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Review of North-South and South-South cooperation and conditions necessary to sustain research capability in developing countries.

The paper extracted pertinent aspects of 21 years (1981-2001) of scientific cooperation among Zimbabwe's Blair Research Laboratory (BRL), the Biomedical Research and Training Institute (BRTI), and the Danish Bilharziasis Laboratory (DBL). DBL supported the building of research capacity at BRL through PhD-level training and short courses on research training organized by BRTI. The BRL-BRTI-DBL cooperation involved institutional support, scientific training, joint research programmes, and technology transfer, and forms a basis for the discussion of North-South and South-South collaboration in this paper. As the collaboration matured, DBL researchers began cooperating with their counterparts at BRL in internationally funded research programmes and partnerships based on mutual interests and responsibilities. Several research projects were formulated under co-principal investigators from the two institutions and later extended to other European and US institutions. An impressive outturn (18 PhDs) of postgraduate students undertaking field-based PhD work was accomplished from 1990 to 2001. As the socioeconomic situation in Zimbabwe deteriorated from 1999, significant attrition of senior scientists began to affect some of BRL's core functions in support of the Ministry of Health's programmes. In solidarity with BRL, DBL and BRTI jointly implemented a management-strengthening project to reduce deterioration of research productivity by retaining mid-level research managers. BRTI, able to respond rapidly to research needs in the Southern Africa Development Community (SADC), is not in competition with national research institutions and universities. An advisory committee of SADC stakeholders sets its priorities. The framework for South-South cooperation is research training to facilitate national scientists to attract resources from local and international funding agencies. It has established a National Institutes of Health-accredited ethical review board that provides ethical assurance for BRTI and non-BRTI-administered projects. Over the last eight years, BRTI has established regional and international legitimacy, and many funding agencies accept the role of the organization in 'Third Country Training for South-South Cooperation'. The article concludes by identifying essential conditions for sustaining research capability at BRL and similar institutions in developing countries. In rolling out a new ethos for research, great expectation is placed on the success of the New Partnership for Africa Development.

Communicable Disease Control↗

Toxicity and bioaccumulation of lead in marine protozoa communities.

The toxicity and bioaccumulation of lead has been studied using marine protozoa communities developed in laboratory microecosystems. The concentrations tested were 500 and 1000 micrograms.L-1 of lead as lead acetate. The protozoan was able to bioaccumulate 27.02-504 micrograms Pb.g-1 dry weight. Bacteria also bioaccumulated lead, but always to a lesser degree than protozoa. Lead caused a significant reduction in the density of protozoa, which could be an indirect response to the cellular increase of lead. On the other hand, the toxicant did not determine a decrease in the number of bacterial cells; this could be due to their capacity to bioaccumulate a lesser amount of lead, the increase in the number of dead cells, and the elimination of their predators by the toxicant. After 120 h, a recovery of the community was observed.

Animals↗

Pain, role play, and videotape. Pain management staff development in a community hospital.

Videotaped role play was an effective staff development strategy used as an initial exercise in a five-part class to update the pain management skills of experienced nurses. It engaged the participants in learning and stimulated discussion and provided concrete feedback of current clinical practices for comparison with the Agency for Health Care Policy and Research pain management guidelines (Acute Pain Management Guideline Panel, 1992).

Clinical Competence↗

Vaginal delivery after one cesarean section.

OBJECTIVE: To determine the success rate and safety of vaginal delivery after a previous cesarean section in a South African teaching hospital serving a developing community. METHOD: One hundred eighty-nine women with a history of one previous cesarean section were studied during a 10.5-month period. Maternal morbidity was studied in 92 of these patients who had infants weighing 2500 g or more. During the study period 5044 women delivered at the hospital. RESULTS: In the study group of 189 women, 85 (44.9%) delivered vaginally, 65 (34.4%) by cesarean section during labor and 39 (20.6%) had elective cesarean sections. One maternal and two perinatal deaths occurred. In the subgroup of 92 women with babies weighing 2500 g or more at birth, 10 women (10.9%) experienced morbidity related to trial of scar. CONCLUSION: Vaginal birth was accomplished less often in this population compared with reports from developed countries, but the procedure was equally safe.

Birth Weight↗

Designing trigger pictures in context: the challenge of balance.

Experience, supported by research, has shown that people interpret pictures against a complex network of communication factors, including various socio-cultural factors. In the process of developing interactive health learning materials for primary schools of less developed communities of South Africa, a set of prototype trigger pictures was pre-tested to determine its suitability for sexuality and HIV/AIDS education. The results suggest a link between socio-cultural factors related to sexual behaviour among young people, and the way they 'read' these pictures. By way of an explanatory model it is recommended that media producers should seek a balance between learner factors, picture coding factors, and socio-cultural factors in the design of contextualized trigger pictures.

Acquired Immunodeficiency Syndrome↗

Beyond therapy: bringing social work back to human services reform.

Based on field interviews in a Chicago community development corporation and settlement houses in New York City and St. Louis, as well as interviews with leading social services innovators and social work educators, this article explores the intersection of current social work practice and human services innovation. The article offers a rationale and a blueprint for a reorientation of social work's "helping relationship," reviews a number of promising innovations and strategies that may help the profession make this reorientation operational, and explores forces restraining as well as driving such change.

Community-Institutional Relations↗

Survey of village informants--an alternate method to estimate paralytic poliomyelitis prevalence in rural area.

Lameness surveys were conducted among children of 0-14 year age group in 60 villages of a Community Development Block of district Ambala in Haryana State. The methods used were: village informants survey and house-to-house survey. Village informants were village chief, school teachers, primary health care workers, traditional birth attendants and several prominent persons from each street/neighbourhood of the village. These informants located lame children in their locality. Subsequently, a house-to-house search for identification of lame children was made in all the 60 sampled villages. Physicians later on, examined the lame children to diagnose paralytic poliomyelitis. Estimate of the prevalence rate of lower extremity paralytic poliomyelitis in 0-14 year age group was found to be 7.9/1000 in village informants survey. This did not differ significantly from the rate of 8.8/1000 revealed by house-to-house survey in the same community (p greater than 0.05). Time required to complete village informants survey was almost one third and costs were also about half as compared to house-to-house survey. Therefore, village informants based lameness survey is a rapid and economical alternative for the estimation of poliomyelitis prevalence in rural communities.

Adolescent↗

A pilot urban church-based programme to reduce risk factors for diabetes among Western Samoans in New Zealand.

We have assessed the impact of a 2-year pilot church-base diabetes risk reduction programme on major lifestyle predictors of future Type 2 diabetes mellitus: exercise and weight control in a prospective non-randomized controlled study of a modular lifestyle and diabetes awareness intervention programme using a community development model. The study involved two complete church congregations from an ethnic group at high risk of diabetes (Western Samoans) (intervention church n = 78; control church n = 144). Weight remained stable (0+/-4.8 kg) in the intervention church but increased by 3.1+/-9.8 kg in the control church (p = 0.05). In the intervention church, there was an associated reduction in waist circumference (-4+/-10 cm vs +2+/-7 cm in control, p < 0.001), an increase in diabetes knowledge (46+/-26% vs 4+/-17% in control, p < 0.001) and an increase in the proportion exercising regularly (+22% vs -8% in control, p < 0.05). Consumption of key fatty foods was also reduced in the intervention church. We conclude that diabetes risk reduction programmes based upon lifestyle change, diabetes awareness, and empowerment of high risk communities can significantly reduce risk factors for future Type 2 diabetes.

Adult↗

A "fair innings" between the sexes: are men being treated inequitably?

In most modern developed communities, women are known to live longer than men. A less known fact is that in many statistics reporting differences in life expectancy between socio-economic classes, on average women in the worst-off social class live as long as men in the best-off social class, if not longer. It is true that women tend to have higher morbidity, or lower health-related quality of life, especially at advanced age, but this female disadvantage does not offset the life expectancy advantage sufficiently to lead to the conclusion that men and women enjoy comparable lifetime health prospects in these communities. Although there is much public and policy discussion about the inequity of health inequalities between the social classes, there is relatively little discussion about such inequalities between the sexes. The paper first discusses the applicability of the fair innings argument to the issue of inequality in health between the sexes. It critically examines six arguments concerning why inequality in health between the sexes may or may not be an inequity. Next, special attention is given to the argument that it is wrong to judge the fairness or unfairness of health inequalities in isolation, but that this judgement should be made only after considering other inequalities relevant to overall human well-being, many of which are believed to work to the disadvantage of women. An analytical framework based on the Gender-related Development Index (a supplementary index to the Human Development Index) is taken as a starting point, to address the issue of health and overall well-being. But this is found wanting, and suggestions are made as to how its conceptual and empirical properties could be improved. Meanwhile we conclude that a prima facie case has been made that the current distribution of health in most countries does not give men a "fair innings", but the broader question about general well-being remains unresolved.

Attitude to Health↗

Tale of two churches: differential impact of a church-based diabetes control programme among Pacific Islands people in New Zealand.

AIMS: To compare the impact on weight and exercise of a 2-year church-based diabetes risk reduction programme in four churches in South Auckland, New Zealand. METHODS: A prospective non-randomized controlled study of a modular lifestyle and diabetes awareness intervention programme applying community development principles. The study involved four complete church congregations, two Samoan and two Tongan, with 516 participants at commencement. Risk of Type 2 diabetes is high among both ethnic groups. RESULTS: Overall, 285 subjects were available for their second assessment. In one intervention church, weight gain was controlled (vs. control 0 +/- 4.8 vs. +3.1 +/- 9.8 kg, respectively; P=0.05), diabetes knowledge (+46 +/- 26% vs. +4 +/- 17%; P<0.001) and regular exercise (at least 3 days per week: +22% vs. -8%; P=0.032) increased and readiness to change weight (P=0.007) shifted towards maintenance (e.g. maintenance +41% vs. +8%, respectively). The other intervention church increased diabetes knowledge (+19 +/- 24 vs. +8 +/- 25; P<0.024), but no other significant personal changes occurred. Attendance and perceived utility of the programme were greater in the first intervention church. CONCLUSIONS: A moderate intensity, community-based, structured diabetes awareness and lifestyle programme can reduce diabetes risk, but increasing diabetes knowledge alone is not necessarily associated with healthier lifestyle choices. Continuous and detailed monitoring of penetration of interventions may be essential to help guide the timing of interventions and identify the need for additional strategies to increase participation and motivation.

Adolescent↗

Early linear growth retardation in Chongqing, China.

OBJECTIVES: The objectives of this study were to investigate early linear growth retardation and to identify potential risk factors for it. METHODOLOGY: A community-based prospective study was performed in Chongqing, China, with infants being examined at 12 and 15 months of age. A total of 101 infants were examined twice. Supine length, bodyweight, lower leg length, head circumference, middle upper arm circumference and biceps skinfold thickness were measured. RESULTS: The prevalence of short stature (length-for-age standard deviation score, < -2) was 22% and 23% at 12 and 15 months of age, respectively, while the incidence of growth stunting (low growth velocity) between 12 and 15 months of age was 24%, using the stunting screening method. A mother having a history of abortion and infants having current episodes of diarrhoea were identified as risk factors for growth stunting. CONCLUSIONS: We conclude that both short stature and growth stunting are common in the population studied. The stunting screening method used is applicable in developing communities.

Anthropometry↗

Treatment of volatile organic compounds in a biotrickling filter under thermophilic conditions.

The objectives of this research were to investigate the potential to biologically treat volatile organic compounds emitted by the forest products industry at thermophilic conditions and to examine the microbial community developed at high temperatures. Three biotrickling filters were run in parallel at temperatures ranging from 40 degrees C (mesophilic control) to 70 degrees C. The first phase involved treatment of methanol, for a 3-month run, and the second phase involved a 260-day run on the treatment of alpha-pinene. Methanol removal rates over 100 g m(-3) h(-1) where achieved at temperatures up to 70 degrees C. Alpha-pinene removal was achieved at temperatures up to 60 degrees C with optimal treatment occurring at 55 degrees C at rates up to 60 g m(-3) h(-1). The time for acclimation increased with increasing temperature and was longer for pinene than for methanol. Filter performance was also able to quickly recover from a shutdown period of up to 2 weeks due to the robustness of the microbial communities as determined by DNA fingerprinting analysis. The high-temperature communities treating methanol or pinene were more similar to each other than the mesophilic communities (i.e., 40 degrees C). The mesophilic methanol community had a high degree of functional redundancy, while the mesophilic pinene community was more unique and very distinct from the others. These results show that biofiltration at high temperatures is achievable and opens up a range of possibilities for applying biofiltration to hot gas streams.

Acclimatization↗

Beyond the biomedical and behavioural: towards an integrated approach to HIV prevention in the southern African mining industry.

While migrant labour is believed to play an important role in the dynamics of HIV-transmission in many of the countries of southern Africa, little has been written about the way in which HIV/AIDS has been dealt with in the industrial settings in which many migrant workers are employed. This paper takes the gold mining industry in the countries of the Southern African Development Community (SADC) as a case study. While many mines made substantial efforts to establish HIV-prevention programmes relatively early on in the epidemic, these appear to have had little impact. The paper analyses the response of key players in the mining industry, in the interests of highlighting the limitations of the way in which both managements and trade unions have responded to HIV. It will be argued that the energy that has been devoted either to biomedical or behavioural prevention programmes or to human rights issues has served to obscure the social and developmental dimensions of HIV-transmission. This argument is supported by means of a case study which seeks to highlight the complexity of the dynamics of disease transmission in this context, a complexity which is not reflected in individualistic responses. An account is given of a new intervention which seeks to develop a more integrated approach to HIV management in an industrial setting.

Adult↗

The feasibility of a nurse practitioner-led primary health care clinic in a school setting: a community needs analysis.

AIM: The aim of this New Zealand study was to determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses (PHNs) were the most appropriate nurses to lead such a clinic. METHOD: Utilizing a community needs analysis method, data were collected from three sources --known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the PHN, and the practicalities of establishing a clinic including the services participants would expect a clinic to provide. Analysis was exploratory and descriptive. RESULTS: Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the PHN was less than anticipated and that community expectations were such that for a PHN to lead a primary health care clinic it would be likely that further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral. CONCLUSION: Overall findings indicated that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment was feasible. While a PHN may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required.

Adolescent↗

Community diagnosis counts.

Because of such validity-research deficits and the ceiling on agreement between instruments imposed by less-than-perfect reliability characteristics of each instrument, it is not appropriate to assume that the semistructured clinician interview is more valid than the epidemiologic interview. The Baltimore ECA site is uniquely situated to address this issue by comparing the outcome of subjects identified with current depression in the 1982 clinical reappraisal interview with those identified by the DIS at the same time to see if the 13-year follow-up is similar to that found over 16 years by Murphy et al. Where do we go from here in improving our diagnostic criteria for DSM-V, constructing better diagnostic instruments, and conducting the next generation of epidemiologic studies? Certainly the categorical diagnostic criteria themselves, without a dimensional symptom level, are never used in clinical treatment trials. Hence the "clinical significance" criteria of significant distress or disability added to DSM-IV should be further refined, with the possible addition of "staging" of disorders. The objective would be to provide a better indication of treatment need and clinical prognosis as in current cancer diagnostic assessments. For epidemiologic studies, the addition of symptom scales and disability assessments to the traditional categorical diagnoses should be helpful in developing community measures of treatment need. Different methods of assessment may be useful for diagnoses in which an impaired perception of reality occurs, such as schizophrenia. With some of these adjustments, it should be feasible to "count" those with clinically significant diagnoses in the community, and thus improve the validity and clinical utility of our diagnoses for predicting clinical course and responsiveness to specific treatments.

Baltimore↗

[Seven Oaks -- a new look at tertiary care].

This article describes a small (38 bed) tertiary mental health facility in the community developed as part of the downsizing and replacement of a large provincial mental hospital in British Columbia. Development took place in two phases: an initial pilot project comprised of 12 beds in two open units (1994-2002) and the subsequent rebuilding as a 38 bed facility which included two secure units (2002 - present). The project has attempted to demonstrate the feasibility of integrating a rehabilitation focus into a program that treats some of the most difficult patients. The planning process and philosophy, the patients, program and staffing are reported, together with the informal results from phase 1 and some of the early results from a formal 5-year evaluation of phase 2.

British Columbia↗

Sexual rights in southern Africa: a Beijing discourse or a strategic necessity?

This article explores the meaning of sexual rights as interpreted by different stakeholders during the development of the Beijing Programme of Action and within the Southern African Development Community (SADC). It illustrates how the lack of sexual rights as understood in the African context results from poverty as well as gender inequality, particularly in sexual relationships. This lack is manifested in the circumstances surrounding the HIV/AIDS pandemic and violence against women. In the European context, in contrast, sexual rights claims are motivated specifically in relation to sexual orientation. The article explores the extent to which these different discourses are being addressed in practice in SADC member countries and the opportunities that exist for building a concrete practice of sexual rights both in the region and internationally.

Africa, Southern↗

Identifying the development needs of community matrons.

AIM: To gain some insight into the needs of community matrons from both the practitioners' and managers' perspectives. METHOD: Focus groups with community matrons in different PCTs. RESULTS: The focus groups identified that skills in physical assessment and prescribing were taken as prerequisites or essential to the role, and that the educational priorities were viewed as clinical education relating to the management of many long-term conditions linked to major causes of unplanned admissions. The preferred format for education appears to be work-based learning delivered by clinicians. CONCLUSION: PCTs need to ensure that community matrons have their learning needs assessed and to put in place systems of work-based learning that allow for appropriate development. Although community matrons themselves may not initially see the value of non-clinical education, this will be vital to the long-term success of their role.

Attitude of Health Personnel↗