Will rights cure malnutrition? Reflections on human rights, nutrition and development.
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The global nutrition community recognizes the usefulness of nuclear and isotopic techniques and especially stable isotopes for accurate measurements in key areas of human nutrition and health. Although progress has been made in many Latin America countries in reducing the absolute number of undernourished people, food policy and public health communities have to face the double burden on health. On one side they have to address the prevention of obesity and on the other side they are trying to reduce undernutrition. However, to be successful in development of sustainable nutrition programs, a combination of relevant scientific knowledge and approaches that are practical is required to assure even a reasonable level of success. The objectives of this review are to highlight the role of isotopic techniques in nutritional studies and to review the role of the International Atomic Energy Agency in supporting nutrition interventions in Latin America countries.
Funded by The Robert Wood Johnson Foundation and the California Endowment and with student financial aid from the W.K. Kellogg Foundation, the primary goal of the Pipeline, Profession, and Practice: Community-Based Dental Education program is to reduce disparities in access to dental care. In a national competition, fifteen dental schools were selected to participate. By the final year (2007) of the five-year project, the schools are expected to achieve three objectives: 1) increase the time (sixty days/year) that senior students and residents spend in patient-centered community clinics and practices treating underserved populations; 2) provide didactic and clinical courses for students and residents that prepare them for their community experiences; and 3) recruit more underrepresented minority and low-income students. The national program office that directs the project is located at Columbia University, and a national advisory committee oversees the program for the sponsoring organizations. The challenge is to demonstrate that the Pipeline objectives are achievable and that the program is sustainable without external support.
Within the Swedish research program SUCOZOMA (Sustainable Coastal Zone Management) several conflict studies have been carried out. Whereas the detailed results of these studies are published separately, this paper reviews important results from conflict research in combination with a summarizing and generalizing discussion of approaches and main results of SUCOZOMA's resource and conflicts studies. After an analysis of interdisciplinary and theoretical research about environmental and resource use conflicts, the methodology used in SUCOZOMA is presented, a combined stakeholder and conflict analysis. It can be summarized in four main points: i) to map the stakeholders and their interests; i) to analyse the conflicts; iii) to develop methods for conflict mitigation and cooperation with stakeholders; iv) to integrate these components in a system for the management of natural resources. Exemplary case studies of resource use conflicts have been carried out at the Swedish west and east coast including coastal fishery, mussel culture, coastal planning and specific conflicts such as between species protection (seals) and coastal fishery. Researchers are involved as experts and as conflicting parties, and the role of scientists as stakeholders deserves special attention in conflict research. Conflict management is not only for the solution of present conflicts, but part of integrated resource management systems where knowledge transfer, institutional development, collective learning of scientific, political and administrative actors, and cooperation between scientists and resource users can occur.
While general online health content can play a role in improving health, a few organizations are adding classes and other online training programs. While most of these educational programs are either in their pilot or planning stages, early results point to quantifiable health benefits for users.
More than 80% of African Americans in Oregon reside in the Portland metropolitan area; African Americans comprise 1.7% of the state's population. Although relatively small, the African American population in the state experiences substantial health disparities. The African American Health Coalition, Inc was developed to implement initiatives that would reduce these disparities and to promote increased communication and trust between the African American community and local institutions and organizations. One of these initiatives is an annual Wellness Week featuring an African American Wellness Village. The Wellness Village uses a model of cultural sensitivity to provide access to free health screenings, links between health care organizations and African American community members, and health education and information. The African American Health Coalition, Inc obtained a Racial and Ethnic Approaches to Community Health (REACH) 2010 grant to sustain this programming. The Wellness Village is supported by five major sponsors; annual attendance has ranged from 700 to 900 participants. The African American Health Coalition's evaluation of the event indicates that more than 50% of respondents identify the Wellness Village as the only place that they receive health screenings. Participants with access to screenings elsewhere report that a culturally sensitive environment that inspires trust is the reason they prefer the screenings offered at the Wellness Village. Culturally sensitive health fairs such as the Wellness Village may play an important role in bringing preventive health screenings to African American communities. Collaboration between black and white health care providers is critical in this effort. Partnerships must be built at multiple levels, including institutions to provide financial resources and in-kind donations, community members to assist with outreach and recruitment, and health care professionals to conduct screenings and services.
Subspecialty training in endocrinology depends in part on local expertise, with fellows having "hands-on" experience in some areas but only "book knowledge" in others. To provide more uniform training in new technologies, The American College of Endocrinology developed Endocrine University, which provides on-site didactic and interactive sessions on thyroid ultrasound, bone densitometry, and other topics over 6 to 7 days. The inaugural event in 2002 was attended by 137 fellows. A second conference in 2003 had capacity attendance of 143. A third course is scheduled for 2004. Fellows pay a token registration fee; the College provides grants to defray the cost of registration, travel, etc. Financial support comes from the College and industry, with plans for an endowment to sustain the program. Fellows value the educational sessions and also the unique opportunity to meet and visit with their peers. This innovative program can serve as a model for other specialties.
The results of a thorough study of morbidity with temporary disablement in 4,164 agro-industrial workers from five types of agro-industrial associations (horned cattle breeding, pork breeding, mechanization, fruit and tobacco growing) are presented. After the main medical causes of morbidity with temporary digestive tract disorders, accidents and poisonings, diseases of the osteo-muscular and respiratory systems) the authors analyses the causal relations with various risk factors (alcohol abuse, non-observance of microclimate standards at the working spot, length of service, means of conveyance, worker's age, types of activities, etc.). It is underlined that a decrease in morbidity with temporary disablement is possible and that more sustained health programs are required.
Taeniasis and cysticercosis caused by Taenia solium, the pork tapeworm, are widespread infections of Latin America, Africa, and Asia. The disease in humans (neurocysticercosis), caused by the cystic larval stages which develop in the central nervous system, is often disabling and sometimes fatal. T. solium infections are endemic in rural and urban areas in some countries that have limited resources to introduce and sustain control programs. To give T. solium control high national priority, the effect of the diseases on health and social care budgets must be accurately measured. Surveys are needed to establish prevalence and geographical distribution of the diseases, to obtain basic epidemiologic data, to learn about transmission, to provide baseline data for the establishment of control measures, and to monitor control measures. Continuing surveys can provide information on changes in prevalence brought about by specific control measures or by changes in the standard of living, education, animal husbandry, and meat processing. Data are not yet available for any endemic-cysticercosis area, and this has hindered efforts to control the disease. There are technical limitations of currently-available methods for diagnosing both taeniasis and cysticercosis in humans in and lower animal hosts. This paper reviews the status and limitations of diagnostic methods and emphasizes the need for further research.
Single and dual photon absorptiometry were performed at the mid-radius, distal radius and lumbar spine in 1105 non-athletic and 124 athletic Caucasian women aged 18-98 years. An age-related loss of bone mineral density in mg/cm2 (BMD) occurred at the three skeletal sites. It was first demonstrated that a single break in the regression line (BMD versus Age) best fit the data. The break represented the approximate age at which an increase in the rate of bone density loss occurred. This break is termed the 'cutpoint'. The approximate (average) age at which the cutpoint occurred was determined by segmented regression analysis with bone density as the dependent variable. The age range studied was between 45 and 55 years. At all three bone sites, the cutpoints in non-athletic women occurred between 47 and 52 years of age, corresponding roughly to the time of menopause. Following this cutpoint the rate of bone loss increased at all three locations in non-athletic women. In athletic women no cutpoint in BMD values could be demonstrated for this age range for the two radial sites. The number of lumbar spine measurements in this group was too small for analysis. The absence of a significant change in rate of bone loss in athletes could have been due to the relatively small number of subjects. It could also suggest that regular sustained exercise programs may delay or minimize the increased rate of loss of BMD which occurs in non-athletic women in the perimenopausal period.
Human immunodeficiency virus (HIV) is one of the most virulent infectious agents ever encountered. This virus, estimated to kill up to a half of those infected, has spread to more than 1 million Americans. There is no safe and effective treatment. Nor is there a vaccine. From our understanding of HIV transmission, further spread of the virus can be stopped by the use of various techniques. The combined use of education-motivation-skill building, serologic screening, and contact tracing/notification could eliminate or substantially reduce transmission. To accomplish this reduction an immense concerted effort by physicians, public health practitioners, business, and community organizations is required to get across the simple prevention messages. Those messages are: Any sexual intercourse (outside of mutually monogamous or HIV antibody-negative relationships) must be protected with a condom. Do not share unsterile needles or syringes. All women who may have been exposed should seek HIV-antibody testing before becoming pregnant and, if positive, avoid pregnancy. Only through a concerted, vigorous, and sustained prevention program that deals frankly with this problem will those individuals at risk be reached and motivated to take personal responsibility to protect themselves. Without such an effort, acquired immunodeficiency syndrome will continue to kill ever-increasing numbers of Americans.
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A major factor in delivering patient care is documenting activities by pharmacists. This documentation is not only essential to sustain existing programs but necessary to justify future growth of resources. A computerized documentation system for clinical interventions and workload activities was developed in a 340-bed university teaching hospital. With the expansion of its pharmaceutical care model, the department reworked its distribution process to allocate more pharmacist time for patient care. Manual documentation of these services, however, soon was identified as an obstacle. A software program was developed to alleviate the problems inherent with manual documentation. This "user-friendly" program tracks clinical recommendations and interventions by pharmacists, and calculates cost savings/avoidance. It also facilitates monthly and annual reporting for department managers.
Rural women were involved in a water and sanitation project (WSS) in which health impacts were compared between children in two areas: intervention and comparison areas. In intervention area people were provided with handpumps, latrines and hygiene education, whereas, in the comparison area, people did not receive these project inputs. In the intervention area women were directly involved in the site selection of handpumps and latrines, their installation, construction, and maintenance. Observations on women's involvement and their performances in the intervention area are presented. About 89% of the pumps maintained by women (n = 30), and 86% of those maintained by project workers (n = 49) were found to be in good working condition. Women supervised the construction of all 754 latrines, fenced 58% of the projects-supported latrines (n = 268) and emptied the pits of 65% of the 276 filled-up latrines. Socio-cultural factors were not barriers to women's involvement and performance. The findings have policy implications for effective involvement of rural women towards the development of sustainable WSS programs.
A serosurvey for human immunodeficiency virus (HIV) infection was carried out in three well-separated population centers in Borno State of Nigeria in 1989-1990. The study subjects were 1,259 made up of sexually transmitted disease (STD) clinic attenders, pregnant women, female prostitutes, and blood donors. Sera were screened by enzyme-linked immunosorbent assay and confirmation was done by Western blotting. The overall seroprevalence was 1.67% (21/1,259), with no significant differences from one population center to another. There were, however, significant differences among the population groups studied: prostitutes, 4.24%; STD clinic attenders, 1.67%; blood donors, 0.71%; and pregnant women, 0.24%. Of the 21 seropositives, 18 were positive for HIV-1 only; 1 was positive for HIV-2 only; and 2 were positive for both HIV-1 and HIV-2. All three HIV-2-positive sera were from prostitutes. Prevalence rates found in this study showed marked increases from 2 to 3 years earlier. There is therefore the need for a vigorous and sustained intervention program.
Two strategies were tested to control Culex quinquefasciatus with Bacillus sphaericus in Maroua (population 130,000), Cameroon. The treatment of all potential breeding sites (27,000) with B. sphaericus during the dry season caused up to a 90% reduction in the adult biting rate. Because of the short persistence of B. sphaericus and the occurrence of new breeding sites, unacceptable levels of adult biting rates were reached again in 5 months. In the second strategy, two treatments per year of the most productive breeding sites (10,000) stopped the biting rate increase during the rainy season. The results were only partially successful because of variations in B. sphaericus toxicity. The first treatment required 1,200 man-days of work vs. 200 for the simplified treatments. The density of breeding sites depends on the rainfall and the presence of a tap-water network. A sustained control program of Cx. quinquefasciatus will depend upon the dynamics of the principal breeding sites and an improved formulation of B. sphaericus.