold titer, because the laboratories lack the skilled, experienced personnel and appropriate facilities to detect and serotype Salmonella isolates. To improve the diagnosis process, clinical management and reliability of public health measures, there is an urgent need for the effective training of laboratory technicians and to provide resources to culture Salmonella species according to published guidelines. Clinicians should understand the limitations of Widal test and recognize that it cannot be expected to give a reliable diagnosis.

Selected risk factors associated with pulmonary tuberculosis among Saharia tribe of Madhya Pradesh, central India.

PubMed

Rao, Vikas G; Gopi, P G; Bhat, Jyothi; Yadav, Rajiv; Selvakumar, N; Wares, Douglas F

2012-04-01

Tuberculosis (TB) is a major public health problem among the Saharia, a marginalized tribal group in Madhya Pradesh state, central India. However, there is no information on the risk factors associated with the development of TB disease in this community. A cross-sectional TB prevalence survey was conducted among the Saharia residing in Sheopur district of Madhya Pradesh. Information on tobacco smoking and alcohol consumption was collected from all the individuals. Persons aged ≥45 years, males, smokers and alcohol consumers had higher risks of developing TB disease. There is an urgent need to develop and implement culturally appropriate awareness raising activities to target smoking and alcohol consumption to support the efforts to control TB in this community.

The dark cloud of recreational drugs and vaping.

PubMed

Blundell, M S; Dargan, P I; Wood, D M

2018-03-01

Electronic cigarettes (e-cigarettes) are increasing in popularity with 19% of UK smokers reporting to have used them. The ability to regulate the evaporation temperature in newer electronic nicotine delivery systems (ENDS) facilitates the potential for use of these devices to 'vape' cannabis, novel psychoactive substances (NPS) and other recreational drugs. Vaping cannabis does have the potential to reduce tobacco use and combustible cannabis/tobacco-related disease, but with over one-third of UK adults reporting life-time use of recreational drugs and increasing e-cigarette uptake in adolescent groups the misuse of these devices poses a serious potential public health risk. Further work is therefore urgently required to inform the appropriate treatment and primary prevention strategies for this emerging issue.

Availability, accessibility, and affordability of neurodiagnostic tests in 37 countries.

PubMed

McLane, Hannah C; Berkowitz, Aaron L; Patenaude, Bryan N; McKenzie, Erica D; Wolper, Emma; Wahlster, Sarah; Fink, Günther; Mateen, Farrah J

2015-11-03

To determine the availability, accessibility, and affordability of EEG, EMG, CSF analysis, head CT, and brain MRI for neurologic disorders across countries. An online, 60-question survey was distributed to neurology practitioners in 2014 to assess the presence, wait time, and cost of each test in private and public health sectors. Data were stratified by World Bank country income group. Affordability was calculated with reference to the World Health Organization's definition of catastrophic health expenditure as health-related out-of-pocket expenditure of >40% of disposable household income, and assessment of providers' perceptions of affordability to the patient. Availability of EEG and EMG is correlated with higher World Bank income group (correlation coefficient 0.38, test for trend p = 0.046; 0.376, p = 0.043); CSF, CT, and MRI did not show statistically significant associations with income groups. Patients in public systems wait longer for neurodiagnostic tests, especially MRI, EEG, and urgent CT (p < 0.0001). The mean cost per test, across all tests, was lower in the public vs private sector (US $55.25 vs $214.62, p < 0.001). Each drop in World Bank income group is associated with a 29% decrease in the estimated share of the population who can afford a given test (95% confidence interval -33.4, 25.2; p < 0.001). In most low-income countries surveyed, only the top 10% or 20% of the population was able to afford tests below catastrophic levels. In surveyed lower-middle-income countries, >40% of the population, on average, could not afford neurodiagnostic tests. Neurodiagnostic tests are least affordable in the lowest income settings. Closing this "diagnostic gap" for countries with the lowest incomes is essential. © 2015 American Academy of Neurology.

Trafficking and Health: A Systematic Review of Research Methods.

PubMed

Cannon, Abby C; Arcara, Jennet; Graham, Laurie M; Macy, Rebecca J

2018-04-01

Trafficking in persons (TIP) is a human rights violation with serious public health consequences. Unfortunately, assessing TIP and its health sequelae rigorously and reliably is challenging due to TIP's clandestine nature, variation in definitions of TIP, and the need to use research methods that ensure studies are ethical and feasible. To help guide practice, policy, and research to assess TIP and health, we undertook a systematic literature review of 70 peer-reviewed, published articles to (a) identify TIP and health research methods being used, (b) determine what we can learn about TIP and health from these varied methodologies, and (c) determine the gaps that exist in health-focused TIP research. Results revealed that there are various quantitative and qualitative data collection and analysis methods being used to investigate TIP and health. Furthermore, findings show that the limitations of current methodologies affect what is known about TIP and health. In particular, varying definitions, participant recruitment strategies, ethical standards, and outcome measures all affect what is known about TIP and health. Moreover, findings demonstrate an urgent need for representative and nonpurposive recruitment strategies in future investigations of TIP and health as well as research on risk and protective factors related to TIP and health, intervention effectiveness, long-term health outcomes, and research on trafficked people beyond women trafficked for sex. We offer recommendations for research, policy, and practice based on review results.

Promoting Oral Health and Quality of Life of Older People - The Need for Public Health Action.

PubMed

Petersen, Poul Erik; Ogawa, Hiroshi

2018-01-01

This report intends to review the global burden of oral disease among older people and to examine their oral health needs. The evidence on the inter-relationships between poor oral health conditions of older people, general health and quality of life is highlighted. Finally, WHO strategies to improve oral health of older people are reviewed. The information relevant to this review was extracted from the WHO Global Oral Health Data Bank, the PubMed database, and the Cochrane Library. Surveys were carried out according to the criteria recommended by the WHO epidemiological manual Oral Health Surveys - Basic Methods. In addition, global data were sought on coverage of oral health care among older people. Finally, WHO policy documents on health care for aged people were gathered through the WHO website. Across the globe, many older people suffer from oral pain or discomfort. Poor oral health during old age is mostly manifest in high caries experience, high prevalence rates of advanced periodontal disease, severe tooth loss, dry mouth, and oral pre-cancer/cancer. In both developing and developed countries, the burden of disease is particularly high among underprivileged and disadvantaged older people. In numerous countries, high proportions of the aged population are not covered by primary oral health care; this is mainly the case in low and middle income countries due to a critical shortage of dentists. In 2015, the WHO published the World Report on Ageing and Health, which outlines a framework for action to foster healthy ageing. The policies are highly relevant to the improvement of oral health. Transformation of oral health systems away from a disease-based curative model and towards disease prevention, as well as the provision of older-person-centred integrated care are required. Moreover, wide-ranging public health action on ageing is urgently needed.

Oral health status, dental caries risk factors of the children of public kindergarten and schools in Phranakornsriayudhya, Thailand.

PubMed

Sutthavong, Sirikarn; Taebanpakul, Suthisa; Kuruchitkosol, Chidchai; Ayudhya, Thananan Isarangul Na; Chantveerawong, Teerapol; Fuangroong, Sarayoot; Cae-Ngow, Supak; Rangsin, Ram

2010-11-01

Dental caries remains a public health problem even though it is preventable. There are several risk factors that relate to dental caries, especially in children in suburban and rural areas, where they normally receive their first dental examination in primary schools by teachers or health care personnel. Their oral health depends primarily on their parents' awareness. To identify prevalence and severity of dental caries and their risk factors among children in public education centers in Phranakornsriayudhya, Thailand. A cross-sectional total study was conducted among children attending public education centers in Koh-Rean Subdistrict, Phranakornsriayudhya District, Phranakornsriayudhya Province, Thailand including a day care center, 2 kindergartens and 2 elementary schools, during the academic year of 2005. All children were invited to attend a dental health survey including general oral examination and a face to face interview for the participants' parents as well as children attending grade 1-6. Standardized questionnaires were used to identify the participants' oral health care behaviors. There were 157 (99.4%) from 158 children aged 2-12 years participated in the survey, 152 (96.8%) students had dental caries. The prevalence of dental caries among pre-school children was 95.4%. The overall average Decay Missing Filling for primary teeth (dmft) was 7.4 (+/- 4.6) and the overall average Decay Missing Filling for permanent teeth (DMFT) was 3.7 (+/- 1.8). The dmft among pre-school children was 9.1 (+/- 5.2). The prevalence of gingivitis was 95.5%. The independence risk factors for dental caries for primary teeth were brushing under supervision of teacher when compared with the parents (Odds ratio = 12.1 (95% CI, 2.6-55.4)), and not brushing after breakfast (Odds ratio = 3.7 (95% CI, 1.1-12.1). There were no significant risk factors of dental caries for permanent teeth. A relatively high prevalence of dental caries was observed among children in suburban area in Thailand, especially in early childhood. It was shown that having the parents supervising their tooth brushing and having tooth brushing after breakfast may protect the dental caries for primary teeth. The public health interventions among this population are therefore urgently needed.

Pollution, health and development: the need for a new paradigm.

PubMed

Landrigan, Philip J; Fuller, Richard

2016-03-01

Pollution is the largest cause of death in low- and middle-income countries. WHO estimates that 8.9 million persons die each year of diseases caused by pollution - 94% of them in poor countries. By comparison, HIV/AIDS causes 1.5 million deaths per year, and malaria and tuberculosis cause fewer than 1 million each. Diseases caused by pollution are very costly. Pollution can be prevented. In high-income countries, legal and technical control strategies have been developed and yielded great health and economic benefits. The removal of lead from gasoline increased the mean IQ of all American children and has generated an annual economic benefit of $213 billion. Unmet need: Despite its enormous human and economic costs, pollution has been overlooked in the international development agenda. Pollution control currently receives <0.5% of development spending. We have formed The Lancet-GAHP-Mount Sinai Commission on Pollution, Health and Development. This Commission will develop robust analyses of the impacts of pollution on health, economics, and development. It will inform heads of state and global funders about the enormous scale pollution's effects. The ultimate goal is to raise the priority of pollution and increase the resources allocated to control of this urgent public health problem.

Health Impact Assessment for Second-Hand Smoke Exposure in Germany--Quantifying Estimates for Ischaemic Heart Diseases, COPD, and Stroke.

PubMed

Fischer, Florian; Kraemer, Alexander

2016-02-05

Evidence of the adverse health effects attributable to second-hand smoke (SHS) exposure is available. This study aims to quantify the impact of SHS exposure on ischaemic heart diseases (IHD), chronic obstructive pulmonary diseases (COPD), and stroke in Germany. Therefore, this study estimated and forecasted the morbidity for the three outcomes in the German population. Furthermore, a health impact assessment was performed using DYNAMO-HIA, which is a generic software tool applying a Markov model. Overall 687,254 IHD cases, 231,973 COPD cases, and 288,015 stroke cases were estimated to be attributable to SHS exposure in Germany for 2014. Under the assumption that the population prevalence of these diseases and the prevalence of SHS exposure remain constant, the total number of cases will increase due to demographic aging. Assuming a total eradication of SHS exposure beginning in 2014 leads to an estimated reduction of 50% in cases, compared to the reference scenario in 2040 for all three diseases. The results highlight the relevance of SHS exposure because it affects several chronic disease conditions and has a major impact on the population's health. Therefore, public health campaigns to protect non-smokers are urgently needed.

Little cigars, big cigars: omissions and commissions of harm and harm reduction information on the Internet.

PubMed

Dollar, Katherine M; Mix, Jacqueline M; Kozlowski, Lynn T

2008-05-01

We conducted a comparative analysis of "harm," "harm reduction," and "little cigar" information about cigars on 10 major English-language health Web sites. The sites were from governmental and nongovernmental organizations based in seven different countries and included "harm" and "harm reduction" information, discussions of little cigars, quantitative estimates of health risks, and qualifying behavioral characteristics (inhalation, number per day). Of the 10 Web sites, 7 offered statements explicitly indicating that cigars may be safer than cigarettes. None of the Web sites reviewed described that little cigars are likely as dangerous as cigarettes. Some Web sites provided quantitative estimates of health risks and extensive discussions of qualifying factors. Reading grade levels were higher than desirable. Extensive and complex information on the reduced risks of cigars compared with cigarettes is available on Web sites affiliated with prominent health organizations. Yet these sites fail to warn consumers that popular cigarette-like little cigars and cigarillos are likely to be just as dangerous as cigarettes, even for those who have never smoked cigarettes. Improvement of these Web sites is urgently needed to provide the public with high-quality health information.

Endocrine disrupting compounds (EDCs) and pharmaceuticals and personal care products (PPCPs) in the aquatic environment: implications for the drinking water industry and global environmental health.

PubMed

Rahman, M F; Yanful, E K; Jasim, S Y

2009-06-01

Endocrine disrupting compounds (EDCs) and pharmaceuticals and personal care products (PPCPs) are a group of chemical compounds with diverse physical and chemical properties. Recent studies have indicated undesired effects of EDCs and PPCPs at their reported trace concentrations (ng l(-1) to microg l(-1)). This paper reviews the current knowledge on the sources, properties, occurrence and health impacts of EDCs and PPCPs, and their removal from drinking water using ozonation and ozone/hydrogen peroxide-based advanced oxidation. The paper also examines the potential threats posed by these chemicals to drinking water and public health. While these compounds are known to have adverse effects on ecosystem health, notably in the fish population, a similar link is yet to be established between ingestion of these compounds through drinking water and human health. In addition, data on the effectiveness of existing methods for the removal of these compounds are not conclusive. Further studies are required to characterize risks, and also to evaluate and optimize existing removal processes. Also concerted international effort is urgent to cut down the risk of exposure and restrain the production and marketing of toxic chemicals.

Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism

PubMed Central

van de Pas, Remco

2017-01-01

There has been much reflection on the need for a new understanding of global health and the urgency of a paradigm shift to address global health issues. A crucial question is whether this is still possible in current modes of global governance based on capitalist values. Four reflections are provided. (1) Ecological –centered values must become central in any future global health framework. (2) The objectives of ‘sustainability’ and ‘economic growth’ present a profound contradiction. (3) The resilience discourse maintains a gridlock in the functioning of the global health system. (4) The legitimacy of multi-stakeholder governance arrangements in global health requires urgent attention. A dual track approach is suggested. It must be aimed to transform capitalism into something better for global health while in parallel there is an urgent need to imagine a future and pathways to a different world order rooted in the principles of social justice, protecting the commons and a central role for the preservation of ecology. PMID:28812849

Health Matters for People with Developmental Disabilities: Creating a Sustainable Health Promotion Program

ERIC Educational Resources Information Center

Marks, Beth; Sisirak, Jasmina; Heller, Tamar

2010-01-01

Adults with developmental disabilities are at significant risk for health problems. Effective health promotion can improve outcomes--and that's why adult day and residential agencies, schools, and other organizations need this invaluable program development guide. An urgent call to action and a start-to-finish framework for health promotion, this…

A review: Fentanyl and non-pharmaceutical fentanyls.

PubMed

Suzuki, Joji; El-Haddad, Saria

2017-02-01

Fentanyl and non-pharmaceutical fentanyls (NPFs) have been responsible for numerous outbreaks of overdoses all over the United States since the 1970s. However, there has been a growing concern in recent years that NPFs are contributing to an alarming rise in the number of opioid-related overdoses. The authors conducted a narrative review of the published and grey literature on fentanyl and NPFs in PubMed, Google Scholar, and Google using the following search terms: "fentanyl", "non-pharmaceutical fentanyl", "fentanyl analogs", "fentanyl laced heroin" and "fentanyl overdose". References from relevant publications and grey literature were also reviewed to identify additional citations for inclusion. The article reviews the emergence and misuse of fentanyl and NPFs, their clinical pharmacology, and the clinical management and prevention of fentanyl-related overdoses. Fentanyl and NPFs may be contributing to the recent rise in overdose deaths in the United States. There is an urgent need to educate clinicians, researchers, and patients about this public health threat. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Need for Improved Methods to Collect and Present Spatial Epidemiologic Data for Vectorborne Diseases

PubMed Central

Eisen, Rebecca J.

2007-01-01

Improved methods for collection and presentation of spatial epidemiologic data are needed for vectorborne diseases in the United States. Lack of reliable data for probable pathogen exposure site has emerged as a major obstacle to the development of predictive spatial risk models. Although plague case investigations can serve as a model for how to ideally generate needed information, this comprehensive approach is cost-prohibitive for more common and less severe diseases. New methods are urgently needed to determine probable pathogen exposure sites that will yield reliable results while taking into account economic and time constraints of the public health system and attending physicians. Recent data demonstrate the need for a change from use of the county spatial unit for presentation of incidence of vectorborne diseases to more precise ZIP code or census tract scales. Such fine-scale spatial risk patterns can be communicated to the public and medical community through Web-mapping approaches. PMID:18258029

[The Road towards the Responsible and Safe Legalization of Cannabis Use in Portugal].

PubMed

Baptista-Leite, Ricardo; Ploeg, Lisa

2018-02-28

Recently, the world has seen examples of the legalization of cannabis for recreational purposes. Due to the diversity of experiences in progress, it is urgent to analyze the impacts of this legalization, from a public health perspective. Therefore, this article aims to review the accumulated knowledge in the states and countries where the use of cannabis is legal and to ponder over the relevance of starting a similar path towards legalization in Portugal, thus supporting political decisions to be properly informed and evidence-based. An extensive literature review was performed using databases and scientific journals, such as PubMed, as well as the search of institutional documentation, including the EMCDDA and SICAD. The gathered information provided insights and enabled assessment of (1) the acute and chronic effects of cannabis use on health, (2) the Portuguese situation related to cannabis and (3) the processes and lessons learned after the legalization of cannabis in other countries or states. Given the above, and according to the data presented, the authors argue for a safe and responsible strategy towards the legalization of cannabis use in Portugal. In accordance, a set of concrete proposals are presented. From a public health perspective, it is assumed that the interest of this proposal is to reduce the problematic use of cannabis, to effectively fight against illicit drug trafficking and drug-related crime, as well as health promotion and prevention of addictions and other adverse health impacts. This article reveals that the effects of legalization might, contrary to general beliefs, generate positive results with respect to these aims, given that there will be greater control on the market, price, quality, and information - to name a few - if implementation occurs with proper consideration and definition. The debate on the responsible and safe legalization of cannabis use in Portugal should be open and promoted, based on a public health perspective.

Drugs for neglected diseases: a failure of the market and a public health failure?

PubMed

Trouiller, P; Torreele, E; Olliaro, P; White, N; Foster, S; Wirth, D; Pécoul, B

2001-11-01

Infectious diseases cause the suffering of hundreds of millions of people, especially in tropical and subtropical areas. Effective, affordable and easy-to-use medicines to fight these diseases are nearly absent. Although science and technology are sufficiently advanced to provide the necessary medicines, very few new drugs are being developed. However, drug discovery is not the major bottleneck. Today's R&D-based pharmaceutical industry is reluctant to invest in the development of drugs to treat the major diseases of the poor, because return on investment cannot be guaranteed. With national and international politics supporting a free market-based world order, financial opportunities rather than global health needs guide the direction of new drug development. Can we accept that the dearth of effective drugs for diseases that mainly affect the poor is simply the sad but inevitable consequence of a global market economy? Or is it a massive public health failure, and a failure to direct economic development for the benefit of society? An urgent reorientation of priorities in drug development and health policy is needed. The pharmaceutical industry must contribute to this effort, but national and international policies need to direct the global economy to address the true health needs of society. This requires political will, a strong commitment to prioritize health considerations over economic interests, and the enforcement of regulations and other mechanisms to stimulate essential drug development. New and creative strategies involving both the public and the private sector are needed to ensure that affordable medicines for today's neglected diseases are developed. Priority action areas include advocating an essential medicines R&D agenda, capacity-building in and technology transfer to developing countries, elaborating an adapted legal and regulatory framework, prioritizing funding for essential drug development and securing availability, accessibility, distribution and rational use of these drugs.

Human Trafficking: The Role of Medicine in Interrupting the Cycle of Abuse and Violence.

PubMed

Macias-Konstantopoulos, Wendy

2016-10-18

Human trafficking, a form of modern slavery, is an egregious violation of human rights with profound personal and public health implications. It includes forced labor and sexual exploitation of both U.S. and non-U.S. citizens and has been reported in all 50 states. Victims of human trafficking are currently among the most abused and disenfranchised persons in society, and they face a wide range of negative health outcomes resulting from their subjugation and exploitation. Medicine has an important role to play in mitigating the devastating effects of human trafficking on individuals and society. Victims are cared for in emergency departments, primary care offices, urgent care centers, community health clinics, and reproductive health clinics. In addition, they are unknowingly being treated in hospital inpatient units. Injuries and illnesses requiring medical attention thus represent unique windows of opportunity for trafficked persons to receive assistance from trusted health care professionals. With education and training, health care providers can recognize signs and symptoms of trafficking, provide trauma-informed care to this vulnerable population, and respond to exploited persons who are interested and ready to receive assistance. Multidisciplinary response protocols, research, and policy advocacy can enhance the impact of antitrafficking health care efforts to interrupt the cycle of abuse and violence for these victims.

Health care and lost productivity costs of overweight and obesity in New Zealand.

PubMed

Lal, Anita; Moodie, Marj; Ashton, Toni; Siahpush, Mohammad; Swinburn, Boyd

2012-12-01

To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006. A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA). Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA. The cost burden of overweight and obesity in NZ is considerable. Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Permissive nicotine regulation as a complement to traditional tobacco control

PubMed Central

Sumner, Walton

2005-01-01

Background Cigarette smoking takes a staggering toll on human health and attracts considerable public health attention, yet real solutions seem distant. The 2004 Family Smoking Prevention and Tobacco Control Act (US Senate bill S2461) would have given the US Food and Drug Administration limited authority to regulate cigarettes to "protect the public health." However, such legislation is unlikely to substantially reduce smoking or related deaths. Discussion The past 500 years of tobacco control efforts demonstrate that nicotine prohibition is a practical impossibility for numerous reasons, state revenue being one of the most ominous. The FDA already has regulatory authority over pharmaceutical grade nicotine products, and requires pharmacists to dispense the most addictive of these only with prescriptions. Meanwhile, every corner store can sell far more addictive and dangerous cigarettes to any adult. The FDA could immediately increase competition between cigarettes and clean nicotine products by approving available nicotine products for over-the-counter sales to adults. Similarly permissive regulation of cigarettes and addictive nicotine products will reduce tobacco use and improve smokers' health, but increase nicotine use in the population. Fortunately, restricted youth access and accurate labeling of nicotine's absolute risks will dissuade many non-smokers from experimenting with it, while accurate depiction of its risks relative to cigarette smoking will encourage many smokers to switch. The FDA could take a series of small steps that might ultimately replace a large proportion of cigarette smoking with equally addictive nicotine products, without risking serious public health setbacks. Vaccine, methadone, and injury prevention policies establish relevant public health precedents. Summary Cigarettes, or an equally addictive alternative, will be a permanent and common product in most societies. Regulations restricting only the safest addictive nicotine products are hard to justify. Addictive nicotine compliments other tobacco control strategies. Modern tobacco control policies are applicable to addictive nicotine. Controlled trials and test market studies are urgently needed to evaluate addictive nicotine as an alternative to smoking. Meanwhile, legislators should preserve the Food and Drug Administration's option to permit non-prescription sales of addictive nicotine. PMID:15730554

Toward a multi-country monitoring system of reproductive health in the context of endocrine disrupting chemical exposure.

PubMed

Le Moal, Joëlle; Sharpe, Richard M; Jϕrgensen, Niels; Levine, Hagai; Jurewicz, Joanna; Mendiola, Jaime; Swan, Shanna H; Virtanen, Helena; Christin-Maître, Sophie; Cordier, Sylvaine; Toppari, Jorma; Hanke, Wojciech

2016-02-01

Worrying trends regarding human reproductive endpoints (e.g. semen quality, reproductive cancers) have been reported and there is growing circumstantial evidence for a possible causal link between these trends and exposure to endocrine disrupting chemicals (EDCs). However, there is a striking lack of human data to fill the current knowledge gaps. To answer the crucial questions raised on human reproductive health, there is an urgent need for a reproductive surveillance system to be shared across countries. A multidisciplinary network named HUman Reproductive health and Global ENvironment Network (HURGENT) was created aiming at designing a European monitoring system for reproductive health indicators. Collaborative work allowed setting up the available knowledge to design such a system. Furthermore we conducted an overview of 23 potential indicators, based upon a weight of evidence (WoE) approach according to their potential relation with EDC exposure. The framework and purposes of the surveillance system are settled as well as the approach to select suitable reproductive indicators. The indicators found with the highest scores according to the WoE approach are prostate and breast cancer incidence, sex ratio, endometriosis and uterine fibroid incidence, indicators related to the testicular dysgenesis syndrome, precocious puberty incidence and reproductive hormone levels. Not only sentinel health endpoints, but also diseases with high burdens in public health are highlighted as prior indicators in the context of EDC exposure. Our work can serve as a basis to construct, as soon as possible, the first multi-country reproductive monitoring system. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Pesticide poisoning in non-fatal deliberate self-harm: A public health issue: Study from Sundarban delta, India

PubMed Central

Chowdhury, A. N.; Banerjee, Sohini; Brahma, Arabinda; Biswas, M. K.

2007-01-01

Background: Non-fatal deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture, and these agents are most frequently used in DSH. Aim: This study aimed to identify the nature of methods and agents used in non-fatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal. Materials and Methods: Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres' (BPHCs') admission registers were analyzed. One Focus Group Discussion (FGD) with the Panchayat Samiti of each block (totally 13 FDGs) was conducted to elicit the Samiti members' perception about the problem of pesticide-related DSH or suicide in the region. Results: A total of 5,178 (1,887 male and 3,291 female) subjects were admitted at the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning-prevention program with a special focus on improving clinical services, as well as initiating farmers' education programs focusing on safe pesticide practices at the primary-care level. PMID:20680138

Scrub Typhus: An Emerging Neglected Tropical Disease in Nepal.

PubMed

Upadhyaya, B P; Shakya, G; Adhikari, S; Rijal, N; Acharya, J; Maharjan, L; Marasini, B R

2016-05-01

Scrub typhus is a neglected tropical disease and is under reported from Nepal. The objective of this study was to investigate the sero-epidemiology of scrub typhus in patients suffering from acute febrile illness. A total of 434 specimens collected from July to November 2015 at National Public Health Laboratory (NPHL) were investigated for detection of immunoglobulin M (IgM) antibody to Orientiatsutsugamushi.The Scrub Typhus Detect TM kit (InBios, USA) was used to detect the antibodies to O.tsutsugamushi in human serum. Randomly selected 10% positive specimens were used for confirmation by dot- enzyme-linked immunosorbent assay and indirect immunofluorescence assay. Of the total, 175 (40.3%) were positive for IgM antibodies to O. tsutsugamushi. Positive results of scrub typhus were highest among female in 11-20 year followed by males in 41-50 years age group. The IgM antibodies to O. tsutusugamushi were positive in specimens of various geographical regions including 30 districts of Nepal. Positive cases were found in various ecological regions of Nepal. Scrub typhus is one of the neglected tropical diseases in Nepal. Patients with acute febrile illness should be investigated for scrub typhus with high priority. There is an urgent need of reliable and affordable diagnostic tests at all level of health facilities of Nepal. Surveillance and public health awareness about the disease transmission and preventive measures needs to be initiated.

Expenditure tracking and review of reproductive maternal, newborn and child health policy in Pakistan.

PubMed

Malik, Muhammad Ashar; Nahyoun, Abdul Sattar; Rizvi, Arjumand; Bhatti, Zaid Ahmad; Bhutta, Zulfiqar Ahmad

2017-07-01

Since 2001 substantial resources have been allocated to the reproductive, maternal, newborn and child health sector (RMNCH) in Pakistan. Many new programmes have been started and coverage of some existing programmes has been extended to un-served and rural areas. Despite these efforts the Millennium Development Goals (MDGs) 4 and 5 were not achieved (2000-15). Maternal Mortality Ratio was reduced to 170 per 100 000 live births (target 100) by 2013 at an annual reduction rate of 3.6% (1990-2013). Against the target of 46 per 1000 live births, the Under Five Mortality Rate was reduced to 81 per 1000 live births by 2015 at an annual reduction rate of 2.1% (1990-2015). We evaluated the comparative expenditures for the RMNCH sector and analysed impact of public expenditures on the use of the public facilities for the RMNCH services. Expenditure on RMNCH increased by 181% (2000-10), reaching PKR 628.79 billion (US$9.67 billion). The Share of the RMNCH expenditure in the total health expenditure increased from 16 to 21% (2005-10). The share of official development assistance for the RMNCH increased from 36 to 51% (2003-10). Equity was modestly achieved with a greater proportion of the poor using public facilities for the childhood diarrhoea (Concentration Index -0.06 in 2001-02 to - 0.11 in 2010-11) and reduction in the proportion of the rich using the public health facilities for institutional births (Concentration Index 0.30 in 2001-02 to 0.25 in 2010-11). Overall the RMNCH disease control programmes focused on vertical primary health approach and targeted the district health system in the un-served areas. Our findings confirm that diseconomies of scale, donor dependence and supply side perspective could only result in a modest progress towards achieving the MDGs. We call for urgent attention of the policy makers for the integration of the vertical and the routine primary health care and reliance on indigenous sustainable healthcare financing. We also recommend acknowledging economic perspective on health policy and health programmes. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

First evaluation of the NHS direct online clinical enquiry service: a nurse-led web chat triage service for the public.

PubMed

Eminovic, Nina; Wyatt, Jeremy C; Tarpey, Aideen M; Murray, Gerard; Ingrams, Grant J

2004-06-02

NHS Direct is a telephone triage service used by the UK public to contact a nurse for any kind of health problem. NHS Direct Online (NHSDO) extends NHS Direct, allowing the telephone to be replaced by the Internet, and introducing new opportunities for informing patients about their health. One NHSDO service under development is the Clinical Enquiry Service (CES), which uses Web chat as the communication medium. To identify the opportunities and possible risks of such a service by exploring its safety, feasibility, and patient perceptions about using Web chat to contact a nurse. During a six-day pilot performed in an inner-city general practice in Coventry, non-urgent patients attending their GP were asked to test the service. After filling out three Web forms, patients used a simple Web chat application to communicate with trained NHS Direct triage nurses, who responded with appropriate triage advice. All patients were seen by their GP immediately after using the Web chat service. Safety was explored by comparing the nurse triage end point with the GP's recommended end point. In order to check the feasibility of the service, we measured the duration of the chat session. Patient perceptions were measured before and after using the service through a modified Telemedicine Perception Questionnaire (TMPQ) instrument. All patients were observed by a researcher who captured any comments and, if necessary, to assisted with the process. A total of 25 patients (mean age 48 years; 57% female) agreed to participate in the study. An exact match between the nurse and the GP end point was found in 45% (10/22) of cases. In two cases, the CES nurse proposed a less urgent end point than the GP. The median duration of Web chat sessions was 30 minutes, twice the median for NHS Direct telephone calls for 360 patients with similar presenting problems. There was a significant improvement in patients' perception of CES after using the service (mean pre-test TMPQ score 44/60, post-test 49/60; p=0.008 (2-tailed)). Patients volunteered several potential advantages of CES, such as the ability to re-read the answers from the nurse. Patients consider CES a useful addition to regular care, but not a replacement for it. Based on this pilot, we can conclude that CES was sufficiently safe to continue piloting, but in order to make further judgments about safety, more tests with urgent cases should be performed. The Web chat sessions as conducted were too long and therefore too expensive to be sustainable in the NHS. However, the positive reaction from patients and the potential of CES for specific patient groups (the deaf, shy, or socially isolated) encourage us to continue with piloting such innovative communication methods with the public.

Assessment of Breast Cancer Knowledge among Health Workers in Bangui, Central African Republic: a Cross-sectional Study.

PubMed

Balekouzou, Augustin; Yin, Ping; Pamatika, Christian Maucler; Nambei, Sylvain Wilfrid; Djeintote, Marceline; Doromandji, Eric; Gouaye, Andre Richard; Yamba, Pascal Gastien; Guessy, Elysee Ephraim; Ba-Mpoutou, Bertrand; Mandjiza, Dieubeni Rawago; Shu, Chang; Yin, Minghui; Fu, Zhen; Qing, Tingting; Yan, Mingming; Mella, Grace; Koffi, Boniface

2016-01-01

Breast cancer is the leading cause of cancer deaths among women worldwide. High breast cancer mortality has been attributed to lack of public awareness of the disease. Little is known about the level of knowledge of breast cancer in Central African Republic. This study aimed to investigate the knowledge of health professionals on breast cancer. This cross-sectional study was conducted among 158 health professionals (27 medical; 131 paramedical) in 17 hospitals in Bangui using a self-administered questionnaire. Descriptive statistical analysis, Person's χ 2 test and ANOVA were applied to examine associations between variables with <0.05 being considered significant. Data analyzed using SPSS version 20 indicates that average knowledge about breast cancer perception of the entire population was 47.6%, diagnosis method 45.5%, treatment 34.3% and risk factors 23.8%. Most respondents (65.8%) agreed that breast cancer is important in the Central African Republic and that family history is a risk factor (44.3%). Clinical assessments and mammography were considered most suitable diagnostic methods, and surgery as the best treatment. The knowledge level was significantly higher among medical than paramedical staff with regard to risk factors, diagnosis and treatment. However the trainee group had very high significant differences of knowledge compared with all other groups. There is a very urgent need to update the various training programs for these professionals, with recommendations of retraining. Health authorities must create suitable structures for the overall management of cancer observed as a serious public health problem.

The requirements and challenges in preventing of road traffic injury in Iran. A qualitative study.

PubMed

Khorasani-Zavareh, Davoud; Mohammadi, Reza; Khankeh, Hamid Reza; Laflamme, Lucie; Bikmoradi, Ali; Haglund, Bo J A

2009-12-23

Road traffic injuries (RTIs) are a major public health problem, especially in low- and middle-income countries. Among middle-income countries, Iran has one of the highest mortality rates from RTIs. Action is critical to combat this major public health problem. Stakeholders involved in RTI control are of key importance and their perceptions of barriers and facilitators are a vital source of knowledge. The aim of this study was to explore barriers to the prevention of RTIs and provide appropriate suggestions for prevention, based on the perceptions of stakeholders, victims and road-users as regards RTIs. Thirty-eight semi-structured interviews were conducted with informants in the field of RTI prevention including: police officers; public health professionals; experts from the road administrators; representatives from the General Governor, the car industry, firefighters; experts from Emergency Medical Service and the Red Crescent; and some motorcyclists and car drivers as well as victims of RTIs. A qualitative approach using grounded theory method was employed to analyze the material gathered. The core variable was identified as "The lack of a system approach to road-user safety". The following barriers in relation to RTI prevention were identified as: human factors; transportation system; and organizational coordination. Suggestions for improvement included education (for the general public and targeted group training), more effective legislation, more rigorous law enforcement, improved engineering in road infrastructure, and an integrated organization to supervise and coordinate preventive activities. The major barriers identified in this study were human factors and efforts to change human behaviour were suggested by means of public education campaigns and stricter law enforcement. However, the lack of a system approach to RTI prevention was also an important concern. There is an urgent need for both an integrated system to coordinate RTI activities and prevention and a major change in stakeholders' attitudes towards RTI prevention. The focus of all activities should take place on road users' safety.

The effects of trypanosomiasis on rural economy*

PubMed Central

Wilson, S. G.; Morris, K. R. S.; Lewis, I. J.; Krog, E.

1963-01-01

Trypanosomiasis, both of humans and of livestock, is one of the most important factors restricting economic development in Africa today. The present paper outlines how this disease is limiting agricultural, veterinary and forestry development in the Sudan, Bechuanaland and West Africa. The present tsetse-fly distribution is reviewed. Glossina palpalis and G. morsitans occur in the south Sudan and G. morsitans in the Ngamiland district of Bechuanaland; G. morsitans, G. palpalis and G. tachinoides are the most important species in West Africa. These tsetse flies have altered the cattle distribution in all three regions and, in addition to causing widespread disease, have created local overstocking problems in the tsetse-free grazing areas, and have enforced nomadism on breeding herds and economic loss in slaughter cattle along the trade cattle routes in West Africa. Human trypanosomiasis is not now such an urgent problem and public health measures have led to its control in all three areas. Increased agricultural development, which can be a successful and economic method of reclaiming land from tsetse flies, must be intensified in all three areas. Forest conservation policy comes into conflict with tsetse control measures only in West Africa. Detailed tsetse-fly surveys and research, on which future plans can be firmly based, are now urgently required. ImagesFIG. 6 PMID:14001093

Profile of hospitalisation and death in the first year after diagnosis of end-stage renal disease in a multi-ethnic Asian population.

PubMed

Teo, Boon Wee; Ma, Valerie; Xu, Hui; Li, Jialiang; Lee, Evan J

2010-02-01

The increasing prevalence of end-stage renal disease (ESRD) is an important public health issue due to the high costs of kidney replacement therapies. We examined the impact of ethnicity and other factors in ESRD management and hospitalisation in a multiracial Asian population in the fi rst year after diagnosis. We analysed a prospectively collected database of 168 new ESRD patients from the National University Hospital, Singapore (NUH) in 2005. Univariate and multivariate analyses were performed to assess factors for mortality and hospitalisation. Sixteen patients eventually chose conservative treatment, 102 haemodialysis, 41 peritoneal dialysis and 9 patients underwent kidney transplantation for their long-term treatment. Although more Chinese patients had dialysis plans (56.7% vs 36.8%, P = 0.022), many still required urgent dialysis initiation via catheters (61.3%). These dialysed patients who required urgent treatment had more admissions (3.6 vs 2.6, P = 0.023) and longer length of stay (9.3 days, P = 0.014). Approximately 40 (7.4%) admissions were related to vascular access complications (thromboses, dislodgements and infections), and 15 (2.8%) were for new tunnelled catheter insertions. Deaths were 23.8% in the fi rst year after diagnosis and median survival was 125 days. Age, fi nal treatment modality, type of therapy centre, history of coronary artery disease, left ventricular ejection fraction (LVEF) <50%, and having no plans for dialysis were associated with mortality. The care of ESRD patients requires substantial commitment of healthcare resources particularly in the fi rst year after diagnosis. Steps to reduce urgent initiation of dialysis will help reduce resource utilisation and improve patient outcomes.

Effects of income and dental insurance coverage on need for dental care in Canada.

PubMed

Duncan, Laura; Bonner, Ashley

2014-01-01

To estimate the strength of the associations among income, dental insurance coverage and need for dental care (both urgent and nonurgent) in Canada. Multinomial logistic models were fit to data from the 2009 Canadian Health Measures Survey to test unadjusted associations among household income, dental insurance coverage and the need for urgent and nonurgent dental care. Adjusted associations, controlling for socio-demographic variables (age, sex, immigration status, education and province of residence) and oral health habits (brushing, flossing and visits to the dentist) were also evaluated. In the unadjusted model, need for treatment was lower among people with dental insurance than among those without insurance coverage (for urgent treatment: odds ratio [OR] 0.76, 95% confidence interval [CI] 0.66-0.89; for nonurgent treatment: OR 0.59, 95% CI 0.50-0.70). In addition, there was an income gradient, whereby people with higher income had less need for dental treatment (for urgent treatment: OR 0.99, 95% CI 0.99-1.00; for nonurgent treatment: OR 0.99, 95% CI 0.98-0.99). Controlling for socio-demographic and oral health variables decreased the magnitude of the association between dental insurance coverage and need for treatment (for urgent treatment: OR 0.80, 95% CI 0.68-0.95; for nonurgent treatment: OR 0.76, 95% CI 0.63-0.92). An interaction term between dental coverage and income was significant in relation to the need for nonurgent treatment: among lower-income individuals, having insurance slightly decreased the odds of needing nonurgent treatment, with this decrease in odds becoming greater for middle-income earners and even greater for high-income earners. Income-related inequality in need for dental care exists even in the presence of dental insurance coverage and good dental hygiene habits. These findings highlight the need for increased access to dental care for low-income populations and families living in poverty.

Genomic analysis of diversity, population structure, virulence, and antimicrobial resistance in Klebsiella pneumoniae, an urgent threat to public health

PubMed Central

Holt, Kathryn E.; Wertheim, Heiman; Zadoks, Ruth N.; Baker, Stephen; Whitehouse, Chris A.; Dance, David; Jenney, Adam; Connor, Thomas R.; Hsu, Li Yang; Severin, Juliëtte; Brisse, Sylvain; Cao, Hanwei; Wilksch, Jonathan; Gorrie, Claire; Schultz, Mark B.; Edwards, David J.; Nguyen, Kinh Van; Nguyen, Trung Vu; Dao, Trinh Tuyet; Mensink, Martijn; Minh, Vien Le; Nhu, Nguyen Thi Khanh; Schultsz, Constance; Kuntaman, Kuntaman; Newton, Paul N.; Moore, Catrin E.; Strugnell, Richard A.; Thomson, Nicholas R.

2015-01-01

Klebsiella pneumoniae is now recognized as an urgent threat to human health because of the emergence of multidrug-resistant strains associated with hospital outbreaks and hypervirulent strains associated with severe community-acquired infections. K. pneumoniae is ubiquitous in the environment and can colonize and infect both plants and animals. However, little is known about the population structure of K. pneumoniae, so it is difficult to recognize or understand the emergence of clinically important clones within this highly genetically diverse species. Here we present a detailed genomic framework for K. pneumoniae based on whole-genome sequencing of more than 300 human and animal isolates spanning four continents. Our data provide genome-wide support for the splitting of K. pneumoniae into three distinct species, KpI (K. pneumoniae), KpII (K. quasipneumoniae), and KpIII (K. variicola). Further, for K. pneumoniae (KpI), the entity most frequently associated with human infection, we show the existence of >150 deeply branching lineages including numerous multidrug-resistant or hypervirulent clones. We show K. pneumoniae has a large accessory genome approaching 30,000 protein-coding genes, including a number of virulence functions that are significantly associated with invasive community-acquired disease in humans. In our dataset, antimicrobial resistance genes were common among human carriage isolates and hospital-acquired infections, which generally lacked the genes associated with invasive disease. The convergence of virulence and resistance genes potentially could lead to the emergence of untreatable invasive K. pneumoniae infections; our data provide the whole-genome framework against which to track the emergence of such threats. PMID:26100894

A randomized controlled trial of a public health nurse-delivered asthma program to elementary schools.

PubMed

Cicutto, Lisa; To, Teresa; Murphy, Suzanne

2013-12-01

Childhood asthma is a serious and common chronic disease that requires the attention of nurses and other school personnel. Schools are often the first setting that children take the lead in managing their asthma. Often, children are ill prepared for this role. Our study evaluated a school-based, multifaceted asthma program that targeted students with asthma and the broader school community. A randomized trial involving 130 schools with grades 1-5 and 1316 children with asthma and their families was conducted. Outcomes of interest for the child, at 1 year, were urgent care use and school absenteeism for asthma, inhaler technique, and quality of life, and for the school, at 14 months, were indicators of a supportive school environment. Improvements were observed at the child and school level for the intervention group. Fewer children in the intervention group had a school absence (50% vs 60%; p < .01), required urgent care for asthma (41% vs 51%; p < .0001), or reported a day of interrupted activity (51% vs 63%; p < .01), and had improved quality of life (5.8 ± 1.2 vs 5.4 ± 1.4; p < .0001). Schools in the intervention group were more likely to have practices supporting an asthma-friendly environment. Implementation of a multifaceted school-based asthma program can lead to asthma-friendly schools that support children with asthma to be successful managers of their asthma and experience improved quality of life and decreased disease associated burden. © 2013, American School Health Association.

No Child Left Behind: The Ongoing Movement for Public Education Reform

ERIC Educational Resources Information Center

Paige, Rod

2006-01-01

In this essay, former secretary of education Rod Paige depicts the No Child Left Behind Act (NCLB) as the culmination of more than half a century of urgent but largely unheeded calls for reform of the nation's public education system. He explains the rationale for the design of NCLB and responds to several criticisms of the legislation, including…

36 CFR 1229.12 - What are the requirements during a state of war or threatened war?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false What are the requirements during a state of war or threatened war? 1229.12 Section 1229.12 Parks, Forests, and Public Property... the interest of the United States, or that they occupy space urgently needed for military purposes and...

Fair ranking of researchers and research teams

PubMed Central

2018-01-01

The main drawback of ranking of researchers by the number of papers, citations or by the Hirsch index is ignoring the problem of distributing authorship among authors in multi-author publications. So far, the single-author or multi-author publications contribute to the publication record of a researcher equally. This full counting scheme is apparently unfair and causes unjust disproportions, in particular, if ranked researchers have distinctly different collaboration profiles. These disproportions are removed by less common fractional or authorship-weighted counting schemes, which can distribute the authorship credit more properly and suppress a tendency to unjustified inflation of co-authors. The urgent need of widely adopting a fair ranking scheme in practise is exemplified by analysing citation profiles of several highly-cited astronomers and astrophysicists. While the full counting scheme often leads to completely incorrect and misleading ranking, the fractional or authorship-weighted schemes are more accurate and applicable to ranking of researchers as well as research teams. In addition, they suppress differences in ranking among scientific disciplines. These more appropriate schemes should urgently be adopted by scientific publication databases as the Web of Science (Thomson Reuters) or the Scopus (Elsevier). PMID:29621316

Electronic Health Records: Overcoming Obstacles to Improve Acceptance and Utilization for Mental Health Clinicians

ERIC Educational Resources Information Center

Odom, Stephen A.

2017-01-01

The dynamics and progress of the integration of the electronic health record (EHR) into health-care disciplines have been described and examined using theories related to technology adoption. Previous studies have examined health-care clinician resistance to the EHR in primary care, hospital, and urgent care medical settings, but few studies have…

“Drivers” of Translational Cancer Epidemiology in the 21st Century: Needs and Opportunities

PubMed Central

Lam, Tram Kim; Spitz, Margaret; Schully, Sheri D.; Khoury, Muin J.

2012-01-01

Cancer epidemiology is at the cusp of a paradigm shift--propelled by an urgent need to accelerate the pace of translating scientific discoveries into healthcare and population health benefits. As part of a strategic planning process for cancer epidemiologic research, the Epidemiology and Genomics Research Program (EGRP) at the National Cancer Institute (NCI) is leading a “longitudinal” meeting with members of the research community to engage in an on-going dialogue to help shape and invigorate the field. Here, we review a translational framework influenced by “drivers” that we believe have begun guiding cancer epidemiology towards translation in the past few years and are most likely to drive the field further in the next decade. The drivers include: (1) collaboration and team science; (2) technology; (3) multi-level analyses and interventions; and (4) knowledge integration from basic, clinical and population sciences. Using the global prevention of cervical cancer as an example of a public health endeavor to anchor the conversation, we discuss how these drivers can guide epidemiology from discovery to population health impact, along the translational research continuum. PMID:23322363

The surgical waiting time initiative: A review of the Nigerian situation

PubMed Central

Abdulkareem, Imran Haruna

2014-01-01

SUMMARY The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24.5%) publications were from obstetrics and gynaecology (O & G) alone, but these were mostly related to emergency antenatal care rather than surgery. Therefore, more research and initiative needs to be undertaken from all the surgical sub-specialties in order to disseminate this concept of SWAT towards early diagnosis and treatment of elective life-threatening conditions, as well as effective patient care. Adopting this concept will help healthcare managers and policy makers to stream line and ring face resources to cater for non-urgent or semi-urgent cases presenting to our hospitals in Nigeria. PMID:25538359

The surgical waiting time initiative: A review of the Nigerian situation.

PubMed

Abdulkareem, Imran Haruna

2014-11-01

The concept of surgical waiting time initiative (SWAT) was introduced in developed countries to reduce elective surgery waiting lists and increase efficiency of care. It was supplemented by increasing popularity of day surgery, which shortens elective waiting lists and minimises cancellations. It is established in Western countries, but not in developing countries like Nigeria where it is still evolving. A search was carried out in Pub Med, Google, African journals online (AJOL), Athens and Ovid for relevant publications on elective surgery waiting list in Nigeria, published in English language. Words include waiting/wait time, waiting time initiative, time to surgery, waiting for operations, waiting for intervention, waiting for procedures and time before surgery in Nigeria. A total of 37 articles published from Nigeria in relation to various waiting times were found from the search and fulfilled the inclusion criteria. Among them, 11 publications (29.7%) were related to emergency surgery waiting times, 10 (27%) were related to clinic waiting times, 9 (24.3%) were related to day case surgery, 2 (5.5%) were related to investigation waiting times and only 5 (13.5%) articles were specifically published on elective surgery waiting times. A total of 9 articles (24.5%) were published from obstetrics and gynaecology (OG), 7 (19%) from general surgery, 5 (13.5%) from public health, 3 (8%) from orthopaedics, 3 (8%) from general practice (GP), 3 (8%) from paediatrics/paediatric surgery, 2 (5.5%) from ophthalmology, 1 (2.7%) from ear, nose and throat (ENT), 1 (2.7%) from plastic surgery, 1 (2.7%) from urology and only 1 (2.7%) article was published from dental/maxillofacial surgery. Waiting times mean different things to different health practitioners in Nigeria. There were only 5/37 articles (13.5%) specifically related to elective surgery waiting times in Nigerian hospitals, which show that the concept of the SWAT is still evolving in Nigeria. Of the 37, 11 (24.5%) publications were from obstetrics and gynaecology (O & G) alone, but these were mostly related to emergency antenatal care rather than surgery. Therefore, more research and initiative needs to be undertaken from all the surgical sub-specialties in order to disseminate this concept of SWAT towards early diagnosis and treatment of elective life-threatening conditions, as well as effective patient care. Adopting this concept will help healthcare managers and policy makers to stream line and ring face resources to cater for non-urgent or semi-urgent cases presenting to our hospitals in Nigeria.

What are the 'active ingredients' of interventions targeting the public's engagement with antimicrobial resistance and how might they work?

PubMed

McParland, Joanna L; Williams, Lynn; Gozdzielewska, Lucyna; Young, Mairi; Smith, Fraser; MacDonald, Jennifer; Langdridge, Darren; Davis, Mark; Price, Lesley; Flowers, Paul

2018-05-27

Changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. A systematic review of interventions that targeted public AMR awareness and associated behaviour was previously conducted. Here, we focus on identifying the active content of these interventions and explore potential mechanisms of action. The project took a novel approach to intervention mapping utilizing the following steps: (1) an exploration of explicit and tacit theory and theoretical constructs within the interventions using the Theoretical Domains Framework (TDFv2), (2) retrospective coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1, and (3) an investigation of coherent links between the TDF domains and BCTs across the interventions. Of 20 studies included, only four reported an explicit theoretical basis to their intervention. However, TDF analysis revealed that nine of the 14 TDF domains were utilized, most commonly 'Knowledge' and 'Environmental context and resources'. The BCT analysis showed that all interventions contained at least one BCT, and 14 of 93 (15%) BCTs were coded, most commonly 'Information about health consequences', 'Credible source', and 'Instruction on how to perform the behaviour'. We identified nine relevant TDF domains and 14 BCTs used in these interventions. Only 15% of BCTs have been applied in AMR interventions thus providing a clear opportunity for the development of novel interventions in this context. This methodological approach provides a useful way of retrospectively mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content. Statement of contribution What is already known on this subject? Evidence of the effectiveness of interventions that target the public to engage them with AMR is mixed; the public continue to show poor knowledge and misperceptions of AMR. Little is known about the common, active ingredients of AMR interventions targeting the public and information on explicit theoretical content is sparse. Information on the components of AMR public health interventions is urgently needed to enable the design of effective interventions to engage the public with AMR stewardship behaviour. What does this study add? The analysis shows very few studies reported any explicit theoretical basis to the interventions they described. Many interventions share common components, including core mechanisms of action and behaviour change techniques. The analysis suggests components of future interventions to engage the public with AMR. © 2018 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

Services oriented architectures and rapid deployment of ad-hoc health surveillance systems: lessons from Katrina relief efforts.

PubMed

Mirhaji, Parsa; Casscells, S Ward; Srinivasan, Arunkumar; Kunapareddy, Narendra; Byrne, Sean; Richards, David Mark; Arafat, Raouf

2006-01-01

During the Hurricane Katrina relief efforts, a new city was born overnight within the City of Houston to provide accommodation and health services for thousands of evacuees deprived of food, rest, medical attention, and sanitation. The hurricane victims had been exposed to flood water, toxic materials, physical injury, and mental stress. This scenario was an invitation for a variety of public health hazards, primarily infectious disease outbreaks. Early detection and monitoring of morbidity and mortality among evacuees due to unattended health conditions was an urgent priority and called for deployment of real-time surveillance to collect and analyze data at the scene, and to enable and guide appropriate response and planning activities. The University of Texas Health Science Center at Houston (UTHSC) and the Houston Department of Health and Human Services (HDHHS) deployed an ad hoc surveillance system overnight by leveraging Internet-based technologies and Services Oriented Architecture (SOA). The system was post-coordinated through the orchestration of Web Services such as information integration, natural language processing, syndromic case finding, and online analytical processing (OLAP). Here we will report the use of Internet-based and distributed architectures in providing timely, novel, and customizable solutions on demand for unprecedented events such as natural disasters.

Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana

PubMed Central

Doyle, John T.; Lefthand, Myra J.; Young, Sara L.; Kindness, Larry; Other Medicine, Roberta; Ford, Timothy E.; Dietrich, Eric; Parker, Albert E.; Hoover, Joseph H.; Camper, Anne K.

2018-01-01

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families’ financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources. PMID:29304032

Impact of the 2008 economic and financial crisis on child health: a systematic review.

PubMed

Rajmil, Luis; Fernandez de Sanmamed, María-José; Choonara, Imti; Faresjö, Tomas; Hjern, Anders; Kozyrskyj, Anita L; Lucas, Patricia J; Raat, Hein; Séguin, Louise; Spencer, Nick; Taylor-Robinson, David

2014-06-01

The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000-50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed children's health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses.

Impact of the 2008 Economic and Financial Crisis on Child Health: A Systematic Review

PubMed Central

Rajmil, Luis; Fernandez de Sanmamed, María-José; Choonara, Imti; Faresjö, Tomas; Hjern, Anders; Kozyrskyj, Anita L.; Lucas, Patricia J.; Raat, Hein; Séguin, Louise; Spencer, Nick; Taylor-Robinson, David

2014-01-01

The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000–50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed children’s health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses. PMID:25019121

Is food allergen analysis flawed? Health and supply chain risks and a proposed framework to address urgent analytical needs.

PubMed

Walker, M J; Burns, D T; Elliott, C T; Gowland, M H; Mills, E N Clare

2016-01-07

Food allergy is an increasing problem for those affected, their families or carers, the food industry and for regulators. The food supply chain is highly vulnerable to fraud involving food allergens, risking fatalities and severe reputational damage to the food industry. Many facets are being pursued to ameliorate the difficulties including better food labelling and the concept of thresholds of elicitation of allergy symptoms as risk management tools. These efforts depend to a high degree on the ability reliably to detect and quantify food allergens; yet all current analytical approaches exhibit severe deficiencies that jeopardise accurate results being produced particularly in terms of the risks of false positive and false negative reporting. If we fail to realise the promise of current risk assessment and risk management of food allergens through lack of the ability to measure food allergens reproducibly and with traceability to an international unit of measurement, the analytical community will have failed a significant societal challenge. Three distinct but interrelated areas of analytical work are urgently needed to address the substantial gaps identified: (a) a coordinated international programme for the production of properly characterised clinically relevant reference materials and calibrants for food allergen analysis; (b) an international programme to widen the scope of proteomics and genomics bioinformatics for the genera containing the major allergens to address problems in ELISA, MS and DNA methods; (c) the initiation of a coordinated international programme leading to reference methods for allergen proteins that provide results traceable to the SI. This article describes in more detail food allergy, the risks of inapplicable or flawed allergen analyses with examples and a proposed framework, including clinically relevant incurred allergen concentrations, to address the currently unmet and urgently required analytical requirements. Support for the above recommendations from food authorities, business organisations and National Measurement Institutes is important; however transparent international coordination is essential. Thus our recommendations are primarily addressed to the European Commission, the Health and Food Safety Directorate, DG Santé. A global multidisciplinary consortium is required to provide a curated suite of data including genomic and proteomic data on key allergenic food sources, made publically available on line.

Epidemiological profile of patients utilising public oral health services in Limpopo province, South Africa.

PubMed

Thema, Lawrence K; Singh, Shenuka

2017-07-12

Despite the impact of oral diseases on the quality of life, there is limited updated evidence on oral health status in Limpopo province. To determine the epidemiological profile of patients utilising public oral health services in Limpopo province. This was a descriptive retrospective clinical chart review conducted in five purposively selected district hospitals in Limpopo province. The collected data included the patient's sociodemographic information, reasons for dental consultation, information on the dental or oral diseases and the treatment received. Five hundred clinical files were systematically selected (100 from each district hospital) for the period 01 January 1995 to 31 December 2013. Data were collected using the World Health Organization's indicator age groups, namely 6-year-olds, 12-year-olds, 18-year-olds and 35-44-year-old groups. A data capturing sheet was used to record the collected information. Data were analysed using the statistical software package for social sciences SPSS version 23.0. The majority of patients were in the age group of 6 to 20 years (n = 375, 75%). The majority were male patients (n = 309; 62%). Dental caries was the most common complaint (n = 298, 60%). The second most common main complaint in this age group was retained primary or deciduous teeth (n = 60, 12%) affecting children mainly in the age group of 6 to 12 years. The most common clinical procedure across all five districts was dental extractions (n = 324, 64%). Other clinical interventions included scaling and polishing (n = 33, 12%) and dental restorative care (n = 20, 3%). There is an urgent need to reorient oral health service delivery in Limpopo province to focus more on preventive oral health programmes.

Expert Consensus Statement on achieving self-sufficiency in safe blood and blood products, based on voluntary non-remunerated blood donation (VNRBD).

PubMed

2012-11-01

All countries face challenges in making sufficient supplies of blood and blood products available and sustainable, while also ensuring the quality and safety of these products in the face of known and emerging threats to public health. Since 1975, the World Health Assembly (WHA) has highlighted the global need for blood safety and availability. WHA resolutions 63·12, 58·13 and 28·72, The Melbourne Declaration on 100% Voluntary Non-Remunerated Donation of Blood and Blood Components and WHO Global Blood Safety Network recommendations have reaffirmed the achievement of 'Self-sufficiency in blood and blood products based on voluntary non-remunerated blood donation (VNRBD)' as the important national policy direction for ensuring a safe, secure and sufficient supply of blood and blood products, including labile blood components and plasma-derived medicinal products. Despite some successes, self-sufficiency is not yet a reality in many countries. A consultation of experts, convened by the World Health Organization (WHO) in September 2011 in Geneva, Switzerland, addressed the urgent need to establish strategies and mechanisms for achieving self-sufficiency. Information on the current situation, and country perspectives and experiences were shared. Factors influencing the global implementation of self-sufficiency, including safety, ethics, security and sustainability of supply, trade and its potential impact on public health, availability and access for patients, were analysed to define strategies and mechanisms and provide practical guidance on achieving self-sufficiency. Experts developed a consensus statement outlining the rationale and definition of self-sufficiency in safe blood and blood products based on VNRBD and made recommendations to national health authorities and WHO. © 2012 World Health Organization. Vox Sanguinis © 2012 International Society of Blood Transfusion.

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

PubMed Central

2009-01-01

Background This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care. PMID:19968871

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program.

PubMed

Chiou, Shang-Jyh; Campbell, Claudia; Horswell, Ronald; Myers, Leann; Culbertson, Richard

2009-12-07

This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care.

Water and health in Europe. A joint report from the European Environment Agency and the WHO Regional Office for Europe.

PubMed

2002-01-01

Shortage of water may be most urgent health problem currently facing some European countries. Climate change is predicted to influence water availability, especially in coastal areas. The extend of provision of piped drinking-water supplies to households varies across Europe and between urban and rural populations. The utilization of water for irrigation and for industry exerts pressure on water resources. Changes in populaton distribution and density are key factors influencing the quality of water resources. Outbreaks of waterborne diseases continue to occur across Europe, and minor supply problems are encountered in all countries. Inadequate sewerage systems are a significant threat to public health. Numerous chemicals are found throughout the aquatic environment. Eutrophication is a major threat to European surface waters. Considerate evidence has accrued linking the quality of bathing water with minor illnesses. Additional efforts are required to sustain the European Region's water resources and to provide safe water. Partnerships and cooperation are needed between the environment and health sectors at al levels of government to disseminate technology, to improve management and to provide financial and institutional support to ensure access to safe water and sanitation for all.

"They see you as a different thing": the experiences of men who have sex with men with healthcare workers in South African township communities.

PubMed

Lane, T; Mogale, T; Struthers, H; McIntyre, J; Kegeles, S M

2008-11-01

To describe interactions between men who have sex with men (MSM) and healthcare workers (HCW) in peri-urban township communities in South Africa. Qualitative study using semistructured in-depth interviews and focus group discussions in the Gauteng province townships of Soweto and Mamelodi. 32 MSM were purposively sampled for in-depth interviews and 15 for focus group discussions. Topics explored included identity, sexuality, community life, use of health services and experiences of stigma and discrimination. MSM felt their options for non-stigmatising sexual healthcare services were limited by homophobic verbal harassment by HCW. Gay-identified men sought out clinics with reputations for employing HCW who respected their privacy and their sexuality and challenged those HCW who mistreated them. Non-gay-identified MSM presented masculine, heterosexual identities when presenting for sexual health problems and avoided discussing their sexuality with HCW. The strategies MSM employ to confront or avoid homophobia from HCW may not be conducive to sexual health promotion in this population. Interventions that increase the capacity of public sector HCW to provide appropriate sexual health services to MSM are urgently needed.

[Challenges in the assessment and managment of health risks associated with emerging water micropollutants].

PubMed

Levi, Yves

2009-06-01

Analytical laboratories can now identify and quantify an impressive number of "new" pollutants present at very low concentrations in water. Nanotechnology products are a new cause for concern. " Emerging " pollutants are defined as substances that were not previously sought or detected (plasticizers, drugs, chlorination byproducts, persistant organic pollutants, ...) and that are now being identified in many continental water resources. The biological actions of these substances, alone and in combination with other more " classical "pollutants, include such effects as endocrine disruption. Contaminants may be present in surface and groundwater resources, may be generated during treatment, and are found in drinking water distribution networks. In industrialized countries, the main source of emerging pollutants for humans is not water, but rather food, cosmetics and air. Urgent measures are needed to protect biodiversity and human health, including quantitative risk assessment, toxicologic studies of xenobiotic mixtures and chronic effects, strategies to protect water resources, technological advances in wastewater treatment, reliable potable water production, and new inert materials for transport and storage. Good sanitation and safe tap water are major contributors to human health and well-being Major efforts and investments are needed, based on rigorous, objective assessments of risks for the environment and public health.

Stigma, lack of knowledge and prevalence maintain HIV risk among Black Africans in New Zealand.

PubMed

Henrickson, Mark; Dickson, Nigel; Mhlanga, Fungai; Ludlam, Adrian

2015-02-01

The AfricaNZ Health project aimed explore HIV risks in Black African communities in NZ with a view to informing HIV infection prevention and health promotion programs. AfricaNZ Health was completed in two phases. The first developed desk estimates of the resident Black African population in New Zealand, and Africans living with HIV. The second comprised two arms: an anonymous survey administered at African community events and a series of focus groups around the country. High levels of knowledge and positive attitudes about HIV were more often found in older than younger age groups. Condom use was higher in the younger group than in older age groups. Traditional attitudes still inform some beliefs about HIV. Stigma about HIV and anyone at risk for HIV remains very high among Africans. Western sexual identity constructs are not meaningful. A culturally informed strategy for risk and stigma reduction is urgently needed. The existing prevention and care infrastructure, informed by MSM experiences, must address increased risk to Black African new settlers, but this is not a reason to discriminate or further stigmatise an already vulnerable population. © 2014 Public Health Association of Australia.

Distribution and utilization of curative primary healthcare services in Lahej, Yemen.

PubMed

Bawazir, A A; Bin Hawail, T S; Al-Sakkaf, K A Z; Basaleem, H O; Muhraz, A F; Al-Shehri, A M

2013-09-01

No evidence-based data exist on the availability, accessibility and utilization of healthcare services in Lahej Governorate, Yemen. The aim of this study was to assess the distribution and utilization of curative services in primary healthcare units and centres in Lahej. Cross-sectional study (clustering sample). This study was conducted in three of the 15 districts in Lahej between December 2009 and August 2010. Household members were interviewed using a questionnaire to determine sociodemographic characteristics and types of healthcare services available in the area. The distribution of health centres, health units and hospitals did not match the size of the populations or areas of the districts included in this study. Geographical accessibility was the main obstacle to utilization. Factors associated with the utilization of curative services were significantly related to the time required to reach the nearest facility, seeking curative services during illness and awareness of the availability of health facilities (P < 0.01). There is an urgent need to look critically and scientifically at the distribution of healthcare services in the region in order to ensure accessibility and quality of services. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Practice nurse and health visitor management of acute minor illness in a general practice.

PubMed

Pritchard, A; Kendrick, D

2001-11-01

To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses. Patients requesting 'urgent' appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service. A general practice in Nottingham, England. Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re-consultations for the same condition within 2 weeks. About 2056 urgent consultations were recorded in the study period, of which 332 (16.1%) were seen by PNs and 46 (2.2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0.033) and PNs (P=0.010). There was no difference by health professional for prescription rates (P=0.76), re-consultations (P=0.14), or referrals to secondary care (P=0.07). General practitioners were more likely to initiate further investigations than the PNs or HV (P < 0.001). With suitable training, PNs and HVs can successfully manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.

Hospitalizations due to selected infections caused by opportunistic premise plumbing pathogens (OPPP) and reported drug resistance in the United States older adult population in 1991-2006.

PubMed

Naumova, Elena N; Liss, Alexander; Jagai, Jyotsna S; Behlau, Irmgard; Griffiths, Jeffrey K

2016-12-01

The Flint Water Crisis-due to changes of water source and treatment procedures-has revealed many unsolved social, environmental, and public health problems for US drinking water, including opportunistic premise plumbing pathogens (OPPP). The true health impact of OPPP, especially in vulnerable populations such as the elderly, is largely unknown. We explored 10 8 claims in the largest US national uniformly collected data repository to determine rates and costs of OPPP-related hospitalizations. In 1991-2006, 617,291 cases of three selected OPPP infections resulted in the elderly alone of $0.6 billion USD per year of payments. Antibiotic resistance significantly increased OPPP illness costs that are likely to be underreported. More precise estimates for OPPP burdens could be obtained if better clinical, microbiological, administrative, and environmental monitoring data were cross-linked. An urgent dialog across governmental and disciplinary divides, and studies on preventing OPPP through drinking water exposure, are warranted.

[Domestic violence in the conception of health professionals trainers].

PubMed

de Souza, Edinilsa Ramos; Ribeiro, Adalgisa Peixoto; Penna, Lúcia Helena Garcia; Ferreira, Ana Lúcia; dos Santos, Neuci Cunha; Tavares, Claudia Mara de Melo

2009-01-01

This article identifies the conceptions and suggestions of professors of medicine and nursing courses about the insertion of this subject in the formation of their students. An exploratory research was carried out using a questionnaire applied to coordinators of disciplines in such courses at public and private universities in the cities of Rio de Janeiro and Cuiabá. Many of them recognizes violence as a health problem, although 40.7% of medicine professors and 71.1% of nursing professors of the two cities discusses this subject in their classes. The medicine professors suggests the insertion of the violence subject in their students formation with visits to institutions, meeting groups with people in violence situations and interviews with experienced professionals of the area. The nursing professors prefer resources such as films and videos, seminaries and conferences. Gaps were also identified in the students and professors formation, which do not feel able to discuss this thematic. It is indicated that a renovation in the curriculum is urgently necessary.

Early warning system for financially distressed hospitals via data mining application.

PubMed

Koyuncugil, Ali Serhan; Ozgulbas, Nermin

2012-08-01

The aim of this study is to develop a Financial Early Warning System (FEWS) for hospitals by using data mining. A data mining method, Chi-Square Automatic Interaction Detector (CHAID) decision tree algorithm, was used in the study for financial profiling and developing FEWS. The study was conducted in Turkish Ministry of Health's public hospitals which were in financial distress and in need of urgent solutions for financial issues. 839 hospitals were covered and financial data of the year 2008 was obtained from Ministry of Health. As a result of the study, it was determined that 28 hospitals (3.34%) had good financial performance, and 811 hospitals (96.66%) had poor financial performance. According to FEWS, the covered hospitals were categorized into 11 different financial risk profiles, and it was found that 6 variables affected financial risk of hospitals. According to the profiles of hospitals in financial distress, one early warning signal was detected and financial road map was developed for risk mitigation.

[Health Council of the Netherlands' report on contraception in intellectually disabled people].

PubMed

Meijer, M M; Ewals, F V P M; Scholte, F A

2003-02-01

Recently the Health Council of the Netherlands published a comprehensive report which incorporates juridical, ethical, medical and social aspects directing the judgement and decision-making regarding contraception in people with an intellectual disability. Although professional responsibility is in the hands of medical practitioners, medical guidelines to manage consent issues and to indicate contraception in this population are missing. There are no ethical and legal grounds for enforcing contraception and it comes down to professional accountability in trying to prevent irresponsible parenthood by a convincing dialogue. People with intellectual disabilities are intellectually, physically, socially and economically prone to be vulnerable parents, who need assistance in making deliberate choices to have children and in raising them. There is an urgent need for advanced sexual education and a comprehensive social discussion on contraception for this population. Physicians for intellectually disabled people embrace the committee's recommendations to stimulate public debate, enhance research, develop guidelines and build professional networks to call on.

Sexual Violence Inside Prisons: Rates of Victimization

PubMed Central

Blitz, Cynthia L.; Shi, Jing; Bachman, Ronet; Siegel, Jane A.

2006-01-01

People in prison are exposed to and experience sexual violence inside prisons, further exposing them to communicable diseases and trauma. The consequences of sexual violence follow the individual into the community upon release. This paper estimates the prevalence of sexual victimization within a state prison system. A total of 6,964 men and 564 women participated in a survey administered using audio-CASI. Weighted estimates of prevalence were constructed by gender and facility size. Rates of sexual victimization varied significantly by gender, age, perpetrator, question wording, and facility. Rates of inmate-on-inmate sexual victimization in the previous 6 months were highest for female inmates (212 per 1,000), more than four times higher than male rates (43 per 1,000). Abusive sexual conduct was more likely between inmates and between staff and inmates than nonconsensual sexual acts. Sexual violence inside prison is an urgent public health issue needing targeted interventions to prevent and ameliorate its health and social consequences, which spatially concentrate in poor inner-city areas where these individuals ultimately return. PMID:16937087

Poultry red mite (Dermanyssus gallinae) infestation: a broad impact parasitological disease that still remains a significant challenge for the egg-laying industry in Europe.

PubMed

Sigognault Flochlay, Annie; Thomas, Emmanuel; Sparagano, Olivier

2017-08-01

The poultry red mite, Dermanyssus gallinae, has been described for decades as a threat to the egg production industry, posing serious animal health and welfare concerns, adversely affecting productivity, and impacting public health. Research activities dedicated to controlling this parasite have increased significantly. Their veterinary and human medical impact, more particularly their role as a disease vector, is better understood. Nevertheless, red mite infestation remains a serious concern, particularly in Europe, where the prevalence of red mites is expected to increase, as a result of recent hen husbandry legislation changes, increased acaricide resistance, climate warming, and the lack of a sustainable approach to control infestations. The main objective of the current work was to review the factors contributing to this growing threat and to discuss their recent development in Europe. We conclude that effective and sustainable treatment approach to control poultry red mite infestation is urgently required, included integrated pest management.

[Health promotion and citizenship: the perception of the teacher about citizenship].

PubMed

Bydlowski, Cynthia Rachid; Lefèvre, Ana Maria Cavalcanti; Pereira, Isabel Maria Teixeira Bicudo

2011-03-01

General health conditions as well as quality of life must urgently be improved in developing countries. This improvement could be achieved, at least in part, by the practice of citizenship. Education exerts a special role in citizenship development. In this regard, teachers in school are of great importance, since they influence and inspire the students beyond the formal curricula. The purpose of this study was to evaluate the citizenship perception of teachers from basic and junior schools, and their opinion about their role and the school on the student citizenship development. Forty teachers from public schools in the city of Sao Paulo (SP, Brazil) were interviewed. Their opinions and speeches were analysed employing qualitative methods. It has been observed that the teachers consider the school as the place where citizenship should be developed. They know how important are their attitudes and disposition of mind on student formation. They understand "citizenship" as active participation in the society, beyond rights, duties and knowledge.

Use of assessment to reinforce patient safety as a habit

PubMed Central

Galbraith, R M; Holtman, M C; Clyman, S G

2006-01-01

The US spends far more than any other nation on health care. Physicians undergo lengthy and comprehensive training that is carefully scrutinized, and are held to high standards in national examinations. At best the care delivered matches or exceeds that in any other country. And yet, often simple preventable medical errors occur at alarming and unacceptable rates. The public, corporate consumers of health care, large payors and malpractice insurance carriers are all becoming impatient with the pace of improvement. The medical profession recognizes that dealing with this problem is an urgent priority and is grappling to find the best approaches. This paper focuses on the constructive use of assessment to embed a pervasive and proactive culture of patient safety into practice, starting with the trainee and extending out into the practice years. This strategy is based on the adage that “assessment drives curriculum” and proposes a series of new assessment tools to be added to all phases of the training‐practice continuum. PMID:17142605

Antimicrobial resistance in Saudi Arabia

PubMed Central

Zowawi, Hosam M.

2016-01-01

Antimicrobial resistance (AMR) is increasingly being highlighted as an urgent public and animal health issue worldwide. This issue is well demonstrated in bacteria that are resistant to last-line antibiotics, suggesting a future with untreatable infections. International agencies have suggested combating strategies against AMR. Saudi Arabia has several challenges that can stimulate the emergence and spread of multidrug-resistant bacteria. Tackling these challenges need efforts from multiple sectors to successfully control the spread and emergence of AMR in the country. Actions should include active surveillance to monitor the emergence and spread of AMR. Infection prevention and control precautions should also be optimized to limit further spread. Raising awareness is essential to limit inappropriate antibiotics use, and the antibiotic stewardship programs in hospital settings, outpatients, and community pharmacies, should regulate the ongoing use of antimicrobials. PMID:27570847

A Biosurfactant-Inspired Heptapeptide with Improved Specificity to Kill MRSA.

PubMed

Liu, Yuan; Ding, Shuangyang; Dietrich, Richard; Märtlbauer, Erwin; Zhu, Kui

2017-02-01

The emergence and rapid spread of methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat to public health. New antibiotics and strategies are urgently needed to combat S. aureus associated infections. Bacaucin, a novel cyclic lipopeptide from Bacillus subtilis CAU21, is reported. Bacaucin shows broad antibacterial activity against Gram-positive bacteria, but is also hemolytic and cytotoxic. However, bacaucin-1, a bacaucin-inspired ring-opened heptapeptide, shows specific antibacterial activity against MRSA by a membrane-disruptive mechanism without detectable toxicity to mammalian cells or induction of bacterial resistance. Bacaucin-1 was efficient in preventing infections in both in vitro and in vivo models and is a valuable prototype antibiotic with high potential against S. aureus infections. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Malaria in pregnancy: the relevance of animal models for vaccine development.

PubMed

Doritchamou, Justin; Teo, Andrew; Fried, Michal; Duffy, Patrick E

2017-10-06

Malaria during pregnancy due to Plasmodium falciparum or P. vivax is a major public health problem in endemic areas, with P. falciparum causing the greatest burden of disease. Increasing resistance of parasites and mosquitoes to existing tools, such as preventive antimalarial treatments and insecticide-treated bed nets respectively, is eroding the partial protection that they offer to pregnant women. Thus, development of effective vaccines against malaria during pregnancy is an urgent priority. Relevant animal models that recapitulate key features of the pathophysiology and immunology of malaria in pregnant women could be used to accelerate vaccine development. This review summarizes available rodent and nonhuman primate models of malaria in pregnancy, and discusses their suitability for studies of biologics intended to prevent or treat malaria in this vulnerable population.

Essential multimeric enzymes in kinetoplastid parasites: A host of potentially druggable protein-protein interactions.

PubMed

Wachsmuth, Leah M; Johnson, Meredith G; Gavenonis, Jason

2017-06-01

Parasitic diseases caused by kinetoplastid parasites of the genera Trypanosoma and Leishmania are an urgent public health crisis in the developing world. These closely related species possess a number of multimeric enzymes in highly conserved pathways involved in vital functions, such as redox homeostasis and nucleotide synthesis. Computational alanine scanning of these protein-protein interfaces has revealed a host of potentially ligandable sites on several established and emerging anti-parasitic drug targets. Analysis of interfaces with multiple clustered hotspots has suggested several potentially inhibitable protein-protein interactions that may have been overlooked by previous large-scale analyses focusing solely on secondary structure. These protein-protein interactions provide a promising lead for the development of new peptide and macrocycle inhibitors of these enzymes.

Problems associated with the control of rodents in tropical Africa

PubMed Central

Gratz, N. G.; Arata, A. A.

1975-01-01

As elsewhere in the world, rodents are responsible for very considerable economic losses in tropical Africa because of their depredations on both growing crops and stored food products. Unfortunately, few accurate data are available on the extent of these losses but there is evidence that they are considerable. The public health importance of rodents, both as reservoirs and vectors of disease in tropical Africa, is also great; plague, leptospirosis, murine typhus, and Lassa fever are among the diseases associated with rodent hosts. Scientifically based rodent control programmes have been carried out in very few areas of Africa and there is urgent need for studies and demonstrations on rodent control in both urban and rural areas. The problems likely to be encountered are reviewed and methods of control proposed. PMID:1085224

Lyme borreliosis: an update for Canadian dermatologists.

PubMed

Potok, Olivia V; Brassard, Alain

2013-01-01

Lyme borreliosis is a multisystemic tick-borne spirochetosis, which may result in dermatologic, musculoskeletal, cardiovascular, and neurologic manifestations. Patients with suspected acute Lyme borreliosis infection may be referred for urgent dermatologic review. Canadian dermatologists should be aware of the latest information regarding the diagnosis and management of Lyme borreliosis. This review is based on a PubMed database search combining the word "Lyme" with variations of the word "Canada." Data sources included articles from the fields of ecology, epidemiology, laboratory diagnostics, and clinical management. In this review, the ecological basis of spirochete transmission by tick vectors is described. The latest available Canadian epidemiologic data are summarized. North American clinical manifestations of Lyme borreliosis are contrasted with European presentations. The Canadian Public Health Laboratory Network's diagnostic guidelines are summarized. Finally, treatment recommendations are outlined.

Will integrated surveillance systems for vectors and vector-borne diseases be the future of controlling vector-borne diseases? A practical example from China.

PubMed

Wu, Y; Ling, F; Hou, J; Guo, S; Wang, J; Gong, Z

2016-07-01

Vector-borne diseases are one of the world's major public health threats and annually responsible for 30-50% of deaths reported to the national notifiable disease system in China. To control vector-borne diseases, a unified, effective and economic surveillance system is urgently needed; all of the current surveillance systems in China waste resources and/or information. Here, we review some current surveillance systems and present a concept for an integrated surveillance system combining existing vector and vector-borne disease monitoring systems. The integrated surveillance system has been tested in pilot programmes in China and led to a 21·6% cost saving in rodent-borne disease surveillance. We share some experiences gained from these programmes.

Advertising of ultra-processed foods and beverages: children as a vulnerable population.

PubMed

Mallarino, Christina; Gómez, Luis F; González-Zapata, Laura; Cadena, Yazmín; Parra, Diana C

2013-10-01

The rapid nutrition transition occurring in Latin America has resulted in a sharp increase of childhood overweight and obesity. Recent evidence has shown that food and beverage advertising has a great influence on children's eating behavior. This population has become a key target market for the ultra-processed foods and beverages industry, which is marketing products in an aggressive way. Evidence shows that Latin American countries have poor regulation of ultra-processed foods and beverages advertising, where the discourse of self-regulation still prevails over statutory regulations. The following commentary explores how advertising might play an important role in developing unhealthy dietary patterns and obesity in Latin American children, as well as the urgent need for government action and the involvement of civil society to tackle this public health issue.

Proliferation of nuclear weapons: opportunities for control and abolition.

PubMed

Sidel, Victor W; Levy, Barry S

2007-09-01

Nuclear weapons pose a particularly destructive threat. Prevention of the proliferation and use of nuclear weapons is urgently important to public health. "Horizontal" proliferation refers to nation-states or nonstate entities that do not have, but are acquiring, nuclear weapons or developing the capability and materials for producing them. "Vertical" proliferation refers to nation-states that do possess nuclear weapons and are increasing their stockpiles of these weapons, improving the technical sophistication or reliability of their weapons, or developing new weapons. Because nation-states or other entities that wish to use or threaten to use nuclear weapons need methods for delivering those weapons, proliferation of delivery mechanisms must also be prevented. Controlling proliferation--and ultimately abolishing nuclear weapons--involves national governments, intergovernmental organizations, nongovernmental and professional organizations, and society at large.

The application of knowledge synthesis methods in agri-food public health: recent advancements, challenges and opportunities.

PubMed

Young, Ian; Waddell, Lisa; Sanchez, Javier; Wilhelm, Barbara; McEwen, Scott A; Rajić, Andrijana

2014-03-01

Knowledge synthesis refers to the integration of findings from individual research studies on a given topic or question into the global knowledge base. The application of knowledge synthesis methods, particularly systematic reviews and meta-analysis, has increased considerably in the agri-food public health sector over the past decade and this trend is expected to continue. The objectives of our review were: (1) to describe the most promising knowledge synthesis methods and their applicability in agri-food public health, and (2) to summarize the recent advancements, challenges, and opportunities in the use of systematic review and meta-analysis methods in this sector. We performed a structured review of knowledge synthesis literature from various disciplines to address the first objective, and used comprehensive insights and experiences in applying these methods in the agri-food public health sector to inform the second objective. We describe five knowledge synthesis methods that can be used to address various agri-food public health questions or topics under different conditions and contexts. Scoping reviews describe the main characteristics and knowledge gaps in a broad research field and can be used to evaluate opportunities for prioritizing focused questions for related systematic reviews. Structured rapid reviews are streamlined systematic reviews conducted within a short timeframe to inform urgent decision-making. Mixed-method and qualitative reviews synthesize diverse sources of contextual knowledge (e.g. socio-cognitive, economic, and feasibility considerations). Systematic reviews are a structured and transparent method used to summarize and synthesize literature on a clearly-defined question, and meta-analysis is the statistical combination of data from multiple individual studies. We briefly describe and discuss key advancements in the use of systematic reviews and meta-analysis, including: risk-of-bias assessments; an overall quality-of-evidence approach; engagement of stakeholders; Bayesian, multivariate, and network meta-analysis; and synthesis of diagnostic test accuracy studies. We also highlight several challenges and opportunities in the conduct of systematic reviews (e.g. inclusion of grey literature, minimizing language bias, and optimizing search strategies) and meta-analysis (e.g. inclusion of observational studies and approaches to address the insufficient reporting of data and significant heterogeneity). Many of these developments have yet to be comprehensively applied and evaluated in an agri-food public health context, and more research is needed in this area. There is a need to strengthen knowledge synthesis capacity and infrastructure at the regional, national, and international levels in this sector to ensure that the best available knowledge is used to inform future decision-making about agri-food public health issues. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Unnatural Deaths Among Children and Adolescents in Isfahan Province, Iran: A Forensic Epidemiology Study of Postmortem Data.

PubMed

Holakouie-Naieni, Kourosh; Koehler, Steven A; Karimi, Roya; Mardani, Fardin; Karimi, Jalal

2016-01-01

The issue of child and adolescent injury and violence is often absent from discussions and is largely invisible in public health policies. The purpose of this study was to describe the frequency and pattern of unnatural deaths during childhood and adolescence in Isfahan province in Iran. This retrospective, descriptive study involved unnatural deaths among individuals under the age of 20 years who died from unnatural causes as determined by a forensic autopsy at the Legal Medicine Center of Isfahan. During the study period, 8,010 unnatural deaths occurred, 1,222 of which were individuals under 20 years old. All 1,222 of these unnatural deaths were identified through autopsy. Among the 1,222 cases, 895 (73.2%) were male, and 327 were female (26.8%). Accidental deaths were found to be the most frequent manner of death comprising 1,029 (83.96%) cases, followed by suicide (120, 9.82%), undetermined cause of death (39, 3.19%), and homicide (9, 2.86%) cases. Road traffic accidents were the number 1 cause of death (597, 49%), followed by burns (122, 10%) and hanging (90, 7.4%). Injuries and violence that occur during childhood and adolescence represent a global public health problem, especially in low- and middle-income regions, and require urgent action.

E-waste issues in Sri Lanka and the Basel Convention.

PubMed

Suraweera, Inoka

2016-03-01

E-waste is hazardous, complex and expensive to treat in an environmentally sound manner. The management of e-waste is considered a serious challenge in both developed and developing countries and Sri Lanka is no exception. Due to significant growth in the economy and investments and other reasons the consumption of electronic and electrical equipment in Sri Lanka has increased over the years resulting in significant generation of e-waste. Several initiatives such as introduction of hazardous waste management rules, ratification of the Basel Convention in 1992 and the introduction of a National Corporate E-waste Management Program have been undertaken in Sri Lanka to manage e-waste. Strengthening policy and legislation, introducing methods for upstream reduction of e-waste, building capacity of relevant officers, awareness raising among school children and the general public and development of an e-waste information system are vital. Research on e-waste needs to be developed in Sri Lanka. The health sector could play a leading role in the provision of occupational health and safety for e-waste workers, advocacy, capacity building of relevant staff and raising awareness among the general public about e-waste. Improper e-waste management practices carried out by informal sector workers need to be addressed urgently in Sri Lanka.

Zika virus, vectors, reservoirs, amplifying hosts, and their potential to spread worldwide: what we know and what we should investigate urgently.

PubMed

Vorou, Rengina

2016-07-01

The widespread epidemic of Zika virus infection in South and Central America and the Caribbean in 2015, along with the increased incidence of microcephaly in fetuses born to mothers infected with Zika virus and the potential for worldwide spread, indicate the need to review the current literature regarding vectors, reservoirs, and amplification hosts. The virus has been isolated in Africa in mosquitoes of the genera Aedes, Anopheles, and Mansonia, and in Southeast Asia and the Pacific area in mosquitoes of the genus Aedes. Aedes albopictus has invaded several countries in Central Africa and all Mediterranean countries, and continues to spread throughout Central and Northern Europe. The wide distribution of the virus in animal hosts and vectors favors the emergence of recombinants. The virus has been isolated in monkeys, and antibodies have been detected in domestic sheep, goats, horses, cows, ducks, rodents, bats, orangutans, and carabaos. It is a public health imperative to define the domestic and wild animal reservoirs, amplification hosts, and vector capacity of the genera Aedes, Anopheles, and Mansonia. These variables will define the geographic distribution of Zika virus along with the indicated timing and scale of the environmental public health interventions worldwide. Copyright © 2016 The Author. Published by Elsevier Ltd.. All rights reserved.

Infant food marketing strategies undermine effective regulation of breast-milk substitutes: trends in print advertising in Australia, 1950-2010.

PubMed

Smith, Julie; Blake, Miranda

2013-08-01

This study addresses the issue of whether voluntary industry regulation has altered companies' marketing of breast-milk substitutes in Australia since the adoption of the World Health Organization (WHO) International Code on the Marketing of Breast-milk Substitutes 1981. Print advertisements marketing breast-milk substitutes were systematically sampled from the Australian Women's Weekly (AWW) magazine and the Medical Journal of Australia (MJA) for the 61 years from 1950 to 2010. Breast-milk substitute advertising in both the MJA and the AWW peaked and began declining before the introduction of the WHO Code in 1981. Although there was almost no infant formula advertising in AWW after 1975-79, other breast-milk substitute advertising has been increasing since 1992, in particular for baby food, toddler formula and food and brand promotion. Companies have adopted strategies to minimise the effects of the Code on sales and profit in Australia, including increasing toddler formula and food advertisements, increasing brand promotion to the public, and complying with more limited voluntary regulatory arrangements. Comprehensive regulation is urgently required to address changed marketing practices if it is to protect breastfeeding in Australia. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

Familiarity with, knowledge of, and attitudes toward epilepsy in residents of Seoul, South Korea.

PubMed

Choi-Kwon, S; Park, K A; Lee, H J; Park, M S; Lee, C H; Cheon, S E; Youn, M H; Lee, S K; Chung, C-K

2004-07-01

The aim of this study was to investigate the perceptions of epilepsy in Seoul, South Korea, a country where social stigma toward epilepsy is still pronounced. We randomly selected 1000 persons living in Seoul and performed telephone interviews regarding public awareness, knowledge, and attitudes toward epilepsy. Among 1000 respondents, the 92% who had read or heard about epilepsy became the subjects of the study. Word of mouth was most often referenced as a source of knowledge (78%). Forty-seven percentage believed that epilepsy is inheritable, whereas 5% thought that epilepsy is a mental illness. Marriage of their children to an epileptic person, childbearing by women with epilepsy, and employing a person with epilepsy were opposed by more than 50% of respondents. The reasons for the negative attitudes were that epilepsy was hereditary and untreatable (P < 0.05, respectively). Our study revealed that there still remains negative attitudes regarding the marriage, childbearing, and employment of persons with epilepsy, which may stem from misconceptions about the cause and treatability of epilepsy, possibly due in part to the influence of herbal medicine, and South Korea's ethnic homogeneity. Public health education either through media or school health education is urgently needed to improve knowledge about, and attitudes toward epilepsy.

Incarcerated sex workers and HIV prevention in China: social suffering and social justice countermeasures.

PubMed

Tucker, Joseph; Ren, Xin; Sapio, Flora

2010-01-01

Sex workers in China are routinely coercively detained through administrative mechanisms outside of legal procedures, but very little is known about the anthropologic and public health context of these policies. This biosocial analysis of female Chinese sex worker detention uses ethnographic, legal, and public health data to describe social suffering and countervailing social justice responses among incarcerated sex workers (ISW) in China. Compared to sex workers not detained in China, ISW face substantive inequalities inscribed in physical and psychological suffering. Chinese sex worker detention camp practices may not only systematically increase HIV/syphilis risk among ISW, but also work to narrow women's social spheres of influence, a particularly cruel tragedy in a Chinese social system that highly values social and personal connections. A limited empiric analysis of Guangxi Province STI clinic data shows that cities detaining sex workers have higher mean HIV prevalence compared to cities that do not detain sex workers. While incipient medical and legal movements in China have generated momentum for expanding ISW services and resources, there is still substantial variation in the implementation of laws that ensure basic life-saving medical treatments. Post-incarceration social justice programs for sex workers linking women to essential STI/HIV resources, reconnecting broken social lives, and helping restore interpersonal relationships are urgently needed.

Moving the Science of Team Science Forward: Collaboration and Creativity

PubMed Central

Hall, Kara L.; Feng, Annie X.; Moser, Richard P.; Stokols, Daniel; Taylor, Brandie K.

2012-01-01

Teams of scientists representing diverse disciplines are often brought together for purposes of better understanding and, ultimately, resolving urgent public health and environmental problems. Likewise, the emerging field of the science of team science draws on diverse disciplinary perspectives to better understand and enhance the processes and outcomes of scientific collaboration. In this supplement to the American Journal of Preventive Medicine, leading scholars in the nascent field of team science have come together with a common goal of advancing the field with new models, methods, and measures. This summary article highlights key themes reflected in the supplement and identifies several promising directions for future research organized around the following broad challenges: (1) operationalizing cross-disciplinary team science and training more clearly; (2) conceptualizing the multiple dimensions of readiness for team science; (3) ensuring the sustainability of transdisciplinary team science; (4) developing more effective models and strategies for training transdisciplinary scientists; (5) creating and validating improved models, methods, and measures for evaluating team science; and (6) fostering transdisciplinary cross-sector partnerships. A call to action is made to leaders from the research, funding, and practice sectors to embrace strategies of creativity and innovation in a collective effort to move the field forward, which may not only advance the science of team science but, ultimately, public health science and practice. PMID:18619406

[Epidemiology's and epidemiologists' vices and virtues].

PubMed

Gennaro, Valerio; Ricci, Paolo; Levis, Angelo Gino; Crosignani, Paolo

2009-01-01

Epidemiology is a public health oriented discipline and is aimed to detect the spatial, temporal, social and causal distribution of diseases in the human population, in order to promote timely and effective preventive solutions. This paper highlights some gold standard of the epidemiological method and suggests some considerations for a critical comprehension of epidemiological studies, in particular those that deny or minimize the existence of public health risks. This paper will focus on some crucial elements such as definition, attribution, misclassification and underestimation of the harmful exposures caused by a multitude of factors, undervaluation of the possible interactions among harmful agents (even when law limits are respected), selection of exposed populations, insufficient number of studied diseases, importance of the right comparisons between similar groups when the reference population is used, disproportion between shortness of follow-up in respect with long latency period of the studied diseases, including cancer. This paper also observes that many epidemiologists carry out confirmative studies rather than exploratory ones, and they end to both underestimate and underevaluate the multiplicity of the causal associations in favour of a reductive and a critical approach to the statistics which, in final analysis, wants to replace epidemiology. It points out, moreover, that neglecting primary prevention as well as precautionary principles in the interpretation of public health studies, arises the suspicion of professional limitation or strong conflict of interests (business bias). Epidemiology is naturally oriented to both primary prevention and public health defense, and today, more than ever before, for many reasons, among which the overwhelming market power that is first and foremost the cause of the general increase of populations affected by avoidable pathologies, a systematic, correct and timely application of this precious discipline seems to be urgent to us. In conclusion, we would suggest that some technical-scientific and institutional initiatives should overcome the intrinsic limits of the current aetiological researches. The rigorous adhesion of epidemiology to its scientific method appears to be absolutely necessary in order to enforce the Italian constitutional principle which states that health defence is a fundamental right of each individual and a concern for the whole community.

Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for indigenous populations in Canada

PubMed Central

Smylie, Janet; Firestone, Michelle

2015-01-01

Canada is known internationally for excellence in both the quality and public policy relevance of its health and social statistics. There is a double standard however with respect to the relevance and quality of statistics for Indigenous populations in Canada. Indigenous specific health and social statistics gathering is informed by unique ethical, rights-based, policy and practice imperatives regarding the need for Indigenous participation and leadership in Indigenous data processes throughout the spectrum of indicator development, data collection, management, analysis and use. We demonstrate how current Indigenous data quality challenges including misclassification errors and non-response bias systematically contribute to a significant underestimate of inequities in health determinants, health status, and health care access between Indigenous and non-Indigenous people in Canada. The major quality challenge underlying these errors and biases is the lack of Indigenous specific identifiers that are consistent and relevant in major health and social data sources. The recent removal of an Indigenous identity question from the Canadian census has resulted in further deterioration of an already suboptimal system. A revision of core health data sources to include relevant, consistent, and inclusive Indigenous self-identification is urgently required. These changes need to be carried out in partnership with Indigenous peoples and their representative and governing organizations. PMID:26793283

Laboratory Diagnosis of Zika Virus Infection.

PubMed

Landry, Marie Louise; St George, Kirsten

2017-01-01

-The rapid and accurate diagnosis of Zika virus infection is an international priority. -To review current recommendations, methods, limitations, and priorities for Zika virus testing. -Sources include published literature, public health recommendations, laboratory procedures, and testing experience. -Until recently, the laboratory diagnosis of Zika infection was confined to public health or research laboratories that prepared their own reagents, and test capacity has been limited. Furthermore, Zika cross-reacts serologically with other flaviviruses, such as dengue, West Nile, and yellow fever. Current or past infection, or even vaccination with another flavivirus, will often cause false-positive or uninterpretable Zika serology results. Detection of viral RNA during acute infection using nucleic acid amplification tests provides more specific results, and a number of commercial nucleic acid amplification tests have received emergency use authorization. In addition to serum, testing of whole blood and urine is recommended because of the higher vial loads and longer duration of shedding. However, nucleic acid amplification testing has limited utility because many patients are asymptomatic or present for testing after the brief period of Zika shedding has passed. Thus, the greatest need and most difficult challenge is development of accurate antibody tests for the diagnosis of recent Zika infection. Research is urgently needed to identify Zika virus epitopes that do not cross-react with other flavivirus antigens. New information is emerging at a rapid pace and, with ongoing public-private and international collaborations and government support, it is hoped that rapid progress will be made in developing robust and widely applicable diagnostic tools.

Comparison of the quality of night paediatric urgent care in rural and urban areas of Lublin Province, eastern Poland - Appraisals by parents of children requiring medical attention.

PubMed

Kołłątaj, Barbara; Kołłątaj, Witold; Wrzołek, Katarzyna; Karwat, Irena Dorota; Klatka, Maria

2017-03-31

 Introduction. The quality of primary medical care for children in Poland is unsatisfactory. In the ranking known as 'the European Health Consumer Index', Poland (taking the patient point of view on healthcare quality) is classified on the 27th position out of the 33 possible. The unsolved problems concern inter alia the quality and availability of night paediatric urgent care. The aim was assessing the quality as well as the level of satisfaction with the night paediatric urgent care in the Lublin Province of eastern Poland. The materials for this study consisted of 540 parents of children aged 6-16 years benefiting from night paediatric urgent medical assistance in Lublin Province. The survey was conducted using the Original Survey Questionnaire. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality and accessibility of night paediatric urgent care facilities as only satisfactory. Inhabitants living in rural areas have worse access to night paediatric urgent care facilities because of having to travel greater distances, and receive less comprehensive medical assistance than inhabitants living in more urbanized areas, and they are more often referred to hospital emergency departments. During the past five years, both the availability and quality of night paediatric urgent care did not change significantly. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality as well as accessibility of night paediatric urgent care facilities as only satisfactory. Rural residents have more reasons for dissatisfaction than urban dwellers. Both the quality and availability of such medical care needs to be improved.

[Health protection and health promotion in formal structures of executive county authorities and executive offices of municipalities having the county status].

PubMed

Nosko, Jan; Marcinkiewicz, Andrzej

2009-01-01

An analysis of the role of public administration in the Polish health system, essential for the effectiveness of health protection and health promotion, is a very important and urgent task faced by scholars. This issue also concerns the authorities of counties (powiaty) and municipalities having the county status (MHCS), and these structures were chosen as the subject of our study. The aim of the study was to analyze whether health related rules and regulations of these administrative structures comply with the requirements of relevant Polish legislation acts. The survey, performed in 2008, covered all the 378 counties and municipalities having the county status. On the basis of 171 Acts reviewed, a list of 11 groups of obligations and duties assigned to county and municipality units were prepared and used as a research tool. It was found that the provisions of the Health Care Institutions Act of 1991 were most evidently (87%) reflected in the rules and regulations of the studies structures; more than a half (57%) refer to prophylaxis and health promotion, however, the most important Act as far as health protection and health promotion are concerned, i.e., the Act of 2004 was reflected in only 11.6%. Also the presence of some outdated regulations was discovered. The results of the study may indicate that the mechanisms, by which the execution of legal regulations on health protection and health promotion tasks should be supervised, are insufficient.

42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... average knowledge of health and medicine, could reasonably expect the absence of immediate medical... woman, the health of the woman or her unborn child; (B) Serious impairment to bodily functions; or (C...

The African Organization for Research and Training in Cancer: historical perspective

PubMed Central

Mohammed, S.I.; Williams, C.K.; Ndom, P.; Holland, J.F.

2012-01-01

The African Organization for Research and Training in Cancer (aortic) is a bilingual (English and French) nonprofit organization dedicated to the promotion of cancer control and palliation in Africa. Its mission in respect to cancer control in Africa includes support of research and training;provision of relevant and accurate information on the prevention, early diagnosis, treatment, and palliation of cancer;promotion of public awareness about cancer and reduction of the stigma associated with it. In seeking to achieve its goal of cancer control in Africa, aortic strives to unite the continent and to make a positive impact throughout the region by collaboration with health ministries and global cancer organizations. The organization’s key objectives are to further research relating to cancers prevalent in Africa, to support training programs in oncology for health care workers, to deal with the challenges of creating cancer control and prevention programs, and to raise public awareness of cancer in Africa. It also plans to organize symposia, workshops, meetings, and conferences that support its mission. Founded in September 1982, aortic was active only between 1983 (when its inaugural conference was held in the City of Lome, Togo, West Africa) and the late 1980s. The organization subsequently became inactive and moribund. In 2000, a group of expatriate African physicians and scientists joined in an effort with their non-African friends and colleagues to reactivate the dormant organization. Since its reactivation, aortic has succeeded in putting cancer on the public health agenda in many African countries by highlighting Africa’s urgent need for cancer control and by holding meetings every two years in various African cities. National and international cancer control organizations worldwide have recognized the challenges facing Africa and have joined in aortic’s mission. PMID:23144576

The African Organization for Research and Training in Cancer: historical perspective.

PubMed

Mohammed, S I; Williams, C K; Ndom, P; Holland, J F

2012-10-01

The African Organization for Research and Training in Cancer (aortic) is a bilingual (English and French) nonprofit organization dedicated to the promotion of cancer control and palliation in Africa. Its mission in respect to cancer control in Africa includes support of research and training;provision of relevant and accurate information on the prevention, early diagnosis, treatment, and palliation of cancer;promotion of public awareness about cancer and reduction of the stigma associated with it.In seeking to achieve its goal of cancer control in Africa, aortic strives to unite the continent and to make a positive impact throughout the region by collaboration with health ministries and global cancer organizations. The organization's key objectives are to further research relating to cancers prevalent in Africa, to support training programs in oncology for health care workers, to deal with the challenges of creating cancer control and prevention programs, and to raise public awareness of cancer in Africa. It also plans to organize symposia, workshops, meetings, and conferences that support its mission.Founded in September 1982, aortic was active only between 1983 (when its inaugural conference was held in the City of Lome, Togo, West Africa) and the late 1980s. The organization subsequently became inactive and moribund. In 2000, a group of expatriate African physicians and scientists joined in an effort with their non-African friends and colleagues to reactivate the dormant organization. Since its reactivation, aortic has succeeded in putting cancer on the public health agenda in many African countries by highlighting Africa's urgent need for cancer control and by holding meetings every two years in various African cities. National and international cancer control organizations worldwide have recognized the challenges facing Africa and have joined in aortic's mission.

Factors affecting emergency preparedness competency of public health inspectors: a cross-sectional study in northeastern China

PubMed Central

Ning, Ning; Kang, Zheng; Jiao, Mingli; Hao, Yanhua; Gao, Lijun; Sun, Hong; Wu, Qunhong

2014-01-01

Objectives To determine the emergency preparedness competency specific to public health inspectors (PHIs), preparedness limitations and needs of the workforce, as well as to identify important factors that affect the preparedness competency of PHIs. Setting Cross-sectional survey was conducted in Heilongjiang, a province in northeastern China. Participants A questionnaire was administered to a sample of 368 PHIs from 17 public health inspection agencies, chosen by stratified cluster sampling strategy. 9 PHIs and 6 agency's leaders were invited to participate in an in-depth interview. Outcome measures Self-rated preparedness competency in quantitative study was measured. Multivariate logistic regression model was used to test the associations between individual determinants and self-rated preparedness competency. Key themes relating to preparedness competency of PHIs in qualitative study were analysed. Results Although 82% of PHIs highly rated their general preparedness competency, there were significant differences among the assessment on specific domains of their competency. Comparing with attitude, the domains of skills and knowledge tend to be lower (p=0.000). Awareness on one's own responsibilities regarding emergency response work was identified as the most important factor associated with preparedness competency (adjusted OR=6.33, 95% CI 3.30 to 12.16). Lack of explicit national job requirements, overlapping responsibilities and poor collaboration among agencies, together with poor knowledge and skills level of personnel, led to an ambiguity of responsibility, and hindered the preparedness competency enhancement of PHIs furthermore. Conclusions Ambiguity responsibility in emergency response is still a prominent issue that hinders the further improvement on the preparedness competency for PHIs’ in China. Intensified capacity-building activities targeting at individuals’ weakness in specific knowledge and skills are urgently needed; in addition, capacity building at policy and system level as well as agency levels is of equal importance. PMID:24384897

What factors might have led to the emergence of Ebola in West Africa?

PubMed

Alexander, Kathleen A; Sanderson, Claire E; Marathe, Madav; Lewis, Bryan L; Rivers, Caitlin M; Shaman, Jeffrey; Drake, John M; Lofgren, Eric; Dato, Virginia M; Eisenberg, Marisa C; Eubank, Stephen

2015-01-01

An Ebola outbreak of unprecedented scope emerged in West Africa in December 2013 and presently continues unabated in the countries of Guinea, Sierra Leone, and Liberia. Ebola is not new to Africa, and outbreaks have been confirmed as far back as 1976. The current West African Ebola outbreak is the largest ever recorded and differs dramatically from prior outbreaks in its duration, number of people affected, and geographic extent. The emergence of this deadly disease in West Africa invites many questions, foremost among these: why now, and why in West Africa? Here, we review the sociological, ecological, and environmental drivers that might have influenced the emergence of Ebola in this region of Africa and its spread throughout the region. Containment of the West African Ebola outbreak is the most pressing, immediate need. A comprehensive assessment of the drivers of Ebola emergence and sustained human-to-human transmission is also needed in order to prepare other countries for importation or emergence of this disease. Such assessment includes identification of country-level protocols and interagency policies for outbreak detection and rapid response, increased understanding of cultural and traditional risk factors within and between nations, delivery of culturally embedded public health education, and regional coordination and collaboration, particularly with governments and health ministries throughout Africa. Public health education is also urgently needed in countries outside of Africa in order to ensure that risk is properly understood and public concerns do not escalate unnecessarily. To prevent future outbreaks, coordinated, multiscale, early warning systems should be developed that make full use of these integrated assessments, partner with local communities in high-risk areas, and provide clearly defined response recommendations specific to the needs of each community.

What Factors Might Have Led to the Emergence of Ebola in West Africa?

PubMed Central

Alexander, Kathleen A.; Sanderson, Claire E.; Marathe, Madav; Lewis, Bryan L.; Rivers, Caitlin M.; Shaman, Jeffrey; Drake, John M.; Lofgren, Eric; Dato, Virginia M.; Eisenberg, Marisa C.; Eubank, Stephen

2015-01-01

An Ebola outbreak of unprecedented scope emerged in West Africa in December 2013 and presently continues unabated in the countries of Guinea, Sierra Leone, and Liberia. Ebola is not new to Africa, and outbreaks have been confirmed as far back as 1976. The current West African Ebola outbreak is the largest ever recorded and differs dramatically from prior outbreaks in its duration, number of people affected, and geographic extent. The emergence of this deadly disease in West Africa invites many questions, foremost among these: why now, and why in West Africa? Here, we review the sociological, ecological, and environmental drivers that might have influenced the emergence of Ebola in this region of Africa and its spread throughout the region. Containment of the West African Ebola outbreak is the most pressing, immediate need. A comprehensive assessment of the drivers of Ebola emergence and sustained human-to-human transmission is also needed in order to prepare other countries for importation or emergence of this disease. Such assessment includes identification of country-level protocols and interagency policies for outbreak detection and rapid response, increased understanding of cultural and traditional risk factors within and between nations, delivery of culturally embedded public health education, and regional coordination and collaboration, particularly with governments and health ministries throughout Africa. Public health education is also urgently needed in countries outside of Africa in order to ensure that risk is properly understood and public concerns do not escalate unnecessarily. To prevent future outbreaks, coordinated, multiscale, early warning systems should be developed that make full use of these integrated assessments, partner with local communities in high-risk areas, and provide clearly defined response recommendations specific to the needs of each community. PMID:26042592

Western Australia facing critical losses in its midwifery workforce: a survey of midwives' intentions.

PubMed

Pugh, Judith D; Twigg, Diane E; Martin, Tracy L; Rai, Tapan

2013-05-01

the ongoing attrition of the midwifery workforce frustrates future workforce planning and the provision of maternity services in Western Australia. This project determined factors contributing to the intention of the midwives to move jobs and/or leave the profession. a cross-sectional survey approach was taken for this descriptive research utilising a self-administered questionnaire developed by the Nursing and Midwifery Office, Department of Health, Western Australia. public and private health sectors in Western Australia, April-May 2010. 1,600 midwives employed in the public and private health sectors throughout Western Australia were invited to participate: 712 responded (44.5%), one-fifth of the state's registered midwives. most midwives worked part-time in a clinical role in public hospitals. Almost half intended moving jobs within 5 years and/or leaving midwifery. Excluding midwives of retirement age, the most common reasons for intending to move jobs were family commitments, working conditions and role dissatisfaction. Those intending to leave midwifery cited work-life balance, career change and family commitments. Midwives thought addressing the following issues would improve midwifery retention: flexible work arrangements, remuneration, staffing and caseload, workplace culture, professional development and models of care. retaining the midwifery workforce requires attention to workforce practices particularly flexible work arrangements and workloads; models of care to strengthen midwives' relationships with clients and colleagues; and accessible professional development. a review of workplace practices at unit and institution levels is urgently required in Western Australia so that midwives can achieve work-life balance and practice to the full extent of their professional role. These changes are necessary to forestall premature retirement of skilled and experienced midwives from the profession and workforce churn. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

The Association Between Stimulant, Opioid, and Multiple Drug Use on Behavioral Health Care Utilization in a Safety-Net Health System.

PubMed

Calcaterra, Susan L; Keniston, Angela; Blum, Joshua; Crume, Tessa; Binswanger, Ingrid A

2015-01-01

Prior studies show an association between drug use and health care utilization. The relationship between specific drug type and emergent/urgent, inpatient, outpatient, and behavioral health care utilization has not been examined. We aimed to determine if multiple drug use was associated with increased utilization of behavioral health care. To assess health care utilization, we conducted a retrospective cohort study of patients who accessed health care at a safety-net medical center and affiliated clinics. Using electronic health records, we categorized patients who used stimulants, opioids, or multiple drugs based on urine toxicology screening tests and/or International Classification of Diseases, 9th Revision (ICD-9). Remaining patients were categorized as patients without identified drug use. Health care utilization by drug use group and visit type was determined using a negative binomial regression model. Associations were reported as incidence rate ratios. Utilization was described by rates of health care-related visits for inpatient, emergent/urgent, outpatient, and behavioral health care among patients who used drugs, categorized by drug types, compared with patients without identified drug use. Of 95,198 index visits, 4.6% (n=4340) were by patients who used drugs. Opioid and multiple drug users had significantly higher rates of behavioral health care visits than patients without identified drug use (opioid incidence rate ratio [IRR]=7.2; 95% confidence interval [CI]: 3.8-13.8; multiple drug use IRR=5.6, 95% CI: 3.3-9.7). Patients who used stimulants were less likely to use behavioral health services (IRR=1.3, 95% CI: 0.9-2.0) when compared with opioid and multiple drug users, but were more likely to use inpatient (IRR=1.6, 95% CI: 1.4-1.8) and emergent/urgent care (IRR=1.4, 95% CI: 1.3-1.5) services as compared with patients without identified drug use. Integrated medical and mental health care and drug treatment may reduce utilization of costly health care services and improve patient outcomes. How to capture and deliver primary care and behavioral health care to patients who use stimulants needs further investigation.

American Indians’ Family Health Concern on a Northern Plains Reservation: “Diabetes Runs Rampant Here”

PubMed Central

Martin, Donna; Yurkovich, Eleanor; Anderson, Kara

2015-01-01

Objectives The objective was to identify significant family health concerns from the perspective of adult tribal members residing in a reservation setting on the Northern Plains of the United States. Findings were used to co-create culturally appropriate strategies to address the most significant family health concern. Design and Sample A focused ethnography within a participatory framework was employed. An advisory council, comprised of seven tribal members, guided the research team. A purposive sampling technique with a snowball process was used. Twenty-one adult tribal members volunteered to participate. Measures Face-to-face, audio-recorded, semi-structured interviews were conducted and transcribed verbatim. Other data sources included field notes of approximately 100 hours of field work, windshield surveys, and a focus group. Data were analyzed using Spradley’s guidelines. Results The significant family health concern was “diabetes runs rampant here” with inter-related cognitive, emotional and behavioral responses. These responses were compounded by accumulated emotional trauma from witnessing premature deaths and severe comorbidities associated with diabetes. Contextual factors shaping “diabetes runs rampant here” were identified. Conclusion Holistic approaches are urgently needed in diabetes prevention and management programs. Implications for public health nurses are discussed and recommendations are provided for future research. PMID:26336881

Vaccination against smoking: an annotated agenda for debate. A review of scientific journals, 2001-13.

PubMed

Wolters, Anna; de Wert, Guido; van Schayck, Onno C P; Horstman, Klasien

2014-08-01

The ongoing development of novel nicotine vaccines makes it urgent to identify the normative questions around this innovative health technology against smoking. A qualitative thematic analysis of peer-reviewed papers on nicotine vaccination published between 2001 and 2013. In the scientific discourse, nicotine vaccination is presented in a neurobiological frame as a potent concept for (long-term) smoking cessation. Nicotine vaccination is also considered a hypothetical strategy to prevent nicotine addiction in minors. Ethical assessments are conducted for the use of nicotine vaccination in public health and clinical medicine. Whereas vaccination for primary prevention is usually associated with public health, the hypothetical case of nicotine prevention in minors is also assessed for individualized protection. Therapeutic and preventive applications are given uneven attention: the classic goal of vaccination (primary prevention in minors) receives methodical consideration and invokes lively debate. The unprecedented use of vaccination, namely smoking cessation, is left largely unattended in the ethical analyses. While health innovations such as nicotine vaccination need broad reflection to guide decisions on their further development and possible future implementations, only a small part of the ethical and social issues of this innovative technology has been discussed. For a debate to come into existence, a 'neurobio-psycho-socio-cultural' frame of smoking and quitting appears fruitful. Important topics for reflection are the human activities and social processes in a vaccine-supported quit attempt, next to respect for individuals, possible harms and questions of (global) justice and research ethics. © 2014 Society for the Study of Addiction.

Feasibility of a low-cost hearing screening in rural Indiana.

PubMed

Khan, Khalid M; Bielko, Sylvanna L; Barnes, Priscilla A; Evans, Sydney S; Main, Anna L K

2017-09-18

Hearing loss remains a neglected public health issue in the rural and agricultural communities in the United States and therefore, promotion of a low-cost hearing screening may be important for these underserved populations. The major objectives of our study were to assess feasibility of a low-cost telephone-administered hearing test in rural Indiana and to identify the challenges, barriers and viable implementation strategies associated with this test. Also, we evaluated whether a focus group session could change the hearing health attitude of rural residents. We recruited 126 adults from six rural Indiana counties who participated in study activities in the following order: 1) a pre-focus group demographic, knowledge and attitude survey, 2) a focus group for discussing the feasibility of a telephone-administered hearing screening, 3) a post focus group attitude survey and 4) hearing was screened using an audiometer and self-assessment scale. These activities generated both qualitative and quantitative data, which were subsequently analyzed. Hearing impairment was perceived as an important public health issue. Many participants expressed interests to try the low-cost National Hearing Test (NHT). However, participants recommended NHT to be facilitated by community organizations to provide access to landline phones. The focus group turned out to be an excellent awareness building activity producing significant improvement in hearing health attitudes. Comparison of self and audiometric evaluations indicated underestimation of hearing handicap in our rural study population. The study results underscore the urgent need for an effective strategy to promote low-cost hearing screening in rural US communities.

Comprehensive approach for hypertension control in low-income populations: rationale and study design for the hypertension control program in Argentina.

PubMed

Mills, Katherine T; Rubinstein, Adolfo; Irazola, Vilma; Chen, Jing; Beratarrechea, Andrea; Poggio, Rosana; Dolan, Jacquelyn; Augustovski, Federico; Shi, Lizheng; Krousel-Wood, Marie; Bazzano, Lydia A; He, Jiang

2014-08-01

Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This article summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. Clinic patients with uncontrolled hypertension, their spouses and hypertensive family members will be enrolled. The comprehensive intervention program targets the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure [BP], health education for medication adherence and lifestyle modification) conducted by community health workers and a mobile health intervention. The primary outcome is net change in systolic BP from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic BP, BP control and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries.

[Stalking: clinical and criminological considerations through the results of a research contribution].

PubMed

Pomilla, Antonella; D'Argenio, Alberto; Mastronardi, Vincenzo

2012-01-01

Among the extensive results supplied by the psychiatric literature on the subject of stalking, few studies focus on the analysis of persecutory behaviors carried out against mental health professionals, who also identified as one of the most affected sample of victims. Particularly, for studies conducted in this way, further examination requires differentiation according to gender type into the social and personal characteristics of the authors' behavior patterns displayed towards the victims. Aim. To obtaine results by an epidemiological survey conducted in public and private psychiatric care structures in the city of Rome, to assess the incidence of the phenomenon as well as gender differences in behavior patterns practised out by the author for the two sample considered. Methods. Administration of a questionnaire to a sample make up by psychiatrists working in out-patient services for the Departments of Mental Health (ASL) of Rome and to a sample of psychiatrists who practise their professional activity in the private sector. Results. Regarding the incidence of the phenomenon, an increased presence has been found in private mental health care settings in comparison to the public service; regarding to the distribution of the phenomenon according to the sexual identity of the authors among the two samples analyzed, a statistical prevalence of female authors has been found in the sample of private sector. Discussion. The health's professionals, so much liable of victimization, are poorly formed on the phenomenon. So it's urgent to operate with integrated approaches (informative trainings; strengthening of administrative and clinical policies of the profession; multidimensional assessment).

Comprehensive Approach for Hypertension Control in Low-income Populations: Rationale and Study Design for the Hypertension Control Program in Argentina (HCPIA)

PubMed Central

Mills, Katherine T.; Rubinstein, Adolfo; Irazola, Vilma; Chen, Jing; Beratarrechea, Andrea; Poggio, Rosana; Dolan, Jacquelyn; Augustovski, Federico; Shi, Lizheng; Krousel-Wood, Marie; Bazzano, Lydia A.; He, Jiang

2014-01-01

Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This paper summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. Clinic patients with uncontrolled hypertension, their spouses and hypertensive family members will be enrolled. The comprehensive intervention program targets the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure, health education for medication adherence and lifestyle modification) conducted by community health workers, and a mobile health intervention. The primary outcome is net change in systolic blood pressure from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic blood pressure, blood pressure control, and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical, and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries. PMID:24978148

Urgent need to reevaluate the latest World Health Organization guidelines for toxic inorganic substances in drinking water.

PubMed

Frisbie, Seth H; Mitchell, Erika J; Sarkar, Bibudhendra

2015-08-13

The World Health Organization (WHO) has established guidelines for drinking-water quality that cover biological and chemical hazards from both natural and anthropogenic sources. In the most recent edition of Guidelines for Drinking-water Quality (2011), the WHO withdrew, suspended, did not establish, or raised guidelines for the inorganic toxic substances manganese, molybdenum, nitrite, aluminum, boron, nickel, uranium, mercury, and selenium. In this paper, we review these changes to the WHO drinking-water guidelines, examining in detail the material presented in the WHO background documents for each of these toxic substances. In some cases, these WHO background documents use literature reviews that do not take into account scientific research published within the last 10 or more years. In addition, there are instances in which standard WHO practices for deriving guidelines are not used; for example, rounding and other mathematical errors are made. According to published meeting reports from the WHO Chemical Aspects Working Group, the WHO has a timetable for revising some of its guidelines for drinking-water quality, but for many of these toxic substances the planned changes are minimal or will be delayed for as long as 5 years. Given the limited nature of the planned WHO revisions to the inorganic toxic substances and the extended timetable for these revisions, we suggest that governments, researchers, and other stakeholders might establish independent recommendations for inorganic toxic substances and possibly other chemicals to proactively protect public health, or at the very least, revert to previous editions of the Guidelines for Drinking-water Quality, which were more protective of public health.

The need for detailed gender-specific occupational safety analysis.

PubMed

Cruz Rios, Fernanda; Chong, Wai K; Grau, David

2017-09-01

The female work in population is growing in the United States, therefore the occupational health and safety entities must start to analyze gender-specific data related to every industry, especially to nontraditional occupations. Women working in nontraditional jobs are often exposed to extreme workplace hazards. These women have their safety and health threatened because there are no adequate policies to mitigate gender-specific risks such as discrimination and harassment. Employers tend to aggravate this situation because they often fail to provide proper reporting infrastructure and support. According to past studies, women suffered from workplace injuries and illnesses that were less prominent among men. Statistics also confirmed that men and women faced different levels of risks in distinct work environments. For example, the rates of workplace violence and murders by personal acquaintances were significantly higher among women. In this paper, the authors analyze prior public data on fatal and nonfatal injuries to understand why we need to differentiate genders when analyzing occupational safety and health issues. The analyses confirmed that women dealt with unique workplace hazards compared to men. It is urgent that public agencies, such as the U.S. Department of Labor, record gender-specific data in details and by occupations and industries. The reader will become aware of the current lack - and need - of data and knowledge about injuries and illnesses separated by gender and industry. Finally, safety and health researchers are encouraged to investigate the gender-specific data in all industries and occupations, as soon as they become available. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries.

PubMed

Bochenek, Tomasz; Abilova, Vafa; Alkan, Ali; Asanin, Bogdan; de Miguel Beriain, Iñigo; Besovic, Zeljka; Vella Bonanno, Patricia; Bucsics, Anna; Davidescu, Michal; De Weerdt, Elfi; Duborija-Kovacevic, Natasa; Fürst, Jurij; Gaga, Mina; Gailīte, Elma; Gulbinovič, Jolanta; Gürpınar, Emre U; Hankó, Balázs; Hargaden, Vincent; Hotvedt, Tor A; Hoxha, Iris; Huys, Isabelle; Inotai, Andras; Jakupi, Arianit; Jenzer, Helena; Joppi, Roberta; Laius, Ott; Lenormand, Marie-Camille; Makridaki, Despina; Malaj, Admir; Margus, Kertu; Marković-Peković, Vanda; Miljković, Nenad; de Miranda, João L; Primožič, Stanislav; Rajinac, Dragana; Schwartz, David G; Šebesta, Robin; Simoens, Steven; Slaby, Juraj; Sović-Brkičić, Ljiljana; Tesar, Tomas; Tzimis, Leonidas; Warmińska, Ewa; Godman, Brian

2017-01-01

Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed.

Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries

PubMed Central

Bochenek, Tomasz; Abilova, Vafa; Alkan, Ali; Asanin, Bogdan; de Miguel Beriain, Iñigo; Besovic, Zeljka; Vella Bonanno, Patricia; Bucsics, Anna; Davidescu, Michal; De Weerdt, Elfi; Duborija-Kovacevic, Natasa; Fürst, Jurij; Gaga, Mina; Gailīte, Elma; Gulbinovič, Jolanta; Gürpınar, Emre U.; Hankó, Balázs; Hargaden, Vincent; Hotvedt, Tor A.; Hoxha, Iris; Huys, Isabelle; Inotai, Andras; Jakupi, Arianit; Jenzer, Helena; Joppi, Roberta; Laius, Ott; Lenormand, Marie-Camille; Makridaki, Despina; Malaj, Admir; Margus, Kertu; Marković-Peković, Vanda; Miljković, Nenad; de Miranda, João L.; Primožič, Stanislav; Rajinac, Dragana; Schwartz, David G.; Šebesta, Robin; Simoens, Steven; Slaby, Juraj; Sović-Brkičić, Ljiljana; Tesar, Tomas; Tzimis, Leonidas; Warmińska, Ewa; Godman, Brian

2018-01-01

Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed. PMID:29403372

Healthy Cities in a global and regional context.

PubMed

Lawrence, Roderick J; Fudge, Colin

2009-11-01

Since the beginning of the WHO European Healthy Cities Network in 1987, the global and regional contexts for the promotion of health and well-being have changed in many ways. First, in 2000, the United Nations Millennium Goals explicitly and implicitly addressed health promotion and prevention at the global and regional levels. Second, the concern for sustainable development at the Rio Conference in 1992 was confirmed at the World Summit in Johannesburg in 2002. During the same period, in many regions including Europe, the redefinition of the roles and responsibilities of national, regional and local governments, reductions in budgets of public administrations, the privatization of community and health services, the instability of world trade, the financial system and employment, migration flows, relatively high levels of unemployment (especially among youth and young adults) have occurred in many countries in tandem with negative impacts on specific policies and programmes that are meant to promote health. Since 1990, the European Commission has been explicitly concerned about the promotion of health, environment and social policies by defining strategic agendas for the urban environment, sustainable development and governance. However, empirical studies during the 1990s show that urban areas have relatively high levels of tuberculosis, respiratory and cardiovascular diseases, cancer, adult obesity, malnutrition, tobacco smoking, poor mental health, alcohol consumption and drug abuse, sexually transmitted diseases (including AIDS), crime, homicide, violence and accidental injury and death. In addition, there is evidence that urban populations in many industrialized countries are confronted with acute new health problems stemming from exposure to persistent organic pollutants, toxic substances in building structures, radioactive waste and increasing rates of food poisoning. These threats to public health indicate an urgent need for new strategic policies and research agendas that address the complex interrelations between urban ecosystems, sustainable development, human health and well-being. The WHO Healthy Cities project is one important vector for achieving this objective at both global and regional levels.

Perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa.

PubMed

Nemutandani, Simon M; Hendricks, Stephen J; Mulaudzi, Mavis F

2016-06-10

The indigenous health system was perceived to be a threat to the allopathic health system. It was associated with 'witchcraft', and actively discouraged, and repressed through prohibition laws. The introduction of the Traditional Health Practitioners Act No 22 of 2007 brought hope that those centuries of disrespect for traditional health systems would change. The study examined the perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa. Qualitative descriptive research methodology was used to collect data from allopathic health practitioners employed by Limpopo's Department of Health. In-depth focus group discussions and meetings were conducted between January and August 2014. Perceptions and experiences of working with traditional health practitioners were explored. Ethical clearance was obtained from the University of Pretoria and approval from the Department's Research Committee. Dominant views were that the two health systems were not compatible with respect to the science involved and the source of knowledge. Overall, quality of health care will be compromised if traditional health practitioners are allowed to work in public health facilities. Allopathic health practitioners do not appear ready to work with traditional health practitioners, citing challenges of quality of health care, differences regarding concept of sciences and source of knowledge; and lack of policy on collaboration. Lack of exposure to traditional medicine seems to impede opportunities to accept and work with traditional healers. Exposure and training at undergraduate level regarding the traditional health system is recommended. Policy guidelines on collaborations are urgently required.

Perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa

PubMed Central

Hendricks, Stephen J.; Mulaudzi, Mavis F.

2016-01-01

Background The indigenous health system was perceived to be a threat to the allopathic health system. It was associated with ‘witchcraft’, and actively discouraged, and repressed through prohibition laws. The introduction of the Traditional Health Practitioners Act No 22 of 2007 brought hope that those centuries of disrespect for traditional health systems would change. The study examined the perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa. Methods Qualitative descriptive research methodology was used to collect data from allopathic health practitioners employed by Limpopo’s Department of Health. In-depth focus group discussions and meetings were conducted between January and August 2014. Perceptions and experiences of working with traditional health practitioners were explored. Ethical clearance was obtained from the University of Pretoria and approval from the Department’s Research Committee. Results Dominant views were that the two health systems were not compatible with respect to the science involved and the source of knowledge. Overall, quality of health care will be compromised if traditional health practitioners are allowed to work in public health facilities. Conclusion Allopathic health practitioners do not appear ready to work with traditional health practitioners, citing challenges of quality of health care, differences regarding concept of sciences and source of knowledge; and lack of policy on collaboration. Lack of exposure to traditional medicine seems to impede opportunities to accept and work with traditional healers. Exposure and training at undergraduate level regarding the traditional health system is recommended. Policy guidelines on collaborations are urgently required. PMID:27380856

Evidence-based approach for disaster preparedness authorities to inform the contents of repositories for prescription medications for chronic disease management and control.

PubMed

Brown, David W; Young, Stacy L; Engelgau, Michael M; Mensah, George A

2008-01-01

Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death. A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications. Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic disease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading causes of disease burden assessed by disability-adjusted life years are presented. The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53,000); (3) for stroke, non-narcotic analgesics (138,000); (4) for chronic obstructive pulmonary disease, anti-asthmatics/bronchodilators (3.2 million); and (5) for diabetes, hypoglycemic agents (261,000). Ten medication categories were common across four or more chronic conditions. Persons with chronic diseases have an urgent need for ongoing care and medical support after public health emergencies. These findings provide one evidence-based approach for informing public health preparedness in terms of planning for and review of the prescription medication needs of clinically vulnerable populations with prevalent chronic disease.

32 CFR 169a.9 - Reviews: Existing in-house commercial activities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Component will place up to three notices of the requirement in the Commerce Business Daily (CBD) over a 90...) When a bona fide urgent requirement occurs, the publication period in the CBD may be reduced to two...

Organization and startup of The Gambia's new community-based medical programme.

PubMed

Chávez, José A; Suárez, Lázaro V; Del Rosario, Odalis; Hechavarría, Suiberto; Quiñones, Judith

2012-01-01

The shortage of health professionals in developing countries and especially in their poorest regions imperils the vision of health for all. New training policies and strategies are needed urgently to address these shortages. The Gambia's new Community-Based Medical Programme is one such strategy. KEYWORDS Medical education, access to health care, healthcare disparities, health manpower, rural health, developing countries, The Gambia.

Bergamot (Citrus bergamia) Essential Oil Inhalation Improves Positive Feelings in the Waiting Room of a Mental Health Treatment Center: A Pilot Study

PubMed Central

Gibson, Jacob; Eggett, Dennis L.; Parker, Tory L.

2017-01-01

Mental health issues have been increasingly recognized as public health problems globally. Their burden is projected to increase over the next several decades. Additional therapies for mental problems are in urgent need worldwide due to the limitations and costs of existing healthcare approaches. Essential oil aromatherapy can provide a cost‐effective and safe treatment for many mental problems. This pilot study observed the effects of bergamot essential oil inhalation on mental health and well‐being, as measured by the Positive and Negative Affect Scale, in a mental‐health treatment center located in Utah, USA. Fifty‐seven eligible participants (50 women, age range: 23–70 years) were included for analysis. Fifteen minutes of bergamot essential oil exposure improved participants' positive feelings compared with the control group (17% higher). Unexpectedly, more participants participated in experimental periods rather than control periods, suggesting even brief exposure to essential oil aroma may make people more willing to enroll in clinical trials. This study provides preliminary evidence of the efficacy and safety of bergamot essential oil inhalation on mental well‐being in a mental health treatment center, suggesting that bergamot essential oil aromatherapy can be an effective adjunct treatment to improve individuals' mental health and well‐being. © 2017 The Authors. Phytotherapy Research published by John Wiley & Sons Ltd. PMID:28337799

Research, public policymaking, and knowledge-translation processes: Canadian efforts to build bridges.

PubMed

Lavis, John N

2006-01-01

Public policymakers must contend with a particular set of institutional arrangements that govern what can be done to address any given issue, pressure from a variety of interest groups about what they would like to see done to address any given issue, and a range of ideas (including research evidence) about how best to address any given issue. Rarely do processes exist that can get optimally packaged high-quality and high-relevance research evidence into the hands of public policymakers when they most need it, which is often in hours and days, not months and years. In Canada, a variety of efforts have been undertaken to address the factors that have been found to increase the prospects for research use, including the production of systematic reviews that meet the shorter term (but not urgent) needs of public policymakers and encouraging partnerships between researchers and policymakers that allow for their interaction around the tasks of asking and answering relevant questions. Much less progress has been made in making available research evidence to inform the urgent needs of public policymakers and in addressing attitudinal barriers and capacity limitations. In the future, knowledge-translation processes, particularly push efforts and efforts to facilitate user pull, should be undertaken on a sufficiently large scale and with a sufficiently rigorous evaluation so that robust conclusions can be drawn about their effectiveness.

Health financing in Malawi: Evidence from National Health Accounts

PubMed Central

2010-01-01

Background National health accounts provide useful information to understand the functioning of a health financing system. This article attempts to present a profile of the health system financing in Malawi using data from NHA. It specifically attempts to document the health financing situation in the country and proposes recommendations relevant for developing a comprehensive health financing policy and strategic plan. Methods Data from three rounds of national health accounts covering the Financial Years 1998/1999 to 2005/2006 was used to describe the flow of funds and their uses in the health system. Analysis was performed in line with the various NHA entities and health system financing functions. Results The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. The country had not met the Abuja of allocating at least 15% of national budget on health. The percentage of total health expenditure from households' direct out-of-pocket payments decreased from 26% in 1998/99 to 12.1% in 2005/2006. Conclusion There is a need to increase government contribution to the total health expenditure to at least the levels of the Abuja Declaration of 15% of the national budget. In addition, the country urgently needs to develop and implement a prepaid health financing system within a comprehensive health financing policy and strategy with a view to assuring universal access to essential health services for all citizens. PMID:21062503

Bio-medical waste management: situational analysis & predictors of performances in 25 districts across 20 Indian States.

PubMed

2014-01-01

A legislative framework for bio-medical waste management (BMWM) was established in the country more than a decade ago. Though some studies have identified gaps at local levels, no systematic effort was done to collect data from different parts of the country. The objective of this nationwide study was to document existing resources, infrastructure and practices related to BMWM across the study districts. The study was conducted in 25 districts spread over 20 States of India including urban and rural areas. Primary (n=388), secondary (n=25) and tertiary care (n=24) health facilities from public (n=238) and private (n=199) sector were assessed and scored for the state of BMWM through 9 items representing system capacity, availability of resources and processes in place. Health facilities were assigned into one of the three categories (Red, Yellow and Green) based on the cumulative median scores. Around 82 per cent of primary, 60 per cent of secondary and 54 per cent of tertiary care health facilities were in the 'RED' category. Multivariate analysis indicated that charts at the point of waste generation, availability of designated person, appropriate containers and bags, availability of functional needle destroyers, availability of personal protective gears, segregation of waste at point of generation and log book maintenance were independently (OR-between 1.2-1.55; P <0.03 or less) associated with better BMWM system in the health facilities. This was true for both rural-urban and public or private health facilities. The study highlighted the urgent need for greater commitments at policy and programme levels for capacity building, and resource investments in BMWM.

Progress toward Development of a Vaccine against Congenital Cytomegalovirus Infection

PubMed Central

Permar, Sallie R.; Plotkin, Stanley A.

2017-01-01

ABSTRACT A vaccine against congenital human cytomegalovirus (CMV) infection is a major public health priority. Congenital CMV causes substantial long-term morbidity, particularly sensorineural hearing loss (SNHL), in newborns, and the public health impact of this infection on maternal and child health is underrecognized. Although progress toward development of a vaccine has been limited by an incomplete understanding of the correlates of protective immunity for the fetus, knowledge about some of the key components of the maternal immune response necessary for preventing transplacental transmission is accumulating. Moreover, although there have been concerns raised about observations indicating that maternal seropositivity does not fully prevent recurrent maternal CMV infections during pregnancy, it is becoming increasing clear that preconception immunity does confer some measure of protection against both CMV transmission and CMV disease (if transmission occurs) in the newborn infant. Although the immunity to CMV conferred by both infection and vaccination is imperfect, there are encouraging data emerging from clinical trials demonstrating the immunogenicity and potential efficacy of candidate CMV vaccines. In the face of the knowledge that between 20,000 and 30,000 infants are born with congenital CMV in the United States every year, there is an urgent and compelling need to accelerate the pace of vaccine trials. In this minireview, we summarize the status of CMV vaccines in clinical trials and provide a perspective on what would be required for a CMV immunization program to become incorporated into clinical practice. PMID:29046308