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PubMed1993

The Latin American trial of psychosocial support during pregnancy: a social intervention evaluated through an experimental design.

Perinatal health problems are a public health priority in Latin America. Among the identified risk factors, psychological and social conditions play a crucial role. However, care during pregnancy and delivery in the region is usually hospital-centered and does not address women's psychological and social conditions. The preeminence of research on perinatal health, along with the necessity for testing interventions that represent alternative models to improve women's health, gave the Latin American Network for Perinatal and Reproductive Research grounds to develop a multicenter randomized controlled trial to evaluate a program of social support and health education during pregnancy. The conceptual framework for this study was based on an ecological model of social support, i.e. a model in which social support and health education play a synergistic role and are meant to modify stressful situations and negative health-related behaviors. The target population consisted of women attending obstetric hospitals before the 22nd gestational week, at high psychological and social risk (n = 2236). The intervention consisted of four to six home visits, carried out by social workers, and had four main components: the reinforcement of pregnant women's social support network, emotional support, health education, and the improvement of health services utilization. The main foci of the intervention were determined after an ethnographic study was carried out to identify stress-producing situations and needs for support during pregnancy. Besides the home visits, the program also offered a hot-line, an office in the hospital, a specially designed poster and booklet, and a 'guided tour' of the health institution. Since this was a multicenter trial, the program's standardization was a crucial methodological aspect that was achieved through the training course for the home-visitors team. Biological and psychosocial outcomes were measured in both experimental and control groups at the 36th week of gestational age, post-partum and at the 40th day after delivery. The attributes of the multicenter population showed an important variability, reflecting differences in the countries or hospitals' population prevalent attributes. The results of the program's implementation were analyzed, demonstrating that home visitors adapted topics discussed during the interviews to the women's conditions and the stage of pregnancy during which the visit took place.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗
PubMedDate not supplied

Recruitment and entrance of participants into a physical activity intervention for hypertensive African American women.

Decreasing health disparities between White Americans and racial/ethnic minority populations is a public health priority. An ongoing inability to attract sufficient numbers of African Americans and other people of color to participate in research studies is a major barrier to accomplishing this goal. Participation of racial/ethnic minorities in intervention studies is especially critical to the development of appropriate strategies to promote health among these populations. This article examines the effectiveness of preintervention meetings as well as interactions between African American research team members and potential participants as recruitment strategies. Intersections between recruitment and health promotion are also addressed.

Black or African American↗
PubMed2002

[Associated factors to depressive symptoms and somatic symptoms in climacteric women in the city of Temuco].

BACKGROUND: Depression is an important mental health problem. The Chilean Ministry of Health has considered depression in women as one of the health priorities for the country. AIM: To assess the prevalence of depressive and somatic symptoms and their risk factors in climacteric women. MATERIAL AND METHODS: A special questionnaire was applied to 171 women (45 to 55 years of age), coming from a community organization (PRODEMU) and a private health institution (ISAPRE Banmedica). Risk factors for depression were determined using multiple logistic regression. RESULTS: The prevalence of depressive symptoms was 43%. Women with primary education had an odds ratio for depression of 2.49, compared with women with high school or university education. Other risk factor for depression was the lack of a renumerated job (Odds ratio 1.9). The risk factors for somatic symptoms were the presence of depressive symptoms (OR 3.2), lack of secondary or university education (OR 2.4), low income (OR 1.9) and having a current partner (OR 3.6). CONCLUSIONS: There is a high prevalence of depressive symptoms in the studied population of climacteric women. Lack of education and of a renumerated job are important risk factors for the presence of such symptoms. Women with a low level of education and with depressive symptoms have also a high risk of presenting somatic symptoms.

Chile↗
PubMed2001

Using the years-of-healthy-life measure to calculate QALYs.

BACKGROUND: The quality-adjusted life year (QALY) is an attractive outcome measure because it captures both health-related quality of life (HRQL) and life expectancy in a single metric. We present a method for calculating QALYs that is simple, utilizes data that are free of charge, and may improve consistency in burden-of-disease investigations. METHODS: For purposes of illustration, we calculated the burden of disease due to stroke using two abridged life tables, each adjusted for HRQL. The first life table was generated using all-cause mortality and morbidity data (a reference cohort) and the second was generated using all diseases except stroke (a stroke-free cohort). The difference in total QALYs and in quality-adjusted life expectancy (QALE) was determined by subtraction. RESULTS: Approximately 61,328 (95% CI=60,272, 62,383) QALYs were lost to stroke in the life-table cohort. Stroke is responsible for a decrement of 0.03 years of life expectancy and 0.61 years of QALE in the United States. CONCLUSIONS: The "years of health life"measure affords a rapid, inexpensive, and sensitive means for estimating the burden of disease for local health priorities and may assist research efforts in including QALYs as an outcome measure.

Adult↗
PubMed1998

Prevalence of cardiovascular risk factors in South Korean adults: results from the Korea Medical Insurance Corporation (KMIC) Study.

PURPOSE: To estimate the prevalence of cardiovascular risk factors in South Korea. METHODS: Data were obtained from the Korea Medical Insurance Corporation (KMIC) which provides insurance to civil servants and private school workers. The study sample included female workers, ages 35 to 59 (n = 67,861), and a systematic random sample of insured male workers, ages 35 to 59 (n = 115,200), who attended insurance examinations in 1990 and 1992. Prevalence estimates were age-adjusted to reflect the Korean population, ages 35 to 59, in 1990. RESULTS: The prevalence of hypertension (systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg) was 28.9% in men and 15.9% in women. The prevalence of hypercholesterolemia (total cholesterol > or = 240 mg/dl) was 8.9% and 10.4% in men and women, respectively. Smoking was highly prevalent in men (57.4%) and uncommon in women (0.6%). The prevalence of a fasting blood sugar > or = 126 mg/dl was 4.7% in men and 1.3% in women. Among men, 74.4% had one or more of the cardiovascular risk factors under study. Among women, 29.0% had one or more of the risk factors. With advancing age, the prevalence of risk factors became more numerous, for both men and women. CONCLUSION: In order to avert the ongoing epidemic of cerebrovascular disease and the emerging problem of ischemic heart disease, prevention and treatment of modifiable risk factors must become an important health priority in South Korea.

Adult↗
PubMed2003

Cost-of-illness studies.

Cost-of-illness studies measure the overall economic impact of a disease on society. Such studies are important in setting public health priorities and for economic evaluation of new treatments. These studies should take the societal perspective and include both direct and indirect costs. Often indirect costs exceed direct costs. Comparison of cost-of-illness studies from different countries is difficult because of differences in population, currency, the way health care is provided, and other social and political factors.

Cost of Illness↗
PubMed2006

Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study.

Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals from 32 European countries, categorised by five geographical regions. A formal IC programme existed in 72% of hospitals, and a multidisciplinary IC committee was operational in 90%. Trained IC nurses (ICNs) were present in 80% of hospitals (ranging from 54% in south-east and central-eastern Europe, to 100% in northern Europe), whereas 74% had one or more trained IC doctors (ICDs) (ranging from 46% in south-east Europe to 84% in western Europe). Median staffing levels were 2.33 ICNs/1,000 beds and 0.94 ICDs/1,000 beds. The intensity of IC programmes scored higher in centres from northern and western Europe than from other European regions. Written guidelines promoted hand hygiene for healthcare workers in 89% of hospitals, education in 85%, and audit in 46%. Guidelines recommended use of alcohol-based solutions (70%) and/or medicated/antiseptic soap (43%) for decontamination of non-soiled hands. Use of alcohol-based solutions varied according to region, from 41% in southern Europe to 100% in northern Europe, compared with use of medicated soap from 77% in southern Europe to 11% in northern Europe (p < 0.01). These findings showed that IC programmes in European hospitals suffer from major deficiencies in human resources and policies. Staffing levels for ICNs were below recommended standards in the majority of hospitals. Education programmes were incomplete and often not supported by audit of performance. Hand hygiene procedures were sub-standard in one-third of centres. Strengthening of IC policies in European hospitals should be a public health priority.

Cross Infection↗
PubMed2004

Screening for diabetic retinopathy in France.

Ocular complications of diabetes, particularly retinopathy, are the major cause of blindness in the working age population in industrialised nations. Laser photocoagulation has shown definite results in reducing visual morbidity with many more likely to benefit if diagnosed early enough. Institution of an efficient screening programme aimed at detecting patients at risk when they can still be effectively treated has been recognised as an urgent priority worldwide. In France, a signatory to the Saint Vincent's Declaration, an analysis of the national healthcare database reveals a gross inadequacy in the current extent of screening for diabetic retinopathy. The possible causative factors have been analysed and the necessary corrective measures, some of which are already under way, have been discussed. Ideally, screening by ophthalmologists at recommended intervals have been advised by national and professional health care associations. This has not been feasible owing to the lack of organised planning and serious manpower deficit caused by a progressive decline in the number of ophthalmologists. Recently, the need for an efficient, widely-available and user-friendly screening tool has led to the evaluation of multifield fundus photography in real time using digital nonmydriatic camera in comparison with more established methods of detecting diabetic retinopathy. Lastly, the future possibility of involving in France non-ophthalmologists like endocrinologists or general practitioner or non medical profession like orthoptists after proper training to meet the necessary manpower shortage has been addressed. Optimal use of telemedicine along with establishment of preferential reference channels for newly discovered cases of sight-threatening cases of retinopathy are public health priority necessary to give to the screening of diabetic retinopathy its full efficiency.

Diabetic Retinopathy↗
PubMed2000

[Reduced morbidity of schistosomiasis: report from an expert workshop on the control of schistosomiasis held at CERMES (15-18 February 2000, Niamey, Niger)].

Schistosomiasis remains a problem for public health in sub-Saharan Africa. Despite past efforts, cases have not decreased significantly. Schistosoma haematobium and S. mansoni are endemic in all the West African countries. The distribution of both parasites is focal. During a workshop held at CERMES in Niamey, in February 2000, a group of experts recommended that schistosomiasis control be considered as a public health priority in all the endemic West African countries, and National Control Programmes rapidly implemented. The objective of these control programmes would be to reduce schistosomiasis-related morbidity. Case detection should be based on clinical symptoms such as haematuria or bloody diarrhoea, and be carried out at two levels: health care centres and schools, in order to reach patients and school-age children. Health workers should be trained in case detection and community based control of schistosomiasis. The assembled experts advocated the use of praziquantel dosed at 40 mg.kg-1, which therefore must be made available and accessible in outlying areas. Associated measures consist of sanitation, water supply and health education, especially aimed at improving patients' treatment-seeking behaviour. A West African network for schistosomiasis control was created during the workshop. It runs on the Web site of CERMES as network co-ordinator. (http://www.mpl.ird.fr/cermes/).

Africa South of the Sahara↗
PubMed2003

High pregnancy rates and reproductive health indicators among female injection-drug users in Vancouver, Canada.

OBJECTIVE: To determine the incidence of pregnancy among active injection-drug users and to identify factors associated with becoming pregnant. METHODS: The Vancouver Injection Drug User Study (VIDUS) is a prospective cohort study that began in 1996. Women who had completed a baseline and at least one follow-up questionnaire between June 1996 and January 2002 were included in the study. Parametric and non-parametric methods were used to compare characteristics of women who reported pregnancy over the study period with those who did not over the same time period. RESULTS: A total of 104 women reported a primary pregnancy over the study period. The incidence of pregnancy over the follow-up period was 6.46 (95% confidence interval (CI) 5.24-7.87) per 100 person-years. The average age of women who reported pregnancy was younger than that of women who did not report pregnancy (27 vs. 32 years, p < 0.001). Women of Aboriginal ethnicity were more likely to report pregnancy (odds ratio 1.6, 95% CI 1.0-2.5). Comparison of drug use showed no significant differences in pregnancy rate with respect to the use of heroin, cocaine or crack (p > 0.05). In examining sexual behavior, women who reported having had a regular partner in the previous 6 months were three times more likely to have reported pregnancy. Despite the fact that 67% of women in this study reported using some form of contraception, the use of reliable birth control was low. Only 5% of women in our study reported the use of hormonal contraceptives. CONCLUSION: There were a high number of pregnancies among high-risk women in this cohort. This corresponded with very low uptake of reliable contraception. Innovative strategies to provide reproductive health services to at-risk women who are injecting drugs is a public health priority.

Adult↗
PubMed2002

A description of a community-oriented cum PBL post graduate training course for health districts managers in Central Africa.

CIESPAC (Centre inter-états d'Enseignement en SantéPublique pour l'Afrique centrale), a sub-regional public health training institution, originally located in Brazzaville, was created with the vocation of providing Central African countries with qualified health services managers (the turbulent events that occurred in Brazzaville in June 1997 prompted the transfer of the institution to Yaoundéin Cameroon). It offers several courses, the most recent of which culminates with a professional diploma in public health and targets mainly potential health district managers (DPSP--Diplôme Professionnel en SantéPublique). This paper reviews the first four-year experience of implementing the "community-oriented problem-based learning" (PBL) pedagogic approach in francophone Africa. About 70 health professionals (mainly MD and diploma nurses) were trained, using the PBL approach, within a period of three years. Practical field training activities involving the neighbouring urban communities of the institution as training sites were given a key place in the course and thus allowed trainees to perceptively appraise the priority health problems of a district. The most important thing trainees learnt during this course was how to learn. Some of them were also able to participate in some operational research. From this experience, it is clear that trainees are coached to learn solving problems on their own for the rest of their professional career. The neighbouring community of a training institution, when properly approached, can provide a very fertile teaching ground where trainees can acquire first hand practical experience in learning to collaborate with local communities. However, the PBL pedagogic approach requests a mutual understanding between trainees and trainers. As such there is a need for a careful selection of trainees and, even more importantly, for a critical mass of competent and motivated trainers.

Journal Article↗
PubMed2006

Building an academic-community partnered network for clinical services research: the Community Health Improvement Collaborative (CHIC).

OBJECTIVE: Community-based participatory research is recommended for research on health disparities and to improve uptake of clinical research findings. We describe the development of a multicenter consortium designed to support a community agency-academic partner infrastructure to support community-based, health-services research on multiple sources of health and healthcare disparities in local communities. DESIGN: We describe the development of the Los Angeles Community Health Improvement Collaborative (CHIC). RESULTS: The CHIC partners examined the research capacity and health priorities of its partners and developed a research agenda focused on four tracer conditions (depression, violence, diabetes, and obesity) and four areas for development of research capacity: public participation in all phases of research; understanding community and organizational context for clinical services interventions; practical clinical services trial methods; and advancing health information technology for clinical services research. The partners pooled resources to develop these areas for the tracer conditions. CONCLUSIONS: The challenges of a participatory approach to community-based clinical services research go beyond the significant methodologic and operational issues for specific projects and include building a sustainable capacity for research, community programs, and partnership across diverse communities and stakeholder organizations even when funding sources are not fully aligned with these goals.

Community Participation↗
PubMed1997

Theories of justice and their implications for priority setting in health care.

The paper aims to show how three theories of distributive justice; utilitarianism, egalitarianism and maximum, can provide a clearer understanding of the normative basis of different priority setting regimes in the health service. The paper starts with a brief presentation of the theories, followed by their prescriptions for distribution, as illustrated with their respective preferred points on a utility possibility frontier. After this general discussion, attention is shifted from utils to health. The paper discusses how the recent Norwegian guidelines for priority setting can be understood in the light of the theories.

Efficiency, Organizational↗
PubMed2001

What to look for in assessing responsiveness to exercise in a health context.

PURPOSE: When attempting to assess responsiveness to habitual exercise in a health context, there is a wide range of issues that need to be addressed in order to provide science-based recommendations for use in evidence-informed health care delivery. Issues regarding responsiveness include characteristics of the exercise regimen or dose as well as characteristics of the response or effect. RESULTS: The exercise dose typically has been characterized by its type, intensity, session duration, and session frequency with the concepts of activity profile, activity volume, and accumulation over multiple bouts throughout the day recently added to these discussions. When establishing the dose for a designated outcome, specificity of the response in relation to exercise type needs to be considered. Understanding the role of intensity as a stimulus for change is critical because of the intensity-related biological responses to exercise, its role in exercise-induce medical complications, and the aversion many adults have to vigorous exercise. Receiving considerable attention is whether a higher intensity or greater volume of endurance-type exercise is more important in producing a variety of health-related benefits. To understand the potential role of accumulation of exercise, more information is needed on benefits derived from very short (< or = 5 min) bouts of exercise performed frequently as well as very long bouts (> or = 90 min) performed infrequently. CONCLUSIONS: When considering the response, it is important to establish the priority health outcomes, the relationship of the dose response for individual biological variables to the dose response for clinical outcomes, the basis for substantial interindividual variations in the response to a specific exercise dose, and the health benefit to health risk relationship for various doses of exercise. Scientific resolution of these issues will substantially facilitate the development and dissemination of appropriate guidelines for the use of exercise in promoting health.

Evidence-Based Medicine↗
PubMed2004

Prevention of unintentional injury to people with intellectual disability: a review of the evidence.

BACKGROUND: Recent research evidence shows that people with intellectual disability (ID) have double the unintentional injury risk of the general population and the risk is further increased in the presence of psychopathology and epilepsy. The pattern of injury and the circumstances surrounding an injury event in those with ID have some similarity with that of young children in the general population. Interventions to prevent injuries are an important health priority in this vulnerable population. This paper reviews evidence from injury prevention studies for people with ID and also considers the relevance of general population injury interventions for this population. METHOD: Information regarding injury prevention in both ID and general populations was identified using online systems and consultation with research and public health organizations. RESULTS: Few published studies were identified addressing the issue of injury prevention for those with ID. Possible injury prevention strategies appropriate for the major causes of injury in the ID population were identified from the general population literature. While many environmental injury prevention strategies for young children in the general population are applicable to the population with ID, some may require design modification to ensure effectiveness. Other promising approaches include improved information for parents/carers, primary care physician counselling, and home visits by well-informed and motivated professionals. There may be injury prevention benefit from improved management of psychopathology and epilepsy. CONCLUSIONS: The issue of injury prevention for those with ID has not been addressed to the extent that the magnitude of the problem requires. Injury prevention programmes trialling a variety of evidence-based approaches and strategies are needed to protect the quality of life for the ID population and their families.

Accidental Falls↗
PubMed2004

[Partner violence and women's health].

The World Health Organization declared violence against women to be a Public Health priority due to its magnitude. This problem affects in Spain one out of seven women, as shown by the 1999 survey conducted by the Instituto de la Mujer, and causes more than fifty annual deaths. The purpose of this essay is to review causes of violence against women and its consequences in health as well as the impact in medical services. The authors analyse the difficulties in systematic recognition of abused women and their neglect, despite the high prevalence, by health care professionals from open care and emergency services. In addition, measures undertaken by Health Authorities in recent years are reviewed. A set of recommendations aimed to eradicate violence against women is given, including those for social, health and research policies and health-professionals education and training.

Battered Women↗
PubMed2001

The cost of hepatitis C and the cost-effectiveness of its prevention.

Hepatitis C infection is an emerging problem in public health and is now the most common blood-borne infection. The virus imposes a significant personal and social burden on those infected, as well as substantial costs to the health care system. In this paper we report an estimate of the costs of hepatitis C and consider the role such information might play in determining an appropriate preventive strategy. Preventing a single case of HCV would release resources valued Aus $6000 and Aus $19,000, depending on whether production loses were included. This information can be used to derive cost-effectiveness thresholds for any preventive activity, but is not in itself necessary in determining health priorities. Information on the marginal cost-effectiveness of preventive methods is both necessary and sufficient.

Australia↗
PubMed1994

Health care workforce priorities: what nursing should do now.

We provide an appraisal of the adequacy of the aggregate supply of nurses and the appropriateness of their educational mix in view of anticipated changes in health care. We view the supply as adequate, but the educational mix as deficient with regard to nurses with baccalaureate and higher degrees who will be in greatest demand in new and expanding roles. Five priority areas are identified in which nursing can make particularly important contributions to improving health and health care: restructuring hospitals, improving primary care availability, contributing to the viability of academic health centers, improving care of the underserved, and redesigning the role of public health in a reformed health care system.

Education, Nursing↗