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PubMed2006

Survey of a pediatric hospital staff regarding cases of suspected child abuse and neglect.

BACKGROUND: The suspicion of child abuse and neglect may arise from manifestations such as physical or psychosomatic symptoms, eating disorders, suicidal behavior, impaired parental functioning, etc. Thus the arrival of an abused or neglected child at the hospital provides an opportunity for detecting the problem and beginning a process of change. Optimal utilization of this potential depends on the awareness, diagnostic ability and cooperation of the staff. OBJECTIVES: To assess knowledge about hospital policy, attitudes and actual behavior of hospital staff in cases of SCAN. METHODS: The questionnaire was adapted and distributed to a convenience sample of personnel at a children's hospital. The questionnaire included items on knowledge of hospital policy regarding SCAN, attitudes towards inquiring about cases that appear suspicious, and behaviors in cases in which the respondent was involved. The comparison of responses to specific questions and among members of different professions was analyzed by chi-square test. RESULTS: Eighty-two staff members completed the questionnaires. Most of the respondents were aware of hospital policy regarding suspected abuse (86.6%), with fewer regarding suspected neglect (77.2%). Physicians were the least aware of these policies, as compared to medical students, nurses and social workers. Although most considered the issue of SCAN a responsibility of members of their own profession, 35.4% considered it primarily the responsibility of the welfare or judicial systems. Over 40% felt uncomfortable discussing suspicions with the child and nearly half felt uncomfortable discussing them with parents. The most often reported reason for this was the sense that they lacked skills or training for dealing with the issue. Despite this, when asked about actual behavior, 94.7% responded that they do try to clarify the circumstances related to the suspicious symptoms. Respondents were more likely to contact the hospital social worker than community resources (91.5% vs. 47.2%). CONCLUSIONS: There is a need to encourage awareness, discourse and training of medical personnel regarding SCAN in order to maximize their potential to identify children at risk.

Adult↗
PubMed2006

Importance of implementation and residual risk analyses in sediment remediation.

Management strategies for addressing contaminated sediments can include a wide range of actions, ranging from no action, to the use of engineering controls, to the use of more aggressive, intrusive activities related to removing, containing, or treating sediments because of environmental or navigation considerations. Risk assessment provides a useful foundation for understanding the environmental benefits, residual hazards, and engineering limitations of different remedy alternatives and for identifying or ranking management options. This article, part of a series of panel discussion papers on sediment remediation presented at the Third International Conference on Remediation of Contaminated Sediments held 20-25 January 2005 in New Orleans, Louisiana, USA, reviews 2 types of risk that deserve careful consideration when evaluating remedy alternatives. The evaluation of remedy implementation risks addresses predominantly short-term engineering issues, such as worker and community health and safety, equipment failures, and accident rates. The evaluation of residual risks addresses predominantly longer-term biological and environmental issues, such as ecological recovery, bioaccumulation, and relative changes in exposure and effects to humans, aquatic biota, and wildlife. Understanding the important pathways for contaminant exposure, the human and wildlife populations potentially at risk, and the possible hazards associated with the implementation of different engineering options will contribute to informed decision making with regard to short- and long-term effectiveness, implementability, and potential environmental hazards.

Ecology↗
PubMed2006

The role of monitored natural recovery in sediment remediation.

The long-term goal of monitored natural recovery (MNR) is to achieve ecological recovery of biological endpoints in order to protect human and ecological health. Insofar as ecological recovery is affected by surface-sediment-contaminant concentrations, the primary recovery processes for MNR are natural sediment burial and contaminant transformation and weathering to less toxic forms. This paper discusses the overall approach for effective implementation of MNR for contaminated sediment sites. Several lines of evidence that may be used to demonstrate natural recovery processes are summarized, including documentation of source control; evidence of contaminant burial; measurement of surface sediment mixing depths and the active sediment benthic layer; measurement of sediment stability; contaminant transformation and weathering; modeling sediment transport, contaminant transport, and ecological recovery; measuring ecological recovery and long-term risk reduction; knowledge of future plans for use and development of the site; and watershed and institutional controls. In general, some form of natural recovery is expected and should be included as part of a remedy at virtually all contaminated sediment sites. Further, MNR investigations and an understanding of natural recovery processes provide cost-effective information and support the evaluation of more aggressive remedies such as capping, dredging, and the use of novel amendments. The risk of dredging or capping may be greater than the risk of leaving sediments in place at sites where capping or dredging offer little long-term environmental gain but pose significant short-term risks for workers, local communities, and the environment.

Ecology↗
PubMed2006

Frequency and determinants of vaginal infection in postpartum period: a cross-sectional survey from low socioeconomic settlements, Karachi, Pakistan.

OBJECTIVE: To determine the frequency and factors associated with perceived vaginal infections among married women in their postpartum period. METHODS: A cross-sectional study was conducted from July 2000 to October 2000 in five squatter settlements of Karachi, Pakistan. These squatter settlements were selected on the basis of an existing surveillance system run by female community health workers for maternal and child healthcare which identified women who had delivered 42-56 days prior to the date of interview. Vaginal infection was considered present when a mother perceived foul smelling vaginal discharge during the postpartum period. Mothers were interviewed to gain insight into socioeconomic and demographic variables, materials used to staunch lochia, duration of labour, personal and perineal hygiene and past obstetric history. RESULTS: A total of 525 women were interviewed. The estimated prevalence of perceived vaginal infection was 5.1%. Factors associated with perceived vaginal infections included, delivery conducted by a non-medical personnel (AOR 3.5, CI 1.3-9.5) and use of unhygienic cloth or cotton for staunch of lochia (AOR 2.7, CI 1.1-6.2). CONCLUSION: Among women who reported perceived vaginal infection, a higher proportion were delivered by non-medical personnel, and used unhygienic material (cloth or cotton) for staunch of lochia as compared to women who did not perceive vaginal infection. We recommend deliveries to be conducted by trained personnel and provision of health education for persons who conduct delivery and women to use hygienic material for staunch of lochia during post partum period.

Adolescent↗
PubMed2006

New developments in mandatory blood testing legislation.

In November 2005, the Liberal government in Ontario introduced a bill that would allow policy officers, other community safety workers and victims of crime to find out more quickly whether they have been exposed to infection from certain viruses. Meanwhile, the Saskatchewan Medical Association (SMA) is opposing similar legislation enacted in that province.

AIDS Serodiagnosis↗
PubMed1991

Trivandrum Developmental Screening Chart.

The Trivandrum Developmental Screening Chart (TDSC) was designed by selecting 17 test items from BSID (Baroda Norms). It was validated both at the hospital and community level against the standard DDST. TDSC had a sensitivity of 66.7% and specificity of 78.8%, which makes it an acceptable simple screening tool even for the community level worker.

Child, Preschool↗
PubMed1991

Against a sea of troubles: AIDS control in Uganda.

HIV infection has spread at an alarming rate in Uganda and is continuing to do so. Polygamy and other long-standing cultural practices on the one hand, and certain life-styles adopted under Western influence on the other, have done much to make the AIDS epidemic so severe. Women are potentially a force for confronting the situation, provided that they are made aware of their rights and empowered to take decisive action in education and other fields in defence of themselves, their children and, indeed, the whole of society.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Prevention of mental handicaps in children in primary health care.

Some 5-15% of children aged 3 to 15 years in both developing and developed countries suffer from mental handicaps. There may be as many as 10-30 million severely and about 60-80 million mildly or moderately mentally retarded children in the world. The conditions causing mental handicaps are largely preventable through primary health care measures in developing countries. Birth asphyxia and birth trauma are the leading causes of mental handicaps in developing countries where over 1.2 million newborns die each year from moderate or severe asphyxia and an equal number survive with severe morbidity due to brain damage. The other preventable or manageable conditions are: infections such as tuberculous and pyogenic meningitides and encephalopathies associated with measles and whooping cough; severe malnutrition in infancy; hyperbilirubinaemia in the newborn; iodine deficiency; and iron deficiency anaemia in infancy and early childhood. In addition, recent demographic and socioeconomic changes and an increase in the number of working mothers tend to deprive both infants and young children of stimulation for normal development. To improve this situation, the primary health care approach involving families and communities and instilling the spirit of self-care and self-help is indispensable. Mothers and other family members, traditional birth attendants, community health workers, as well as nurse midwives and physicians should be involved in prevention and intervention activities, for which they should be trained and given knowledge and skills about appropriate technologies such as the risk approach, home-based maternal record, partograph, mobilogram (kick count), home-risk card, icterometer, and mouth-to-mask or bag and mask resuscitation of the newborn. Most of these have been field-tested by WHO and can be used in the home, the health centre or day care centres to detect and prevent the above-mentioned conditions which can cause mental handicap.

Adolescent↗
PubMed1991

Socioeconomic development, health interventions and mortality decline in Costa Rica.

Costa Rica, whose life expectancy was 74 years by 1985, has reached a health level comparable to a developed country. The health achievements of this country are product of political and socioeconomic circumstances as well as of right public health policies. Until about 1970 the features of Costa Rica mortality, although somewhat better than the Latin American average, evolved in a similar way to the rest of the region. In particular, the decades of 1940s and 1950s saw dramatic improvements in life expectancy, thanks mainly to the import of low-cost, high-effectiveness health technologies. In the 1970s, however, Costa Rica departed from a regional pattern of stagnation and managed to close the gap with developed countries in terms of mortality levels. A dramatic decline in the infant mortality rate from 60 to 19 per 1,000 took place in this decade. The main determinants of this breakthrough were health interventions, notably a primary health care program, even though favorable socioeconomic conditions and a reduced fertility also played a role. Ecological data and other evidence suggest that up to three fourths of the mortality decline was accounted for contemporary improvements in public health services, with about 40 percent attributable to primary health care interventions. Furthermore, by targeting interventions on the less privileged population, these interventions had the merit of reducing geographic and socioeconomic differentials in child mortality.

Cause of Death↗
PubMed1991

Sleeping sickness and tsetse awareness: a sociological study among the Tambo and Lambya of the northern Luangwa Valley, Zambia.

Data on awareness of tsetse flies and knowledge of trypanosomiasis were collected in May, 1988, in the Luangwa Valley of Isoka District in the Northern Province of Zambia. One thousand and nine hundred adult males and females were interviewed. There was a high level of fly awareness among all the respondents, regardless of duration of residence and age groups. Malaria was considered as the most serious illness in the community, and hence overshadowed the impact of trypanosomiasis in the community. Disease awareness gravity cannot be attributed to individual's socio-economic levels.

Adolescent↗
PubMed1991

Acute respiratory infections.

During the past decade, recognition of the significance of pneumonia for childhood mortality has greatly increased. Etiologic studies have clarified the role of Streptococcus pneumoniae and H. influenzae as the pathogens most responsible for childhood pneumonia in developing countries. Case management intervention strategies using community health workers to identify cases of pneumonia by counting respiratory rate and observing chest indrawing have been shown to reduce ARI-related mortality. Although research is underway to develop more effective vaccines against Streptococcus pneumoniae and non-type b H. influenzae, effective case management will remain the most realistic method of reducing mortality in the next decade. Important gaps remain in our understanding of the pathogenesis, etiology, and epidemiology of acute respiratory infections. Our understanding is complicated by the multiplicity of viral and bacterial agents and their interrelationships, by an abundance of interacting host risk factors, and by diverse social, cultural, and environmental factors. However, sufficient knowledge is available to support the implementation of the WHO case management intervention strategies, which will save the lives of the many children now dying because of pneumonia.

Acute Disease↗
PubMed1991

Child health and education in Kenyan schools programmes.

Jane Fleming describes the health education in schools programme launched by the Aga Khan Health Services in Kisumu, Kenya. The project has brought major improvements in child health and mortality rates as well as better health awareness to the community as a whole.

Child↗
PubMed1990

Prevalence of trachoma among school children in Plateau State, Nigeria.

3005 primary school children from randomly selected primary schools in Jos and its environ were screened for trachoma. The schools were divided into 3 groups reflecting the socio-economic status, and the degree of personal hygiene of the pupils. The prevalence of trachoma was 7.5% in the group A schools attended by the children of the rich, 15.9% in the group B schools attended by children of the poor but living in the urban town and 19.4% in group C schools attended by children of the poor living in the sub-urban town. The difference in the prevalence and severity of trachoma in the 3 groups was found to be statistically significant (P less than 0.01). Trachoma was found to be more common in freshly scholarised pupils as compared to pupils in the terminal class. There was no difference in the frequency of trachoma among girls and boys in our study group. The type of water used in bathing was not found to be important in the prevalence of trachoma. The authors next discussed the simplicity of the Dawson's classification, the need to start a trachoma control programme in Nigeria and the possible role of community health workers in any programme for the eradication of trachoma.

Child↗
PubMed1990

[Evaluation of the effectiveness of health care].

During the last two decades, the economic aspects of health care acquired an outstanding attentiveness in all developed countries. Simultaneously, the methods have been searched for a more intensive and perfect application of internal health sources, i.e. manpower, materials and money. New approaches in evaluating health care efficacy (conception of health provision as a branch of national economy) have been made. In accord with them, the efficiency of either individual or partial health actions such as health care programs, preventive measures, diagnostical and curative procedures etc.) is measured. All these questions are the up to date topic for Health care of Czechoslovakia which now is far to dispose of sources comparable with the majority of economically developed countries in Europe. At present, they are approximately similar in supplying 1 person health care needs with 500-1000 dol. a year and even more in several countries, whereas Czechoslovakia spends about 200 dol. on health needs of 1 inhabitant a year. This fact is closely connected with relatively low efficacy of our economy incapable to produce the sufficient sources for providing health care on one hand, and on the other it is due both to the budgetary politics as practiced now and the conception of national product division. The shortage in Health care sources is manifested mainly in retardation of material and technical base of health service altogether with low levelled renumeration of health workers consequential in psychologic, social and political problems. The consequences of this condition are reflected negatively in a level of health service provision. This is as far important as the czechoslovac population health status viewed from the so-called strategic health indices (averaged life expectancy, specific mortality, occurrence of cardiovascular diseases and malignancies etc.) is not favourable due to a number of factors, and its improvement will require considerable efforts from both the health workers and community as a whole. Besides the needful enlargement of sources, these complicated questions are resolvable in observing unity of medical, organizational and economical rationality on all levels of health service management and in all health institutions. This is also the way how to improve the efficiency of health care. The term of efficiency in relation to the health services. In economics, the efficiency is the ratio between the achieved result (effect) and the expenditure of a specified amount of resources. Mathematically, this ratio is expressed as follows: efficiency = end-result/costs Linked to the Health care, the efficiency may be understood also differently from its economic term.(ABSTRACT TRUNCATED AT 400 WORDS)

Czechoslovakia↗
PubMed1990

Working families and eldercare: a national perspective in an aging America.

The competing demands of employment and caring for a dependent elderly family member can create stress for families, and some employers are becoming concerned about the impact of eldercare on the workplace. This first national survey of workers examined the extent of eldercare and its impact on workers. In this article, the authors profile the employees who described themselves as caregivers, the older people they were caring for, the care they were giving, the extent to which they reported conflict between their work and caregiving responsibilities, and the workplace supports they would have found helpful in managing these roles. Women were devoting more time to caregiving and were more likely to report work and caregiving conflict than were men. Social workers in occupational and community settings can play a key role in providing information about eldercare services, in counseling caregivers, and in advocating for employee benefits and community services to help workers maintain both work and family roles.

Activities of Daily Living↗
PubMed1990

Measles vaccination coverage and its determinants in a rapidly growing peri-urban area.

A study was undertaken to ascertain the vaccination coverage of children aged 12-23 months living in Khayelitsha, a peri-urban township outside Cape Town, and to identify factors associated with measles vaccination coverage. A stratified proportional cluster sampling technique was used to select 46 clusters of 10 children each. Three strata were defined according to area of residence. The vaccination status of each child was determined from the preschool card. Usable information was obtained for 432 children; in 75.4% of cases the respondent was the child's mother, and 69.4% of children possessed a preschool card. Measles vaccination coverage was 63.5% (95% confidence interval 58-67%). Three factors had a significant association with incomplete measles vaccination: less than 6 months' residence in the area (odds ratio (OR) 3.1), having been born outside Cape Town (OR 2.5), and home delivery (OR 2.0). The mothers' level of education and children's age were not associated with measles vaccination status. Children in the New Shanty area were identified as a high-risk group. Carers of children in the New Shanty area were the least likely to know of the need for measles vaccination and to be visited by a community health worker. Greater efforts are required to identify high-risk children and areas.

Black or African American↗