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PubMed1969

"Abre la boca".

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Agriculture↗
PubMed2006

Promises and challenges of faith-based AIDS care and support in Mozambique.

OBJECTIVES: We sought to examine the role of religious organizations in the provision of HIV/AIDS-related assistance in Africa. METHODS: We used data collected from Christian religious organizations in southern Mozambique. Bivariate comparisons and logistic regression analysis of survey data were performed. We conducted an analysis of the qualitative data to complement the quantitative results. RESULTS: Our analysis revealed little involvement of religious organizations in provision of assistance. Most assistance was decentralized and consisted of psychological support and some personal care and household help. Material or financial help was rare. Assistance to nonmembers of congregations was reported more often than to members. Members of larger and better-secularly connected congregations were more likely to report assistance than were members of smaller and less-secularly engaged ones. Assistance was reported more in cities than in rural areas. Women were more likely than men to report providing assistance to congregation members, and the reverse was true for assistance provided to nonmembers. The cooperation of religious organizations in provision of assistance was hindered by financial constraints and institutional rivalry. CONCLUSIONS: Policy efforts to involve religious organizations in provision of HIV/AIDS-related assistance should take into account that organization's resources, institutional goals, and social characteristics.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Survey of rabies preexposure and postexposure prophylaxis among missionary personnel stationed outside the United States.

BACKGROUND: Of the 36 cases of human rabies that have occurred in the United States since 1980, 12 (33%) were presumed to have been acquired abroad. In the United States, it is recommended that international travelers likely to come in contact with animals in canine rabies-enzootic areas that lack immediate access to appropriate medical care, including vaccine and rabies immune globulin, should be considered for preexposure prophylaxis. In 1992, the death of an American missionary who had contracted rabies while stationed in Bangladesh highlighted this high-risk group. METHODS: To assess their knowledge of rabies risk, rabies exposures, and compliance with preventive recommendations, we asked 695 missionaries and their family members to complete questionnaires about their time stationed abroad. RESULTS: Of the 293 respondents stationed in countries where rabies is endemic, 37% reported prior knowledge of the presence of rabies in their country of service. Only 28% of the personnel stationed in rabies-endemic countries received preexposure prophylaxis. Having preexposure prophylaxis specifically recommended increased the likelihood of actually receiving it (O.R. 15.6, 95%CI 7.4 - 34.9). There were 38 reported exposures (dogs = 66%, another human = 20%), proven or presumed to be rabid. Three of the people exposed received rabies immune globulin and vaccine; 11 received vaccine alone; 8 received only basic first aid, and 16 received no treatment. CONCLUSIONS: Although American missionaries stationed abroad are at an increased risk for exposure to rabies, compliance with established preventive measures was low. Prior to being stationed abroad, an educational rabies-prevention briefing, including encouragement to receive preexposure prophylaxis, could be an effective intervention for missionaries to decrease their risk of rabies.

Adult↗
PubMed1997

Asthma in Hawaii: a tradition of excess mortality.

Hawaii has the highest asthma mortality in the nation and clinically has always had high rates. In contrast, international consensus has it that deaths have been rare over the past two centuries to 1950. The objective of this study was to document Hawaii's asthma mortality over the centuries to 1950. Asthma mortality was examined from pre- and early European times through kahunas, aphorisms, historical libraries, and materia medica. In 1879, vital statistics became available locally and from 1901 from the federal government. Asthma deaths were not rare in ancient Hawaii. Vital statistics in 1879 revealed an asthma mortality of 83/100,000 which declined to 4.0 by 1950. U.S. and international mortality, at least to 1930, was almost unknown. Compared to U.S. and international rates, Hawaii's asthma mortality has been excessive since ancient days.

Adolescent↗
PubMed1980

Rabies exposure among Norwegian missionaries working abroad.

Based on the results of an inquiry among 296 Norwegian missionaries and Foreign Aid workers, we present some observations on the present rabies situation in several African countries, India and Bangladesh, Equador and Bolivia. Traditionally these countries receive a large proportion of our missionaries and Foreign Aid personnel. The incidence of rabies varies considerably in the areas covered by this investigation. When calculated for the mean length of stay (4 to 5 years) the average rating of physical exposure to proven or suspected rabies was 16% per household and 7% per individual household member. The risk of exposure was higher with children (10%) than adults (6%). the family dog equalled the stray dog as the source of suspected infection. Of the 48 persons who had been recommended post-exposure vaccination two thirds had only tended or been licked by the offending animal. However, in such animals the ratio of proven or highly probable rabies to non-proven or unknown diagnosis was 2:1. The rabies situation was considered as a minor factor of psychic stress by two thirds of the responding persons, even in highly epizootic countries. The results of this study may be of some value in the process of forming a policy for pre-exposure prophylaxis against rabies for people who are going to stay for a prolonged period of time in these areas of the world.

Adult↗
PubMed1989

LTC in the Third World.

1. More than half the world's elderly, 370 million people, live in Third World Nations. As this population increases, the growth rate is fastest for the oldest of the old, those most likely in need of health services. Provision of long-term care is a vital issue in future development planning. 2. A major threat to the elderly's health was communicable disease, a societal dilemma that will require further economic development and advances in the country's community health system. 3. The aged in this setting in India experienced multiple chronic diseases and degenerative conditions, potential problems with polypharmacy, and major functional losses. Some also expressed feelings of uselessness and dependency. These issues can be compared to those of institutionalized elderly in the West.

Aged↗
PubMed1991

Persecution and martyrdom of nurses in selected regions of Asia during the period 1900-1978--Part 2.

The persecution and martyrdom of nurses identified in selected regions in Asia since the beginning of the twentieth century is discussed. Many missionary workers lost their lives in China during the Boxer rebellion in 1900. The persecution and martyrdom suffered by nurses working in China at the time is described followed by an account of the events which led to the deaths of nurses working in Korea, Thailand, Vietnam, Laos and East Pakistan during the early and latter half of the twentieth century.

Asia, Eastern↗
PubMed1990

Effect of malaria chemoprophylaxis on the development of antibodies to Plasmodium falciparum in expatriates living in west Africa.

We studied the relationship between exposure to malaria, the use of long-term chemoprophylaxis with chloroquine, and the prevalence of sporozoite antibodies in 446 expatriates who had lived in 7 West African countries for 6 months-41 years. Filter paper blood samples from 12% of the subjects had antibodies to the repeat region of the Plasmodium falciparum circumsporozoite protein, with a positive correlation between enzyme-linked immunosorbent assay (ELISA) absorbance and years of exposure (r = 0.32, P = less than 0.01). Development of sporozoite antibodies did not correlate with reported use of chloroquine. Ten samples from expatriates with the highest ELISA titers and 10 samples from West African nationals, which were matched for ELISA titer and duration of exposure, were characterized more fully. All 20 samples reacted strongly with sporozoites by immunofluorescence. The 10 samples from nationals reacted strongly with liver-stage antigens by immunofluorescence and with blood-stage antigens by immunofluorescence and immunoblotting. In contrast, the 10 samples from expatriates were negative or only weakly positive in the liver- and blood-stage assays. These results imply that sporozoite antibodies are generally not cross-reactive with blood-stage antigens, and suggest that protective immunity to malaria does not develop during long-term malaria chemoprophylaxis against the erythrocytic stage.

Adolescent↗
PubMed1990

High incidence of viral hepatitis among American missionaries in Africa.

Protestant missionaries (n = 360) serving in sub-Saharan Africa between 1967-1984 were studied to determine the risk of hepatitis A virus (HAV) and hepatitis B virus (HBV) infection. Personnel were serologically screened for antibody to both the hepatitis A virus (anti-HAV) and the surface antigen to the hepatitis B virus (anti-HBs) prior to departure, periodically during service abroad, and upon completion of their African tour. Rates of seroconversion were used as measures of the incidence of infection. Prior to service, 16% of the staff had anti-HAV and 3% had anti-HBs; post-service rates were 42% and 26%, respectively. Over 90% of the staff with greater than 20 years of service were seropositive for anti-HAV. For both viruses, the infection rate was highest during the first 1-2 years of service, when 28% of those susceptible to HAV and 11% of those susceptible to HBV became infected. Over the next decade, the median annual attack rate was 5.4% for HAV and 4.2% for HBV. Differences in the missionary HBV infection rate among the various African nations served tended to reflect differences in the magnitude of chronic HBV carriage among indigenous population groups. We conclude that missionaries to sub-Saharan Africa are at enhanced risk of both HAV and HBV infection, and that all should receive passive immunization with immune globulin and active immunization with hepatitis B vaccine.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Mortality trends of American missionaries in Africa, 1945-1985.

Mortality trends of missionary staff serving in sub-Saharan Africa were tracked for the period 1945-1985. For 1945-1970, when more complete incidence data were available, the missionary death rate was approximately 40% lower, after adjustment, than would be expected in a comparable US population. This trend persisted through 1985. Between 1945 and 1970, the largest number of fatalities was attributable to malignancy, atherosclerosis, accidents, and infectious disease, and the greatest mortality risks, compared with the US experience, were from homicides, the complications of pregnancy, and infections, notably malaria, hepatitis, and polio. Beginning in the late 1950s, motor vehicle accidents became the leading cause of death. Since the 1960s, accidental causes of death have been approximately 50% higher than in the US, and homicides have been four times higher. During this same period, the infectious disease death rate decreased to approximately that within the US. Currently, the leading causes of mortality are motor vehicle accidents, malignancy, and atherosclerosis, followed by other accidental causes, notably aircraft mishaps and drownings. Viral hepatitis is presently the leading infectious disease cause of death. Other contemporary lethal infections include malaria, rabies, typhoid, Lassa fever, and retroviral infection. It was concluded that missionaries in sub-Saharan Africa had a death rate approximately half that expected in a comparable domestic control population. Preventive strategies, particularly relative to accident and infectious disease prevention, could effectively reduce mortality risk further.

Accidents, Traffic↗