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At least 991 records · Page 55Linked to original sources
PubMed1998

HIV: mother to child transmission, current knowledge and on-going studies.

It is estimated that approximately 6000 women of childbearing age, mostly living in the developing world, acquire HIV infection every day. Taking into account that approximately 98% of HIV infected children have acquired HIV from the mother, during pregnancy, at delivery or through breastfeeding, therefore, prevention of mother-to-child transmission (MTCT) is a major health priority. Several studies have showed how MTCT of HIV may be prevented using antiretrovirals. Results from a study conducted in Thailand have also recently showed how a short oral zidovudine course during pregnancy and labor may reduce the risk of HIV transmission by approximately 50%. These findings represent a major challenge for the International Health Agencies and Organizations that will have the major obligation to provide HIV tests, counseling and antiviral drugs in settings with high HIV prevalence.

Acquired Immunodeficiency Syndrome↗
PubMed2005

"Harnessing genomics to improve health in Africa" - an executive course to support genomics policy.

BACKGROUND: Africa in the twenty-first century is faced with a heavy burden of disease, combined with ill-equipped medical systems and underdeveloped technological capacity. A major challenge for the international community is to bring scientific and technological advances like genomics to bear on the health priorities of poorer countries. The New Partnership for Africa's Development has identified science and technology as a key platform for Africa's renewal. Recognizing the timeliness of this issue, the African Centre for Technology Studies and the University of Toronto Joint Centre for Bioethics co-organized a course on Genomics and Public Health Policy in Nairobi, Kenya, the first of a series of similar courses to take place in the developing world. This article presents the findings and recommendations that emerged from this process, recommendations which suggest that a regional approach to developing sound science and technology policies is the key to harnessing genome-related biotechnology to improve health and contribute to human development in Africa. METHODS: The objectives of the course were to familiarize participants with the current status and implications of genomics for health in Africa; to provide frameworks for analyzing and debating the policy and ethical questions; and to begin developing a network across different sectors by sharing perspectives and building relationships. To achieve these goals the course brought together a diverse group of stakeholders from academic research centres, the media, non-governmental, voluntary and legal organizations to stimulate multi-sectoral debate around issues of policy. Topics included scientific advances in genomics innovation systems and business models, international regulatory frameworks, as well as ethical and legal issues. RESULTS: Seven main recommendations emerged: establish a network for sustained dialogue among participants; identify champions among politicians; use the New Plan for African Development (NEPAD) as entry point onto political agenda; commission an African capacity survey in genomics-related R&D to determine areas of strength; undertake a detailed study of R&D models with demonstrated success in the developing world, i.e. China, India, Cuba, Brazil; establish seven regional research centres of excellence; and, create sustainable financing mechanisms. A concrete outcome of this intensive five-day course was the establishment of the African Genome Policy Forum, a multi-stakeholder forum to foster further discussion on policy. CONCLUSION: With African leaders engaged in the New Partnership for Africa's Development, science and technology is well poised to play a valuable role in Africa's renewal, by contributing to economic development and to improved health. Africa's first course on Genomics and Public Health Policy aspired to contribute to the effort to bring this issue to the forefront of the policy debate, focusing on genomics through the lens of public health. The process that has led to this course has served as a model for three subsequent courses (in India, Venezuela and Oman), and the establishment of similar regional networks on genomics and policy, which could form the basis for inter-regional dialogue in the future.

Editorial↗
PubMedDate not supplied

Prevention-oriented primary care: a collaborative model for office-based cardiovascular risk reduction.

All physicians are in a unique position to influence their patients risk of coronary artery disease (CAD). The physician must first assess the degree of CAD risk, and then, collaborating with the patient, develop a CAD risk reduction strategy that is tailored to the patient's needs and likely to succeed. Prevention-oriented primary care (POPC) is a host/environment office-based model that can be used in primary care practices to accomplish this goal. This article describes a patient-physician interactive model that can be used as an office-based approach to CAD risk reduction. This model can guide the physician and patient through a collaborative approach to healthcare aimed at preventing CAD. It is based on the recognition that a clear systematic interchange between physician and patient that is evidence based and patient centered is the key to successful risk factor modification. The efficacy of this evidence-based model is currently being studied. It uses a computer software product our team developed called the ERIS/St. Joseph health risk appraisal. This article describes eight important elements of this CAD risk reduction model: 1) physician-patient interviewing/communication styles; 2) defined physician and patient roles; 3) a computerized, prevention-oriented patient history and health-risk appraisal; 4) the patient's list of his or her health priorities; 5) the physician's list of medical priorities for CAD risk reduction; 6) a shared patient-physician priority list; 7) specific intervention plans, with target goals, and critical pathways/strategies for reaching the goals; and 8) planned follow-up care with measurable and targeted outcome goals.

Coronary Disease↗
PubMed1994

[Disasters. Assistance plans].

A disaster is defined as a unseasonable event that provoke such an amount of victims that the health care capacity of the community is exceeded. The aim of this paper is to review the health attention during an emergency period, whose pre-hospital and hospital services are inherent to critical care medicine. The reduction in victim's morbidity and mortality depends on the opportuneness and efficacy of pre-hospital care. Trained personnel is required to establish command posts, perform the rescue, categorize seriousness of victims to receive priority health care and transport to better equipped health centers. At the hospitals an emergency team must elaborate, publish and periodically review emergency care plans and eventually coordinate actions with other community organizations. The diverse phases of the plan must be specified, including preparatives, alerting of involved services, victim care, and reestablishment of normal duties when the emergency situation ceases. As complement, the hospital must have security and evacuation plans to face own emergency situations such as fires, explosions and inundations.

Disaster Planning↗
PubMed2005

Polio eradication initiative in India: deconstructing the GPEI.

The Global Polio Eradication Initiative (GPEI) promised eradication of polio by the year 2000 and certification of eradication by 2005. The first deadline is already a matter of history. With the reporting of polio cases in 2004, the new deadline for polio eradication by 2004 is postponed further. This article seeks to argue that the scientific and technical bodies spear-heading the GPEI, including the WHO, UNICEF, and the U.S. Centers for Disease Control, have formulated a conceptually flawed strategy and that it is not weak political will that is the central obstacle in this final push for global eradication. The validity of the claims of "near success" by the proponents of the GPEI is also examined in detail. By taking India as a case study, the authors examine the achievements of the GPEI in nine years of intense effort since 1995. They conclude that the GPEI is yet another exercise in mismanaging the health priorities and programs in developing countries in the era of globalization.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

Prevalence of anaemia in semi-urban areas of Peshawar, Pakistan: a challenge for health professionals and policy makers.

Iron deficiency anaemia is a serious problem among Pakistani children. Pre-intervention haematological status of children under two years was assessed as part of a double-blind, randomized controlled community-based study conducted in two semi-urban areas of Peshawar. The primary objective was to assess the impact of iron deficiency anaemia and iron intervention on growth and morbidity. Three hundred and twenty children who met the criteria of a "healthy child" were recruited for the study. Blood samples were drawn from 275 children for haemoglobin (Hb) and serum ferritin (SF) analyses. The children were classified as anaemic (Hb < 11 g/dl); iron deficient (SF < 12 ng/ml) and iron deficient anaemic (Hb < 11 g/dl and SF < 12 ng/ml). Ninety percent of the children were anaemic, 67% iron deficient and 63% iron deficient anaemic. Anaemia was more prevalent in boys who had significantly lower Hb and SF values than girls. The magnitude of anaemia in these children tended to increase with age. The study demonstrates that iron deficiency is the predominant cause of anaemia (69%) in children under two years. Minimization of iron deficiency anaemia should be a public health priority in order to prevent suffering of children and avert the associated cognitive and physical deficits in child development.

Anemia, Iron-Deficiency↗
PubMed1985

Probable future funding priorities in maternal and child health: a modified Delphi National Survey.

Recent enactment of program consolidation block grants proposed by the Reagan administration has left many observers of public health services wondering about the impact of such a change on categorical programs in maternal and child health (MCH). This study first presents predictions about the future of 23 specific MCH services, derived from a modified Delphi Survey of MCH experts, and then examines the implications of these predictions for future public health.

Adult↗
PubMedDate not supplied

Priorities for maternal and child health services: the consumer's perspective.

A convenience sample of 206 inner city department of public health patients were asked to rank the importance of health care services relative to other problems they face. Respondents spontaneously ranked money, unemployment, and housing as their most pressing concerns. When presented with a list of potential problems, housing, crime, and rent were most frequently cited. Health of children and own health were priorities for 15 and 21 respondents respectively. Pregnancy prevention and having a good pregnancy were important for seven individuals. The priorities attached by these medically and socially high risk people for maternal and child health services are placed in the context of published data on expert opinion on need for maternal and child health services and the availability of these services. The results of this survey suggest that public health administrators define realistic, specific goals for preventive maternal and child health services. Aggressive consumer education programs aimed at providing information on the importance of these services to maintaining well-being are also in order.

Adult↗
PubMed2005

Access to exercise referral schemes -- a population based analysis.

BACKGROUND: Sedentary behaviour is a public health priority in many countries. Hundreds of community-based exercise referral schemes have been established in Europe and USA, to increase physical activity. Experimental evidence questions the effectiveness of these schemes. No previous evaluations have considered a population approach nor provide detailed information on the types of people accessing these schemes. This is of concern given increasing health inequalities in other areas of care. Our register-based study quantified the numbers and characteristics of patients referred and accessing a district-wide exercise referral scheme. The analysis considers the effectiveness of these schemes to a geographically defined population. METHODS: Data were collected prospectively from a patient register for referrals made to a district-wide exercise referral scheme in north-west England. Analysis examined referral rates and the influence of practitioner and patient characteristics on access to the scheme. RESULTS: Over 5 years, 6,610 adults were referred from 125 general practices, with 60.8 per cent female and a mean age of 51.3 years (SD 12.6). This represents 4 per cent of the adult sedentary population in that district. The most common reason for referral was musculoskeletal or cardiovascular risk. Overall, 79 per cent attended at least the first appointment, with statistically significant predictors by age and reason for referral. Those referred for 'fitness' or 'mental health' were most likely to attend. Patients in the youngest and oldest age groups were least likely to attend. Patient's sex and deprivation and the number of patients referred by each general practice did not influence attendance. CONCLUSIONS: Primary-care patients seem to view the concept of exercise referral schemes positively but practitioners remain reluctant to refer many of their sedentary patients. There is doubt that exercise referral schemes like this will influence population levels of sedentary behaviour, when considered alongside their impact on physical activity in the longer term.

Adolescent↗
PubMed2002

A community-based obesity prevention program for minority children: rationale and study design for Hip-Hop to Health Jr.

UNLABELLED: BACKGROUND; The increasing prevalence of overweight among children in the United States presents a national health priority. Higher rates of overweight/obesity among minority women place their children at increased risk. Although increased rates of overweight are observed in 4- to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early prevention efforts incorporating families are critical. METHODS: The primary aim of Hip-Hop to Health Jr. is to alter the trajectory toward overweight/obesity among preschool African-American and Latino children. This 5-year randomized intervention is conducted in 24 Head Start programs, where each site is randomized to either a 14-week dietary/physical activity intervention or a general health intervention. RESULTS: This paper presents the rationale and design of the study. Efficacy of the intervention will be determined by weight change for the children and parent/caretaker. Secondary measures include reductions in dietary fat and increases in fiber, fruit/vegetable intake, and physical activity. Baseline data will be presented in future papers. CONCLUSIONS: The problem of overweight/obesity is epidemic in the United States. Behaviors related to diet and physical activity are established early in life and modeled by family members. Early intervention efforts addressing the child and family are needed to prevent obesity later in life. This paper describes a comprehensive, family-oriented obesity prevention program for minority preschool children.

Black or African American↗
PubMed2003

Newborn screening in Indonesia.

In Indonesia, newborn screening is not yet a policy, and the incidence of preventable causes of mental retardation detected by newborn screening is not known. Congenital hypothyroidism (CH) is not infrequent. Without a screening program, unrecognized CH patients were neglected for years. Since May 1999, the International Atomic Energy Agency (IAEA) has assisted in starting a CH Newborn Screening Project to estimate the local incidence of CH and to evaluate the problems associated with the screening. In June 2000, a pilot study was conducted using primary TSH measurement, supplemented by T4 in infants with elevated TSH. The target was to screen 12,000 newborn infants, using cord blood serum taken at birth, or a heel prick between 2 to 6 days of age. Between June 2000 and February 2001, 3,534 neonates born in 4 hospitals were screened using cord blood serum taken at birth (recall rate 3.3%). From March 2001 onwards, the heel prick method was used and participating hospitals increased from 4 to 7. Using this approach, until August 2001, 3,309 samples were analysed and the recall rate was much lower (0.64%). The number of unsatisfactory samples was relatively high due to an unstable process of blood collection. Parental refusal and low acceptance of screening among policy makers resulted from lack of awareness of the dangers of CH, and the screening program was not considered a health priority. Recall of patients after screening was a major barrier, with problems in tracking patients arising from urbanization and a high rate of relocation. To advance the CH screening program nationwide, infrastructure must be improved along with the recall system, and education as well as information campaigns for parents and medical professionals must be intensified. The Department of Health must be persuaded to give a national mandate.

Attitude to Health↗
PubMedDate not supplied

A community health report card: comprehensive assessment for tracking community health (CATCH).

A systematic method for assessing the health status of communities has been under development at the University of South Florida since 1991. The system, known as CATCH, draws 226 indicators from multiple sources and uses an innovative comparative framework and weighted evaluation criteria to produce a rank-ordered community problem list. The CATCH results from II Floridian counties have focused attention on high priority health problems and provided a framework for measuring the impact of health expenditures on community health status outcomes. The method and plans to create an automated data warehouse to support its expansion and enrichment are described.

Community Health Planning↗
PubMed2005

Maternity referral systems in developing countries: current knowledge and future research needs.

A functioning referral system is generally considered to be a necessary element of successful Safe Motherhood programmes. This paper draws on a scoping review of available literature to identify key requisites for successful maternity referral systems in developing countries, to highlight knowledge gaps, and to suggest items for a future research agenda. Key online social science, medical and health system bibliographic databases, and websites were searched in July 2004 for evidence relating to referral systems for maternity care. Documentary evidence on implementation is scarce, but it suggests that many healthcare systems in developing countries are failing to optimise women's rapid access to emergency obstetric care, and that the poor and marginalised are affected disproportionately. Likely requisites for successful maternity referral systems include: a referral strategy informed by the assessment of population needs and health system capabilities; an adequately resourced referral centre; active collaboration between referral levels and across sectors; formalised communication and transport arrangements; agreed setting-specific protocols for referrer and receiver; supervision and accountability for providers' performance; affordable service costs; the capacity to monitor effectiveness; and underpinning all of these, policy support. Theoretically informed social and organisational research is required on the referral care needs of the poor and marginalised, on the maternity workforce and organisation, and on the implications of the mixed economy of healthcare for referral networks. Clinical research is required to determine how maternity referral fits within newborn health priorities and where the needs are different. Finally, research is required to determine how and whether a more integrated approach to emergency care systems may benefit women and their communities.

Developing Countries↗
PubMed2000

Priority setting, justice, and health care: conceptual analysis.

In this paper, priority setting in health care is defined as distributional decisions at the individual level involving clear and direct limitation of access to beneficial health care according to some categorical criterion other than the market. The justification of a particular rule of priority setting depends on conceptual issues as well as on the choice of value premises. Especially important is the type of scarcity involved (whether the imbalance between supply and need can be overcome or not) and the concept of justice used or presupposed (for instance, whether the conception of justice emphasizes efficiency or fairness or both). The proposal put forward is that the task of medical ethics is to provide conceptual clarification and value premises relevant to justify rules of priority setting. The actual choice of such rules belongs primarily to the domain of politics.

Ethics, Medical↗
PubMed1989

[Growth in the number of physicians and the structure of medical practice. Has the quality of ambulatory care changed?].

In order to realize a good health policy that, over the long term, combines humanity, effectiveness and efficiency, corrections in the evolution of the number of physicians, changes in the structure of practices, and the preservation of quality in ambulatory care are urgent tasks for the remaining decade of this century. In this connection, the development of medical orientational data and the so-called priority health aims, will be of use. In particular, the system of "health-insurance" doctors is threatened by external influences outside the control and authority of the administrative organs concerned. Here, the influence on the overcapacity of doctors arises in the present constitutional provision which states that all those physicians who wish to work within the health-insurance system, must be allowed to do so. Owing to the increasing "financial bottlenecks" that health-insurance doctors will encounter, the future practicing physician will increasingly become a "businessman", since rising costs and decreasing turnover will exercise a powerful effect on the doctor's practice. In such a situation new practice structures might have a positive effect. In view of all these factors that threaten the independence of the practicing physician, the difficulty arises of preserving the quality of medical care. Already, attempts are being made, on an "outside the medical profession" basis, to ensure quality control, and the proposals made by the expert councils are an indication that this discussion must be intensified among the medical profession itself.

Ambulatory Care↗
PubMed1993

Current situation of African trypanosomiasis.

African trypanosomiasis (sleeping sickness) is fatal, if untreated, and occurs in 36 African countries, south of the Sahara, where some 50 million people are at risk of acquiring infection. In the absence of adequate control measures epidemics occur, which are costly and difficult to control. The history of sleeping sickness has been characterized by waves of epidemics, resurgences and outbreaks. Nevertheless, sleeping sickness has been brought practically under control in the early 1950s, in West and Central Africa, through systematic surveillance of the population at risk and in East Africa, mainly by vector control. Following the attainment of independence from colonial rule in subsequent years, failure by national health authorities to give due attention to sleeping sickness control, due to civil and political unrest, lack of adequate resources and competing national health priorities, has resulted in epidemics and the recrudescence of many old foci and the appearance of new ones. Thus, sleeping sickness is currently a major concern among many countries, particularly in East and Central Africa. During the past decade, progress has been achieved through research in the development of new tools for diagnosis, which are simple to use by national health personnel and for vector control, which can be used at the community level. Eflornithine, a new drug, has been registered for the treatment of gambiense sleeping sickness, and although it is expensive, it is relatively safe and provides an alternative therapy to the existing treatment, which may cause severe adverse effects. These tools have raised hopes for improved control, but their integration into health care systems, which could improve surveillance of the population at risk, has been slow. In view of the worsening economic situation of endemic countries, and the focus of attention and resources on the AIDS pandemic, prospects of any significant improvement in the sleeping sickness situation would largely depend on the successful mobilization of external resources.

Africa↗
PubMed2001

[Child abuse in in the city Temuco. Prevalence study and associated factors].

BACKGROUND: Child maltreatment is recognised as a significant health problem in developed countries. There is increasing awareness on family violence in Chile, becoming a health priority in the last five years, but there is scant information about its prevalence. AIM: Determine prevalence of child abuse, and associated factors in a population sample from Temuco, Chile. MATERIAL AND METHODS: A standardised questionnaire was applied to a sample of 422 women at their homes. Instrument had questions about disciplinary practices by caretakers, a standardised questionnaire to assess mental health, as measures of risk and protective factors for violence RESULTS: The prevalence of psychological aggression delivered by mothers or fathers was 17.5% and 6.8% respectively. The figures for corporal punishment delivered by mother or fathers were 42.3% and 17% respectively. Three percent of mothers and 1.2% of fathers recognised severe physical abuse. Associated factors were mother impaired mental health, antecedents of child abuse in both parents, parents alcohol abuse and child emotional/behavioral problem. CONCLUSION: Child abuse is a extended significant problem in Temuco that requires multidisciplinary intervention programs.

Adolescent↗