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PubMed1987

AIDS and prevalence of antibody to human immunodeficiency virus (HIV) in high risk groups in Thailand.

Since September 1984, six cases of acquired immune deficiency syndrome (AIDS) and 11 cases of AIDS related complex (ARC) have been reported in Thailand. All people with AIDS were homosexual or bisexual men; two were Thai and the rest were European or American. Nine of the 11 people with ARC were homosexual or bisexual men, one was the female sexual partner of a man with AIDS, and one was a Thai man who had lived in the United States of America for several years, but denied having had any homosexual contact. Nine of the 11 people with ARC were Thai. In a survey in April 1985 at a resort area near Bangkok, antibodies to human immunodeficiency virus (HIV) (confirmed by western blot) were detected in 2.4% of 127 homosexual men and none of 77 female prostitutes. In a more extensive survey in October 1985, antibodies were detected in 0.8% of 720 homosexual men, but none of 2880 female prostitutes or 309 sexually active heterosexual men. HIV has been introduced into Thailand primarily by homosexual transmission. The public health policy of Thailand concerning AIDS is discussed.

AIDS-Related Complex↗
PubMed1984

Essential health care: a framework for its definition and implementation in health districts.

This paper presents a framework for the definition and implementation of essential health care. It is based upon current experiences in developing countries. Its aim is to facilitate the description, in operational terms, of a range of activities for clearly defined targets--individuals, families and communities. It seeks to bring to the attention of responsible citizens and professionals the major areas which they should address in the search for "Health for All by the year 2000". It is hoped that this will facilitate integration of health care into socio-economic development activities; and promote a partnership between people and governments in community health development.

Community Mental Health Services↗
PubMed1990

Training of village health workers in Tanzania; a comparison of two approaches.

The paper compares the costs of training for two groups of Village Health Workers (VHWs) in Tanzania, where the policy of developing a system based on Primary Health Care principles will require the training of more than 16,000 VHWs during the next decade. In the Kilombero District, one group of VHWs was trained according to the guidelines of the National Programme of the Ministry of Health, and another group followed the training programme of the Kilombero Project, based on the Swiss Tropical Institute Field Laboratory. The training scheme of the Kilombero project cost almost 80% less for one VHW, largely because it depended on on-the-spot training by local staff. The results of a first investigation of the efficacy of the training were encouraging; a long-term evaluation is in progress. The curricula for the two programmes also differed; the Kilombero programme had shorter blocks of theory, interspersed with supervised practical work, and introduced curative medicine earlier in the course. The advantage and disadvantages of the two programmes are discussed, not only in terms of cost but also in terms of their efficacy in training VHWs who will be motivated, efficient and accepted by the community.

Community Health Workers↗
PubMed1993

Health of the nation: way forward in sexual health.

Sexual health is a wide concept encompassing education, health promotion and disease prevention, diagnosis and management of sexually transmitted diseases, screening and counselling for HIV antibodies, management of HIV infected patients, family planning, termination of pregnancy, psychosexual counselling, prevention of cervical and lower genital tract cancers, and sexual abuse. Implementation of The Health of the Nation (1992) will include assessing the current situation, views, alliances and interventions, need for research and development and within alliances setting challenging but achievable targets. The Health of the Nation includes a target for gonorrhoea which is a surrogate for partner change, sexually transmitted diseases in general and HIV infection, and a target for conceptions among those under 16 years of age. These targets need to be adjusted locally and may be staged. All interventions to achieve these targets must be available. Implementation of The Health of the Nation to achieve the main objectives which are to reduce the incidence of HIV infection and other sexually transmitted diseases as well as reducing the number of unwanted pregnancies and provision of effective family planning services will be challenging but sexual health gain will be well worthwhile.

Family Planning Services↗
PubMed2005

A genetic study of autism in Costa Rica: multiple variables affecting IQ scores observed in a preliminary sample of autistic cases.

BACKGROUND: Autism is a heritable developmental disorder of communication and socialization that has not been well studied in Hispanic populations. Therefore, we are collecting and evaluating all possible cases of autism from a population isolate in the Central Valley of Costa Rica (CVCR) for a clinical and genetic study. METHODS: We are assessing all subjects and parents, as appropriate, using the newly translated Spanish versions of the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) as well as tests of intelligence and adaptive behavior. Detailed obstetric and family medical/psychiatric histories are taken. All cases are tested for Fragile X and will be extensively evaluated for cytogenetic abnormalities. RESULTS: To date we have obtained clinical evaluations on over 76 cases of possible autism referred to our study and report data for the initial 35 complete cases. The mean age of the probands is 6.7 years, and 31 of the 35 cases are male. Twenty-one of the cases have IQs <50 and only 6 cases have IQs > or = 70. Over half of the mothers had complications during pregnancy and/or delivery. No cases have tested positively for Fragile X or PKU. Chromosomal G-banding is not yet complete for all cases. CONCLUSION: Diagnostic data gathered on cases of autism in the CVCR using Spanish versions of the ADI-R and ADOS look similar to that generated by studies of English-speaking cases. However, only 17% of our cases have IQs within the normal range, compared to the figure of 25% seen in most studies. This result reflects an ascertainment bias in that only severe cases of autism come to treatment in the CVCR because there are no government-sponsored support programs or early intervention programs providing an incentive to diagnose autism. The severity of mental retardation seen in most of our cases may also be exaggerated by the lack of early intervention programs and the use of IQ tests without Costa Rican norms. Still, we must formally train healthcare providers and teachers to recognize and refer autistic cases with normal or near normal IQs that are not seen in treatment.

Adult↗
PubMed1998

Risk profile of female sex workers who participate in a routine penicillin prophylaxis programme in Surabaya, Indonesia.

We conducted a sexually transmitted disease (STD) prevalence survey of 1867 female sex workers in Surabaya, Indonesia, some of whom reported participation in a routine penicillin prophylaxis programme. In Surabaya, 34% of female sex workers had received a prophylactic penicillin injection programme from the government within 28 days. Sex workers who had received routine prophylaxis injection were more likely to be less educated, to work in brothel complexes, and to have more customers per week than other sex workers. The prevalence rates of syphilis, gonorrhoea, chlamydia, and trichomoniasis were higher among sex workers who received the routine penicillin treatment than among those who had not received antibiotic treatment in the last 28 days. However, after adjustment for age, education, fee per sex act, number of customers, and condom use in the previous 7 days, only trichomoniasis was still significantly different (adjusted odds ratio of 3.2). High-risk women were more likely to participate in the routine penicillin prophylaxis programme. The lack of a demonstrable individual-level protection from this prophylaxis treatment programme in this cross-sectional study appears due to differential uptake of penicillin prophylaxis by women at higher presumptive risk for STD. Randomized clinical trials and mathematical modelling, together with observational data such as presented here, all can contribute to optimal understanding of a complex intervention like mass chemoprophylaxis for STD among female sex workers.

Adult↗
PubMed1989

Fostering primary and secondary prevention in public policy for pregnant adolescents.

The diverse factors associated with sexuality among adolescents and the specific issues related to contraception in this developmentally diverse group result in complexity in policy formation. The future of an adolescent may be determined solely on the basis of access to supportive physical and emotional services funded by public and private sector monies. The purpose of this paper is to briefly present contemporary and social policies regarding pregnant adolescent health care. Suggestions as to how these policies can be translated into public adolescent health models are provided. The strategies will be related to primary and secondary public policy interventions.

Adolescent↗
PubMed1985

Two models for change in the health services in Zimbabwe.

The health situation in pre-Independence Zimbabwe was much as elsewhere in the Third World. While the majority suffered excess mortality and morbidity, the affluent enjoyed a health status similar to that of the populations of developed countries. The health services also showed the familiar pattern, with expenditure concentrated on sophisticated facilities in the towns, leaving the rural majority with practically no services at all. With the coming of Majority Rule, the previous pattern of controlling access to facilities on the basis of race could not continue. Two broad routes forward were defined. On the one hand, the private doctors, the private insurance companies, and the settler state proposed a model based on improving urban facilities, depending on a trickle-down to eventually answer the needs of the rural people. On the other hand, the post-Independence Ministry of Health advocated a policy of concentrating on developing services in the rural areas. The pattern of the future health service will depend on the capacity of the senior health planners and on the enthusiasm of front-line health workers but, of overriding importance will be the political commitment to answer the needs of the majority and the outcome of the inevitable struggle for access to scarce health sector resources.

Community Health Workers↗
PubMed2005

Impact of news of celebrity illness on breast cancer screening: Kylie Minogue's breast cancer diagnosis.

OBJECTIVES: To describe the main media narratives in the reportage of singer Kylie Minogue's illness with breast cancer; and to assess the impact of this coverage on bookings for screening for breast cancer by mammography in four Australian states. SETTING: Government sponsored BreastScreen programs in Queensland, Victoria, Tasmania and Western Australia. MAIN OUTCOME MEASURES: Narratives on breast cancer in television news programs 17-27 May 2005; initial and re-screening bookings for mammograms. PARTICIPANTS: Women aged > or = 40 years who booked for mammograms in BreastScreen programs in the 19 weeks before, the 2 weeks during, and the 6 weeks after the publicity. RESULTS: There was a 20-fold increase in news coverage of breast cancer, which emphasised that young women do get breast cancer and that early detection was critical. Overall screening bookings rose 40% in the 2 weeks of the publicity, with a 101% increase in non-screened women in the eligible age-group 40-69 years. Six weeks after the publicity, bookings remained more than a third higher in non-screened women. CONCLUSIONS: News coverage of Kylie Minogue's breast cancer diagnosis caused an unprecedented increase in bookings for mammography. Health advocates should develop anticipatory strategies for responding to news coverage of celebrity illness.

Australia↗
PubMed1980

Japan's experience in pertussis epidemiology and vaccination in the past thirty years.

The experience in Japan that pertussis was controlled by the nation-wide regular vaccination and that the reincrease of case notification occurred recently after the decrease of vaccine acceptance rate upholds the view that pertussis vaccine produced under the national control system is fully protective. Though the recent decrease of the vaccine acceptance rate was due to the public reaction to rather imbalaanced arguments concerning the vaccine risk, it is also true that a more potent and less toxic component vaccine is urgently needed at this moment.

Adolescent↗