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PubMed2000

Ageing in Portugal: regional iniquities in health and health care.

The health of the Portuguese has improved considerably in the last twenty years. Economic and social transformations that have contributed to the progressive amelioration of problems of feeding, sanitation, hygiene, housing and social conditions in general, as well as health services, have had decisive effect on this phenomenon. The spectacular regression of the indicators related to transmitted diseases, infant, perinatal (more than 50% between 1985 and 1994) and maternal mortality, and the mortality of children 1 to 4 yr old, also reflects this impact. The positive changes that took place in health indicators were reflected in the growth of life expectancy at birth (2.2 yr more for male and 2.3 more for women between 1985 and 1994) in spite of the fact that the difference in life expectancy in relation to EU countries has grown. Improvement in life expectancy, especially in the older age groups, is not normally associated with significant reductions in morbidity. In fact, increased longevity has become more generally associated with chronic illness or other disabilities requiring more medical services and other forms of personal care. This paper reviews some of the evidence for regional differences in the health status of elderly people in Portugal and considers how health services have reacted to these differences. A preliminary study of health status and patterns of utilisation of elderly people was undertaken. After 30 yr of a National Health Service (NHS) in Portugal we may ask why do inequities in health and access to health care of the elderly population persist? Proactive policies to prevent illness and promote health are still relatively underdeveloped in the Portuguese NHS, and the factors that influence health, such as housing, diet and occupational health hazards, remain largely absent from health and welfare policies. Poor accessibility to health services is the most serious barrier consumers have to face in order to get a medical appointment, and this is more relevant to the oldest part of the population. Geographical location of health care facilities unequally affects the ease of access of different groups of consumers and influences utilisation patterns. Examining the distribution of health services resources is an important way to understand the inequities of access to health and to health care.

Aged↗
PubMed2003

Providing clean water, keeping water clean: an integrated approach.

Millions of people, most of whom are children in developing countries, die of basic hygiene-related diseases every year. Interventions in hygiene, sanitation and water supply have been shown to control disease burden. Universal access to improved water sources and basic sanitation remains elusive but is an important long-term goal. Studies have shown that improving the microbiological quality of household water by on-site or point-of-use treatment and safe storage in improved vessels reduces diarrhoeal and other waterborne diseases in communities and households of developing and developed countries. The extent to which improving drinking water quality at the household level reduces diarrhoeal disease probably depends on a variety of technology-related and site-specific environmental and demographic factors that require further investigation, characterisation and analyses.

Chlorine Compounds↗
PubMed2000

Analysis of the 1998 outbreak of leptospirosis in Missouri in humans exposed to infected swine.

OBJECTIVE: To determine the extent of leptospirosis in persons exposed to infected swine, confirm the source of disease, define risk factors for infection, and identify means for preventing additional infections during an outbreak in Missouri in 1998. DESIGN: Cross-sectional study. SAMPLE POPULATION: 240 people and 1,700 pigs. PROCEDURE: An epidemiologic investigation was conducted of people exposed to infected pigs from the University of Missouri-Columbia swine herd. The investigation included review of health of the pigs, a cross-sectional study of the people handling the pigs, serologic testing of human and porcine sera, and risk-factor analysis for leptospirosis within the human population. RESULTS: Serologic testing of samples collected at the time of the investigation indicated that 59% of the pigs had titers to leptospires, denoting exposure. Of the 240 people in the exposed study population, 163 (68%) were interviewed, and of these, 110 (67%) submitted a blood sample. Nine (8%) cases of leptospirosis were confirmed by serologic testing. Risk factors associated with leptospirosis included smoking (odds ratio [OR], 14.4; 95% confidence interval [CI], 1.39 to 137.74) and drinking beverages (OR, 5.1; 95% CI, 1.04 to 24.30) while working with infected pigs. Washing hands after work was protective (OR, 0.2; 95% CI, 0.03 to 0.81). CONCLUSIONS AND CLINICAL RELEVANCE: Leptospirosis is a risk for swine producers and slaughterhouse workers, and may be prevented through appropriate hygiene, sanitation, and animal husbandry. It is essential to educate people working with animals or animal tissues about measures for reducing the risk of exposure to zoonotic pathogens.

Abattoirs↗
PubMed1995

The changing epidemiology of human hookworm infection in Australia.

OBJECTIVE: To document the distribution of human hookworm infection in Australia. DESIGN: A retrospective study of published data and accessible archival records. METHODS: The core data were derived from the report of the Australian Hookworm Campaign, annual reports of various State health departments and the Queensland Institute of Medical Research, and unpublished files of the former Queensland Aboriginal Health Programme. FINDINGS: Today, hookworm infection is endemic only among Aboriginal communities of northern Western Australia and the Northern Territory, where Ancylostoma duodenale may be the sole species. Early this century, infection was also established in Queensland and northern New South Wales, in both Aboriginal and white communities, and Necator americanus predominated. The origin of these parasites is obscure. Sustained control programs seem to have eradicated hookworms from Queensland. CONCLUSIONS: Improved sanitation, hygiene and chemotherapy have eliminated hookworms from white populations of Australia. Continued anthelminthic campaigns will also clear the parasites from Aboriginal communities, but unless living conditions improve significantly infection will recur.

Ancylostomiasis↗
PubMedDate not supplied

[Working experience of the analytical group of the specialized epidemic brigade].

The working experience of the analytical group as the section of the specialized antiepidemic brigade for the organization and realization of antiepidemic measures, made under the conditions of the antiterrorist operation in the Chechen Republic in the year 2000, is generalized. The necessity for equipping the specialized brigade with a modern computer with peripherals and the necessary specialized computer programs, as well as with modem and fax-telephone facilities, is shown. The necessity of equipping this brigade with the electronic variant of the information and legal data base (references on methods, sanitary norms and other normative documents on sanitation, hygiene, epidemiology, bacteriology and the organization of health service) is indicated.

Communicable Disease Control↗
PubMed2004

Risk of Giardia intestinalis infection in children from an artificially recharged groundwater area in Mexico City.

The objective of this study was to assess the risk of infection with Giardia intestinalis in children living in an area with artificial groundwater recharge and potable water reuse in Mexico City. Eligible wells and surrounding homesteads were defined by using a geographic information system. Five wells were tested for G. intestinalis cysts per 400 liters of water. A total of 750 eligible households were visited during two cross-sectional surveys. Stool samples were provided by 986 children in the rainy season study and 928 children during the dry season survey for parasitologic tests. Their guardians provided information on water, sanitation, hygiene, and socioeconomic variables. The prevalence rates of G. intestinalis infection were 9.4% in the rainy season and 4.4% in the dry season. Higher rates of infection were observed in older individuals (9.5% and 10.6%) and girls had a lower risk of infection than boys (odds ratio [OR] =0.55, 95% confidence interval [CI] = 0.34, 0.88 in the rainy season and OR = 0.47, 95% CI = 0.25, 0.90 in the dry season). During the wet season survey, a health risk was detected among those storing water in unprotected receptacles (OR = 4.00, 4.69, and 5.34 for those using uncovered jars, cisterns or tanks, and buckets, respectively), and bathing outside the dwelling, i.e., using a tap (OR = 1.93, 95% CI = 1.10, 3.39). A health risk was also detected among children from households with unsafe food hygiene practices (OR =2.41, 95% CI =1.10, 5.30) and those with no hand-washing habits (OR = 2.27, 95% CI = 1.00, 5.20). Groundwater reserves are at risk of fecal pollution, as indicated by the presence of G. intestinalis cysts. However, the endemic pattern of intestinal infection reflects low standards of personal hygiene and unsafe drinking water storage and food-related practices at household level. Prevention activities must address health education and environmental protection policies.

Animals↗
PubMed2005

Disaster relief and initial response to the earthquake and tsunami in Meulaboh, Indonesia.

The Singapore Humanitarian Assistance Support Group deployed a team of 32 medical relief workers to Meulaboh, Indonesia to provide medical assistance for victims of the 26 December earthquake and tsunami disaster. The team was deployed at a primary healthcare clinic at an internally displaced persons' (IDP) camp and at the sole hospital's emergency and surgical departments. The team saw a total of 1841 patients, 1371 at the clinic and 446 at the hospital's emergency department, and performed surgery on 24 patients. Tsunami-related trauma cases accounted for 31.8% (142) of cases at the emergency department, 1.6% (22) of cases at the clinic, and 91.7% (22) of surgeries. This paper details the difficulties and lessons learnt by the team, including the lack of important resources for healthcare delivery. Water, sanitation, hygiene, and vector control were some of the problems faced, with the goal to provide the most effective public health for the greatest number of people given the limited resources available.

Disasters↗
PubMedDate not supplied

National Rural Health Mission--a critical review.

National Rural Health Mission is strategic framework to implement the National Health Policy 2002. The scheme of Accredited Social Health Activist is an improvement over the earlier Community Health Guide Scheme. Integration of various health and family welfare programmes will result in economy and allocation of resources as per needs of the districts. Decentralised planning with the involvement of Panchayati Raj Institutions is likely to make health as people's programme. Converging water supply, sanitation, hygiene and nutrition with health planning is a logical step. The proposal to strenthen institutions of primary health care and Community Health Centres as functional Rural Hospitals alongwith introduction of Indian Public Health Standards and accountability of public health institutions to the public is likely to revolutionise the status of health care in rural India.

Community Health Workers↗
PubMedDate not supplied

[Nutrition in preschool children from Băile-Herculane].

In the effected study we investigated the feeding quality in Baile-Herculane, during the period 2003-2004. The study was realised in two samples consisted in 659 preschool children (55% girls and 45% boys) and 359 children (65% girls and 35% boys) respectively, homogenous and statistical representative. The method consisted in feeding investigation using based on food lists consulting, effected 2 times in a year, in the winter season (November) and in the spring season (April). The inquiry period was 10 days consequently, in each season. We had established the nutritive value of feeding portions in two months (November and April), counted the average of the nutritive ration for the both investigated periods and compared them with nutritional necessity established for the same age group. We investigated the menu structure and diversity. In the first period of feeding investigation (November 2000) we established a decreased intake of foods which determine a small intake of calories, proteins, minerals and vitamins under the nutritional necessities. In April the nutritive value of the consumed food was less than in November. The decreased consumption of milk, cheese, eggs, vegetables and fruits determined a less intake of calories, fats, minerals and vitamins than nutritional necessities. The increased intake of bread, cereals and meat caused increased values of carbohydrates, vitamin B1 and iron. The menu was divided in two meals and a snack (breakfast - 15%, snack - 15%, lunch 50%). The menu variation and courses' succession were in line with the hygienic-sanitation rules.

Child↗
PubMed2006

Recurrent critical violations of the food code in retail food service establishments.

Records of restaurant inspections by public health departments provide sequential "snapshots" of conditions in retail food service establishments that can be used to identify risk factors and evaluate the effectiveness of interventions. Data from a random 10 percent sample of restaurant inspection files from 31 counties in Oklahoma, including 4,044 inspections conducted during 1996-2000 in "medium-risk" and "high-risk" establishments, were analyzed to determine rates of critical violations and recurrent violations for different categories of establishments. Repeat violations accounted for about half of all violations. Establishments subjectively designated as high risk by health department personnel were in fact found to have higher violation rates than those described as medium-risk establishments. Outside Oklahoma County, regional chain restaurants were significantly more likely than other restaurants to have recurrent violations of critical items related to food-holding temperature, hygiene practices, sanitization, and hygiene facilities. Differences observed in violation rates among individual establishments were not primarily attributable to inconsistent enforcement by individual inspectors; rather, they appeared to be indicative of real differences in hygienic conditions and practices.

Food Inspection↗
PubMed1991

[Environment in the Third World].

The major health problems in developing countries are associated with poverty, lack of food, poor sanitation, hygiene and high population growth. Malaria and schistosomiasis have increased along with more frequent use of large scale irrigation schemes. During recent decades some countries have managed to control the communicable diseases. However, new health problems have developed, often as a result of environmental degradation and uncontrolled population growth. Urbanization and industrialization are closely related to, and often cause pollution, ecological imbalances and occupational health problems. Indoor air pollution is a neglected problem. Health workers in third world must identify problems and seek solutions by applying epidemiological principles. National and international cooperation are both needed to cope with the problems.

Developing Countries↗
PubMed1990

Surgical asepsis revisited.

Basic principles, rituals, and surgical conscience are essential components of surgical asepsis. Surgical asepsis has become too complicated. Protective asepsis describes principles of good hygiene, sanitation, and impeccable aseptic technique; the term has received renewed interest in the advent and increased awareness of bloodborne diseases. Rituals may actually enhance learning and efficiency in the operating room even though they may or may not directly affect nosocomial infection rates.

Asepsis↗
PubMed1989

Strategies for developing innovative programs in international medical education. Identification of educational needs.

A U.S. medical educator noted that the needs of developing countries are not necessarily addressed by traditional methods of medical education in the United States, involving high-technology education, technology transfer, development of academic personnel, and the like. In many developing nations, where there may be a surplus of doctors and many unemployed doctors, there is also a vast population of underserved people. Many of the physicians may have been trained inappropriately, or they were not comfortable in certain environments. In order to have an impact on the vast population, that kind of anachronism must be addressed. He inquired whether there is a role for the United States in addressing the health of communities rather than the sickness of individuals. It was observed that the health needs of developing countries are often thought to relate to the issues of hygiene, sanitation, and prevention and that these needs are homogeneous. The needs for interventional technology and preventive primary care should be differentiated, and the requirements at both levels of assistance should be heeded, be it at a primary and preventive level or at the level of specialist-oriented technological intervention. There was discussion about the dichotomy that exists between schools of public health in the United States and the medical schools with which they are associated. They were referred to as "two separate cultures." Thus, some suggested that U.S. physicians involved in curative medicine need to be exposed to community-based medicine in other countries, and many questioned whether other countries should seek to model their systems after those in the United States.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗
PubMed1983

Role of veterinary public health in the environmental pollution in Nigeria.

Veterinary public health has a part to play in the environmental pollution control programme. However there is a need to conduct research surveys to draw a line of demarkation where a public health hazard could be considered as well a problem of environmental pollution. In the developed countries some of these diseases have been successfully dealth with by the rigourous enforcement of law pertaining to hygiene, sanitation, quarantine, compulsory vaccination etc. In the developing countries by contrast this has so far not been possible due to the scarcity of funds for control programme and of inadequacy of law enforcement and monitoring agencies.

Animals↗
PubMed1993

[Water and viral hepatitis].

The main agents responsible for acute viral hepatitis throughout the world are the hepatitis A virus (HAV) and the hepatitis E virus (HEV). Both are transmitted by fecal-oral route and can provoke large epidemics, HAV in developed countries and HEV in developing countries. Water is a major vehicle of spread. However, two different epidemiological patterns have to be distinguished: level of HAV excretion is short but high. Because of its resistance to physical and chemical agents, HAV remains infectious for a long time under environmental conditions. Progress in hygiene have nearly stopped the circulation of HAV in industrialized countries, making populations more susceptible to the infection and increasing the epidemic risk. Conventional measures sometimes fail to prevent HAV infections. Vaccine is currently the best way for hepatitis A prophylaxis; HEV is excreted briefly and at low concentrations. Viral particles are fragile in vitro and their viability in environment is not yet understood. Epidemics mainly occur in countries with poor sanitary conditions, resulting from heavy water pollutions. High case-fatality rates are observed, especially among pregnant women. The control of enterically transmitted viral hepatitis remains a major public health challenge. Virological surveillance of waste water could improve strategies based on hygiene, sanitation and supply of drinking water.

Feces↗
PubMedDate not supplied

Prevention of gastrointestinal diseases.

The prevalence of gastrointestinal diseases markedly differs between developed and developing countries because of the poor sanitation, hygiene, impure water and food ingestion, widespread illiteracy and poverty in the developing world. The incidence of gastrointestinal diseases such as diarrhoea, cholera, typhoid, dysentery, viral hepatitis (A and E virus) can be substantially reduced by providing clean water and food to the population. Restricting consumption of tobacco and nonsteroidal anti-inflammatory drugs will reduce diseases and/or complications of the upper gastrointestinal tract. Diminishing alcohol intake and overuse of blood transfusion and improving blood banks would prevent many acute and chronic liver diseases. Costly passive and active immunoprophylaxis will become unnecessary if these measures are undertaken.

Esophageal Diseases↗
PubMed1997

[Hepatitis A virus infection in children in Argentina: a pilot study].

UNLABELLED: The severity and/or the prognostic of infections with the hepatitis A virus (HAV) is related to the age at which the infection occurs. Since transmission of the virus occurs by the fecal-oral route, the prevalence and age-relate incidence of infection is determined by the adequacy of sanitation hygienic measures and the socio economic level of exposed populations. Thus, the disease is having an increasing impact in developing countries with improving sanitary standards whereas inhabitants of industrialized countries are particularly at risk while visiting under-developed countries. We have established a cooperative group for the serologic study of children range between six months to ten years old, without sintomatology of acute hepatitis. The patients live in Buenos Aires, San Justo, Trelew, Rosario and Tucumán cities. We studied 3699 children. The specific Ab-antiHAV IgG were measured by enzyme immunoassay with commercial available kits (Organon and-or Abbott). The variable of study were age, sex and water quality. RESULTS: 45.19% were of San Justo, 26.15% of Rosario, 13% of Buenos Aires, 8.37% of Trelew and 7.29% of Tucumán. We observed the highest of possibility percentage (%POS) in Tucumán (81.4%), followed by San Justo (57.8%), Rosario (46.5%), Trelew (41.99%) and Buenos Aires (29.4%). In all the cities the lowest %POS was found in children under three years old. Between three and six years old the results were variable and an increase in %POS was observed related to the growth. The global %POS was 51.56%. CONCLUSIONS: This study confirms Argentina as a high endemic country for HAV infection. A global vaccination program is the only strategy that has the potential to prevent recurrent epidemics of hepatitis A and its erradication.

Age Factors↗