Biomedical subjects
Jerry Spiegel
Publications and source records attributed to Jerry Spiegel.
Sociocultural, environmental, and health challenges facing women and children living near the borders between Afghanistan, Iran, and Pakistan (AIP region).
BACKGROUND: For hundred of years, people in the region encompassed by the Afghanistan-Iran-Pakistan borders (AIP region) have been challenged by conflict and political and civil instability, mass displacement, human rights abuses, drought, and famine. It not surprising that health and quality of life of vulnerable groups in this region are among the worst in the world. In general, women and children, in particular girls, in the AIP region have had especially limited access to healthcare. Women and children have dramatically high rates of communicable and non-communicable disease, morbidity, and mortality and a general low life expectancy that is rapidly declining. In spite of national and international efforts to improve health status of vulnerable populations in this region, the key underlying sociocultural determinants of health and disparities (ie, gender, language, ethnicity, residential status, and socioeconomic status) have not been systematically studied, nor have their relationships to environmental challenges been examined. OBJECTIVES: We set out to summarize existing information regarding the sociocultural, environmental, and traditional determinants of health disparities among different population groups in the AIP region; identify gaps in research regarding the communities' needs in the region; and highlight factors that must be considered in the design and implementation of future health intervention studies in the region. METHODS: We reviewed current health literature, official documents, and other information (eg, reports of UN agencies) related to the social, cultural, and environmental factors that may influence the health outcomes of subpopulations living in the AIP region. We also interviewed individuals who had recently worked in this region. RESULTS: Overall, the health problems faced by this underdeveloped region can be categorized into those resulting from lack of essential supplies and services and those stemming from the existing cultural practices in the area. The low health status of the people, particularly women and children, in the AIP region is associated with not only poor hygiene and lack of water but also limited knowledge and lack of access to healthcare services. In addition, cultural, political, and socioenvironmental factors play a role, including gender inequality and differences between languages spoken locally in the region and those most often used in written health education materials. CONCLUSION: Future intervention programs designed for this region must use culturally sensitive strategies not only to provide health information and health services but also to address the underlying nonmedical determinants of health related to gender inequalities.
What the Cuban context provides health researchers: the feasibility of a longitudinal multi-method study of the impact of housing improvements on health in Havana, Cuba.
BACKGROUND: From extensive participatory research in inner city communities in Central Havana, Cuba, we found housing to be the largest perceived source of health risk. The objective of this study, therefore, was to ascertain the feasibility of conducting a multi-method longitudinal evaluation of the impact of housing improvements on health. METHODS: Meetings with community and governmental stakeholders were held; housing policy documents were reviewed; key informants were interviewed; decisions were made by a collaborative interdisciplinary team regarding measurement instruments for health as well as housing quality; training was conducted for use of new measurement tools; and a 3 month multi-method trial with repeated measures was conducted on individuals in good housing and poor housing in the inner city of Central Havana. Questionnaires were administered at monthly intervals for 3 months to 25 adults living in good housing and 25 in poor housing. RESULTS: Cuba's housing policies made it easy to identify a suitable cohort and control group for possible longitudinal study. Consent to participate was enthusiastically obtained, and no difficulties were encountered in collecting or analysing the data. Housing quality measurements were conducted using validated instruments with minimal difficulties. There was strong community involvement and support for a comprehensive longitudinal study. CONCLUSION: Cuba, although a poor country, has the necessary infrastructural support and capacity to make it an excellent site for health and housing intervention studies.
Tackling the "10-90 gap": a Canadian report.
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Setting global health research priorities.
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Change in health risk perception following community intervention in Central Havana, Cuba.
It is increasingly recognized that individual values, beliefs and behavior operate within a social context. There is growing consensus that local perceptions and indigenous knowledge should be important elements in the evaluation of programs aimed at improving health. Thus, an assessment of changes in health risk perception was included in the evaluation of a multi-component intervention project undertaken between 1996 and 1999 aimed at improving the health and well-being of residents in the inner city community of Cayo Hueso, in Centro Habana, Cuba. The community intervention involved a tremendous mobilization of government and non-governmental organizations, to promote social and cultural activities and address deficiencies in housing, water supply, waste disposal and street illumination. Prior to the interventions, 365 adults were surveyed regarding their perceived health risks regarding 41 health determinants, scored on four-point Likert scales ranging from 'without risk' to 'very risky'. A factor analysis of these data classified perception of risk into five areas: social environment, threats to personal health, lifestyle choices, environmental sanitation and housing conditions. The objective of the current analysis was to determine if there were changes in the level of perceived risk to health over the 5 years pre- versus post-intervention in Cayo Hueso, and if so, whether these changes were significantly different from changes seen during the same 5-year period in Colón, another community in Centro Habana not receiving focused interventions. During the first quarter of 2001, 1703 individuals living in 654 households in Cayo Hueso and Colón were interviewed in their homes using an enhanced version of the 1996 risk perception instrument. Ordinal logistic regression models, adjusted for age, gender and years of education, were fit to assess change in health risk perception between 1996 and 2001. Significant declines in perceived health risk were found in both Cayo Hueso and Colón within all five domains, with significantly greater declines in many areas in Cayo Hueso compared with Colón, particularly with respect to housing-related health risks, indeed the main target of the intervention. Risk perception surveys are useful characterizations of widely held views in a target population. Our findings of decreased perceived health risk following public health, physical and social interventions to improve health suggests that this line of inquiry merits consideration in planning evaluations of multi-sectoral community-based health promotion interventions.
Community participation in a multisectoral intervention to address health determinants in an inner-city community in central Havana.
It is increasingly acknowledged that the process of community involvement is critical to the successful implementation of community-based health interventions. Between 1995 and 1999, a multisectoral intervention called Plan Cayo Hueso was launched in the inner-city community of Cayo Hueso in Havana, Cuba, to address a variety of health determinants. To provide a better understanding of the political structures and processes involved, the Cuban context is described briefly. The interventions included improvements in housing, municipal infrastructure, and social and cultural activities. A qualitative study, consisting of interviews of key informants as well as community members, was conducted to evaluate the community participatory process. Questions from an extensive household survey pre- and postintervention that had been conducted in Cayo Hueso and a comparison community to assess the effectiveness of the intervention also informed the analysis of community participation, as did three community workshops held to choose indicators for evaluating effectiveness and to discuss findings. It was found that formal leaders led the interventions, providing the institutional driving force behind the plan. However, extensive community involvement occurred as the project took advantage of the existing community-based organizations, which played an active role in mobilizing community members and enhanced linkage systems critical to the project's success. Women played fairly traditional roles in interventions outside their households, but had equivalent roles to men in interventions within their household units. Most impressive about this project was the extent of mobilization to participate and the multidimensional ecosystem approach adopted. Indeed, Plan Cayo Hueso involved a massive mobilization of international, national, and community resources to address the needs of this community. This, as well as the involvement of community residents in the evaluation process, was seen as resulting in improved social interactions and community well-being and enhanced capacity for future action. While Cuba is unique in many respects, the lessons learned about enhancing community participation in urban health intervention projects, as well as in their evaluation, are applicable worldwide.
Retaining Canada's health care system as a global public good.
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Dengue in Cuba: mobilisation against Aedes aegypti.
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Effectiveness of installing overhead ceiling lifts. Reducing musculoskeletal injuries in an extended care hospital unit.
The effectiveness of replacing floor lifts with mechanical ceiling lifts was evaluated in the extended care unit of a British Columbia hospital. Sixty-five ceiling lifts were installed between April and August 1998. Injury data were abstracted from injury reports for all staff musculoskeletal injuries (MSI) occurring in the unit during a 3 year period prior to installation and a 1.5 year follow up period. Descriptive statistics were calculated for injuries pre- versus post-installation. Rates were calculated as number of injuries per 100,000 worked hours. Rates for three pre- and three post-installation intervals were compared using Poisson regression. The rate of MSI caused by lifting/transferring patients was significantly reduced (58% reduction, p = .011) after installation, but rates of all MSI and MSI caused by repositioning did not statistically decline (p > .05). Further follow up is necessary to determine whether or not ceiling lifts also can be effective for decreasing injuries related to repositioning patients on this unit.
Implementing a resident lifting system in an extended care hospital. Demonstrating cost-benefit.
1. Implemeting mechanical resident lifting equipment in an extended care facility produced a payback from direct savings alone within 4 years. Payback occurred more quickly when the effect of indirect savings or the trend to rising compensation costs was considered. 2. Combining the observations of the occupational health nurses related to staff well being with relevant cost-benefit data is useful in influencing decision makers and in securing funding for prevention measures. 3. Clear identification of a viewpoint is an important part of an economic evaluation and cost-benefit analysis.
Evaluating the effectiveness of a multi-component intervention to improve health in an inner-city Havana community.
The ecosystem approach to human health was applied to guide an evaluation of the effectiveness of a multi-component intervention to improve quality of life and health in an inner-city Havana community. A pre- versus post-intervention analysis was carried out in the study community of Cayo Hueso, and Colon, a concurrent comparison community. A household survey of 1,703 individuals was conducted in 30 neighborhoods, equally divided between the two areas. Greater improvements in housing, local infrastructure, and exposure to risk were perceived to have occurred in the targeted community, more so from the perspective of benefit to the community rather than with regard to the residents' own households. Improvements in some lifestyle-related risk factors and self-rated health in the most vulnerable subgroups (elderly and adolescents) were also achieved. Overall, the Cayo Hueso Plan was considered highly successful in improving the quality of life amid difficult circumstances. Its lessons are being embraced by other communities.
Canada and global health research: 2005 update.
From a global perspective, large disparities persist between the focus of health research investments and the global burden of illness. Over the past four years, Canadian efforts to address these disparities have steadily increased. The objectives of this paper are to present these recent achievements and to highlight continuing challenges. We summarize the activities of two complementary Canadian initiatives, both aimed at increasing Canada's investment and involvement in global health research. They are the Global Health Research Initiative--a partnership involving four federal agencies; and the Canadian Coalition for Global Health Research--a not-for-profit membership organization. Several achievements include: increased investment in global health research; increased knowledge production and use through "South-Canada" partnerships; stronger advocacy and increased awareness; enhanced capacity development; and improved coordination and communication. Based on these achievements, important current and future challenges are identified. They include: more coherent resource allocation; more focussed health research priorities; and the need to maintain and build momentum.
Learning together: a Canada-Cuba research collaboration to improve the sustainable management of environmental health risks.
OBJECTIVE: To build a national Cuban capacity for training environmental health professionals directly linked to the needs of policy-makers and communities. PARTICIPANTS: The University of Manitoba and University of British Columbia collaborated with an established training centre in Cuba (the Instituto Nacional de Higiene y Epidemiologia--INHEM) and new centres in the Central (Santa Clara) and Eastern (Santiago) regions of the country. SETTING: Cuba. INTERVENTION: In the mid-1990s, a comprehensive curriculum (masters and diploma programs) was collaboratively developed, applying interactive teaching methods, and was delivered through a series of workshops and other interactions in Cuba, and short-term visits to Canada by Cuban PhD students. OUTCOMES: The collaboration was successful in fulfilling capacity-building targets (over 50 Masters graduates, 467 Diploma graduates, over 30 trained core faculty in all regional centres as well as new curriculum and new accredited regional programs). Alongside this, a number of collaborative community-based research projects were undertaken in all three regions (drinking water in Santiago; housing and urban renewal, and dengue control in Havana; and tourism-related effects, and effective intersectoral management of population health determinants in Santa Clara). CONCLUSION: The collaboration led to adopting new strategies for challenges such as a dengue epidemic in 2002, and new research on the effectiveness of intersectoral management of risks of particular interest to both Cuban and Canadian policy-makers. It triggered an ambitious collaboration between the Canadian-Cuban team and colleagues in Ecuador in order to build a similar national network there, built on South-South and North-South links.