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PubMed1992

Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women.

BACKGROUND: Regional, metropolitan, and socioeconomic factors related to the onset of decline of coronary heart disease (CHD) mortality among White women are reported. Such studies are important for planning population-level interventions. METHODS: Mortality data for 1962 to 1978 were used, to estimate the year of onset of decline. Ecological analyses of socioeconomic data from the US census were used to emphasize structural and organizational aspects of changes in disease, rather than as a substitute for an individual-level design. RESULTS: Onset of decline of CHD mortality among White women was estimated to have occurred by 1962 in 53% of 507 state economic areas (SEAs), ranging from 79% in the Northeast to 39% in the South. Metropolitan areas experienced earlier onset of decline than did nonmetropolitan areas. Average income, education, and occupational levels were highest in early onset areas and declined across onset categories. CONCLUSIONS: The results provide additional evidence for previously observed geographic and social patterns of CHD decline. Emphasis on structural economic factors determining the shape of the CHD epidemic curve does not detract from the medical importance of risk factors, but underscores the importance of community development to public health improvements. The results are consistent with the idea that the course of the CHD epidemic in the United States has been strongly influenced by socioeconomic development.

Adult↗
PubMedDate not supplied

Individual and community: normative conflicts in the development of a new therapeutic community for older persons.

This paper examines the role of ideology in the establishment of a new therapeutic community for geriatric patients in a state mental hospital. Contradictory role expectations, reflected both in staff-staff and in staff-patient relationship, interfered with the program's achieving its stated goals. In order to apply a humanistic approach to programs for elderly patients, realistic goals-encompassing the range of patient competence-must be set within a reasonable time framework, and the program must provide for an appropriate range of structure.

Aged↗
PubMed2002

Comment and controversies: since "Silent Spring": new voices, new analyses, and new movements.

Forty years ago, in the enormously praised and fiercely criticized book, "Silent Spring", Rachel Carson demonstrated the dangers of pesticides to humans and ecosystems and called for precaution in their use. Yet, the majority of environmental regulations passed since 1962 have primarily addressed pollutant discharge rather than cleaner products and technologies. The number of active ingredients in pesticides used in the United States has risen from 32 in 1939 to 860 in recent times, while the overall volume of agrochemicals applied has nearly doubled since the publication of Silent Spring. The last 40 years have brought significant changes with respect to environmental policies, agricultural technologies, urbanization, civil rights, women's rights, the roles of non-profit organizations and community development, and increased poverty, hunger, and economic inequality. In recent years, new voices, new analyses, and new movements have emerged offering fresh perspectives on how we can answer Carson's clarion call to protect our planet and ourselves.

Journal Article↗
PubMed2006

A successful experience of soil-transmitted helminth control in the Republic of Korea.

Soil-transmitted helminths (STH), namely Ascaris, Trichuris and hookworms (Ancylostoma and Necator), present a global health problem to about a half of the earthos population. In the Republic of Korea, STH were highly prevalent and were considered a high priority target for national control. To promote the control, a non-governmental organization named Korea Association for Parasite Eradication (currently Korea Association of Health Promotion) was founded in 1964, and mass fecal examination followed by selective mass chemotherapy with anthelmintics was performed twice a year from 1969 to 1995 targeting whole nationwide schoolchildren. Meanwhile, decreasing patterns of national STH infections have been monitored by 7 timeso quinquennial national surveys targeting general population. In 1971, the overall intestinal helminth egg positive rate was 84.3% (Ascaris 58.2%, Trichuris 65.4%, and hookworms 10.7%), which became 63.2% in 1976, 41.1% in 1981, 12.9% in 1986, 3.8% in 1992, 2.4% in 1997, and 4.3% (Ascaris 0.03%, Trichuris 0.02%, and hookworms 0%) in 2004. During the control period, national economy rapidly developed, and living standards including environment, sanitation, and agricultural technology greatly improved, which undoubtedly boosted the STH control effects. Our experience indicates that social driving force to establish an eligible national control system to conduct repeated mass chemotherapy, together with improvement of environment and sanitation, is important for initiating and achieving STH control in a developing community.

Ancylostomatoidea↗
PubMedDate not supplied

Bacterial pneumonia in the AIDS patients.

OBJECTIVE: To determine the incidence, microbiological pattern and prognostic factor of bacterial pneumonia in AIDS patients. STUDY DESIGN: Prospective study of AIDS patients from July 2001 to Dec 2002. METHODOLOGY: Adults AIDS patients on HAART drugs that develop acute fever, cough with bronchial breathing or lung crepitations had diagnostic evaluation that included chest x-ray, paired sputum microscopy, culture and sensitivity, paired blood culture and haematological profiles including CD4' cell count. RESULTS: Twenty-one patients (22.6%), 9 males and 12 females developed community acquired pneumonia during this 16-month period. Pneumonia was confirmed in 9 patients (42.9%), presumed in 4 (19%) and probable in 8 (38%). Streptococcus pneumoniae accounted for 22% of the cases when immunity was less impaired. Staplhylococcus aureus accounted for another 22 % while Klebsiella pneumoniae, Pseudomonas aeraginosa and Escherichial coli were isolated in 11% each when immunity was severely compromised. Fifteen patients (71.4%) were successfully treated with routine antibiotics. Six cases (28.6%) died. All had anaemia, leucopoenia and low CD4 cell count. Four (66.7%) of this had positive bacterial culture with bacteremia in three of them. CONCLUSION: Bacterial pneumonia in HIV-infected patients has similar presentation to that in the general population, Staphylococcus aureus and gram-negative bacilli especially Klebsiella pneumoniae were seen in a good proportion of the cases. Outcome of treatment was poor in the presence of positive bacterial culture, anemia, leucopoenia and very low CD4+ lymphocytes.

AIDS-Related Opportunistic Infections↗
PubMed2002

Composition and physiological profiling of sprout-associated microbial communities.

The native microfloras of various types of sprouts (alfalfa, clover, sunflower, mung bean, and broccoli sprouts) were examined to assess the relative effects of sprout type and inoculum factors (i.e., sprout-growing facility, seed lot, and inoculation with sprout-derived inocula) on the microbial community structure of sprouts. Sprouts were sonicated for 7 min or hand shaken with glass beads for 2 min to recover native microfloras from the surface, and the resulting suspensions were diluted and plated. The culturable fraction was characterized by the density (log CFU/g), richness (e.g., number of types of bacteria), and diversity (e.g., microbial richness and evenness) of colonies on tryptic soy agar plates incubated for 48 h at 30 degrees C. The relative similarity between sprout-associated microbial communities was assessed with the use of community-level physiological profiles (CLPPs) based on patterns of utilization of 95 separate carbon sources. Aerobic plate counts of 7.96 +/- 0.91 log CFU/g of sprout tissue (fresh weight) were observed, with no statistically significant differences in microbial cell density, richness, or diversity due to sprout type, sprout-growing facility, or seed lot. CLPP analyses revealed that the microbial communities associated with alfalfa and clover sprouts are more similar than those associated with the other sprout types tested. Variability among sprout types was more extensive than any differences between microbial communities associated with alfalfa and clover sprouts from different sprout-growing facilities and seed lots. These results indicate that the subsequent testing of biocontrol agents should focus on similar organisms for alfalfa and clover, but alternative types may be most suitable for the other sprout types tested. The inoculation of alfalfa sprouts with communities derived from various sprout types had a significant, source-independent effect on microbial community structure, indicating that the process of inoculation alters the dynamics of community development regardless of the types of organisms involved.

Brassica↗
PubMed2003

Coronary heart disease in Indians: a review of literature.

A literature review utilising literary databases, World Wide Web and hand checking of written articles was conducted to determine the magnitude of the problem of coronary heart disease (CHD) in Indians with a particular emphasis on those in Australia. Health care professionals need to be aware that Indians have a higher than average risk of CHD at an earlier age and poorer survival and this is impacted on by genetic, social and cultural factors. The experiences of Indians with CHD needs to be researched so that prevention and rehabilitation programs can be individualised for this well developed community group in Australia.

Australia↗
PubMed1996

Occupation and the risk of lung cancer in Uruguay.

OBJECTIVES: The purpose of this study was to provide more information regarding the risk of lung cancer associated with asbestos, and other exposures in the Uruguayan work force. METHODS: This multisite case-referent study was part of a large project designed for evaluating the role of occupational exposures in cancer risk in Uruguay. According to the design employed, cases were a subset of the data base corresponding to a particular site (in this instance lung cancer), and they were compared with all other sites combined (referents). RESULTS: Significant increases in risk associated with workers in the construction industry were mainly observed for squamous-cell carcinoma. Asbestos, silica dust, and DDT (dichlorodiphenyltrichloroethane) exposure were also associated with increases in the risk of lung cancer. Pipefitters, bakers, and textile workers were also at increased risk of developing lung cancer. CONCLUSIONS: Workers employed in the construction industry, as well as those exposed to DDT may have an excess risk of lung cancer. These findings are particularly important in showing that developing countries like Uruguay display risk patterns of similar magnitude as those observed in developed communities.

Adult↗
PubMed2005

The pervasive triad of food security, gender inequity and women's health: exploratory research from sub-Saharan Africa.

OBJECTIVES: This study was designed to explore the interactions between food securing activities, health and gender equity from the perspective of rural east African women. The specific objectives were to document the critical interaction among these three issues-food security, gender inequity, women's health within the context of sub-Saharan Africa; to describe the nature of this triad from the perspective of women farmers in Africa; and to propose a framework for linking available interventions to the vicious nature of this triad. SETTING: In-depth interviews and focus group discussions were conducted with rural women farmers in Kwale District, Kenya and Bagamoyo District, Tanzania. METHODS: A total of 12 in-depth interviews and 4 focus group discussions have been included in this analysis. Transcribed text from interviews and focus group discussions were coded and thematic conceptual matrices were developed to compare dimensions of common themes across interviews and settings. A thematic analysis was then performed and a framework developed to understand the nature of the triad and explore the potential for interventions within the interactions. FINDINGS: The vicious cycle of increasing work, lack of time, and lack of independent decision making for women who are responsible for food production and health of their families, has health and social consequences. Food securing activities have negative health consequences for women, which are further augmented by issues of gender inequity. CONCLUSION: The African development community must respond by thinking of creative solutions and appropriate interventions for the empowerment of women farmers in the region to ensure their health.

Agriculture↗
PubMed1994

Careers and training in tropical health.

Tropical health is described as an academic discipline, as an institution, and in terms of professional practice. Poverty, and not climate, is the major determinant of the distribution of tropical disease. A recent World Bank Report analysed global disease and made recommendations about public funding of essential services; this approach emphasised "vertical" programs of disease control. An alternative approach, defined as "primary health care" in the Declaration of Alma Ata, emphasised community development and has had a major influence on health services in developing countries. Conflict between these approaches could be partly resolved by strengthening district health services. A strong technical background and a general understanding of factors affecting health and health care are prerequisites for Australians wishing to work in developing countries.

Career Choice↗
PubMed1991

Key issues in mergers and acquisitions. Healthcare organizations must approach collaborations with caution.

Most collaborations between healthcare providers are based on a desire to better serve their communities, develop critical mass, eliminate duplicative services, create economies of scale, and enhance survivability. Unfortunately, collaborations may not always produce the benefits desired. Thus careful planning and execution are critical to first determine whether the transaction makes sense and, if it does, to develop strategies that maximize the expected benefits. Whether the participating entities are secular, religious, public, or private, I recommend they consider the following 11 key issues when evaluating or pursuing a merger or acquisition: (1) understand the transaction's magnitude, (2) assess the alternatives, (3) select potential partners carefully, (4) determine and examine threshold issues early, (5) focus on the right issues, (6) agree on a valuation approach, (7) recognize the importance of governance, (8) develop an acceptable structure, and use a memorandum of understanding, (9) establish and adhere to a communications policy, (10) perform due diligence, and (11) recognize the significance of activities after the transaction.

Catholicism↗
PubMed1992

Promoting health and evaluating change.

Health promotion is a term that includes a range of approaches aimed at maintaining and promoting the population's health. In its broadest sense health promotion includes: health protection legislation and enforcement; healthy public policy; mass media communications; community development in health; health education; and preventive health services. The use of these approaches has been associated with improved health in Australia, but evaluating the effectiveness of health promotion is not easy. Multi-faceted approaches are most effective, but are difficult to evaluate using experimental or quasi-experimental designs. In addition, health promotion has yet to meet the challenge of measuring progress towards improving health and well-being, as distinct from reductions in disease and in behavioural risk factors for disease. This paper discusses health promotion, its strategies and impacts, and some issues involved in its evaluation.

Accidents, Traffic↗
PubMedDate not supplied

Newfoundland responds to change.

The authors recount how Newfoundland's health care system accommodated severe fiscal restraint imposed by the provincial government in 1990. By outlining the role of the Newfoundland Hospital and Nursing Home Association and other provincial health partners, the authors contend that dialogue and cooperation are key to successful reform. Newfoundland's health care community developed specific objectives, guidelines for restructuring, and a province-wide perspective to help reduce the effect of funding cuts.

Cost Control↗
PubMed1994

Biomaterial and design concepts to minimize wear in total joint arthroplasties.

The evolution of high technology-based total joint arthroplasty (TJA) materials and designs has resulted in systems that provide significant advantages related to surgical procedures, functional mechanics, and short-term and long-term rehabilitation. The research and development community has been addressing key issues associated with attachment-to-tissues for force transfer and wear and debris from articulating surfaces. To minimize wear, multiple material and design technologies have been applied, with recent emphasis on surface and bulk modifications of alloys and polymers plus the reconsideration of ceramic and metallic articulations. This article provides an overview of the biomaterial considerations for articulating surfaces of existing TJA systems, efforts to control wear phenomena, and implications on the clinical aspects of long-term function.

Alloys↗
PubMedDate not supplied

How Hermann Hospital is saving resources through enterprise-wide reengineering.

Hermann Hospital, a 650-bed tertiary care facility and teaching hospital (Houston, TX), recognized the need for institution wide reengineering if they were to remain viable in a changing healthcare environment. Having already implemented total quality management (TQM) programs in various departments, Hermann wanted to provide a comprehensive line of healthcare services that worked cohesively with other areas, such as business development, community relations, and finance, and to do it competitively. Management knew that anticipated changes would require a holistic understanding of their system, so that reengineering efforts in one area didn't ¿break things¿ in another.

Cost Savings↗
PubMed1997

The psychological effect of orphanhood: a study of orphans in Rakai district.

This paper examines the psychological effect of orphanhood in a case study of 193 children in Rakai district of Uganda. Studies on orphaned children have not examined the psychological impact. Adopting parents and schools have not provided the emotional support these children often need. Most adopting parents lack information on the problem and are therefore unable to offer emotional support; and school teachers do not know how to identify psychological and social problems and consequently fail to offer individual and group attention. The concept of the locus of control is used to show the relationship between the environment and individuals' assessment of their ability to deal with it and to adjust behaviour. Most orphans risk powerful cumulative and often negative effects as a result of parents' death, thus becoming vulnerable and predisposed to physical and psychological risks. The children were capable of distinguishing between their quality of life when their parents were alive and well, when they became sick, and when they eventually died. Most children lost hope when it became clear that their parents were sick, they also felt sad and helpless. When they were adopted, many of them felt angry and depressed. Children living with widowed fathers and those living on their own were significantly more depressed. These children were also more externally oriented than those who lived with their widowed mothers. Teachers need to be retrained in diagnosing psycho-social problems and given skills to deal with them. Short courses should be organized for guardians and community development workers in problem identification and counselling.

Adaptation, Psychological↗
PubMedDate not supplied

Socio-economic profile and performance of CHVs in Gujarat: implications for selection and support.

What type of person should be selected as Community Health Volunteer (CHV) has been a matter of debate. This study relates socio-economic characteristics--age, sex, marital status, education, caste, organisation membership and landownership--with performance on direct patient care, mother and child health, family welfare and environmental sanitation. The paper further suggests strategies for selection, training and support in case of CHVs whose performance is poor.

Community Health Workers↗
PubMed1986

Hospitals' key role in the adoption experience.

Although adoption offers a positive, moral solution to a problem pregnancy, it often is overlooked and misunderstood. Many birthmothers, for example, turn to independent placements so that their medical costs will be covered--without realizing the risks of such arrangements. In addition to failing to guarantee privacy, such placements tend to provide insufficient counseling and screening of the involved parties. Licensed agencies, on the other hand, not only must comply with the law but also must conform to professional standards of practice. Committed to honoring the confidentiality of all parties, they are in a better position to serve the needs of those in the adoption circle. In addition to developing an awareness of accepted adoption procedures, health care providers have a special role to play during the adoption experience. They must be sensitive to the new mother's situation, helping to affirm rather than undo her decision to relinquish her child. Health care administrators must ensure that hospital policy addresses the rights of all involved in the adoption process and that standards reflect high-quality adoption practice. Providers and administrators also have the opportunity to develop community partnerships that promote a positive image of professional adoption services to the public.

Adoption↗