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PubMed2001

Setting standards in the evaluation of community-based health promotion programmes--a unifying approach.

Community-based health promotion often emphasizes elements of empowerment, participation, multidisciplinary collaboration, capacity building, equity and sustainable development. Such an emphasis may be viewed as being in opposition to equally powerful notions of evidence-based decision making and accountability, and with funders' and government decision-makers' preoccupation with measuring outcomes. These tensions may be fuelled when community practitioners and lay participants feel evaluations are imposed upon them in a manner that fails to appreciate the uniqueness of their community, its programme, and practitioners' skills and experience. This paper attempts to provide an approach that depicts evaluation as being mutually beneficial to both funders/government and practitioners. First, a values stance for health promotion, termed a 'salutogenic' orientation, is proposed as a foundation for the evaluation of community-based health promotion. Secondly, we discuss possible objects of interest, the first component of an evaluation. We then discuss the spirit of the times and its implications for community-based health promotion. Finally, we address the key question of setting standards. A typology of standards is presented. Arbitrary, experiential and utility standards are based on perceived needs and priorities of practitioners, lay participants or professional decision-makers. Historical, scientific and normative standards are driven by empirical, objective data. Propriety and feasibility standards are those wherein the primary concern is for consideration of resources, policies, legislation and administrative factors. The 'model' standards approach is presented as an exemplar of a combined approach that incorporates elements of each of the other standards. We argue that the 'optimal' standard for community-based health promotion depends on the setting and the circumstances. There is no 'magic bullet', 'one-size-fits-all' or 'best' standard. Further, we argue that standards should be set from an inclusive, salutogenic orientation. This approach offers a means of creating a situation in which policy-makers and funders are more supportive of evaluation designs that fit with community realities, and community stakeholders are more capable and consistent in rigorously evaluating community-based health promotion programmes and policies.

Canada↗
PubMed1997

Protection provided by hepatitis B vaccine in a Yupik Eskimo population--results of a 10-year study.

A hepatitis B virus vaccine demonstration project was conducted in southwest Alaska in 1981-1982 to determine the immunogenicity and efficacy of the vaccine. A total of 1630 susceptible persons in the Alaskan Native population were vaccinated with the recommended three-dose regimen of plasma-derived hepatitis B vaccine, and 94% demonstrated antibody to hepatitis B surface antigen (anti-HBs) at levels > or = 10 mIU/mL. After 10 years of follow-up, 76% of those immunized had anti-HBs levels > or = 10 mIU. During the 10 years following the first dose of vaccine, 13 study participants developed antibody to hepatitis B core antigen (10 vaccine responders, 3 nonresponders), and none developed sustained HBs positivity or had clinical hepatitis. These data suggest that immunization with hepatitis B vaccine continues to provide high levels of protection from clinical disease for at least 10 years.

Adolescent↗
PubMed2000

Occupational and environmental medicine: moving the factory fence or hedging our bets?

Occupational and environmental medicine evolved out of concern for the effect of work hazards on health. The experienced gained in considering such hazards has been extended to understanding general risks in the environment. As we look toward the future, classical occupational and environmental hazards such as over exposure to lead, asbestos and mercury are waning and being replaced by concerns around sustainable development, toxicology testing and exposure information for high production volume chemicals, development of better approaches for setting workplace and community exposure limits, environmental justice and many others. The opportunities for the future exist in overcoming these new challenges.

Endocrine System Diseases↗
PubMed1991

Standards for analysis of ventricular late potentials using high resolution or signal-averaged electrocardiography. A statement by a Task Force Committee between the European Society of Cardiology, the American Heart Association and the American College of Cardiology.

Sufficient data are available to recommend that the high-resolution or signal-averaged electrocardiogram can be used in patients recovering from myocardial infarction without bundle branch block to help to determine their risk for developing sustained ventricular tachyarrhythmias. However, no data are available regarding the extent to which pharmacologic or non-pharmacologic interventions in patients with late potentials have an impact on the incidence of sudden cardiac death. Therefore, controlled, prospective studies are required before this issue can be definitely answered. As refinements in techniques evolve, it is anticipated that the clinical value of high-resolution or signal-averaged electrocardiography will continue to increase in the future.

Arrhythmias, Cardiac↗
PubMed2026

Trade-Offs Associated with Virulence of Soybean Cyst Nematode on the Broad-Spectrum Resistance Source PI 437654.

The soybean cyst nematode (SCN; Heterodera glycines) poses a major challenge to soybean production, intensified by the declining effectiveness of natural resistance against this pathogen. Although the use of resistant soybean varieties can be effective, their widespread and repeated use ultimately results in the emergence of virulent nematode populations that can successfully attack these resistant hosts. To assess for potential trade-offs between virulence and fitness, we investigated the hatch response, penetration rate, and reproductive potential of SCN adapted to overcome the broad-spectrum resistance source PI 437654. The hatching process is a critical phase in the life cycle of the SCN, influencing its ability to infect hosts and complete its life cycle. Our results indicated that SCN populations exhibit preferential and heightened hatch responses to their adapted host compared to alternative hosts, regardless of their virulence profile. Additionally, we found that SCN populations adapted to overcome broad-spectrum resistance showed reduced reproductive success on susceptible hosts compared to unadapted populations. This reduction in reproductive success was not attributed to differences in hatch response or penetration rates. The results from our study highlight the potential trade-offs associated with SCN virulence adaptation and emphasize the importance of considering these evolutionary dynamics in developing sustainable management strategies.

Disease Control and Pest Management↗
PubMed1986

Subcellular membrane properties in vascular and non-vascular smooth muscles of Dahl hypertensive rats.

Subcellular membrane fractions were isolated from mesenteric arteries and vas deferens of salt-resistant and salt-sensitive Dahl rats on low-salt (0.4% NaCl) high-salt (8.0% NaCl) diets. Only the salt-sensitive Dahl rats on the high-salt diet developed sustained high blood pressure (BP) after 5 weeks of the high-salt diet. Protein contents, membrane associated enzyme activities, calcium ion (Ca2+) binding and ATP-dependent CA2+ transport were compared in fractions isolated from all four groups. No obvious changes were observed, except for minor enhancement in magnesium ion (Mg2+)- and CA2+ ATPase activities of mesenteric arterial membranes isolated from salt-sensitive Dahl rats on high-salt diet compared to those from other groups of rats. The membrane fractions from vas deferens of salt-sensitive Dahl rats on the high-salt diet, on the other hand, showed decreased ATP-dependent Ca2+ transport compared to those from salt-sensitive Dahl rats on the low-salt diet. No difference was observed in membrane fractions isolated from salt-resistant Dahl rats on high-salt diet compared to those on low-salt diet. The significance of these observations are discussed in relation to the findings previously obtained from corresponding smooth muscle tissues of spontaneous hypertensive rats (SHR).

Adenosine Triphosphate↗
PubMed1988

Caffeine-containing beverages and the prevalence of hypertension.

Caffeine can produce a mild hypertensive effect for a few hours after use. Some epidemiological data relate chronic coffee intake to an increased risk of cardiovascular disease. We explored the possibility that a regular intake of caffeine-containing beverages (tea, coffee, cola) might produce a chronic increase in blood pressure and increase the likelihood of developing sustained hypertension. A random population survey of 2436 adults was made, with standardized blood pressure readings and a food-frequency questionnaire to determine the regular intake of various nutrients. We found evidence that caffeine intake was positively related to an increased diastolic blood pressure but the effect was small (less than 1 mmHg at usual caffeine intake). There was no evidence that a regular caffeine intake increases the risk of being classified as hypertensive.

Age Factors↗
PubMed1989

Arterial hypertension as a complication of prolonged ketoconazole treatment.

Two of 14 patients with Cushing's syndrome treated on a long-term basis with ketoconazole developed sustained hypertension. In both cases normal plasma and urinary free cortisol levels had been achieved following ketoconazole therapy, yet continuous blood pressure monitoring demonstrated hypertension 31 (patient 1) and 52 weeks (patient 2) after treatment. In patient 1, plasma levels of deoxycorticosterone and 11-deoxycortisol were elevated. In patient 2, in addition to an increase in both deoxycorticosterone and 11-deoxycortisol levels, plasma aldosterone values were raised, with a concomitant suppression of renin levels. Our findings show that long-term treatment with high doses of ketoconazole may induce enzyme blockade leading to mineralocorticoid-related hypertension.

Adolescent↗
PubMed1986

Clinical assessment of the patient with borderline hypertension.

Borderline hypertension occurs in approximately 15% of adults. While these individuals are at increased risk for developing sustained hypertension, roughly three-fourths do not progress to that level. In order to facilitate the clinical assessment, we have reviewed the known pathophysiology of the borderline hypertensive state. The recommended clinical evaluation including history, physical and laboratory examinations is directed at identifying those borderline hypertensives at highest risk for future hypertension and cardiovascular complications. Therapeutic interventions are directed at the high risk subgroup.

Electrocardiography↗
PubMed2003

Electrocardiographic effects of intravenous cocaine: an experimental study in a canine model.

Cocaine abuse causes cardiac dysfunction. Acute intravenous administration of cocaine may lead to development of severe arrhythmias, conduction abnormalities, ST-T changes, and sudden death. Understanding arrhythmogenesis due to cocaine may provide a therapeutic approach to reduce morbidity and mortality. We studied the arrhythmogenic activity and other electrocardiographic abnormalities resulting from an intravenous bolus of cocaine. Baseline and postanesthetic electrocardiographic findings were compared with those after administration of intravenous bolus of various doses of cocaine hydrochloride in 20 dogs. The study was done in three phases (phase I: low dose of cocaine [1 mg/kg, 15 experiments]; phase II: medium dose [2 mg/kg, 30 experiments]; and phase III: high dose [5-7 mg/kg, 10 experiments]). Plasma levels of cocaine were estimated. The low dose induced sinus bradycardia, sinus arrhythmia, atrial ectopic, wandering pacemaker, unifocal ventricular premature contractions, and ventricular couplets. The medium dose generated moderately severe arrhythmias that were of supraventricular origin. Atrial flutter and atrial fibrillation were observed in two experiments each. Ventricular arrhythmias were manifested as unifocal, multifocal, interpolated ventricular premature contractions as well as bigeminy, trigeminy, couplets, and salvos. The high dose of 5-7 mg/kg increased electrocardiographic intervals and caused ST-segment elevation as well as serious life-threatening arrhythmias. Three of the dogs developed sustained ventricular tachycardia followed by ventricular flutter-fibrillation and death.

Animals↗
PubMedDate not supplied

A longitudinal investigation of the relationships among alcohol consumption, psychosocial factors, and blood pressure.

Although a number of studies have demonstrated a link between alcohol intake and blood pressure, virtually no research has examined this relationship or the relevance of psychosocial variables in this context over time. This study utilized data from 416 subjects in the Air Traffic Controller Health Change Study to track these associations across five examinations over a 3-year period. Following obesity, alcohol consumption was consistently the second-best predictor of blood pressure. Alcohol intake rose among those subjects who developed sustained elevated blood pressure during the course of the study. Further, obesity became less important in predicting blood pressure at higher levels of alcohol intake. Factors predictive of alcohol use were also studied, and the suggestion is made that psychosocial variables may be linked primarily to alcohol use, which in turn combines with obesity to influence blood pressure levels.

Adult↗
PubMed1983

Chlamydia trachomatis infection as a cause of pneumonia after human marrow transplantation.

Seventy-two marrow transplant patients were studied to assess the role of Chlamydia trachomatis infection in the etiology of pneumonia in the compromised host. Sixty-four patients had pneumonia from various causes and eight died of causes other than pneumonia. Chlamydial serologies and cultures of lung tissue, or other sites, or both, were obtained from all patients. C trachomatis was recovered from a single sputum specimen obtained at the onset of pneumonia in one patient, and three patients developed sustained IgG and IgM antibody responses to chlamydiae during their pneumonia. Two of the four patients died of pneumonia. These data further confirm that C trachomatis infection occurs in immunosuppressed patients in association with pneumonia. The source of the organism and the frequency of infection remain to be determined.

Adolescent↗
PubMed1999

Blood Pressure Monitoring. Task force III: Target-organ damage, morbidity and mortality.

OBJECTIVE: To reach a consensus on ambulatory blood pressure (ABP) as a predictor of target-organ damage (TOD), morbidity and mortality. METHOD: The members of task force III wrote this article in preparation for the Seventh International Consensus Conference (23-25 September 1999). This article was amended after the meeting to reflect the consensus reached at the conference. POINTS OF CONSENSUS: In most studies, TOD in essential hypertension was more closely associated with ABP than it was with clinic blood pressure, the mean weighted correlation coefficients for the relationship of left ventricular mass with blood pressure being 0.50/0.44 (24h systolic/diastolic blood pressure) and 0.35/0.32 (clinic systolic/diastolic blood pressure), respectively. The above correlation coefficients vary among studies, possibly because of different standardizations of clinic blood pressure measurements and ways of selecting subjects, among other reasons. The closeness of the association between clinic blood pressure and left ventricular mass increases with the numbers of clinic measurements of blood pressure and visits to a clinic. Thus, the variance of left ventricular mass explained by ABP in addition to that explained by clinic blood pressure diminishes with the number of clinic blood pressure readings. The proportion of variability of left ventricular mass that is directly accounted for by the day-night difference in blood pressure is 15% at the most. Thus, the advantage of ABP over clinic blood pressure appears to be, at least in part, a result of the greater number of measurements over the 24h. It might also depend, however, on the information offered by ambulatory blood pressure monitoring (ABPM) on daily-life variations in blood pressure. TOD appears to be more closely associated with ABP than it is with clinic blood pressure for the subjects with reproducible ABP tracings, but not for those with poorly reproducible tracings. The probability of developing sustained clinic hypertension at follow-up seems to be better predicted by clinic blood pressure on several occasions over a 6-month period than it is by ABP at baseline, although, when also ABPM is repeatedly performed at follow-up, its ability to predict clinical outcomes of hypertensive patients remains superior to that of repeated clinic blood pressure measurements. ABPM of the elderly appears feasible and is tolerated well. A blunted day-night fall in blood pressure ('non-dipping') seems to be harmful, while evidence regarding the potentially harmful effect of extreme dipping is still limited. Authors of the Syst-Eur study recently demonstrated the prognostic value of ambulatory systolic blood pressure and in particular, of night-time blood pressure, in assessing old subjects with isolated systolic hypertension. The assessment of variability of blood pressure has been shown to provide a further prediction of cardiovascular risk and the potentially prognostic value of beat-to-beat variability assessed non-invasively (using a Finapres or Portapres device)needs further study. In the published event-based studies, the prognostic value of ABP recorded during a single session was superior to that of clinic blood pressure. Since the authors of published event-based prognostic studies compared ABP with only a few clinic measurements of blood pressure, it is not known how many visits or measurements of blood pressure (and at what cost) would equate to a single session of ABPM in terms of prediction of cardiovascular events. ABPM might allow one to identify a subset with 'normal' ABP (white-coat or isolated clinic hypertension). Daytime ABP levels <135 mmHg systolic and 85 mmHg diastolic can be defined as normal and values <130/80 mmHg could be defined as optimal. Cardiovascular risk for subjects with normal ABP seems to be lower than that for those with abnormally high ABP. Long-term observational and intervention studies concerning subjects with white-coat hypertension are needed. (ABST

Activities of Daily Living↗
PubMed2003

Water for food and nature in drought-prone tropics: vapour shift in rain-fed agriculture.

This paper quantifies the eco-hydrological challenge up until 2050 of producing food in balance with goods and services generated by water-dependent ecosystems in nature. Particular focus is given to the savannah zone, covering 40% of the land area in the world, where water scarcity constitutes a serious constraint to sustainable development. The analysis indicates an urgent need for a new green revolution, which focuses on upgrading rain-fed agriculture. Water requirements to produce adequate diets for humans are shown to be relatively generic irrespective of hydro-climate, amounting to a global average of 1,300 m(3) cap(-1) yr(-1). Present food production requires an estimated 6,800 km(3) yr(-1) of consumptive green water (5,000 km(3) yr(-1) in rain-fed agriculture and 1,800 km(3) yr(-1) from irrigated crops). Without considering water productivity gains, an additional 5,800 km(3) yr(-1) of water is needed to feed a growing population in 2,050 and eradicate malnutrition. It is shown that the bulk of this water will be used in rain-fed agriculture. A dynamic analysis of water productivity and management options indicates that large 'crop per drop' improvements can be achieved at the farm level. Vapour shift in favour of productive green water flow as crop transpiration could result in relative water savings of 500 km(3) yr(-1) in semi-arid rain-fed agriculture.

Agriculture↗
PubMed2003

Integrated management of land and water resources based on a collective approach to fragmented international conventions.

Interlinked crises of land degradation, food security, ecosystem decline, water quality and water flow depletion stand in the way of poverty reduction and sustainable development. These crises are made worse by increased fluctuations in climatic regimes. Single-purpose international conventions address these crises in a piecemeal, sectoral fashion and may not meet their objectives without greater attention to policy, legal, and institutional reforms related to: (i) balancing competing uses of land and water resources within hydrologic units; (ii) adopting integrated approaches to management; and (iii) establishing effective governance institutions for adaptive management within transboundary basins. This paper describes this global challenge and argues that peace, stability and security are all at stake when integrated approaches are not used. The paper presents encouraging results from a decade of transboundary water projects supported by the Global Environment Facility in developing countries that test practical applications of processes for facilitating reforms related to land and water that are underpinned by science-based approaches. Case studies of using these participative processes are described that collectively assist in the transition to integrated management. A new imperative for incorporating interlinkages among food, water, and environment security at the basin level is identified.

Biodiversity↗
PubMed2005

Monitoring change in the abundance and distribution of insects using butterflies and other indicator groups.

Conservative estimates suggest that 50-90% of the existing insect species on Earth have still to be discovered, yet the named insects alone comprise more than half of all known species of organism. With such poor baseline knowledge, monitoring change in insect diversity poses a formidable challenge to scientists and most attempts to generalize involve large extrapolations from a few well-studied taxa. Butterflies are often the only group for which accurate measures of change can be obtained. Four schemes, used successfully to assess change in British butterflies, that are increasingly being applied across the world are described: Red Data Books (RDB) list the best judgements of experts of the conservation status of species in their field of expertise; mapping schemes plot the changing distributions of species at scales of 1-100 km2; transect monitoring schemes generate time series of changes in abundance in sample populations of species on fixed sites across the UK; and occasional surveys measure the number, boundaries and size of all populations of a (usually RDB) species at intervals of 10-30 years. All schemes describe consistent patterns of change, but if they are to be more generally useful, it is important to understand how well butterflies are representative of other taxa. Comparisons with similarly measured changes in native bird and plant species suggest that butterflies have declined more rapidly that these other groups in Britain; it should soon be possible to test whether this pattern exists elsewhere. It is also demonstrated that extinction rates in British butterflies are similar to those in a range of other insect groups over 100 years once recording bias is accounted for, although probably lower than in aquatic or parasitic taxa. It is concluded that butterflies represent adequate indicators of change for many terrestrial insect groups, but recommended that similar schemes be extended to other popular groups, especially dragonflies, bumblebees, hoverflies and ants. Given institutional backing, similar projects could be employed internationally and standardized. Finally, a range of schemes designed to monitor change in communities of aquatic macro-invertebrates is described. Although designed to use invertebrates as a bio-indicator of water quality for human use, these programmes could be extended to monitor the 2010 biodiversity targets of the World Summit on Sustainable Development.

Animals↗
PubMed2005

Prospects for monitoring freshwater ecosystems towards the 2010 targets.

Human activities have severely affected the condition of freshwater ecosystems worldwide. Physical alteration, habitat loss, water withdrawal, pollution, overexploitation and the introduction of non-native species all contribute to the decline in freshwater species. Today, freshwater species are, in general, at higher risk of extinction than those in forests, grasslands and coastal ecosystems. For North America alone, the projected extinction rate for freshwater fauna is five times greater than that for terrestrial fauna--a rate comparable to the species loss in tropical rainforest. Because many of these extinctions go unseen, the level of assessment and knowledge of the status and trends of freshwater species are still very poor, with species going extinct before they are even taxonomically classified. Increasing human population growth and achieving the sustainable development targets set forth in 2002 will place even higher demands on the already stressed freshwater ecosystems, unless an integrated approach to managing water for people and ecosystems is implemented by a broad constituency. To inform and implement policies that support an integrated approach to water management, as well as to measure progress in halting the rapid decline in freshwater species, basin-level indicators describing the condition and threats to freshwater ecosystems and species are required. This paper discusses the extent and quality of data available on the number and size of populations of freshwater species, as well as the change in the extent and condition of natural freshwater habitats. The paper presents indicators that can be applied at multiple scales, highlighting the usefulness of using remote sensing and geographical information systems technologies to fill some of the existing information gaps. Finally, the paper includes an analysis of major data gaps and information needs with respect to freshwater species to measure progress towards the 2010 biodiversity targets.

Conservation of Natural Resources↗
PubMed2005

The 2010 challenge: data availability, information needs and extraterrestrial insights.

At the 2002 Johannesburg World Summit on Sustainable Development, 190 countries endorsed a commitment to achieve, by 2010, a significant reduction of the current rate of biodiversity loss at the global, regional and national levels. A wide range of approaches is available to the monitoring of progress towards this objective. The strengths and weaknesses of many of these approaches are considered, with special attention being given to the proposed and existing indicators described in the other papers in this issue. Recommendations are made about the development of indicators. Most existing and proposed indicators use data collected for other purposes, which may be unrepresentative. In the short term, much remains to be done in expanding the databases and improving the statistical techniques that underpin these indicators to minimize potential biases. In the longer term, indicators based on unrepresentative data should be replaced with equivalents based on carefully designed sampling programmes. Many proposed and existing indicators do not connect clearly with human welfare and they are unlikely to engage the interest of governments, businesses and the public until they do so. The extent to which the indicators already proposed by parties to the Convention on Biological Diversity are sufficient is explored by reference to the advice an imaginary scientific consultant from another planet might give. This exercise reveals that the range of taxa and biomes covered by existing indicators is incomplete compared with the knowledge we need to protect our interests. More fundamentally, our understanding of the mechanisms linking together the status of biodiversity, Earth system processes, human decisions and actions, and ecosystem services impacting human welfare is still too crude to allow us to infer reliably that actions taken to conserve biodiversity and protect ecosystem services are well chosen and effectively implemented. The involvement of social and Earth system scientists, as well as biologists, in collaborative research programmes to build and parameterize models of the Earth system to elucidate these mechanisms is a high priority.

Biodiversity↗