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At least 973 records · Page 54Linked to original sources
PubMed2003

What's in a country average? Wealth, gender, and regional inequalities in immunization in India.

Recent attention to Millennium Development Goals by the international development community has led to the formation of targets to measure country-level achievements, including achievements on health status indicators such as childhood immunization. Using the example of immunization in India, this paper demonstrates the importance of disaggregating national averages for a better understanding of social disparities in health. Specifically, the paper uses data from the India National Family Health Survey 1992-93 to analyze socioeconomic, gender, urban-rural and regional inequalities in immunization in India for each of the 17 largest states. Results show that, on average, southern states have better immunization levels and lower immunization inequalities than many northern states. Wealth and regional inequalities are correlated with overall levels of immunization in a non-linear fashion. Gender inequalities persist in most states, including in the south, and seem unrelated to overall immunization or the levels of other inequalities measured here. This suggests that the gender differentials reflect deep-seated societal factors rather than health system issues per se. The disaggregated information and analysis used in this paper allows for setting more meaningful targets than country averages. Additionally, it helps policy makers and planners to understand programmatic constraints and needs by identifying disparities between sub-groups of the population, including strong and weak performers at the state and regional levels.

BCG Vaccine↗
PubMedDate not supplied

Health indicators for mothers and children in rural Herat Province, Afghanistan.

INTRODUCTION: Following years of conflict and neglect, major efforts now are underway to develop health policy and rehabilitate the health facilities in Afghanistan. As part of these efforts, there is a need to better understand the health status and health-seeking behaviors. As part of an effort to assist local non-governmental organizations (NGOs), a household survey of mothers with children under the age of five years was conducted in two rural districts of Herat Province, Karokh and Chesht-e-Sharif. METHODS: A two-stage, 30-cluster approach was used for each district. This included 622 mothers of 926 children under the age of five years living in the two districts. Outcome measures included demographic characteristics, antenatal services, immunization coverage, hemoglobin levels of the mothers, nutritional status and practices, environmental health indicators, recent illness, and health seeking behaviors. RESULTS: The mean value of ages of the mothers was 27 years with an average parity of 6.1. Less than 5% of mothers ever had attended school. Half of women had lost at least one child before the child reached the age of five years. Under-five-year mortality was estimated at 325. Only 29% of the women had attended an antenatal clinic during their last pregnancy. Virtually all deliveries occurred at home. Only 7.6% of women had received three doses of tetanus toxoid. Less than 9% of the children 12-59 months of age were fully immunized. According to the measurements of mid-upper-arm circumference (MUAC), 11% of children were malnourished. Although breastfeeding almost was universal, greater than one-third of the women did not start breastfeeding until the second day after delivery. Protected water sources and appropriate control of feces were lacking in both districts. In the previous two weeks, 45.7% of children had experienced diarrhea, and dysentery had occurred in 10%. Fever had been present in one-quarter of the children. CONCLUSIONS: Household health indicators indicate serious maternal and child health concerns in these two districts. Of particular concern is the poor immunization coverage, lack of reproductive health service, and the prevalence of common childhood illness in these populations. The feeding practices for children and the anemia among mothers also raised concerns. Poor environmental health contributes substantially to childhood illness. Without special emphasis, efforts to rebuild the health sector are likely to reach the household level only late in the process. An aggressive program to integrate community development and promotion of sound health practices is needed to improve the health of the Afghanistan people.

Adult↗
PubMedDate not supplied

Early growth faltering of rural Mesoamerindian breast-fed infants.

Early growth faltering has been described in breast-fed infants 4-6 months of age from less-developed communities. The timing and magnitude of growth faltering, however, depends on the appropriateness or comparability of the reference used to evaluate growth performance. In this paper we compared the growth performance of a group of rural Mesoamerindian breast-fed infants from birth through 6 months of age to that of a reference group of breast-fed infants reared under favourable nutritional and environment conditions in the United States. The validity of this assessment is based upon the comparability of infant feeding mode. Mean weights and lengths and corresponding weight-for-age and length-for-age percentiles and z-scores were significantly lower among the Mesoamerindian (Otomi Indian) infants (p = 0.001). Mean weight-for-length percentiles and z-scores did not differ between groups. Weight gain (g/day) was significantly lower among the Otomi infants throughout the entire 6 months (p = 0.001). Length velocities of the Otomi infants were lower than reference infants at 3-6 months (p = 0.001). The growth pattern of the Otomi infants differed from that of the reference group: decreases in growth velocities and weight-for-age and length-for-age z-scores were significantly more precipitous for the Otomi infants between 4 and 6 months of age (p = 0.001). We conclude that growth faltering was evident among the Otomi infants between 4 and 6 months of age, relative to a reference growth of breast-fed infants.

Body Height↗
PubMed1976

An introductory course in prescription drugs for community health workers developed by a systems approach.

A 16-hour introductory course in prescription drugs for community health workers was developed by a systems approach. It featured an emphasis on: (1) learning the broad indications, side effects, and adverse reactions of the 30 most commonly prescribed drugs in the outpatient clinic, and (2) aiding the workers in patient education. Teaching materials were simple and inexpensive. An evaluation based on a pretest of the course's objectives compared to a final test documented the success of the instruction.

Boston↗
PubMed1976

Prognosis in schizophrenia. A ten-year follow-up of first admissions.

Eighty-eight of 92 first admission schizophrenics from 1963, being an incidence by first admission cohort, were followed up between 1974 and 1975. Fifty-eight percent were reported as showing no social or intellectural deficit, and only 8% were unremitting institutionalized, with 51% being considered as having normal economic productivity, and 69% with a good or fair social adjustment. Despite difficulties in comparison, birth, marriage, and divorce rates appear to be not very different from those for the general population, although the percentage of married patients is lower. Deaths would seem greater than expected. Possible reasons for the improved prognosis in schizophrenia are considered to be short initial hospitalization, almost universal use of phenothiazines, use of developing community services (social and psychiatric), and generally good econimic conditions.

Adolescent↗
PubMed2000

Guidelines and recommendations for content, structure, and deployment of mutation databases: II. Journey in progress.

The HUGO Mutation Database Initiative has produced guidelines and recommendations addressing uniform nomenclature of (human) genes and alleles, and computing standards to permit a moderate level of built-in redundancy, searchable interfaces, and compatibility between the comprehensive (genomic) and locus-specific types of databases. The participating community (developers and users) have been moving the project along rapidly, as described here.

Databases, Factual↗
PubMed1997

Propagation of handclasp grooming among captive chimpanzees.

A grooming posture previously reported for two wild chimpanzee (Pan troglodytes) communities developed spontaneously in a captive group of the same species. This offered a unique opportunity to follow the propagation of a new social custom. The posture consists of two partners grasping hands--either both right hands or both left hands--and raising the arms in an A-frame above their heads while mutually grooming with their free hands. The propagation of this pattern was followed over a 5 year period. In the beginning, handclasps were always initiated by the same adult female. This female initiated the posture mainly with her adult female kin. In subsequent years, these relatives became frequent participants in the posture with each other as well as with nonrelatives. Over the years the posture increased in frequency and duration and spread to the majority of adults and also to a few adolescents and older juveniles. The pattern persisted after removal of the apparent originator.

Animals↗
PubMed1999

Enamel hypoplasia in a Canadian historic sample.

Analyses of historical skeletal samples provide useful comparisons of the prevalence of skeletal indicators of stress to documentary information on health, diet, and socioeconomic status. A sample of the permanent dentitions of 253 adults from the St. Thomas' Anglican Church 19th-century skeletal sample in Belleville, Ontario, was examined macroscopically for the prevalence of enamel defects on the six anterior maxillary and mandibular teeth. The maximum frequency of hypoplasias on the left mandibular canine is 36.1%. The prevalence of enamel defects is low to moderate compared to almost all other reported frequencies in historical samples, which is consistent with historical descriptions of this developing community of middle to high socioeconomic status Canadians. Hypoplasias are significantly more frequent in males but there are no significant differences in the mean age at death between individuals with hypoplasia and those without. Calculations of the peak ages of occurrence of hypoplasias fall within the commonly observed 2-4-year range. This is not consistent with separate studies, demographic, isotopic and historical, of the introduction of complementary foods to 19th-century Belleville infants and of the weaning process. These results do not support the view that peak ages of occurrence of hypoplastic defects are associated with the cessation of breast-feeding or the weaning process in general. Am. J. Hum. Biol. 11:513-524, 1999. Copyright 1999 Wiley-Liss, Inc.

Journal Article↗
PubMed1976

The pattern of intestinal obstruction in Malaysia.

This is a review of 261 patients operated for 271 instances of mechanical intestinal obstruction over a 5-year period in a developing country in the tropics. The pattern of intestinal obstruction in Chinese is similar to that in Caucasians, where adhesions account for the largest number of cases. The occurrence in Malays, Indians, Pakistanis and Ceylonese is similar to that in other developing communities where external hernia is commonest while adhesive or tumour obstruction is rare; however, these racial groups do not exhibit the high incidence of intussusception and volvulus found in Africa and India. The operative mortality was 13-9 per cent, which is comparable to that in Western series. The major adverse factors in intestinal obstruction, i.e. extremes of age, associated disease, gangrenous bowel, large bowel obstruction and malignancy, were confirmed. Fluid and electrolyte imbalance was frequent, as in other tropical series, but with intensive preoperative correction it was not an important adverse factor.

Adolescent↗
PubMedDate not supplied

Informal risk-sharing arrangements (IRSAs) in rural Burkina Faso: lessons for the development of community-based insurance (CBI).

In resource-poor environments, community-based insurance (CBI) is increasingly being propagated as a strategy to improve access of poor rural populations to modern health care. It has been repeatedly hypothesized that CBI schemes need to be grounded in national as well as local traditions of solidarity. This paper presents a typology of informal risk sharing arrangements (IRSAs) in a rural area of North-Western Burkina Faso and discusses their modus operandi as well as the underlying concepts of solidarity and reciprocity. The research was explicitly multi-disciplinary, combining anthropological and economic as well as qualitative and quantitative data collection methods. Focus group and interview data were complemented by a census of existing IRSAs. In addition to presenting the main features of existing institutions, the paper discusses whether IRSAs can serve as entry points for CBI schemes. In spite of the fact that existing IRSAs fulfil important solidarity functions in the rural Burkinian context, we conclude that they cannot serve as institutional models for more formalized CBI schemes. Community participation in a future CBI scheme will need to tap into existing notions of solidarity and mutuality. The CBI scheme itself, however, needs to be newly tailored.

Burkina Faso↗
PubMed1989

Coronavirus-like particles in adults in Melbourne, Australia.

Coronavirus-like particle(s) (CVLP) are faecal-derived pleomorphic membrane bound virus-like particles characterised by a fringe of club-shaped spikes that measure about 27 nm in length. The association of CVLP with a variety of social, clinical, and epidemiological factors was examined after a 69 month survey of faeces received for routine testing at an infectious diseases hospital. CVLP was found most commonly in three groups: first, intellectually retarded individuals who were usually inmates of institutions; second, recent overseas travellers who were either Indochinese refugees/immigrants or were overseas travellers who had usually visited developing communities for lengthy periods; and, third, male homosexuals who had a history of multiple sexual contacts and/or venereal disease. It was concluded that the excretion of CVLP had a strong association with unhygienic living or working conditions irrespective of any clinical symptoms the individual might show.

Adolescent↗
PubMed1979

[Theater nurse and midwife in Cameroon. Impressions and experiences in the grasslands (Northwest Cameroon) during a six-and-a-half month stay in a hospital situated at a height of 1800 m].

The author describes the circumstances of the hospital and out-of-hospital situation in the region she worked in, in focussing on the relevant practical features of the daily life of patients and staff. She deals among other things with the maternity ward (including the separate "camp" devoted to prenatal stays) and the operating theatre. As regards health activities outside the hospital, she mentions those of the existing health centres and of auxiliary personnel called first-aiders (whose job description is close to the one of the village health workers advocated by WHO and others). A health team, usually led by a physician, makes periodic visits to bush villages. The importance of the contacts thus created, for health work itself (including collaboration with traditional health practitioners) as well as for community development, is underlined.

Cameroon↗
PubMed1994

Training generalist physicians: structural elements of the curriculum.

To train more generalist physicians, structural changes must be made along the continuum of medical education. Future generalists require in-depth exposure to primary care practice, with substantive experience in the longitudinal management of patient panels and the opportunity to work with successful generalist role models. Clinical training and course work must incorporate a wide range of skills and disciplines, including areas now under-emphasized, such as epidemiology, health services, and psychosocial medicine. Recommendations for structural changes to increase the generalist focus of medical education include: 1) the development within institutions of central authorities, involving departments of internal medicine, family medicine, and pediatrics, in joint efforts to foster all aspects of generalist training, including recruitment, curriculum development, community linkages, innovative approaches to training, and recognition and support for successful generalist teachers; 2) commitment of a minimum of 50% of clinical training to ambulatory care settings at both medical school and residency levels; 3) required longitudinal care experiences for all medical students and a 20% or greater time commitment to longitudinal care for internal medicine, pediatrics, and family medicine residents; and 4) increased numbers of generalist faculty and enhanced teaching skills among faculty in the outpatient environment, to guarantee increased exposure of medical students and residents to generalist role models.

Adult↗
PubMedDate not supplied

What's preventing more prevention? Barriers to development at academic medical centers.

OBJECTIVE: To determine the views of leaders in academic medicine concerning the need for programs in preventive medicine (PM) and the prevailing barriers to program development. DESIGN: Structured interviews. SETTING: Medical schools of the United States. PATIENTS/PARTICIPANTS: 90% of deans and chairpersons of departments of medicine and preventive medicine. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 91% considered academic PM underdeveloped and 100% considered their own programs average or worse. Identified barriers to development included funding constraints, academic partiality to biomedicine, inadequate quality of preventive medicine research and faculty, public preferences for technologic care, and organization of academic medical centers (AMCs). While 80% perceived a shortage of able PM faculty and 60% considered PM research quality to be inadequate, only 12% of PM units gave research training high priority. While 95% of respondents held that AMCs should develop community programs and 75% identified social problems as a cause of chronic diseases, 65% agreed that community programs are not considered scholarly. Only 23% of PM units gave community service high priority. CONCLUSIONS: A policy contradiction exists: academic leadership agreed on the problems and needed changes in PM, yet the problems were often attributed to nonacademic sources, particularly finding and public preferences, and current academic practices commonly fail to address recognized developmental barriers within academic institutions. A chain of barriers is apparent. Breaking the chain may require a change in our understanding of the role of prevention.

Attitude of Health Personnel↗
PubMed2000

Medical genetics in primary health care.

Medical genetics has been at the forefront of developments in medicine for the last 50 years. This progress has mainly benefited industrialized countries. Due to continuing improvements in the socio-economic and health indices in developing nations more than half of them have now reached a stage where it has become relevant for them to initiate and develop medical genetic services. The WHO foresaw this eventuality in 1985 and further recognised the need to develop community based medical genetic services that are relevant to and can be incorporated into primary health care. The need for primary health care based medical genetic services has subsequently also been accepted in industrialized nations. This paper summarises those primary health care based interventions that can be undertaken to ensure the control of genetic disorders and birth defects.

Community Health Services↗
PubMed1988

Effects on school children of prophylaxis of mothers with iodized oil in an area of iodine deficiency.

The results of tests of intellectual and psychomotor performance and school performance in a group of school children from a rural impoverished and iodine deficient Andean community whose mothers received injections of iodinated oil prior to the end of the first trimester of pregnancy have been compared with results in children from a neighboring comparable community whose mothers had received no iodinated oil. Subjects between ages 8 and 15 were studied. Statistically significant differences were not observed between the two groups in tests of intellectual function, but children of mothers who had received iodinated oil performed better on tests of psychomotor maturation. The group whose mothers had received oil performed distinctly better when assessed in terms of school drop-out rates, grades achieved, grades repeated, and in overall performance as judged by teacher notes in school records. Performance of both groups on standard tests of intellectual and psychomotor function was lower than standard scores. This may be a result of social and cultural deprivation, the general malnutrition prevailing in the region or other unidentified factors. The improved scoring and school performance exhibited by the children of mothers who received iodinated oil underlines the importance of prophylaxis with iodine in iodine deficient regions as one important contributor to community development.

Adolescent↗
PubMed2004

Review of the knowledge of microbial contamination of the Russian manned spacecraft.

The 15-year experience of orbital station Mir service demonstrated that specifically modified space vehicle environments allows for the consideration of spaceship habitats as a certain ecological niche of microbial community development and functioning, which was formed from the organisms of different physiological and taxonomical groups. The base unit of the orbital station (OS) Mir was launched on February 20, 1986, and on March 13 the first crew arrived to it. From that moment a unique microbiocenosis started forming in the closed environment of the space station, and vital activity of the microorganisms continued for the next 15 years in a specifically changed environment, in conditions of continuous influence of a set of factors intrinsic to space flight. A total of 234 species of bacteria and fungi were found onboard orbital station Mir, among which microorganisms capable of resident colonization of the environment of space objects as a unique anthropotechnological niche were revealed. In such conditions the evolution of microflora is followed by the rise of medical and technical risks that can affect both sanitary-microbiological conditions of the environment and the safety and reliability characteristics of space equipment. The latter is caused by progressing biological damage to the structural materials. The microbial loading dynamic does not have linearly progressing character, but it is a wavy process of alternation of the microflora activation and stabilization phases; on this background there is a change of the dominating species by quantity and prevalence. The accumulated data is evidence of the necessity of the constant control of the microbial environmental factors to maintain their sanitary and microbiological optimum condition and to prevent the processes of constructional materials biodestruction.

Air Microbiology↗
PubMed2006

Quorum sensing and phenazines are involved in biofilm formation by Pseudomonas chlororaphis (aureofaciens) strain 30-84.

The biological control bacterium Pseudomonas chlororaphis (aureofaciens) strain 30-84 employs two quorum sensing (QS) systems: PhzR/PhzI regulates the production of the antibiotics phenazine-1-carboxylic acid, 2-hydroxy-phenazine-1-carboxylic acid, and 2-hydroxy-phenazine, whereas CsaR/CsaI regulates currently unknown aspects of the cell surface. Previously characterized derivatives of strain 30-84 with mutations in each QS system and in the phenazine biosynthetic genes were screened for their ability to form surface-attached biofilm populations in vitro, using microtiter plate and flow cell biofilm assays, and on seeds and roots. Results from in vitro, seed, and root studies demonstrated that the PhzR/PhzI and the CsaR/CsaI QS regulatory systems contribute to the establishment of biofilms, with mutations in PhzR/PhzI having a significantly greater effect than mutations in CsaR/CsaI. Interestingly, phenazine antibiotic production was necessary for biofilm formation to the same extent as the PhzR/PhzI QS system, suggesting the loss of phenazines was responsible for the majority of the biofilm defect in these mutants. In vitro analysis indicated that genetic complementation or AHL addition to the growth medium restored the ability of the AHL synthase phzI mutant to form biofilms. However, only phenazine addition or genetic complementation of the phenazine biosynthetic mutation in trans restored biofilm formation by mutants defective in the transcriptional activator phzR or the phzB structural mutant. QS and phenazine production were also involved in the establishment of surface-attached populations on wheat seeds and plant roots, and, as observed in vitro, the addition of AHL extracts restored the ability of phzI mutants, but not phzR mutants, to form surface attached populations on seeds. Similarly, the presence of the wild type in mixtures with the mutants restored the ability of the mutants to colonize wheat roots, demonstrating that AHL and/or phenazine production by the wild-type population could complement the AHL- and phenazine-deficient mutants in situ. Together, these data demonstrate that both QS systems are involved in the formation of surface-attached populations required for biofilm formation by P. chlororaphis strain 30-84, and indicate a new role for phenazine antibiotics in rhizosphere community development beyond inhibition of other plant-associated microorganisms.

Bacterial Proteins↗