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PubMed2006

Impact of umbilical cord cleansing with 4.0% chlorhexidine on time to cord separation among newborns in southern Nepal: a cluster-randomized, community-based trial.

OBJECTIVE: Within a community-based, cluster-randomized study of the effects of 4.0% chlorhexidine on omphalitis and mortality risk, we aimed to describe the distribution of times to separation and the impact of topical chlorhexidine treatment on cord-separation times. METHODS: Between November 2002 and March 2005, 15123 infants were assigned randomly within communities in southern Nepal to receive 1 of the following 3 cord-care regimens: cleansing with 4.0% chlorhexidine, cleansing with soap and water, or dry cord care. In intervention clusters, field workers cleansed the cord in the home on days 1, 2, 3, 4, 6, 8, and 10 after birth. Newborns were monitored throughout the newborn period for signs of omphalitis, and the time to cord separation was noted. Separation times were compared across treatment groups. Cord infection risk and a range of infant and household characteristics were assessed for their relationships to separation time. RESULTS: The mean separation time was shorter in dry cord care (4.24 days) and soap/water (4.25 days) clusters than in chlorhexidine clusters (5.32 days; mean difference: 1.08 days). Cords of infants who received chlorhexidine were 3.6 times more likely to separate after 7 days. Separation time was not associated with omphalitis. Home-delivered topical antiseptics, facility-based birth, and birth attendant hand-washing were associated with greater likelihoods of cord separation after 7 days of age. CONCLUSIONS: In this setting, the umbilical cord separated more rapidly than observed in hospital-based studies, and the impact of chlorhexidine cleansing on separation times was negligible. Increased cord-separation time attributable to topical chlorhexidine treatment should not be considered a factor in decision-making in settings where the baseline risk of omphalitis is high and chlorhexidine might reduce infection and mortality risks significantly.

Chlorhexidine↗
PubMed2004

Evaluation of the VecTest Malaria Antigen Panel assay for the detection of Plasmodium falciparum and P. vivax circumsporozoite protein in anopheline mosquitoes in Thailand.

We evaluated the performance of the VecTest Malaria Antigen Panel (V-MAP) assay for the detection of Plasmodium falciparum and P. vivax (variants 210 and 247) circumsporozoite protein in anopheline mosquitoes in Thailand. The V-MAP assay is a rapid, one-step procedure using a 'dipstick' wicking test strip. The circumsporozoite (CS) ELISA was used as the reference standard. Mosquitoes evaluated in the study included field-collected specimens (n = 930) and laboratory-reared specimens that had been fed on blood collected from patients with and without Plasmodium gametocytes (n = 4,110) or on cultured P. falciparum gametocytes (n = 262). Field-collected mosquitoes were triturated individually or in pools of 2-5 and tested using 613 V-MAP assays. Laboratory-reared specimens were tested individually using 4,372 V-MAP assays. Assay performance depended on the species of Plasmodium and the number of sporozoites used as the cut-off. For P. falciparum, optimal performance was achieved using a cut-off of 150 sporozoites (sensitivity = 100%, specificity = 99.2%, and accuracy = 0.99). For P. vivax variant 210, optimal performance was also achieved using a cut-off of 150 sporozoites (sensitivity = 94.8%, specificity = 94.5%, and accuracy = 0.95). We were unable to develop a standard-curve for the CS-ELISA using P. vivax variant 247 because of a lack of sporozoites; however, using a cut-off of 30 pg P. vivax 247 antigen (mosquitoes with less than this amount of antigen were considered negative), assay performance (sensitivity = 94.3%, specificity = 99.2%, and accuracy = 0.99) was comparable to that achieved for P. falciparum and P. vivax 210. These results clearly demonstrate that the V-MAP assay performs at an acceptable level and offers practical advantages for field workers needing to make rapid surveys of malaria vectors.

Animals↗
PubMed1998

Prevention strategy for vibration hazards by portable power tools, national forest model of comprehensive prevention system in Japan.

In the 1950s, the introduction of portable power tools into the production process of many industries began on a large scale around the world and resulted in many cases of occupational vibration syndrome after the 1960s. There was an urgent world wide need to undertake preventive steps, medical assessment and therapy. At the end of 1964, our investigation began in Japanese national forests, and then in mines and stone quarries. The Japanese Association of Industrial Hygiene established a "Committee for Local Vibration Hazards" (1965), and many researchers in the medical and technological fields joined this Committee. After 10 years, a comprehensive system for the prevention of vibration syndrome was established in the national forestry. It consists of 1) improvements in vibrating tools, 2) hygienic regulation of operation time with an alternative working system, 3) health care system involving early medical checks, early therapy and age limitations in operation of vibrating tools, 4) protection against cold in the workplace and while commuting, and 5) education and training for health and safety. The prevention strategy for vibration syndrome in our national forests is to establish a comprehensive prevention system in cooperation among researchers in the medical and technological fields, workers and administration. The Ministry of Labor presented that strategy as good model of prevention for other industries (1976). New designs for this model were developed and adapted according to the special conditions of each industry. Thus comprehensive system for prevention of vibration syndrome developed successfully from the late 1970s to 1980s in Japan.

Forestry↗
PubMedDate not supplied

Telematics in research planning processes: an example from global health.

It is increasingly recognized that the appropriate application of information and communication technology can substantially improve communication and cooperative work processes in terms of quantity, quality and cost-effectiveness. Within large organizations, strategic decision making is one of the key cooperative processes which have to be faced. In this paper the authors discuss one example of this class of cooperative processes: research planning within the World Health Organization (WHO). The paper presents conceptual details of a process designed to assist in creating global networks of scientists, planners and field workers interested in cooperating to promote health development activities of WHO. The implementation of this process was realized in an Internet-based system to support global research planning. In particular, this application shows that the utilization of information and communication technology can not only quantitatively change existing processes, but can create new ones--and on a qualitatively improved level.

Cooperative Behavior↗
PubMedDate not supplied

Indoor air pollution and pulmonary adenocarcinoma among females: a case-control study in Shenyang, China.

Factors that affect the risk of lung adenocarcinoma among females were investigated in Shenyang, China, using a population-based case-control study design. A total of 72 new cases, ages 35-69, diagnosed with incident, primary pulmonary adenocarnoma, were collected between April 1991 and December 1995, and were 1:1 age-matched with healthy females randomly selected from the general population. A questionnaire covering demographics, diet/nutritional preferences and cooking habits, living conditions, family history of cancer, sources of indoor/outdoor/occupational pollution, exposure to ETS from spousal smoking, workplace exposure, and exposure during childhood, history of menstruation and pregnancy, was given to each subject in a structured in-person interview given by trained field workers. Univariate analysis was performed on the data collected. The results showed that cooking fumes, family history of lung cancer, economic status, and number of live births and intake of vitamin E were risk factors significantly associated with adenocarcinoma of the lung. In particular, exposure to different levels of cooking fumes, an indoor air pollutant, increased the odds ratio of lung adenocarcinoma by 1.33, 7.33 and 1.67, respectively (trend p=0.006). Another important risk factor was family history of lung cancer, which gave an OR of 7.65 (95% CI, 0.90-169.84). Intake of beta-carotene from vegetables and fruit offered protection against lung adenocarcinoma, giving an OR of 0.28 (95% CI, 0.12-0.69). These results were confirmed by multivariable logistic regression analysis.

Adenocarcinoma↗
PubMed2005

[Young people's perceptions of tobacco-related cancer].

An anthropological study was conducted on the island of Reunion between March and September 2004 within the framework of a project called "The non-smoking generation" carried out by the Regional Committee for Health Education. The primary objective was to provide field workers with a basis for reflection which they could incorporate into their tobacco prevention activities aimed at young people. The perceptions of youth on tobacco-use related cancer were explored using a sample population group of 37 young people aged between 14 and 25 years old (girls and boys, smokers and non-smokers, those who attend school and those who don't) from across the island. Interviews were conducted using an anthropological analysis grid and completed through observational sessions in their homes, schools and neighborhoods. The results, set within the context of time and the places where tobacco is consumed, demonstrate that their relationship to cigarettes symbolises some of the inherent characteristics of adolescence, namely, the difficulty in finding and establishing one's own limits, in integrating oneself into society and in envisioning one's potential future. An interesting observation was also made regarding their views on the one hand of a paradoxical approach relating the development of cancer and tobacco consumption behaviour, and the real, concrete physical and psychological impact of the disease on the other. The young people often expressed a certain fatality and a feeling of control ("I can quit whenever I want to!"). The team also found within their remarks a sense of being unfortunate as opposed to that of being in control, coupled with fear as opposed to feeling invincible ("cancer only happens to other people"). Finally, the study has allowed for reflections on youth tobacco prevention interventions to be nurtured with respect to how individual young people position the consequences of tobacco use and smoking, mainly with regard to their own personal responsibility.

Adolescent↗
PubMed1991

The training and use of research assistants for a survey in a Third World setting.

This article describes an approach to gathering data in a black township. It emphasizes the importance of using indigenous interviewers and offers suggestions for their training. Innovative techniques were used to help the field workers to understand and apply the concept of randomization to the streets and houses of their Township. It emphasizes the need to supervise and reinforce the research standards throughout the data collection process.

Allied Health Personnel↗
PubMed1979

Control of schistosomiasis: report of a workshop.

Nineteen scientists, field workers, and representatives of funding agencies active in schistosomiasis research and control met in Bellagio, Italy in October 1977 to attempt to evaluate the effectiveness of current control methods and what might be accomplished with available technology. The deliberations included summaries of knowledge on the biology, transmission, and control of schistosomiasis and assessment of major control programs and methodologies. The groups concluded that in the major endemic areas considerable gains in control of schistosomiasis could be made with current technology. However, maintenance of control in most countries, and establishment of serious control programs in countries in which schistosomiasis is a less severe public health problem, would require development of less expensive modalities which would need little monitoring and possibly have benefits extending beyond schistosomiasis control.

Agriculture↗
PubMed2004

Fate of Listeria monocytogenes in bovine manure-amended soil.

The survival and growth of Listeria monocytogenes in soil amended with bovine manure was studied under different environmental conditions of temperature, nutrients, and soil microflora. Autoclaved soil was compared with unautoclaved soil for assessing the influence of competitive soil microflora on the survival of L. monocytogenes. Initial L. monocytogenes cell numbers of 5 to 6 log CFU/g survived for up to 43, 43, and 14 days in manure-amended autoclaved soil at 5, 15, and 21 degrees C, respectively. In manure-amended unautoclaved soil, the pathogen was detectable for up to 43, 21, and 21 days at 5, 15, and 21 degrees C, respectively. L. monocytogenes was inactivated more rapidly in autoclaved soil amended with manure at a manure/soil ratio of 1:10 than in the more dilute (1:100) manure in soil samples at both 15 and 21 degrees C. However, in manure-amended unautoclaved soil, L. monocytogenes survived longer in samples with ratios of 1:10 than in the more dilute (1:100) manure-amended soil. The persistence of L. monocytogenes for several weeks in manure-amended soil suggests listeriae could be transmitted through soil to fresh produce or to shoes, clothing, and hands of field workers, especially during the cold months.

Antibiosis↗
PubMed1998

Childhood immunization coverage in zone 3 of Dhaka City: the challenge of reaching impoverished households in urban Bangladesh.

A household survey of 651 children aged 12-23 months in Zone 3 of Dhaka City carried out in 1995 revealed that 51% of them had fully completed the series of childhood immunizations. Immunization coverage in slum households was only half that in non-slum households. Apart from residence in a slum household, other characteristics strongly associated with the completion of the entire series of childhood immunizations included the following: educational level of the mother, number of children in the family household, mother's employment status, distance from the nearest immunization site, and number of home visits from family-planning field workers. The findings point to the need to improve childhood immunization promotion and service delivery among slum populations. Two promising strategies for improving coverage are to reduce the number of missed opportunities for immunization promotion during encounters between health workers and clients, and to identify through visits to households those children who need additional immunizations. In the long run, increasing the educational level of women will provide a strong stimulus for improving childhood immunization coverage in the population.

Age Factors↗
PubMed2000

The development of a protocol to manage the potential of groundwater contamination from on-site sanitation.

The provision of water supply and sanitation services to the developing and water scarce areas of South Africa is one of the goals of the Reconstruction and Development Programme. One of the principles of the South African National Sanitation Policy stipulates that sanitation systems which have unacceptable impacts on the environment cannot be considered to be an adequate form of sanitation. The greatest contamination concern with respect to ventilated improved pit toilets is in relation to groundwater resources. To this end the National Sanitation Co-ordination Office (NaSCO) and the Directorate of Geohydrology of the Department of Water Affairs and Forestry have developed "A Protocol to Manage the Potential of Groundwater Contamination from On-Site Sanitation". The aim of the protocol is to ensure that reasonable measures are taken to guard against contamination of valuable groundwater resources by inappropriately located or designed sanitation systems. The protocol focuses on dry on-site sanitation systems and provides a brief background to the current understanding of groundwater contamination by on-site sanitation systems. It also presents a procedure to be followed by those involved in implementing new, or upgrading old systems--the procedure allows the field worker to assess whether groundwater resources may be at risk of pollution. The protocol is specifically aimed at engineering and technical staff who are not groundwater specialists.

Humans↗
PubMedDate not supplied

[Case report of accidental stab wound to the heart].

A 33 year-old Polish field-worker was found by his colleagues kneeling in front of his trailer, with a bloody stab wound in the heart region. In spite of prompt surgical intervention, the man died from his injury a few hours later. Upon examination of the dead man's trailer a blood-smeared vegetable-knife was found in the sink, and on the floor, a pullover with a slit-like cut. On the wall hung a jacket on a hook with a cut in the inner surface of the left breast pocket but not in the outside layer. The examination of the clothes, the autopsy and a reconstruction of the sequence of events led to the following conclusion: The knife had been placed into the breast pocket of the jacket with the tip facing downwards. As the man put down a sack of potatoes, the knife hooked into a pre-existing gap in the sack and was driven into the chest cavity by the pressure weight of the heavy sack.

Accidents, Occupational↗
PubMed2000

Bangladeshi rural mothers prepare safer rice oral rehydration solution.

Mothers in rural Bangladesh were trained to prepare and use either Rice-ORS (R-ORS) or Glucose-ORS (G-ORS) solutions to treat children with diarrhoea. Families were provided with either G-ORS or R-ORS of the same electrolyte composition through a depot holder. Subsequently, random samples of solutions actually used for treatment by the mothers were collected from homes by field workers. A total of 227 R-ORS and 239 G-ORS samples were analysed. The sodium concentration in about 90% of the samples had a safe range (50-120 mmol/l). Only 4% of R-ORS solutions were above 120 mmol/l in sodium concentration, while 12% of G-ORS solutions exceeded these limits (p < 0.0025). R-ORS (after acid hydrolysis) provided significantly higher glucose (257 +/- 42 mmol/l) for active but safe absorption compared to G-ORS (115 +/- 39 mmol/l). To make R-ORS liquid enough to drink requires addition of sufficient water, preventing the risk of higher sodium concentration. Unlike rice starch, glucose is a highly soluble substance. It is thus possible to prepare a drinkable solution containing dangerously high concentrations of both sodium and glucose, but this can be minimized by more intensive training of the mothers.

Bangladesh↗
PubMed1999

[Splendor and misery in the local organization of mental health: a look at the field].

Collaboration among public and community resources (or concentration as it is referred to in French) is a practice much favoured by governments for ideological and economic reasons. But if administrative collaboration is relatively easy to set up, what about collaboration among front-line field workers? What are the ingredients likely to engender true collaboration among practitioners, and what obstacles do they meet with on a practical day-to-day level? Experience acquired in the West Island area of greater Montreal has led us to the conclusion that many issues need to be examined and understood: the difficulty of reconciling client empowerment with treatment; the difficulty of harmonizing the values and convictions prevailing in institutional and community-based networks; the tendency for practitioners to keep clienteles for themselves within a treatment environment. Despite these difficulties, it is evident that there will be a trend towards increasing collaboration where clienteles are growing and where problems are becoming more complex.

Community Mental Health Services↗
PubMedDate not supplied

Community-based tobacco control program: the Mamre study, a demonstration project.

OBJECTIVES: To assess the feasibility of a 5-year community-based tobacco control program in the community of Mamre in South Africa, while measuring the smoking and quitting rates at the beginning and end of this demonstration project. METHODS: A tobacco intervention program was developed at low cost in collaboration with the community, and involved a wide range of activities targeting people of all ages, especially those at risk for cardiovascular disease. Community members were trained to deliver smoking cessation programs and specific advice to smokers. Cross-sectional surveys were conducted in 1989 in a random sample of 1238 people, aged 15 years and older, prior to the 5-year demonstration project, and again in 1996 among 974 people at the end of the project. Demographic data and smoking and quitting patterns were collected by interviewer-administered questionnaires. Trained field workers used standardized procedures for recording blood pressure, height, and weight. RESULTS: The community participated with enthusiasm in the activities surrounding smoking cessation and the annual World No Smoking Day. The smoking rate decreased significantly between the two surveys (OR 1996/1989 = 0.82; 95% CI of 0.69-0.99), and the quitting rate increased significantly during the 5-year intervention period compared to the 5 years prior to the baseline survey (OR 1996/1989 = 0.74; 95% CI of 0.57-0.98). Men who participated in the program but continued to use tobacco in 1996 smoked more cigarettes than those who smoked in 1989. People who quit during the intervention period tended to be older, hypertensive, and obese; they consumed no alcohol, and noticed the health warnings posted in the community if they were older and had 10 or more years of education. CONCLUSIONS: A low-cost community-based tobacco control program was successfully implemented in the Mamre community. The program was received enthusiastically, built tobacco cessation skills, and significantly reduced the community's smoking rate compared to that before the demonstration project.

Adolescent↗
PubMed2001

Infectious risk associated with wastewater reuse: an epidemiological approach applied to the case of Clermont-Ferrand, France.

Wastewater reuse raises the question of health risk and the epidemiological surveys needed. An epidemiological and environmental approach was used to check the security for the exposed populations (surrounding and agricultural population in Clermont-Ferrand. Four information systems were set up: two sentinel systems joining general physicians (15) and pharmacists (7) for the surrounding population and two follow-up surveys among field workers and farmers. Water quality monitoring and a study of aerosols from spray irrigation were performed. No epidemic event was identified with only some case clusters (not related to water exposure) being observed. All the declared cases were benign. The workers' survey underlined a substantial incidence of nettle rashes, itchy skins, sunburns, and cuts. The follow-up study among farmers and their families did not reveal any particular phenomena. The bacteriological quality of treated wastewater throughout conformed with the recommendations of the Superior Council of Public Health of France (1,000 faecal coliforms/100 mL). No faecal bacteria were observed in aerosols with water concentrations equal to 10(3) cfu/100 mL and an exposure time of 20 min. The survey of such an irrigation system, towards potential and actual risks, required the conjunction of different epidemiological information sources and microbiological data.

Adult↗
PubMed2001

[The community pharmacist and the problem of excessive drinkers].

On a daily basis, the community pharmacist is just as concerned with alcohol (when detecting the interactions between alcohol and medication, or the use of alcohol as an excipient or active ingredient), as with alcoholism (when filling prescriptions, providing advice and guidance to patients, or undertaking other health education actions). In order to define the pharmacist's perception of the problem of alcoholism, an opinion poll was conducted by direct interrogation using a standardised questionnaire. The poll surveyed the owners of 101 randomly selected pharmacies in Puy de Dome. All of the pharmacists questioned are sensitive to and aware of the problem of interactions resulting from mixing alcohol and medication at the time of filling prescriptions. On the other hand, their perception of alcoholism and their behavior towards alcoholic patients vary. They frequently stressed the difficulty of establishing a dialogue. In spite of receiving information and training on alcoholism, perceived as insufficient, pharmacists claim to be really concerned by this problem. As field workers, community pharmacists think that they have a major role to play in carrying out health education campaigns and alcoholism prevention. In fact, the pharmacy is a privileged setting for facilitating encounters and discussions, where alcoholism, like all public health problems, can be addressed.

Adult↗
PubMed2002

Microbiological quality of a waste stabilization pond effluent used for restricted irrigation in Valle Del Cauca, Colombia.

This paper discusses the applicability of effluent reuse in agriculture after treatment in a series of anaerobic, facultative and maturation ponds. The WSP system is located in Ginebra municipality, a small town in southwest Colombia. The total HRT is 12 days. Several samples of the final effluent were taken over a 55 day period and were analysed for E. coli, Streptococcus spp. and helminth eggs. Some additional grab samples were taken to determine the presence of pathogenic bacteria such as Salmonella spp. and Shigella spp. The results showed that the system was able to remove 4 log units of E. coli, 1 log unit of Streptococcus spp. and 100% of helminth eggs. Meanwhile, Salmonella spp. were detected in the effluent of the facultative pond whilst Shigella spp. were not detected in any sample. The main species of helminth eggs encountered were Taenia spp., Ascaris spp., Trichuris spp., Hymenolepis nana, H. diminuta and Enterobius vermicularis. Removal efficiencies were satisfactory despite the relatively short HRT. Nevertheless, WHO guidelines were slightly surpassed in the case of E. coli for unrestricted irrigation. The helminth egg value was always below the maximum WHO limit. Hence, this effluent can be safely used for restricted irrigation provided that field workers are protected from direct contact with wastewater given the presence of Salmonella spp. in the facultative pond effluent.

Agriculture↗