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PubMed1988

Bone marrow transplantation: economic, ethical, and social issues.

Bone marrow transplantation is a useful model for the controversies surrounding medical technologies that involve high cost, mortality, and complications. This essay first delineates the economic circumstances of bone marrow transplantation, comparing it with other organ transplantations. Although children represent a significant proportion of bone marrow transplantation patients, little research has focused on the economic impact for this population. Next, the financial, social, and ethical motivations and controversies that surround bone marrow transplantation are explored, along with current allocation mechanisms. Finally, recommendations are offered for guiding discussions regarding the appropriate use of bone marrow transplantation. In making transplantation decisions, physicians must consider the costs and benefits of bone marrow transplantation for each patient. Such analyses, whether based on medical or socioeconomic criteria, are insufficient to resolve the fundamental cultural dilemmas posed by this procedure and other expensive medical technologies, however. The goal is to foster broader discussion of these issues to achieve more candid decisions in allocating resources among competing health priorities.

Aborted Fetus↗
PubMed2004

The emergence of political priority for safe motherhood in Honduras.

Each year an estimated 500,000 to 600,000 women die due to complications from childbirth, making this one of the leading causes of death globally for women in their reproductive years. In 1987 a global initiative was launched to address the problem, but few developing countries since then have experienced a documented significant decline in maternal mortality levels. Honduras represents an exception. Between 1990 and 1997 the country's maternal mortality ratio--the number of deaths due to complications during pregnancy, childbirth and the postpartum period per 100,000 live births--declined 40% from 182 to 108, one of the largest reductions ever documented in such a short time span in the developing world. This paper draws on three political science literatures--constructivist international relations theory, policy transfer and agenda-setting--to explain how political priority for safe motherhood emerged in Honduras, a factor that underpinned the decline. Central to the explanation is the unusually cooperative relationship that developed between international donors and national health officials, resulting in effective transfer of policy and institutionalization of the cause within the domestic political system. The paper draws out implications of the case for understanding the political dynamics of health priority generation in developing countries.

Delivery of Health Care↗
PubMed2000

The African-American church: a potential forum for adolescent comprehensive sexuality education.

PURPOSE: To investigate the attitudes and beliefs of clergy from African-American churches towards sexuality education and the provision of sexuality education in their churches. METHODS: A pilot study was designed to survey a convenience sample of clergy leaders from African-American churches about their young adolescent members. The survey asked about priority health topics, prevalence of sexual and drug risk behavior and the clergy's desire for health education programs. The churches were located in a county (1990 population approximately 200,000, 40% African-American) in the southeastern United States. RESULTS: The respondents' highest priority issues were drugs, violence, HIV/AIDS, pregnancy and alcohol. Many (76%) had discussed one or more of these issues in church. All respondents wanted additional health seminars for their adolescents, though some clergy (30%) excluded some sexual topics (i.e., anal sex, bisexuality, homosexuality, masturbation, oral sex). Only 6% would make condoms available in their churches, but all would allow contraceptive education. CONCLUSIONS: Many African-American churches are open to including sexuality education among their health education offerings for young adolescents. The church should be considered as a potential forum for providing comprehensive sexuality education for African-American adolescents.

Adolescent↗
PubMed2005

Interventions for preventing obesity in children.

BACKGROUND: Obesity prevention is an international public health priority. The prevalence of obesity and overweight is increasing in child populations throughout the world, impacting on short and long-term health. Obesity prevention strategies for children can change behaviour but efficacy in terms of preventing obesity remains poorly understood. OBJECTIVES: To assess the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity and/or lifestyle and social support. SEARCH STRATEGY: MEDLINE, PsycINFO, EMBASE, CINAHL and CENTRAL were searched from 1990 to February 2005. Non-English language papers were included and experts contacted. SELECTION CRITERIA: Randomised controlled trials and controlled clinical trials with minimum duration twelve weeks. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twenty-two studies were included; ten long-term (at least 12 months) and twelve short-term (12 weeks to 12 months). Nineteen were school/preschool-based interventions, one was a community-based intervention targeting low-income families, and two were family-based interventions targeting non-obese children of obese or overweight parents. Six of the ten long-term studies combined dietary education and physical activity interventions; five resulted in no difference in overweight status between groups and one resulted in improvements for girls receiving the intervention, but not boys. Two studies focused on physical activity alone. Of these, a multi-media approach appeared to be effective in preventing obesity. Two studies focused on nutrition education alone, but neither were effective in preventing obesity. Four of the twelve short-term studies focused on interventions to increase physical activity levels, and two of these studies resulted in minor reductions in overweight status in favour of the intervention. The other eight studies combined advice on diet and physical activity, but none had a significant impact. The studies were heterogeneous in terms of study design, quality, target population, theoretical underpinning, and outcome measures, making it impossible to combine study findings using statistical methods. There was an absence of cost-effectiveness data. AUTHORS' CONCLUSIONS: The majority of studies were short-term. Studies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that focused on dietary or physical activity approaches showed a small but positive impact on BMI status. Nearly all studies included resulted in some improvement in diet or physical activity. Appropriateness of development, design, duration and intensity of interventions to prevent obesity in childhood needs to be reconsidered alongside comprehensive reporting of the intervention scope and process.

Adolescent↗
PubMedDate not supplied

[Identification of problems and needs in health: description of a participative experience in primary care].

OBJECTIVE: To identify health problems and needs from a Health area population. To detect inequalities in relation with sociodemographic variables. METHODS: An observational descriptive study, cross-sectional study, qualitative research. SETTING: A Health area in Cordoba divided in three different areas: residential, inner city and rural area. We select three different groups of population and the following instruments of measurements: a) general population older than 15 years old (survey by interview completed door-to-door and personally) (N = 12,801) (coverage = 96.6%); b) Representatives of the community (N = 47), by Delphi technique (answering rate = 62.5%) and Nominal Group technique applied to participants in Health Councils (answering rate = 65.4%); c) Health workers (N = 45), by Delphi Process (answering rate = 58.5%). RESULTS: The people consider pains in their joints and allergies as the priority health problems, for the representatives of the community and the health workers the most important problems were dental hygiene and some chronic diseases. The needs detected as most important were, for the people from residential area, the lack of public gardens and cultural sites, for people from the inner city area it was the lack of public safety and in the rural area it was the lack of proper health resources. CONCLUSIONS: Although the different groups we study maintain a close agreement on what are the most important health problems and needs, we observed several interesting disagreement that could be explained by the different point of view that each group has on the process of health-disease, on perceiving problems and needs and on the sociodemographic differences among them.

Adolescent↗
PubMed2001

Developing cultural competence in the baccalaureate nursing student: a population-based project with the Hutterites.

The purpose of this article is to articulate the process of educating baccalaureate students to apply culturally competent, population-based nursing care to the Hutterites. The Hutterites are a German dialect-speaking, ethnoreligious population. Campinha-Bacote's culturally competent model guided the student learning process. Groups of students developed culture-specific, population-based assessment models to identify the health-related needs of the Hutterites. One example of a Hutterite health assessment model that was derived from Dever's epidemiologic model and Purnell and Paulanka's model for cultural competence is presented. Priority health needs of Hutterite colonies are described, and examples of health programs are given. Recommendations for working with the Hutterite population as part of an undergraduate public health nursing course are put forth. The culturally congruent process of teaching and learning for nursing students can be applied to other health-related professions and adapted to other cultural contexts.

Clinical Competence↗
PubMed2005

The use of simplified verbal autopsy in identifying causes of adult death in a predominantly rural population in Ethiopia.

BACKGROUND: Information on adult mortality is essentially non-existent in Ethiopia particularly from rural areas where access to health services is limited and most deaths occur at home. This study was conducted with the aim of identifying causes of adult death in a rural population of Ethiopia using a simplified verbal autopsy instrument. METHODS: All deaths in the age-group 15-49 years during the period of 1995-99 were taken from computerized demographic surveillance database maintained by the Butajira Rural Health Program. Data on the causes of death were collected from close relatives of the deceased persons by lay interviewers. Causes of death were diagnosed using "expert algorithm" programmed onto a computer. RESULTS: The major causes of death were acute febrile illnesses (25.2%), liver diseases (11.3%), diarrheal diseases (11.1%), tuberculosis (9.7%) and HIV/AIDS (7.4%). Overall communicable diseases accounted for 60.8% of the deaths. The high levels of mortality from communicable diseases reflect the poor socioeconomic development of the country, and the general poor coverage of health and education services in rural Ethiopia. The tools used in this study can easily be added-on to the numerous health surveys conducted in the country. CONCLUSION: The simplified approach to verbal autopsy diagnosis can produce useful data that can effectively guide priority health interventions in rural areas where routine information system is either very weak or non-existent.

Adolescent↗
PubMed1983

From whom the bell tolls: WHO and health care in the developing world.

Per capita expenditure on health is low in developing countries. Distribution of health care resources reflects the tension among perceived health priorities. Medical perceptions of "best care" generate expectations of technologically advanced, hospital-based, urban care within a staged referral system. World Health Organization presses a decentralized model for accessible, acceptable illness care linked with education for prevention, infrastructure development and peripheral responsibility.

Community-Institutional Relations↗
PubMed1999

Science, ethics, and the future of research into maternal infant transmission of HIV-1. Perinatal HIV Intervention Research in Developing Countries Workshop participants.

Effective, feasible interventions to prevent perinatal transmission of HIV-1 in developing nations are an urgent necessity. Scientific issues of concern include a need to identify other effective antiretroviral agents; to define the shortest effective course of therapy; to assess interventions other than antiretroviral agents; and to investigate interventions that may reduce HIV-1 transmission via breastfeeding. Sound scientific design is fundamental to all research studies. Ethical standards must guide such studies and include the necessity that the problem studied be a health priority in the host country; that the highest standard of care attainable in the country be assured to participants; that the health-care resources of the country not be harmed; that the informed consent of participants be obtained; and that a process of discussion ensure that a successful intervention will be considered for implementation. There are circumstances in which a no-antiretroviral comparison may be ethically justified.

Developing Countries↗
PubMed2006

[A french-speaking institute for tropical medicine in Asia: the IFMT in Vientiane, Lao PDR].

Since the year-2000, a French-speaking Institute for Tropical Medicine (French acronym, IFMT) has been operating in Lao PDR through funding provided by the Agence Universitaire de la Francophonie. The IFMT is a postgraduate teaching centre dedicated to improving skills of health care professionals in clinical sciences, epidemiology, public health and management as well as to research and health care intervention. These activities are conducted in the capital as well as provinces and districts throughout Laos with special focus on priority health issues facing developing countries in tropical regions. The IFMT organizes a 4-semester international course taught in French to medical doctors from Southeast Asia, mainly Laos, Cambodia, Vietnam and Southern China, but also from other countries. To date, a total of 72 students have graduated from the IFMT. In 2005 the Institute delivers a master degree. This article describes the course objectives and some features of the curriculum. It also presents a general overview of health, teaching, and research facilities in Southeast Asia as well as of the major challenges now confronting the region.

Developing Countries↗
PubMed2001

Research priorities in occupational health in Italy.

OBJECTIVE: To find a broad consensus on research priorities and strategies in the field of occupational health and safety in Italy. METHODS: A two phase questionnaire survey was based on the Delphi technique previously described in other reports. 310 Occupational safety and health specialists (from universities and local health units) were given an open questionnaire (to identify three priority research areas). The data obtained from respondents (175, 56.4%) were then used to draw up a list of 27 priority topics grouped together into five macrosectors. Each of these was given a score ranging from 1 (of little importance) to 5 (extremely important). With the mean scores obtained from a total of 203 respondents (65.4%), it was possible to place the 27 topics in rank order according to a scale of priorities. RESULTS: Among the macrosectors, first place was given to the question of methodological approach to research in this field, and for individual topics, occupational carcinogenesis and quality in occupational medicine were ranked first and second, respectively. The question of exposure to low doses of environmental pollutants and multiple exposures ranked third among the priorities; the development of adequate and effective approaches and methods for worker education and participation in prevention was also perceived as being an important issue (fourth place). CONCLUSIONS: This study (the first of its kind in Italy) enabled us to achieve an adequate degree of consensus on research priorities related to the protection of occupational health and safety. Disparities in the mean scores of some of the issues identified overall as being research priorities, seem to be linked both to geographical area and to whether respondents worked in local health units or universities. This finding requires debate and further analysis.

Decision Making↗
PubMed1994

Extremes in body mass index: probability of healthcare expenditures.

BACKGROUND: This study was conducted as a first initiative to investigate the relationship between body mass index [BMI, weight(kg)/height(m)2] and healthcare expenditures by third party providers for lifestyle-related diseases and disorders. METHOD: Data were analyzed for 383 individuals who were continuously employed and covered by the same comprehensive health insurance plan during a 2-year baseline period followed by a 5-year observation period. A multiple logistic regression analysis that adjusted for covariates was used to ascertain whether BMI and baseline expenditure status separately or in combination influenced the probability of healthcare expenditures during the observation period. RESULTS: After controlling for age, gender, and smoking status, probability of healthcare expenditures for lifestyle-related medical problems was significantly (P < 0.04) greater during the observation period for adults with high as well as low BMIs plus baseline expenditures and lowest for subjects whose BMIs were in the midrange regardless of their baseline expenditures. Odds of expenditures increased significantly (P = 0.0079) with age of nonsmokers, but was approximately constant and high for smokers at all ages. The absence of any significant interaction of either smoking status or age with BMI indicated that the relationship between BMI and the log odds of expenditures was consistent across age and smoking categories. CONCLUSIONS: The analyses support the conclusion that the highest probability of expenditures occurs with the combination of baseline insurance expenditures and BMI extremes and the lowest probability occurs when BMIs are near 26 or 27 (approximately 19% above the ideal of 22). The findings also provide further justification for focusing on extremes in body weight as health priorities.

Adult↗
PubMed2006

Mental health assistance to populations affected by disasters: World Health Organization's role.

In this article, the authors describe the role of the World Health Organization (WHO) in mental health post-disaster recovery. The article covers the mandate and structure of WHO, mental health activities by the WHO Department of Mental Health and Substance Abuse, WHO-supported principles and strategies in mental health post-disaster recovery, and available WHO technical assistance. The paper outlines a public mental health approach to make very basic mental health services broadly available in post-disaster countries. Using examples based on the Asian tsunami experience, suggestions for delivering mental health assistance are made. The response to mental health of disaster victims should be seen in the context of national health priorities.

Asia, Southeastern↗
PubMed2006

Differences in health status and health behaviour among young Swiss adults between 1993 and 2003.

OBJECTIVE: Very few studies specifically have examined the health status of 20-year-olds. The purpose of the present study is to examine the changes in health status and behaviour among young Swiss adults between 1993 and 2003. METHODS: The present study used data from the Swiss Federal Surveys of Adolescents, conducted in 1993 and 2003 among 20-year-olds in Switzerland. The study sample included military recruits and a representative community cohort. More than 20,000 subjects participated in each survey. RESULTS: Young adults in 2003 reported fewer traffic- and sports-related accidents, but more work-related and other accidents versus young adults in 1993. A greater percentage of men were overweight or obese in 2003. Also in 2003, a greater percentage of males and females regularly used alcohol, cigarettes and cannabis. In particular, the number that smoked cigarettes daily increased by almost 30% and daily cannabis users increased more than two-fold. Young adults reported higher rates of inter-personal violence and theft in 2003. Compared to 1993, in 2003 young adults were more likely to report a sense of coherence; they also had fewer thoughts of suicide, but a greater sense that life is meaningless. CONCLUSIONS: Our study provides the first Swiss data comparing the health status of 20-year-olds a decade apart. The findings suggest a significant increase in substance use. Health prevention efforts among young adults ages 18-24 should focus on substance use. In addition, developing strategies to decrease interpersonal violence, delinquent behaviour, and obesity should be a major public health priority.

Accidents↗
PubMedDate not supplied

The carcinogenic and toxic effects of tobacco smoke: are women particularly susceptible?

Smoking is the leading preventable cause of premature death and disability in Canadian women. Lung cancer, ischemic heart disease, chronic obstructive lung disease, and stroke account for two-thirds or more of the smoking-attributable deaths in women. Lung cancer now exceeds breast cancer as the leading cause of cancer death in women, and both incidence and mortality rates continue to climb. Strong evidence suggests that for the same number of cigarettes smoked, women are more susceptible than men to the carcinogenic effects on their lungs. Evidence also is growing that lung function in women is more adversely affected by smoking and that smoking may be a stronger risk factor for myocardial infarction in women than it is in men. More research into the mechanisms underlying these gender-related susceptibilities is needed. Policies and programs to prevent girls from starting to smoke and to facilitate quitting in women of all ages must be public health priorities.

Breast Neoplasms↗
PubMedDate not supplied

Where does reproductive health fit into the lives of adolescent males?

CONTEXT: To develop interventions to promote responsible sexual behaviors and design reproductive health services for adolescent males, we need a better understanding of the context of reproductive health in adolescent males' lives. METHODS: A total of 32 males (mean age, 15.5 years) were recruited from two urban high schools. At each school, three group sessions, consisting of both individual free-listing activities and focus group discussions, were conducted; each addressed issues related to one of three domains-masculinity, responsibility and priorities. Data from the focus groups were examined through standard content analyses. RESULTS: Participants identified school, family, future career and sports as their current life priorities; health was not a top concern. Pregnancy and sexually transmitted infections (STIs) were not seen as interrelated health concepts. STIs were considered a health issue, whereas pregnancy was perceived as a negative event that could prevent achievement of specific life goals. At times, notions regarding how a male behaves reflected traditional masculine beliefs: that violence is justified as a way to protect oneself, that having sex is part of a male's role in a relationship and that males should handle health issues by themselves. CONCLUSIONS: To meet the reproductive health needs of adolescent males, program developers should consider how other life priorities and traditional masculine beliefs may serve as barriers to care and how to ensure that services reflect the adolescent male's perspective.

Adolescent↗
PubMed1984

Control of oral cancer in developing countries. A WHO meeting.

Oral cancer is one of the 10 most common cancers in the world. In Bangladesh, India, Pakistan, and Sri Lanka it is the most common and accounts for about a third of all cancers. More than 100 000 new cases occur every year in south and south-east Asia, with poor prospects of survival.The importance of oral cancer as a public health priority is underscored by the fact that the suffering, disfigurement, and death it causes need not occur. The commonest cause of oral cancer-tobacco use-is well known and can be eliminated. For the oral cancer cases that do occur, detection at an early stage is possible, allowing simple inexpensive treatment, and resulting in long-term survival.Enough is already known about the disease and its prevention for action to be taken. With firm commitment, correct priorities, and concerted efforts by governments and individuals, strategies can be designed, programmes can be implemented, and the disease can be prevented. The economic saving in health care costs to a country, by itself, justifies these steps; the prevention of suffering and death of oral cancer victims makes them mandatory.This article reviews the current knowledge about the epidemiology, etiology, pathology, prevention, and treatment of oral cancer. It describes a strategy for controlling the disease, sets priorities, and recommends actions that governments and individuals can take. Finally, it identifies targets for future research.

Asia↗
PubMed2000

The global burden of disease study: implications for neurology.

Because of the epidemiological transition, the global burden of illness has changed. Several factors have contributed to this change, including improvements in maternal and child health, increasing age of populations, and newly recognized disorders of the nervous system. It is now evident that neurologic disorders have emerged as priority health problems worldwide. This is reflected in the Global Burden of Disease Study, jointly published by the World Health Organization and other groups. The proportionate share of the total global burden of disease resulting from neuropsychiatric disorders is projected to rise to 14.7% by 2020. Although neurologic and psychiatric disorders comprise only 1.4% of all deaths, they account for a remarkable 28% of all years of life lived with a disability. This study provides compelling evidence that one cannot assess the neurologic health status of a population by examining mortality statistics alone. Health ministries worldwide must prioritize neurologic disorders, and neurologists must be prepared to provide care for increased numbers of people individually and in population groups.

Adolescent↗