WorldWideScience

Sample records for addressing complex health

  1. Applied social and behavioral science to address complex health problems.

    Livingood, William C; Allegrante, John P; Airhihenbuwa, Collins O; Clark, Noreen M; Windsor, Richard C; Zimmerman, Marc A; Green, Lawrence W

    2011-11-01

    Complex and dynamic societal factors continue to challenge the capacity of the social and behavioral sciences in preventive medicine and public health to overcome the most seemingly intractable health problems. This paper proposes a fundamental shift from a research approach that presumes to identify (from highly controlled trials) universally applicable interventions expected to be implemented "with fidelity" by practitioners, to an applied social and behavioral science approach similar to that of engineering. Such a shift would build on and complement the recent recommendations of the NIH Office of Behavioral and Social Science Research and require reformulation of the research-practice dichotomy. It would also require disciplines now engaged in preventive medicine and public health practice to develop a better understanding of systems thinking and the science of application that is sensitive to the complexity, interactivity, and unique elements of community and practice settings. Also needed is a modification of health-related education to ensure that those entering the disciplines develop instincts and capacities as applied scientists. PMID:22011425

  2. Assessing correlations between geological hazards and health outcomes: addressing complexity in medical geology

    Wardrop, Nicola A.; Le Blond, Jennifer S

    2015-01-01

    Background: The field of medical geology addresses the relationships between exposure to specific geological characteristics and the development of a range of health problems: for example, long-term exposure to arsenic in drinking water can result in the development of skin conditions and cancers. While these relationships are well characterised for some examples, in others there is a lack of understanding of the specific geological component(s) triggering disease onset, necessitating further...

  3. 'Change of Heart!': A New E-Learning Model Geared to Addressing Complex and Sensitive Public Health Issues

    Hillier, Dawn; Mitchell, Alice; Millwood, Richard

    2005-01-01

    Psychosocial risk factors for poor health show that we are highly sensitive to particular dimensions of the social and work environments. Central is the contrast between mutually supportive collaborative relationships versus stressful relationships of social dominance--in the workplace and at home. These social ordeals can exacerbate the effect of…

  4. Road Map to Address Cognitive Health

    2014-06-09

    In this podcast, CDC’s Dr. Lynda Anderson highlights the important roles that states and communities can play in addressing cognitive health as part of overall health.  Created: 6/9/2014 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/9/2014.

  5. The role of health education in addressing the health divide

    Simovska, Venka

    2013-01-01

    The aim of this chapter is to argue that an approach to health education, consistent with critical education theory echoing Freire’s ideas, has the potential to play a significant role in addressing determinants of health by, first and foremost, providing children and young people with...

  6. EPIDEMIOLOGÍA Y ANTROPOLOGÍA: Una propuesta frente a problemas complejos en Salud Pública Epidemiology and Anthropology: a proposal to address complexity in public health

    Guillermo Sánchez Vanegas

    2012-09-01

    Full Text Available Los problemas de salud pública son objetos complejos, multifacéticos, concatenados y contradictorios. La epidemiología requiere de un complemento que le permita lidiar con esos objetos. El riesgo visto desde la perspectiva epidemiológica de los modelos multivariados, ofrece un alto potencial, pero es insuficiente para la comprensión integral de los fenómenos de estudio. La propuesta plantea una integración entre la epidemiología y la antropología, a partir del diálogo entre modelos de riesgo y narrativas provenientes de una etnografía abductiva, iterativa y recursiva.Public health problems are complex, multifaceted, concatenated and contradictory; epidemiology is in need of a complement allowing it to deal with such objects. Risk seen from the point of view of multivariate models' epidemiological perspective would seem to offer great potential in this respect but, nevertheless, this is inadequate for an integral understanding of study phenomena. The current proposal suggests integrating epidemiology and anthropology from dialogue between risk and narrative models arising from abductive, iterative and recursive ethnography.

  7. Enhancing Written Communications to Address Health Literacy

    Gloria Mayer; Michael Villaire

    2009-01-01

    Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Poor health literacy affects nearly one in two United States adults and greatly increases the cost of healthcare. Most patient education materials are written at a grade level too high to understand. This article describes how to write and design printed patient education materials to make them mor...

  8. Radiation and occupational health: opening address

    The part of address discusses the following issue: benefits of radiological protection in Malaysia, traceability and accountability as assurance of the validity of radiation measurement, Laboratory Accreditation Scheme, Atomic Energy Licensing Act

  9. Addressing health literacy in patient decision aids

    McCaffery, K; Holmes-Rovner, M.; S. Smith; Rovner, D.; Nutbeam, Don; Clayman, M.L.; Kelly-Blake, K.; Wolf, M.(University of Notre Dame, Notre Dame, USA); Stacey, S

    2013-01-01

    Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-...

  10. Community Changes Address Common Health Threat

    2013-09-30

    This podcast helps residents living in multiunit housing, like apartments and condos, understand the threat of secondhand smoke. It also helps residents understand what steps they can take to breathe a little easier if involuntarily exposed to secondhand smoke.  Created: 9/30/2013 by Division of Community Health, National Center for Chronic Disease Prevention and Health Promotion.   Date Released: 9/30/2013.

  11. Ubiquitous Health Monitoring Systems: Addressing Security Concerns

    Mahmoud Elkhodr

    2011-01-01

    Full Text Available Problem statement: It is important to secure the transmission of patient’s EHR in remote health monitoring systems. Security is among the main issues that need to be realized for the adaption of this monitoring technology. The face of healthcare is changing as ubiquitous computing technologies are being incorporated into the existing infrastructure. We specify the requirements, needed security mechanism, outstanding issues and the future challenges as well as the open problems that need to be achieved. Approach: Although there were benefits to technology, approaches that offer reliable privacy and security features must be presented to users in order to make these systems socially accepted. Results: We investigated the privacy and security implications generated from the deployment of remote health monitoring technology. To achieve these security requirements, building on the strengths of Transport Layer Security (TLS protocol, a trust negotiation approach was proposed. The application of this approach results in significant improvements in overcoming security related concerns compared to the traditional identity-based only access control techniques. Conclusion: We believe these considerations will eventually contribute toward an efficient and practical deployment of remote monitoring systems.

  12. Actions States and Communities Can Take to Address Cognitive Health

    2014-06-09

    In this podcast, CDC’s Dr. Lynda Anderson highlights the important roles that states and communities can play in addressing cognitive health as part of overall health.  Created: 6/9/2014 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/9/2014.

  13. Complexity and Health Coaching: Synergies in Nursing

    Mitchell, Gail J.; Nadine Cross; Michelle Wilson; Shauna Biernacki; Winnie Wong; Behnam Adib; Danica Rush

    2013-01-01

    Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in thi...

  14. Nursing leadership in addressing the social determinants of health.

    Lathrop, Breanna

    2013-02-01

    Social determinants of health have a profound impact on health status and the prevalence of health disparities in the United States. Significant improvements in national health indices are not possible without addressing social determinants of health. Drawing on their historical legacy as patient advocates, patient care expertise, and community focused education, nurses are ideally positioned to lead the nation in strategies to promote health equity. Nurses can embrace this new leadership role through the use of interdisciplinary collaboration, advocacy, political involvement, and community partnerships. PMID:23793135

  15. Complexity and Health Coaching: Synergies in Nursing

    Gail J. Mitchell

    2013-01-01

    Full Text Available Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons’ lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.

  16. 75 FR 51831 - Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs

    2010-08-23

    ... Address Health Plan Members' Health Literacy Needs AGENCY: Agency for Healthcare Research and Quality... health providers address health plan enrollees' health literacy needs and how well they communicate with... supplemental item set (the ``new instrument'') for addressing health literacy for the CAHPS Health Plan...

  17. National Institutes of Health addresses the science of diversity.

    Valantine, Hannah A; Collins, Francis S

    2015-10-01

    The US biomedical research workforce does not currently mirror the nation's population demographically, despite numerous attempts to increase diversity. This imbalance is limiting the promise of our biomedical enterprise for building knowledge and improving the nation's health. Beyond ensuring fairness in scientific workforce representation, recruiting and retaining a diverse set of minds and approaches is vital to harnessing the complete intellectual capital of the nation. The complexity inherent in diversifying the research workforce underscores the need for a rigorous scientific approach, consistent with the ways we address the challenges of science discovery and translation to human health. Herein, we identify four cross-cutting diversity challenges ripe for scientific exploration and opportunity: research evidence for diversity's impact on the quality and outputs of science; evidence-based approaches to recruitment and training; individual and institutional barriers to workforce diversity; and a national strategy for eliminating barriers to career transition, with scientifically based approaches for scaling and dissemination. Evidence-based data for each of these challenges should provide an integrated, stepwise approach to programs that enhance diversity rapidly within the biomedical research workforce. PMID:26392553

  18. Scientific foundations of addressing risk in complex and dynamic environments

    Grotan, T.O., E-mail: tor.o.grotan@sintef.n [Norwegian University of Science and Technology (NTNU), Department of Production and Quality Engineering, Trondheim (Norway); SINTEF Technology and Society, Safety Research, Trondheim (Norway); Storseth, F.; Albrechtsen, E. [SINTEF Technology and Society, Safety Research, Trondheim (Norway)

    2011-06-15

    Development, deployment and application of Information and Communication Technology (ICT) and digital infrastructure continue with unabated intensity in the petroleum-related activity on the Norwegian shelf. This development towards what is denoted Integrated Operations (IO) creates new ways of organizing work, new work processes and increased automation, e.g. closer collaboration offshore-onshore, cooperation across organizational and geographical borders. This creates new challenges for managing risk. Although there are different versions of IO today, we argue that it is possible to identify and study generic properties within such IO manifestations. The current paper focus on the potential complexity of IO in the generic sense, and some scientific implications in terms of addressing risk. The paper uses the century-old metaphor of 'wildness in wait' to engage the wide field of complexity theory in a productive way to address systemic properties of risk. The paper further uses the Cynefin sensemaking framework in order to identify and address the crucial distinction between directed (resultant) and un-directed (emergent) order. The paper finally discusses the importance of seeing risk assessment as a social knowledge practice.

  19. Scientific foundations of addressing risk in complex and dynamic environments

    Development, deployment and application of Information and Communication Technology (ICT) and digital infrastructure continue with unabated intensity in the petroleum-related activity on the Norwegian shelf. This development towards what is denoted Integrated Operations (IO) creates new ways of organizing work, new work processes and increased automation, e.g. closer collaboration offshore-onshore, cooperation across organizational and geographical borders. This creates new challenges for managing risk. Although there are different versions of IO today, we argue that it is possible to identify and study generic properties within such IO manifestations. The current paper focus on the potential complexity of IO in the generic sense, and some scientific implications in terms of addressing risk. The paper uses the century-old metaphor of 'wildness in wait' to engage the wide field of complexity theory in a productive way to address systemic properties of risk. The paper further uses the Cynefin sensemaking framework in order to identify and address the crucial distinction between directed (resultant) and un-directed (emergent) order. The paper finally discusses the importance of seeing risk assessment as a social knowledge practice.

  20. Redesigning Health Care Practices to Address Childhood Poverty.

    Fierman, Arthur H; Beck, Andrew F; Chung, Esther K; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Siegel, Benjamin; Chamberlain, Lisa J; Conroy, Kathleen; Federico, Steven G; Flanagan, Patricia J; Garg, Arvin; Gitterman, Benjamin A; Grace, Aimee M; Gross, Rachel S; Hole, Michael K; Klass, Perri; Kraft, Colleen; Kuo, Alice; Lewis, Gena; Lobach, Katherine S; Long, Dayna; Ma, Christine T; Messito, Mary; Navsaria, Dipesh; Northrip, Kimberley R; Osman, Cynthia; Sadof, Matthew D; Schickedanz, Adam B; Cox, Joanne

    2016-04-01

    Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty. PMID:27044692

  1. Ethnocentric approach to address South Asian health issues.

    Sharif, A

    2012-09-01

    South Asian populations have distinct healthcare requirements to other ethnic demographics. Epidemiologically they constitute a high-risk group for many public health diseases such as cardiovascular disease, chronic kidney disease and diabetes mellitus. Despite individuals of South Asian backgrounds encompassing many individual countries, cultures, religions and backgrounds they share many common health concerns that are poorly tackled in established models of healthcare delivery. To successfully address this burgeoning public health burden, it is important for healthcare professionals and providers to appreciate the need for an ethnocentric approach to South Asian health requirements. Key stakeholders need to understand the need for an integrated ethnocentric approach to challenge the poor health status of this population. Appreciation of the socio-cultural dimension to South Asian healthcare requirements should help guide targeted and focused strategies to improve the outlook for this unique population at high public health risk. PMID:22753671

  2. Linking Obesity Prevention and Mental Health Promotion to Address Health Disparities.

    Claydon, Elizabeth; Austin, Anna; Smith, Megan V

    2016-05-01

    Considerable racial health disparities exist, especially in mental health and obesity. However, few approaches exist to address obesity and mental health simultaneously in minority groups. An intervention to address mental health in a low-income, minority group of urban mothers was designed using results from a needs assessment. Participating women were asked to rank their top health concerns and personal goals. Along with mental health concerns and basic needs, the majority of mothers desired assistance with improving their physical well-being. These results are surprising, but lend credence to creating interventions that aim to address both mental health and obesity concerns simultaneously. PMID:26303902

  3. Challenges in Diabetes Care: Can Digital Health Help Address Them?

    Iyengar, Varun; Wolf, Alexander; Brown, Adam; Close, Kelly

    2016-07-01

    In Brief There is great enthusiasm for the potential of digital health solutions in medicine and diabetes to address key care challenges: patient and provider burden, lack of data to inform therapeutic decision-making, poor access to care, and costs. However, the field is still in its nascent days; many patients and providers do not currently engage with digital health tools, and for those who do, the burden is still often high. Over time, digital health has excellent potential to collect data more seamlessly, make collected data more useful, and drive better outcomes at lower costs in less time. But there is still much to prove. This review offers key background information on the current state of digital health in diabetes, six of the most promising digital health technologies and services, and the challenges that remain. PMID:27621530

  4. Addressing Maternal and Newborn Health: A Leadership Perspective.

    Mancuso, Leslie; Johnson, Peter; Hart, Leah; Austin, Kate

    2015-01-01

    Globally, each year 289,000 mothers die in childbirth and three million infants die in the first four weeks of life. The shortcomings in maternal and newborn health are particularly devastating in low-resource countries. This qualitative study describes the experience of an international nongovernmental organization, Jhpiego, which has been implementing public health programs to address maternal and newborn health outcomes for more than 40 years. Themes emerged from interviews with leaders of offices in a variety of countries with unique challenges related to health systems, human resources and infrastructure. Results emphasized the importance of partnerships with governments and international agencies for long-term program impact, as well as the recruitment of local talent for improving health systems to address problems that are best understood by the people who live and work in these countries. The discussion of program successes and challenges may inform best practices for promoting the health and wellness of women and families around the world. PMID:26860758

  5. Connectivity and complex systems in geomorphology: addressing some key challenges

    Pöppl, Ronald; Turnbull-Lloyd, Laura; Parsons, Anthony; Bracken, Louise; Keesstra, Saskia; Masselink, Rens

    2016-04-01

    "Connectivity thinking" and related concepts have a long history in geomorphology. Since the beginning of the 21st century connectivity research experienced a huge boom in geomorphology as geomorphologists started to develop new concepts on connectivity to better understand the complexity of geomorphic systems and system response to change. However, progress in the field of connectivity in geomorphology has mostly been developing in a parallel manner, resulting in a multiplicity of definitions, concepts and methodological approaches. Nevertheless, a set of common key challenges amongst the different connectivity concepts and approaches used to understand complex geomorphic systems are also evident. In the course of a theory think tank of the COST Action ES1306 (CONNECTEUR - Connecting European Connectivity Research) the following five different key challenges were detected (Turnbull et al., in prep.): (i) defining the fundamental unit, (ii) distinguishing between structural and functional boundaries, (iii) emergent behavior, (iv) memory effects, (v) measuring connectivity. In this presentation we will a) discuss how these key challenges are addressed and approached in connectivity research in geomorphology, b) evaluate ways in which cross-disciplinary advances may be made by exploring potential for a common toolbox approach to the study of connectivity.

  6. Developing integrated methods to address complex resource and environmental issues

    2016-01-01

    IntroductionThis circular provides an overview of selected activities that were conducted within the U.S. Geological Survey (USGS) Integrated Methods Development Project, an interdisciplinary project designed to develop new tools and conduct innovative research requiring integration of geologic, geophysical, geochemical, and remote-sensing expertise. The project was supported by the USGS Mineral Resources Program, and its products and acquired capabilities have broad applications to missions throughout the USGS and beyond.In addressing challenges associated with understanding the location, quantity, and quality of mineral resources, and in investigating the potential environmental consequences of resource development, a number of field and laboratory capabilities and interpretative methodologies evolved from the project that have applications to traditional resource studies as well as to studies related to ecosystem health, human health, disaster and hazard assessment, and planetary science. New or improved tools and research findings developed within the project have been applied to other projects and activities. Specifically, geophysical equipment and techniques have been applied to a variety of traditional and nontraditional mineral- and energy-resource studies, military applications, environmental investigations, and applied research activities that involve climate change, mapping techniques, and monitoring capabilities. Diverse applied geochemistry activities provide a process-level understanding of the mobility, chemical speciation, and bioavailability of elements, particularly metals and metalloids, in a variety of environmental settings. Imaging spectroscopy capabilities maintained and developed within the project have been applied to traditional resource studies as well as to studies related to ecosystem health, human health, disaster assessment, and planetary science. Brief descriptions of capabilities and laboratory facilities and summaries of some

  7. Vaal Triangle air pollution health study. Addressing South African problems

    Terblanche, P.; Nel, R. [CSIR Environmental Services, Pretoria (South Africa); Surridge, T. [Dept. of Mineral and Energy Affairs (South Africa); Annegarn, H. [Annegarn Environmental Research, Johannesburg (South Africa); Tosen, G. [Eskom, Johannesburg (South Africa); Pols, A. [CSIR Informationtek, Pretoria (South Africa)

    1995-12-31

    Situated in the central region of South Africa, the Vaal Triangle is an area which plays a vital role in driving the economic dynamo of South Africa. Also, because of the concentration of heavy industry, it is an area which provides a challenge in effective air pollution control. The Vaal Triangle lies within the Vaal River Basin, at an altitude of 1 500 m above sea level. Meteorological conditions in the area are highly conducive to the formation of surface temperature inversions, resulting in a poor dispersion potential. Because of multiple sources of air pollution in the area, poor dispersion conditions increase the risk pollution build-up and subsequent adverse impacts. The situation is further exacerbated by the continued combustion of coal in households, even after the electrification of residences. This is particularly chronic in the developing communities and during winter. Vaal Triangle Air Pollution Health Study (VAPS) was initiated in 1990 by the Department of Health, the Medical Research Council and major industries in the area to determine effects of air pollution on the health of the community. The final results of that study summarised in this article, and options to ameliorate problems are addressed. (author)

  8. A Student-Led Health Education Initiative Addressing Health Disparities in a Chinatown Community

    Lee, Benjamin J.; Wang, Sheila K.; So, Chunkit; Chiu, Brandon G.; Wang, Wesley Y.; Polisetty, Radhika; Quiñones-Boex, Ana; Liu, Hong

    2015-01-01

    Together with community advocates, professional student organizations can help improve access to health care and sustain services to address the health disparities of a community in need. This paper examines the health concerns of an underserved Chinese community and introduces a student-led health education initiative that fosters service learning and student leadership. The initiative was recognized by the American Association of Colleges of Pharmacy (AACP) and received the 2012-2013 Studen...

  9. A Student-Led Health Education Initiative Addressing Health Disparities in a Chinatown Community.

    Lee, Benjamin J; Wang, Sheila K; So, Chunkit; Chiu, Brandon G; Wang, Wesley Y; Polisetty, Radhika; Quiñones-Boex, Ana; Liu, Hong

    2015-11-25

    Together with community advocates, professional student organizations can help improve access to health care and sustain services to address the health disparities of a community in need. This paper examines the health concerns of an underserved Chinese community and introduces a student-led health education initiative that fosters service learning and student leadership. The initiative was recognized by the American Association of Colleges of Pharmacy (AACP) and received the 2012-2013 Student Community Engaged Service Award. PMID:26839422

  10. Managing interoperability and complexity in health systems.

    Bouamrane, M-M; Tao, C; Sarkar, I N

    2015-01-01

    In recent years, we have witnessed substantial progress in the use of clinical informatics systems to support clinicians during episodes of care, manage specialised domain knowledge, perform complex clinical data analysis and improve the management of health organisations' resources. However, the vision of fully integrated health information eco-systems, which provide relevant information and useful knowledge at the point-of-care, remains elusive. This journal Focus Theme reviews some of the enduring challenges of interoperability and complexity in clinical informatics systems. Furthermore, a range of approaches are proposed in order to address, harness and resolve some of the many remaining issues towards a greater integration of health information systems and extraction of useful or new knowledge from heterogeneous electronic data repositories. PMID:25579862

  11. Deconcentration of Attention: Addressing the Complexity of Software Engineering

    Kusakov, Igor

    2012-01-01

    This article attempts to describe specific mental techniques that are related to resolving very complex tasks in software engineering. This subject may be familiar to some software specialists to different extents; however, there is currently no common consensus and popular terminology for this subject area. In this article, the area is charted from a practical usability perspective. This article also proposes to treat software engineering itself as research on human thinking because software...

  12. Deconcentration of Attention: Addressing the Complexity of Software Engineering

    Kusakov, Igor

    2012-01-01

    This article attempts to describe specific mental techniques that are related to resolving very complex tasks in software engineering. This subject may be familiar to some software specialists to different extents; however, there is currently no common consensus and popular terminology for this subject area. In this article, the area is charted from a practical usability perspective. This article also proposes to treat software engineering itself as research on human thinking because software is meant to simulate thinking.

  13. An approach to addressing governance from a health system framework perspective

    Mikkelsen-Lopez Inez

    2011-12-01

    Full Text Available Abstract As countries strive to strengthen their health systems in resource constrained contexts, policy makers need to know how best to improve the performance of their health systems. To aid these decisions, health system stewards should have a good understanding of how health systems operate in order to govern them appropriately. While a number of frameworks for assessing governance in the health sector have been proposed, their application is often hindered by unrealistic indicators or they are overly complex resulting in limited empirical work on governance in health systems. This paper reviews contemporary health sector frameworks which have focused on defining and developing indicators to assess governance in the health sector. Based on these, we propose a simplified approach to look at governance within a common health system framework which encourages stewards to take a systematic perspective when assessing governance. Although systems thinking is not unique to health, examples of its application within health systems has been limited. We also provide an example of how this approach could be applied to illuminate areas of governance weaknesses which are potentially addressable by targeted interventions and policies. This approach is built largely on prior literature, but is original in that it is problem-driven and promotes an outward application taking into consideration the major health system building blocks at various levels in order to ensure a more complete assessment of a governance issue rather than a simple input-output approach. Based on an assessment of contemporary literature we propose a practical approach which we believe will facilitate a more comprehensive assessment of governance in health systems leading to the development of governance interventions to strengthen system performance and improve health as a basic human right.

  14. Oral health in Libya: addressing the future challenges

    Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

    2014-01-01

    Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. T...

  15. Managing a scarce resource: addressing critical health workforce challenges.

    Giepmans. P.; Dussault, G.; Batenburg, R.; Frich, J.; Olivers, R.; Sermeus, W.

    2013-01-01

    With health care services significantly changing, the challenge is to initiate innovative, situational and integrated workforce forecasting and planning. Many health systems require a shift in mindset to move to the planning of skill mixes for health care professionals. This implies great challenges

  16. Developing Social Marketing Capacity to Address Health Issues

    Whitelaw, S.; Smart, E.; Kopela, J.; Gibson, T.; King, V.

    2011-01-01

    Purpose: Social marketing is increasingly being seen as a potentially effective means of pursuing health education practice generally and within various specific areas such as mental health and wellbeing and more broadly in tackling health inequalities. This paper aims to report and reflect on the authors' experiences of undertaking a health…

  17. Infusing Oral Health Care into Nursing Curriculum: Addressing Preventive Health in Aging and Disability

    Joan Earle Hahn

    2012-01-01

    Full Text Available Access to oral health care is essential for promoting and maintaining overall health and well-being, yet oral health disparities exist among vulnerable and underserved populations. While nurses make up the largest portion of the health care work force, educational preparation to address oral health needs of elders and persons with disabilities is limited across nursing curricula. This descriptive study reports on the interdisciplinary development, implementation, and testing of an oral health module that was included and infused into a graduate nursing curriculum in a three-phase plan. Phase 1 includes evaluation of a lecture presented to eight gerontological nurse practitioner (GNP students. Phase 2 includes evaluation of GNP students’ perceptions of learning, skills, and confidence following a one-time 8-hour practicum infused into 80 required practicum hours. The evaluation data show promise in preparing nurse practitioner students to assess and address preventive oral health needs of persons aging with disabilities such that further infusion and inclusion in a course for nurse practitioners across five specialties will implemented and tested in Phase 3.

  18. The World Health Organization Addressing Violence Against Women

    Claudia Garcia-Moreno

    2001-01-01

    Claudia Garcia-Moreno describes the approach of the World Health Organization to violence against women as a major public health issue. She explains how the focus of WHO's work is on building the knowledge base for policy and action and identifying the role of the health sector in the prevention of violence against women and in providing care for those experiencing abuse. Development (2001) 44, 129–132. doi:10.1057/palgrave.development.1110280

  19. Addressing the changing sources of health information in Iran

    Amir Alishahi Tabriz; Mohammad Reza Sohrabi; Nazanin Kiapour; Nina Faramarzi

    2013-01-01

    Background : Following the entrance of new technologies in health information era, this study aimed to assess changes in health information sources of Iranian people during past decade. Methods : Totally 3000 people were asked about their main sources of health information. They were selected as two community-based samples of 1500 people of more than 18-years-old in two different periods of time in August 2002 and August 2010 from the same locations in Tehran, the capital of Iran. Data ana...

  20. Wind versus Biofuels for Addressing Climate, Health, and Energy

    The favored approach today for addressing global warming is to promote a variety of options: biofuels, wind, solar thermal, solar photovoltaic, geothermal, hydroelectric, and nuclear energy and to improve efficiency. However, by far, most emphasis has been on biofuels. It is shown here, though, that current-technology biofuels cannot address global warming and may slightly increase death and illness due to ozone-related air pollution. Future biofuels may theoretically slow global warming, but only temporarily and with the cost of increased air pollution mortality. In both cases, the land required renders biofuels an impractical solution. Recent measurements and statistical analyses of U.S. and world wind power carried out at Stanford University suggest that wind combined with other options can substantially address global warming, air pollution mortality, and energy needs simultaneously.

  1. Addressing the changing sources of health information in Iran

    Amir Alishahi Tabriz

    2013-01-01

    Conclusion : Although during 8 years of study radio and television remained as main source of health information but there is an increasing tendency to use internet especially in men. Policymakers should revise their broadcasting strategies based on people demand.

  2. Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

    Hodgkinson, Stacy; Beers, Lee; Southammakosane, Cathy; Lewin, Amy

    2014-01-01

    Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of th...

  3. Why public health might address the emerging role of vaccinomics?

    Stefania Boccia

    2010-12-01

    Full Text Available The greatest public health benefit of the advances brought about by the understanding of the human genome, completely sequenced in 2000, will likely occur as genomic medicine expands its focus from rare genetic disorders towards the inclusion of more common diseases also, such as coronary heart disease, diabetes mellitus, cancer and infectious disease. Advances in Genomics hold the promise of improving the delivery of health care, particularly that of preventive medicine, and of tailoring drug treatment.

  4. Addressing the Changing Sources of Health Information in Iran

    Alishahi-Tabriz, Amir; Sohrabi, Mohammad-Reza; Kiapour, Nazanin; Faramarzi, Nina

    2013-01-01

    Background: Following the entrance of new technologies in health information era, this study aimed to assess changes in health information sources of Iranian people during past decade. Methods: Totally 3000 people were asked about their main sources of health information. They were selected as two community-based samples of 1500 people of more than 18-years-old in two different periods of time in August 2002 and August 2010 from the same locations in Tehran, the capital of Iran. Data analyzed based on age group, sex, educational level and household income in two different periods of time using Chi-square. Odds ratios associated with each basic characteristic were calculated using logistic regression. Results: Most common sources of health information in 2002 were radio and television (17.7%), caregivers (14.9%) and internet (14.2%) and in 2010 were radio and television (19.3%), internet (19.3%) and caregivers (15.8%) (P 0.05). Conclusion: Although during 8 years of study radio and television remained as main source of health information but there is an increasing tendency to use internet especially in men. Policymakers should revise their broadcasting strategies based on people demand. PMID:23412519

  5. Keeping Current. Library Media Specialists: Addressing the Student Health Epidemic

    Buddy, Juanita

    2005-01-01

    Health and educational leaders are sounding the alarm about the unhealthy condition of many students in America's K-12 schools. Each day, new scientific studies confirm that "The majority of American youth are sedentary and do not eat well. Sixteen percent of school-aged children and adolescents--or nine million--are overweight, a figure that has…

  6. A Framework for Addressing the Global Obesity Epidemic Locally: The Child Health Ecological Surveillance System (CHESS)

    Ronald C. Plotnikoff, PhD; Penny Lightfoot, MHSA; Linda Barrett, MSc; Carla Spinola, MA; Gerry Predy, MD, FRCPC

    2008-01-01

    Childhood obesity has reached epidemic levels in the developed world. Recent research and commentary suggest that an ecological approach is required to address childhood obesity, given the multidimensional nature of the problem. We propose a Canadian prototype, the Child Health Ecological Surveillance System, for a regional health authority to address the growing obesity epidemic. This prototype could potentially be used in other jurisdictions to address other child health issues. We present ...

  7. Addressing domestic violence through antenatal care in Sri Lanka's plantation estates: Contributions of public health midwives.

    Infanti, Jennifer J; Lund, Ragnhild; Muzrif, Munas M; Schei, Berit; Wijewardena, Kumudu

    2015-11-01

    Domestic violence in pregnancy is a significant health concern for women around the world. Globally, much has been written about how the health sector can respond effectively and comprehensively to domestic violence during pregnancy via antenatal services. The evidence from low-income settings is, however, limited. Sri Lanka is internationally acknowledged as a model amongst low-income countries for its maternal and child health statistics. Yet, very little research has considered the perspectives and experiences of the key front line health providers for pregnant women in Sri Lanka, public health midwives (PHMs). We address this gap by consulting PHMs about their experiences identifying and responding to pregnant women affected by domestic violence in an underserved area: the tea estate sector of Badulla district. Over two months in late 2014, our interdisciplinary team of social scientists and medical doctors met with 31 estate PHMs for group interviews and a participatory workshop at health clinics across Badulla district. In the paper, we propose a modified livelihoods model to conceptualise the physical, social and symbolic assets, strategies and constraints that simultaneously enable and limit the effectiveness of community-based health care responses to domestic violence. Our findings also highlight conceptual and practical strategies identified by PHMs to ensure improvements in this complex landscape of care. Such strategies include estate-based counselling services; basic training in family counselling and mediation for PHMs; greater surveillance of abusive men's behaviours by male community leaders; and performance evaluation and incentives for work undertaken to respond to domestic violence. The study contributes to international discussions on the meanings, frameworks, and identities constructed at the local levels of health care delivery in the global challenge to end domestic violence. In turn, such knowledge adds to international debates on the roles

  8. Equity-focused health impact assessment: A tool to assist policy makers in addressing health inequalities

    In Australasia (Australia and New Zealand) the use of health impact assessment (HIA) as a tool for improved policy development is comparatively new. The public health workforce do not routinely assess the potential health and equity impacts of proposed policies or programs. The Australasian Collaboration for Health Equity Impact Assessment was funded to develop a strategic framework for equity-focused HIA (EFHIA) with the intent of strengthening the ways in which equity is addressed in each step of HIA. The collaboration developed a draft framework for EFHIA that mirrored, but modified the commonly accepted steps of HIA; tested the draft framework in six different health service delivery settings; analysed the feedback about application of the draft EFHIA framework and modified it accordingly. The strategic framework shows promise in providing a systematic process for identifying potential differential health impacts and assessing the extent to which these are avoidable and unfair. This paper presents the EFHIA framework and discusses some of the issues that arose in the case study sites undertaking equity-focused HIA

  9. North and South addressing the English health divide.

    Bambra, C; Barr, B.; Milne, E.

    2014-01-01

    The North South divide in England has been a popular trope from the mid-19th century novels of Charles Dickens (Hard Times, 1854) and Elizabeth Gaskell (North and South, 1855) through to TV and radio documentaries of 2014.1,2 These often focus on culture and the economy, but it is also well known that there are large and longstanding geographical inequalities in health in England.3 Between 2009 and 2011 people in Manchester were more than twice as likely to die early (455 deaths per 100 000) ...

  10. School Nurses' Perceived Prevalence and Competence to Address Student Mental Health Problems

    Stephan, Sharon H.; Connors, Elizabeth H.

    2013-01-01

    Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their…

  11. Complex health care interventions: Characteristics relevant for ethical analysis in health technology assessment

    Lysdahl, Kristin Bakke

    2016-03-01

    Full Text Available Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1 multiple and changing perspectives, 2 indeterminate phenomena, 3 uncertain causality, 4 unpredictable outcome, and 5 ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.

  12. New smart materials to address issues of structural health monitoring.

    Chaplya, Pavel Mikhail

    2004-12-01

    Nuclear weapons and their storage facilities may benefit from in-situ structural health monitoring systems. Appending health-monitoring functionality to conventional materials and structures has been only marginally successful. The purpose of this project was to evaluate feasibility of a new smart material that includes self-sensing health monitoring functions similar to that of a nervous system of a living organism. Reviews of current efforts in the fields of heath-monitoring, nanotechnology, micro-electromechanical systems (MEMS), and wireless sensor networks were conducted. Limitations of the current nanotechnology methods were identified and new approaches were proposed to accelerate the development of self-sensing materials. Wireless networks of MEMS sensors have been researched as possible prototypes of self-sensing materials. Sensor networks were also examined as enabling technologies for dense data collection techniques to be used for validation of numerical methods and material parameter identification. Each grain of the envisioned material contains sensors that are connected in a dendritic manner similar to networks of neurons in a nervous system. Each sensor/neuron can communicate with the neighboring grains. Both the state of the sensor (on/off) and the quality of communication signal (speed/amplitude) should indicate not only a presence of a structural defect but the nature of the defect as well. For example, a failed sensor may represent a through-grain crack, while a lost or degraded communication link may represent an inter-granular crack. A technology to create such material does not exist. While recent progress in the fields of MEMS and nanotechnology allows to envision these new smart materials, it is unrealistic to expect creation of self-sensing materials in the near future. The current state of MEMS, nanotechnology, communication, sensor networks, and data processing technologies indicates that it will take more than ten years for the

  13. A Framework for Addressing the Global Obesity Epidemic Locally: The Child Health Ecological Surveillance System (CHESS

    Ronald C. Plotnikoff, PhD

    2008-07-01

    Full Text Available Childhood obesity has reached epidemic levels in the developed world. Recent research and commentary suggest that an ecological approach is required to address childhood obesity, given the multidimensional nature of the problem. We propose a Canadian prototype, the Child Health Ecological Surveillance System, for a regional health authority to address the growing obesity epidemic. This prototype could potentially be used in other jurisdictions to address other child health issues. We present 8 guiding principles for the development and implementation of a regional framework for action.

  14. Obesity, Complexity, and the Role of the Health System

    Frood, Sarah; Johnston, Lee M.; Matteson, Carrie L.; Finegood, Diane T.

    2013-01-01

    As obesity continues to increase throughout the world, there is still no well-defined solution to the issue. Reducing obesity poses a significant challenge for the health care system because it is a complex problem with numerous interconnections and elements. The complexity of obesity challenges traditional primary care practices that have been structured to address simple or less complicated conditions. Systems thinking provides a way forward for clinicians that are discouraged or overwhelme...

  15. Providing Inclusive Sex Education in Schools Will Address the Health Needs of LGBT Youth

    Sanchez, Marisol

    2012-01-01

    Implementation of programs that incorporate and address the health needs of lesbian, gay, bisexual, and transgender (LGBT) youth will help reduce risky behaviors and negative health effects and create safer, more supportive, and more inclusive environments in the nation’s schools.

  16. Addressing social determinants of health inequities through settings: a rapid review.

    Newman, Lareen; Baum, Fran; Javanparast, Sara; O'Rourke, Kerryn; Carlon, Leanne

    2015-09-01

    Changing settings to be more supportive of health and healthy choices is an optimum way to improve population health and health equity. This article uses the World Health Organisation's (1998) (WHO Health Promotion Glossary. WHO Collaborating Centre for Health Promotion, Department of Public Health and Community Medicine, University of Sydney, NSW) definition of settings approaches to health promotion as those focused on modifying settings' structure and nature. A rapid literature review was undertaken in the period June-August 2014, combining a systematically conducted search of two major databases with targeted searches. The review focused on identifying what works in settings approaches to address the social determinants of health inequities, using Fair Foundations: the VicHealth framework for health equity. This depicts the social determinants of health inequities as three layers of influence, and entry points for action to promote health equity. The evidence review identified work in 12 settings (cities; communities and neighbourhoods; educational; healthcare; online; faith-based; sports; workplaces; prisons; and nightlife, green and temporary settings), and work at the socioeconomic, political and cultural context layer of the Fair Foundations framework (governance, legislation, regulation and policy). It located a relatively small amount of evidence that settings themselves are being changed in ways which address the social determinants of health inequities. Rather, many initiatives focus on individual behaviour change within settings. There is considerable potential for health promotion professionals to focus settings work more upstream and so replace or integrate individual approaches with those addressing daily living conditions and higher level structures, and a significant need for programmes to be evaluated for differential equity impacts and published to provide a more solid evidence base. PMID:26420808

  17. Exploring the potential of Web 2.0 to address health disparities.

    Gibbons, M Chris; Fleisher, Linda; Slamon, Rachel E; Bass, Sarah; Kandadai, Venk; Beck, J Robert

    2011-01-01

    This article addresses use of the Internet and Web 2.0 technologies by racial and ethnic minorities and explores the potential opportunities and challenges in leveraging Web 2.0 approaches to impact health disparities. These opportunities and challenges include developing approaches and methods to (a) identify strategies for integrating social media into health promotion interventions focused on major health-related issues that affect members of medically underserved groups; (b) amalgamate techniques to leverage and connect social-media technologies to other evidence-informed online resources; (c) integrate health communication best practices, including addressing health literacy issues; (d) capitalize on social networking to enhance access and communication with health care providers; and (e) advance current efforts and ongoing expansion of research participation by individuals from underserved communities. PMID:21843097

  18. The Mexican experience in monitoring and evaluation of public policies addressing social determinants of health

    Martinez Valle, Adolfo

    2016-01-01

    Monitoring and evaluation (M&E) have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) called for interventions and policies aimed at tackling the social determinants of health (SDH). This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and comp...

  19. Intervention Fidelity for a Complex Behaviour Change Intervention in Community Pharmacy Addressing Cardiovascular Disease Risk

    McNamara, K. P.; O'Reilly, S. L.; George, J.; Peterson, G. M.; Jackson, S. L.; Duncan, G.; Howarth, H.; Dunbar, J. A.

    2015-01-01

    Background: Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists…

  20. Opening address

    The impact of the Chernobyl accident on health has been dramatic but different than expected. It has posed a tremendous health, social and economic burden on the people of Belarus, the Russian Federation and Ukraine. Now the picture of the impact of the accident on health and environment is clearer and the agenda can further move towards development and focused health programmes. The work of the Chernobyl Forum, which allowed this important objective to be reached, is an example of the multiplied added value that different United Nations agencies working together can achieve when addressing complex problems affecting large communities in an independent, comprehensive and credible way. This model should be the basis for future action with the Member States towards reconstruction, development and better health

  1. Visible and Invisible Trends in Black Men's Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health.

    Gilbert, Keon L; Ray, Rashawn; Siddiqi, Arjumand; Shetty, Shivan; Baker, Elizabeth A; Elder, Keith; Griffith, Derek M

    2016-03-18

    Over the past two decades, there has been growing interest in improving black men's health and the health disparities affecting them. Yet, the health of black men consistently ranks lowest across nearly all groups in the United States. Evidence on the health and social causes of morbidity and mortality among black men has been narrowly concentrated on public health problems (e.g., violence, prostate cancer, and HIV/AIDS) and determinants of health (e.g., education and male gender socialization). This limited focus omits age-specific leading causes of death and other social determinants of health, such as discrimination, segregation, access to health care, employment, and income. This review discusses the leading causes of death for black men and the associated risk factors, as well as identifies gaps in the literature and presents a racialized and gendered framework to guide efforts to address the persistent inequities in health affecting black men. PMID:26989830

  2. Sex education for local tourism/hospitality employees: addressing a local health need.

    Bauer, Irmgard L

    2009-11-01

    Health concerns arising from sexual relationships between tourists and locals usually focus on the travelling public. The local sex partners' health, and their impact on their communities' health, seem far less acknowledged. This paper describes a local health education session which implemented recommendations based on a study in Cuzco/Peru on tourists' and locals' views, knowledge, attitudes and experiences relating to sexual relationships between them. On location, fifteen discotheque employees received a health education session at the establishment's owner's request. Concluding from the positive experience, it is argued that researchers should, where possible, respond to requests to deliver ad hoc health education sessions while on location to address an identified local health need. PMID:19945015

  3. Security and Health Research Databases: The Stakeholders and Questions to Be Addressed

    Stewart, Sara

    2006-01-01

    Health research database security issues abound. Issues include subject confidentiality, data ownership, data integrity and data accessibility. There are also various stakeholders in database security. Each of these stakeholders has a different set of concerns and responsibilities when dealing with security issues. There is an obvious need for training in security issues, so that these issues may be addressed and health research will move on without added obstacles based on misunderstanding s...

  4. Corruption of pharmaceutical markets: addressing the misalignment of financial incentives and public health.

    Gagnon, Marc-André

    2013-01-01

    This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives. PMID:24088147

  5. Enhancing readiness of health profession students to address tobacco cessation with patients through online training

    Anne Maynard; Maripat Metcalf; Lyla Hance

    2012-01-01

    Objectives: To evaluate effectiveness of an online training program in preparing health care students to address tobacco use with patients. Methods: The program was evaluated on knowledge, attitude, self-efficacy, intended behavior, and user satisfaction. Participants consisted of 4,180 medical, nursing, dentistry, pharmacy, and other allied health professions students. Multiple choice questions assessed knowledge before and after the educational experience. Likert scales were used for self-r...

  6. Radiation and occupational health: keynote address: the impact of radiation on health

    The part of address discusses the following issue: sources of exposure, effects of ionizing radiations, deterministic effects, stochastic effects, in utero exposure, recommendations of radiation protection: principles, practices, intervention, radiation protection in practices

  7. Addressing Agricultural Issues in Health Care Education: An Occupational Therapy Curriculum Program Description

    Smallfield, Stacy; Anderson, Angela J.

    2008-01-01

    Context: Medical and allied health professionals who work in agricultural states frequently address the needs of clients who live and work in rural and frontier environments. The primary occupations of those living in rural areas include farming, ranching, or other agriculture-related work. Farming is consistently ranked as one of the most…

  8. Health care voluntourism: addressing ethical concerns of undergraduate student participation in global health volunteer work.

    McCall, Daniel; Iltis, Ana S

    2014-12-01

    The popularity and availability of global health experiences has increased, with organizations helping groups plan service trips and companies specializing in "voluntourism," health care professionals volunteering their services through different organizations, and medical students participating in global health electives. Much has been written about global health experiences in resource poor settings, but the literature focuses primarily on the work of health care professionals and medical students. This paper focuses on undergraduate student involvement in short term medical volunteer work in resource poor countries, a practice that has become popular among pre-health professions students. We argue that the participation of undergraduate students in global health experiences raises many of the ethical concerns associated with voluntourism and global health experiences for medical students. Some of these may be exacerbated by or emerge in unique ways when undergraduates volunteer. Guidelines and curricula for medical student engagement in global health experiences have been developed. Guidelines specific to undergraduate involvement in such trips and pre-departure curricula to prepare students should be developed and such training should be required of volunteers. We propose a framework for such guidelines and curricula, argue that universities should be the primary point of delivery even when universities are not organizing the trips, and recommend that curricula should be developed in light of additional data. PMID:25079381

  9. Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

    Mala Rao

    Full Text Available Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE, in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential

  10. Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic

    Fidel C.T. Budy, MPH

    2016-01-01

    Full Text Available Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia.

  11. Lessons from complex interventions to improve health.

    Hawe, Penelope

    2015-03-18

    Complexity-resulting from interactions among many component parts-is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health. PMID:25581153

  12. Fast and Scalable IP Address Lookup with Time Complexity of LogmLogm(n

    Abhishant Prakash

    2014-05-01

    Full Text Available Router is a device which is used to route the incoming data packets from the sender to the destination using the IP address of the destination side. Since the router performs the task in the real time so there are millions and millions of the data packets which the router has to process. The main task in the routing process is to find the corresponding port number for a particular IP address entry stored in the router. Since the router performs the searching task for the millions of incoming data packets an efficient searching algorithm is required to be performed on the routing table. In this paper we proposed an efficient searching algorithm for the routing table of the routers. Various algorithms has been performed in this field with the best time complexity of logm(n of the balanced m way search tree and log2log2(n, we in this paper proposed an efficient searching algorithm with the time complexity of logmlogm(n in the worst case applicable to both the IPV4 and IPV6.

  13. Promoting Health by Addressing Basic Needs: Effect of Problem Resolution on Contacting Health Referrals

    Thompson, Tess; Kreuter, Matthew W.; Boyum, Sonia

    2016-01-01

    Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g., housing). Callers to 2-1-1 in Missouri (N = 1,090) with at least one behavioral…

  14. Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health.

    Paskett, Electra; Thompson, Beti; Ammerman, Alice S; Ortega, Alexander N; Marsteller, Jill; Richardson, DeJuran

    2016-08-01

    Multilevel interventions are those that affect at least two levels of influence-for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice. We discuss how two projects from the National Institutes of Health's Centers for Population Health and Health Disparities used multilevel interventions to reduce health disparities. The interventions, which focused on the uptake of the human papillomavirus vaccine and community-level dietary change, had mixed results. The design and implementation of multilevel interventions are facilitated by input from the community, and more advanced methods and measures are needed to evaluate the impact of the various levels and components of such interventions. PMID:27503968

  15. A Strategic Framework for Utilizing Late-Stage (T4) Translation Research to Address Health Inequities.

    Lopez-Class, Maria; Peprah, Emmanuel; Zhang, Xinzhi; Kaufmann, Peter G; Engelgau, Michael M

    2016-01-01

    Achieving health equity requires that every person has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Inequity experienced by populations of lower socioeconomic status is reflected in differences in health status and mortality rates, as well as in the distribution of disease, disability and illness across these population groups. This article gives an overview of the health inequities literature associated with heart, lung, blood and sleep (HLBS) disorders. We present an ecological framework that provides a theoretical foundation to study late-stage T4 translation research that studies implementation strategies for proven effective interventions to address health inequities. PMID:27440979

  16. Public health at the vicinity of nuclear installations: how to address the raised issues

    This document is proposed by a work-group which gathered the IRSN, public local information commissions and the French Health Survey Institute (InVS). It is designed to be a methodological document on the benefits and limits of health analysis tools with respect to real situations. The first part discusses the implementation of a public health survey, its approach, its modalities and how its results are published. The second part deals with methodological issues for the definition of the specifications of a public health survey, and its protocol. Thus, it discusses how releases in the environment are to be addressed (releases from nuclear installations and from other activities involving radioactivity), the different pathologies to be studied, the existing health data and survey tools (mortality and cancer incidence data, medical-administrative data), and the possible survey types (descriptive or analytical epidemiological surveys) and their limitations

  17. Health Literacy as a Complex Practice

    Judy Hunter

    2012-05-01

    Full Text Available As attention to health literacy grows as an area for policy intervention, policy discourse continues to draw on skills deficit and patient compliance, buttressed by the dominant political discourse of individual responsibility. But for patients, the health domain is interwoven with linguistic challenges, significant affective issues, underlying cultural dimensions, political and economic exigencies, variable access to resources, and cognitive and situated complexity. From these perspectives, this article reports on findings of an ongoing study of health literacy demands in the Midlands region of the North Island of New Zealand, an area of high ethnic and socio-economic diversity. The study focuses on patients with diabetes and cardiovascular disease - two chronic areas strongly associated with ‘failure to care’ and identifed as having reached epidemic proportions. It analyses work to date: health professionals’ conceptions of and responses to perceived patients’ health literacy needs, and health information documents for patients. Implications of the study support the need for improvement in language and literacy skills among patients, but also the recognition of complexity and a collective responsibility for effective health communication.

  18. Addressing Geriatric Oral Health Concerns through National Oral Health Policy in India

    Abhinav Singh

    2015-01-01

    Full Text Available There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world’s elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries

  19. Mapping of Health Communication and Education Strategies Addressing the Public Health Dangers of Illicit Online Pharmacies.

    Anderson, Allison C; Mackey, Tim K; Attaran, Amir; Liang, Bryan A

    2016-04-01

    Illicit online pharmacies are a growing global public health concern. Stakeholders have started to engage in health promotion activities to educate the public, yet their scope and impact has not been examined. We wished to identify health promotion activities focused on consumer awareness regarding the risks of illicit online pharmacies. Organizations engaged on the issue were first identified using a set of engagement criteria. We then reviewed these organizations for health promotion programs, educational components, public service announcements, and social media engagement. Our review identified 13 organizations across a wide spectrum of stakeholders. Of these organizations, 69.2% (n = 9) had at least one type of health promotion activity targeting consumers. Although the vast majority of these organizations were active on Facebook or Twitter, many did not have dedicated content regarding online pharmacies (Facebook: 45.5%, Twitter: 58.3%). An online survey administered to 6 respondents employed by organizations identified in this study found that all organizations had dedicated programs on the issue, but only half had media planning strategies in place to measure the effectiveness of their programs. Overall, our results indicate that though some organizations are actively engaged on the issue, communication and education initiatives have had questionable effectiveness in reaching the public. We note that only a few organizations offered comprehensive and dedicated content to raise awareness on the issue and were effective in social media communications. In response, more robust collaborative efforts between stakeholders are needed to educate and protect the consumer about this public health and patient safety danger. PMID:26846423

  20. Health-related safety: a framework to address barriers to aging in place.

    Lau, Denys T; Scandrett, Karen Glasser; Jarzebowski, Mary; Holman, Kami; Emanuel, Linda

    2007-12-01

    Maintaining safety in the home and community is a national public health concern, especially for older adults who "age in place." In this article, we introduce a multicausal concept called "health-related safety," which is defined as the minimization of the probability of preventable, unintended harm in community-dwelling individuals. Derived from the modern patient safety movement, health-related safety attributes adverse health events in the home and community to systematic breakdowns in the societal system, not to the commission of errors by particular individuals. Extending beyond health care institutions, the health-related safety framework is composed of multiple levels: micro (consumers and providers); mezzo (homes and communities); and macro (policies). Because the societal system is complex with inherent risks, health-related safety will require a culture shift and system redesign, new tools of risk assessments and management, and continuous safety improvement. We propose a research agenda to further refine the health-related safety framework by using empirical evidence and to develop appropriate mathematical and practical models from safety sciences to support this initiative. This article moves the field forward by applying systems thinking and safety sciences to health-related safety in the home and community, thereby paralleling what researchers have begun to do with patient safety in health care systems. PMID:18192636

  1. Evaluating the evidence base: policies and interventions to address socioeconomic status gradients in health.

    Dow, William H; Schoeni, Robert F; Adler, Nancy E; Stewart, Judith

    2010-02-01

    This chapter discusses the current evidence base for policies that could address socioeconomic status (SES) health gradients in the United States. The present volume has documented an enormous amount of research on the linkages between SES and health, but there are still relatively few studies that rigorously establish the effectiveness of particular policies or interventions in reducing those gradients. Given the difficulty in developing randomized evidence for many types of interventions related to social determinants of health, we argue for conducting policy analysis from a Bayesian perspective. This Bayesian approach combines information on best available theory and evidence regarding probable health benefits and costs of an intervention, providing a framework that also incorporates the probable costs of inaction. The second half of the chapter adopts a ladder metaphor to classify policies and interventions that could reduce SES gradients in population health. Using this framework, we consider the evidence base for various types of policies, focusing primarily on the social determinants of health, under the rubric that "all policy is health policy." We conclude by discussing promising strategies for future strengthening of the evidence base for policy, including the role of health impact assessment. PMID:20201876

  2. Swimming upstream: the challenges and rewards of evaluating efforts to address inequities and reduce health disparities.

    Hughes, Dana; Docto, Lindsay; Peters, Jessica; Lamb, Anne Kelsey; Brindis, Claire

    2013-06-01

    Racial and ethnic disparities in the health of Americans are widespread and persistent in the United States despite improvements in the health of Americans overall. Increasingly, strategies for reducing disparities have focused on addressing the factors that contribute to - if not fundamentally underlie - health disparities: social, economic, and environmental inequities, which limit access to resources and cause unhealthy exposures. As public health shifts to interventions that seek to improve the circumstances of disproportionately affected populations and achieve equity through policy change, alternative methods to evaluate these efforts are also required. This paper presents an example of such approaches to addressing asthma disparities through Regional Asthma Management and Prevention's (RAMP) programmatic efforts and an evaluation of these activities. The paper describes RAMP's targets and strategies, as well as the specific evaluation methods applied to each, including activity tracking, observations, surveys, key informant interviews, and case studies. Preliminary evaluation findings are presented, as are lessons learned about the efficacy of the evaluation design features - both its strengths and shortcomings. Findings discussed are intended to contribute to the growing literature that provides evidence for the application of emerging approaches to evaluation that reflect non-traditional public health and support others interested in expanding or replicating this work. PMID:23416287

  3. Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context

    2014-01-01

    Background International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Discussion Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address

  4. Consumer-Involved Participatory Research to Address General Medical Health and Wellness in a Community Mental Health Setting.

    Iyer, Sharat P; Pancake, Laura S; Dandino, Elizabeth S; Wells, Kenneth B

    2015-12-01

    Barriers to sustainably implementing general medical interventions in community mental health (CMH) settings include role uncertainty, consumer engagement, workforce limitations, and sustainable reimbursement. To address these barriers, this project used a community-partnered participatory research framework to create a stakeholder-based general medical and wellness intervention in a large CMH organization, with consumers involved in all decision-making processes. Consumers faced practical barriers to participating in organizational decision making, but their narratives were critical in establishing priorities and ensuring sustainability. Addressing baseline knowledge and readiness of stakeholders and functional challenges to consumer involvement can aid stakeholder-based approaches to implementing general medical interventions in CMH settings. PMID:26174950

  5. Addressing social and gender inequalities in health among seniors in Canada

    Plouffe Louise A.

    2003-01-01

    Full Text Available Although canadian seniors enjoy economic security and good health and have made substantial gains in recent decades, this well-being is not equally shared among socioeconomic groups and between men and women. As for younger age groups, income predicts health status in later life, but less powerfully. Potential alternative explanations include an overriding influence of the aging process, the subjective effects of income loss at retirement and the attenuation of the poverty gap owing to public retirement income. Older women are more likely to age in poverty than men, to live alone and to depend on inadequately resourced chronic health care and social services. These differences will hold as well for the next cohort of seniors in Canada. Addressing these disparities in health requires a comprehensive, multisectoral approach to health that is embodied in Canada's population health model. Application of this model to reduce these disparities is described, drawing upon the key strategies of the population health approach, recent federal government initiatives and actions recommended to the government by federal commissions.

  6. New dialogue for the way forward in maternal health: addressing market inefficiencies.

    McCarthy, Katharine; Ramarao, Saumya; Taboada, Hannah

    2015-06-01

    Despite notable progress in Millennium Development Goal (MDG) five, to reduce maternal deaths three-quarters by 2015, deaths due to treatable conditions during pregnancy and childbirth continue to concentrate in the developing world. Expanding access to three effective and low-cost maternal health drugs can reduce preventable maternal deaths, if available to all women. However, current failures in markets for maternal health drugs limit access to lifesaving medicines among those most in need. In effort to stimulate renewed action planning in the post-MDG era, we present three case examples from other global health initiatives to illustrate how market shaping strategies can scale-up access to essential maternal health drugs. Such strategies include: sharing intelligence among suppliers and users to better approximate and address unmet need for maternal health drugs, introducing innovative financial strategies to catalyze otherwise unattractive markets for drug manufacturers, and employing market segmentation to create a viable and sustainable market. By building on lessons learned from other market shaping interventions and capitalizing on opportunities for renewed action planning and partnership, the maternal health field can utilize market dynamics to better ensure sustainable and equitable distribution of essential maternal health drugs to all women, including the most marginalized. PMID:25467178

  7. Education and Sexuality: Towards Addressing Adolescents’ Reproductive Health Needs in Nigeria

    James Godswill

    2012-07-01

    Full Text Available The aim of this study is to assess the crucial role of sexuality education in addressing adolescents’ reproductive health needs within the backdrops of immense challenges in Nigerian environment. Young people have been well documented as a special need group in the area of reproductive health. Adolescent sexuality and reproductive health are important contemporary concerns especially for reproductive health problems such as early marriage, unintended/unwanted pregnancy, maternal mortality and sexually transmitted diseases, including AIDS. A large number of adolescents in Nigeria decide to be more sexually active without access to preventive measure, such as condoms or family planning devices and thus face undesired consequences, including unwanted pregnancies, Sexually Transmitted Diseases (STDs, including the Acquired Immunodeficiency Syndrome (AIDS and the social consequences of both. In fact, adolescents have a higher prevalence of most reproductive health problems because of lack of information and poor access to service. However, one of the 2004 Nigerian National Population Policy objectives is increasing the integration of adolescents and young people into development efforts and effectively addressing their reproductive health and related needs. The study, which relies mainly on secondary data, examines the crucial role and benefits of sexuality education against the backdrops of the challenges including reaching the youths with sexuality and reproductive information and service, or motivating them to change behavior in the light of new information and awareness, more institutional support and creating the social and economic climate, which will make the desired changes possible and sustainable. The author contends that it is a violation of ones fundamental human rights and freedom guaranteed by numerous international, regional and national policies as well as legal instruments when attempts are made to control rather than educate

  8. Large system change challenges: addressing complex critical issues in linked physical and social domains

    Waddell, Steve; Cornell, Sarah; Hsueh, Joe; Ozer, Ceren; McLachlan, Milla; Birney, Anna

    2015-04-01

    Most action to address contemporary complex challenges, including the urgent issues of global sustainability, occurs piecemeal and without meaningful guidance from leading complex change knowledge and methods. The potential benefit of using such knowledge is greater efficacy of effort and investment. However, this knowledge and its associated tools and methods are under-utilized because understanding about them is low, fragmented between diverse knowledge traditions, and often requires shifts in mindsets and skills from expert-led to participant-based action. We have been engaged in diverse action-oriented research efforts in Large System Change for sustainability. For us, "large" systems can be characterized as large-scale systems - up to global - with many components, of many kinds (physical, biological, institutional, cultural/conceptual), operating at multiple levels, driven by multiple forces, and presenting major challenges for people involved. We see change of such systems as complex challenges, in contrast with simple or complicated problems, or chaotic situations. In other words, issues and sub-systems have unclear boundaries, interact with each other, and are often contradictory; dynamics are non-linear; issues are not "controllable", and "solutions" are "emergent" and often paradoxical. Since choices are opportunity-, power- and value-driven, these social, institutional and cultural factors need to be made explicit in any actionable theory of change. Our emerging network is sharing and building a knowledge base of experience, heuristics, and theories of change from multiple disciplines and practice domains. We will present our views on focal issues for the development of the field of large system change, which include processes of goal-setting and alignment; leverage of systemic transitions and transformation; and the role of choice in influencing critical change processes, when only some sub-systems or levels of the system behave in purposeful ways

  9. Student assistance program: a new approach for student success in addressing behavioral health and life events.

    Veeser, Peggy Ingram; Blakemore, Carol Warren

    2006-01-01

    College health centers, whether large or small, often find it challenging to provide counseling and supportive services for all students (including remotely located students) 24 hours a day, 7 days a week. Student assistance programs (SAPs) are services provided to students through a contractual arrangement to the university or college as a part of student services. The goal is to address psychosocial concerns that may interfere with academic performance within the realm of short-term counseling. These services range from traditional behavioral health concerns about stress and depressive reactions to how to find child care with foreign-speaking services. In this article, the authors describe a method to provide such short-term counseling to a 2,200-student health-science campus. They present data from 1 year of service as well as the benefits and limitations. PMID:16789654

  10. Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities

    Baba, Josifini T; Brolan, Claire E; Hill, Peter S

    2014-01-01

    Background Aboriginal and Torres Strait Islanders persistently experience a significantly lower standard of health in comparison to non-Indigenous Australians. The factors contributing to this disparity are complex and entrenched in a history of social inequality, disempowerment, poverty, dispossession and discrimination. Aboriginal medical services (AMS) provide a culturally appropriate alternative to mainstream medical services as a means to address this health disparity and also advocate f...

  11. Asymptomatic rheumatic heart disease in South African schoolchildren: Implications for addressing chronic health conditions through a school health service.

    Shung-King, Maylene; Zühlke, Liesel; Engel, Mark E; Mayosi, Bongani M

    2016-08-01

    When new evidence comes to light, it compels us to contemplate the implications of such evidence for health policy and practice. This article examines recent research evidence on the prevalence of asymptomatic rheumatic heart disease (RHD) in South Africa and considers the implications for the Integrated School Health Programme (ISHP). RHD is still a major burden of disease in developing countries, and elimination of this preventable condition ranks high among World Heart Federation goals. If left untreated, it becomes a chronic health condition that individuals have to cope with into their adult lives. The ISHP regards the health needs of children with chronic health conditions, which include conditions such as RHD, as a key service component. However, the chronic health component of the ISHP is still poorly developed and can benefit from good evidence to guide implementation. A recent study to ascertain the prevalence of RHD in asymptomatic schoolchildren through mass screening affords an opportunity to reflect on whether, and how, asymptomatic chronic health conditions in schoolchildren could be addressed, and what the implications would be if this were done through a school-based programme such as the ISHP. PMID:27499395

  12. The Exocyst Complex in Health and Disease

    Martin-Urdiroz, Magdalena; Deeks, Michael J.; Horton, Connor G.; Dawe, Helen R.; Jourdain, Isabelle

    2016-01-01

    Exocytosis involves the fusion of intracellular secretory vesicles with the plasma membrane, thereby delivering integral membrane proteins to the cell surface and releasing material into the extracellular space. Importantly, exocytosis also provides a source of lipid moieties for membrane extension. The tethering of the secretory vesicle before docking and fusion with the plasma membrane is mediated by the exocyst complex, an evolutionary conserved octameric complex of proteins. Recent findings indicate that the exocyst complex also takes part in other intra-cellular processes besides secretion. These various functions seem to converge toward defining a direction of membrane growth in a range of systems from fungi to plants and from neurons to cilia. In this review we summarize the current knowledge of exocyst function in cell polarity, signaling and cell-cell communication and discuss implications for plant and animal health and disease.

  13. The first federal budget under Prime Minister Justin Trudeau: Addressing social determinants of health?

    Ruckert, Arne; Labonté, Ronald

    2016-01-01

    A challenging budget environment during the Harper years has meant that crucial investments in the social determinants of health (SDHs) have increasingly been neglected. The tabling of what is widely considered a more progressive budget with expansionary fiscal elements under the new Prime Minister, Justin Trudeau, raises the question as to what extent this budget invests in policy areas that are crucial for achieving a more equitable distribution in the social determinants of health, as promised in the Liberal party platform. In this commentary, we argue that the first Liberal budget represents a step in the right direction, but that this first step needs to be followed up with a sustained commitment to address the pervasive (and unfair) social inequalities that are the root cause of persistent health inequities in Canada. We conclude that the first Trudeau budget, while moving in the right direction, does not fully embody the sustained policy changes needed to effectively address SDHs, including a more expansive role for the federal government in the redistribution of income and wealth. PMID:27526222

  14. The Mexican experience in monitoring and evaluation of public policies addressing social determinants of health.

    Valle, Adolfo Martinez

    2016-01-01

    Monitoring and evaluation (M&E) have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) called for interventions and policies aimed at tackling the social determinants of health (SDH). This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and complete information, which is not regularly available. Prospera, for example, evaluated programs seeking to improve the living conditions of families in extreme poverty in terms of direct effects on health, nutrition, education and income. Monitoring of Prospera's implementation has also helped policy-makers identify windows of opportunity to improve the design and operation of the program. Seguro Popular has monitored the reduction of health inequalities and inequities evaluated the positive effects of providing financial protection to its target population. Useful and sound evidence of the impact of programs such as Progresa and Seguro Popular plus legal mandates, and a regulatory evaluation agency, the National Council for Social Development Policy Evaluation, have been fundamental to institutionalizing M&E in Mexico. The Mexican experience may provide useful lessons for other countries facing the challenge of institutionalizing the M&E of public policy processes to assess the effects of SDH as recommended by the WHO CSDH. PMID:26928215

  15. The Mexican experience in monitoring and evaluation of public policies addressing social determinants of health

    Adolfo Martinez Valle

    2016-02-01

    Full Text Available Monitoring and evaluation (M&E have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO Commission on Social Determinants of Health (CSDH called for interventions and policies aimed at tackling the social determinants of health (SDH. This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and complete information, which is not regularly available. Prospera, for example, evaluated programs seeking to improve the living conditions of families in extreme poverty in terms of direct effects on health, nutrition, education and income. Monitoring of Prospera's implementation has also helped policy-makers identify windows of opportunity to improve the design and operation of the program. Seguro Popular has monitored the reduction of health inequalities and inequities evaluated the positive effects of providing financial protection to its target population. Useful and sound evidence of the impact of programs such as Progresa and Seguro Popular plus legal mandates, and a regulatory evaluation agency, the National Council for Social Development Policy Evaluation, have been fundamental to institutionalizing M&E in Mexico. The Mexican experience may provide useful lessons for other countries facing the challenge of institutionalizing the M&E of public policy processes to assess the effects of SDH as recommended by the WHO CSDH.

  16. Addressing Health Workforce Distribution Concerns: A Discrete Choice Experiment to Develop Rural Retention Strategies in Cameroon

    Paul Jacob Robyn

    2015-03-01

    the analysis of locally relevant, actionable incentives, generated through the involvement of policymakers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health.

  17. How do integrated health care systems address racial and ethnic disparities in colon cancer?

    Rhoads, KF; Patel, MI; Ma, Y.; Schmidt, LA

    2015-01-01

    © 2015 by American Society of Clinical Oncology. Purpose: Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality...

  18. Using community-based participatory research to address Chinese older women's health needs: Toward sustainability.

    Chang, E-Shien; Simon, Melissa A; Dong, XinQi

    2016-01-01

    Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study-a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach. Working with Chinese older women requires trust, respect, and understanding of their unique historical, social, and cultural positions. We also discuss implications for developing impact-driven research partnerships that meet the needs of this vulnerable population. PMID:27310870

  19. Globalisation, complex humanitarian emergencies and health.

    O'Dempsey, T J D; Munslow, B

    2006-01-01

    A new political economy of conflict has emerged in the aftermath of colonialism and the Cold War. Complex political emergencies have been simmering in the post-colonial world for more than three decades. Intra-country armed conflict, often combined with natural disasters, at present contributes to the displacement of over 20 million people world-wide. The international community remains profoundly uncomfortable with the complex political emergencies of the new era, torn between the respect for national sovereignty upon which the international political system of the United Nations and other agencies is built, and the growth of concern with human rights and a burgeoning International Humanitarian Law. Globalisation may have brought many benefits to some but there are also many losers. The Word Bank and the International Monetary Fund imposed structural adjustment policies to ensure debt repayment and economic restructuring that have resulted in a net reduction in expenditure on health, education and development. A downward spiral has been created of debt, disease, malnutrition, missed education, economic entrapment, poverty, powerlessness, marginalization, migration and instability. Africa's complex political emergencies are particularly virulent and tenacious. Three examples that are among the most serious humanitarian emergencies to have faced the world in recent times--those in Angola, the Democratic Republic of Congo and Sudan--are reviewed here in detail. The political evolution of these emergencies and their impact on the health of the affected populations are also explored. PMID:16899151

  20. Comparing the health impacts of different sources of energy. Keynote address

    Assessing health impacts of different energy sources requires synthesis of research results from any different disciplines into a rational framework. Information is often scanty; qualitatively different risks, or energy systems with substantially different end uses, must be put on a common footing. Historically institutional constraints have inhibited agencies from making incisive comparisons necessary for formulating energy policy; this has exacerbated public controversy over appropriate energy sources. Risk assessment methods reviewed include examples drawn from work of the Biomedical and Environmental Assessment Division at Brookhaven National Laboratory and elsewhere. Uncertainty over the mechanism and size of air pollution health damage is addressed through a probabilistic health-damage function, using sulfate-particle exposure as an indicator. This facilitates intercomparison through analysis of each step in the whole fuel cycle between a typical coal and nuclear powerplant. Occupational health impacts, a significant fraction of overall damage, are illustrated by accident trends in coal mining. In broadening comparisons to include new technologies, one must include the impact of manufacturing the energy-producing device as part of an expanded fuel cycle, via input/output methods. Throughout the analysis, uncertainties must be made explicit in the results, including uncertainty of data and uncertainty in choice of appropriate models and methods. No single method of comparative risk assessment is fully satisfactory; each has its limitations. One needs to compare several methods if decision-making is to be realistic

  1. Comparing the health impacts of different sources of energy. Keynote address

    Hamilton, L.D.

    1981-01-01

    Assessing health impacts of different energy sources requires synthesis of research results from any different disciplines into a rational framework. Information is often scanty; qualitatively different risks, or energy systems with substantially different end uses, must be put on a common footing. Historically institutional constraints have inhibited agencies from making incisive comparisons necessary for formulating energy policy; this has exacerbated public controversy over appropriate energy sources. Risk assessment methods reviewed include examples drawn from work of the Biomedical and Environmental Assessment Division at Brookhaven National Laboratory and elsewhere. Uncertainty over the mechanism and size of air pollution health damage is addressed through a probabilistic health-damage function, using sulfate-particle exposure as an indicator. This facilitates intercomparison through analysis of each step in the whole fuel cycle between a typical coal and nuclear powerplant. Occupational health impacts, a significant fraction of overall damage, are illustrated by accident trends in coal mining. In broadening comparisons to include new technologies, one must include the impact of manufacturing the energy-producing device as part of an expanded fuel cycle, via input/output methods. Throughout the analysis, uncertainties must be made explicit in the results, including uncertainty of data and uncertainty in choice of appropriate models and methods. No single method of comparative risk assessment is fully satisfactory; each has its limitations. One needs to compare several methods if decision-making is to be realistic.

  2. Community health workers as cultural producers in addressing gender-based violence in rural South Africa.

    de Lange, Naydene; Mitchell, Claudia

    2016-01-01

    South Africa has been experiencing an epidemic of gender-based violence (GBV) for a long time and in some rural communities health workers, who are trained to care for those infected with HIV, are positioned at the forefront of addressing this problem, often without the necessary support. In this article, we pose the question: How might cultural production through media making with community health workers (CHWs) contribute to taking action to address GBV and contribute to social change in a rural community? This qualitative participatory arts-based study with five female CHWs working from a clinic in a rural district of South Africa is positioned as critical research, using photographs in the production of media posters. We offer a close reading of the data and its production and discuss three data moments: CHWs drawing on insider cultural knowledge; CHWs constructing messages; and CHWs taking action. In our discussion, we take up the issue of cultural production and then offer concluding thoughts on 'beyond engagement' when the researchers leave the community. PMID:27080871

  3. Toolsets Maintain Health of Complex Systems

    2010-01-01

    First featured in Spinoff 2001, Qualtech Systems Inc. (QSI), of Wethersfield, Connecticut, adapted its Testability, Engineering, and Maintenance System (TEAMS) toolset under Small Business Innovation Research (SBIR) contracts from Ames Research Center to strengthen NASA's systems health management approach for its large, complex, and interconnected systems. Today, six NASA field centers utilize the TEAMS toolset, including TEAMS-Designer, TEAMS-RT, TEAMATE, and TEAMS-RDS. TEAMS is also being used on industrial systems that generate power, carry data, refine chemicals, perform medical functions, and produce semiconductor wafers. QSI finds TEAMS can lower costs by decreasing problems requiring service by 30 to 50 percent.

  4. Addressing gaps in abortion education: a sexual health elective created by medical students.

    Caro-Bruce, Emily; Schoenfeld, Elizabeth; Nothnagle, Melissa; Taylor, Julie

    2006-05-01

    Medical school curricula frequently contain gaps in the areas of abortion and sexual health. A group of first- and second-year medical students at the authors' institution organized a collaborative, multidisciplinary elective course to address such omissions in the preclinical curriculum. This paper describes the process of creating and implementing the elective. Medical students identified curricular gaps in the areas of abortion, sexual assault, lesbian/gay/bisexual/transgender health, and HIV counseling. Clinical faculty and community-based professionals were invited to address these topics in a weekly lecture series organized by students. The course also included a half-day experience shadowing at a local abortion clinic. Collaboration with several student groups helped broaden student interest in and increase financial support for the elective. Some 37% of all first- and second-year students enrolled in the elective and received institutional credit for the course. Written and verbal evaluations confirmed student satisfaction with the lectures and the clinical experience. Dynamic and well-prepared speakers who presented interesting medical content received the highest ratings from students. Student leaders identified several challenges in implementing the elective. Ultimately the elective proved to be a successful collaboration among students, faculty, and healthcare providers, and resulted in permanent changes in the standard medical school curriculum. Challenges for student-initiated electives include difficulty in finding administrative support, securing funding and ensuring sustainability. This paper aims to make this process accessible and applicable to other students and faculty interested in addressing curricular gaps at their respective medical schools. PMID:16753723

  5. Preventive interventions addressing underage drinking: state of the evidence and steps toward public health impact.

    Spoth, Richard; Greenberg, Mark; Turrisi, Robert

    2008-04-01

    The epidemiological features of underage drinking and evidence of its social, health, and economic consequences suggest compelling reasons for the development and dissemination of effective preventive interventions. To clarify the nature and extent of the current evidence base on preventive interventions addressing underage drinking, a review of the literature was conducted through extensive searches of the research literature on outcome evaluations, existing reviews of this body of outcome research (N = 25), and summary reports of evidence on specific interventions. More than 400 interventions were identified and screened, and the evidence for 127 was reviewed. Criteria for the evaluation of evidence were established for intervention studies with alcohol-specific outcome measures for 3 developmental periods ( or = 20 years of age). Ultimately, 12 interventions met criteria for "most promising" evidence and 29 met criteria for "mixed or emerging" evidence. Conducting this review revealed clear advances in the number of evidence-based interventions available and the quality of outcome research; however, much work remains to achieve greater public health impact through evidence-based interventions. This work should consider (1) the great need for intervention research related to understudied developmental phases, intervention domains (eg, family, school, community, and media), and populations (eg, early tweens, late teens, young adults not attending college, and nonmajority populations); (2) the critical importance of addressing key issues in research design and methods (eg, limited longitudinal studies, replication studies, and dissemination research); and (3) the need for improved consistency in application of evidence and reporting standards. Finally, we recommend the application of emerging consumer-oriented and community-participatory models for intervention development and research, designed to increase the likelihood of "real-world" public health impact

  6. Complexity and Dynamism from an Urban Health Perspective: a Rationale for a System Dynamics Approach

    Tozan, Yesim; Ompad, Danielle C.

    2015-01-01

    In a variety of urban health frameworks, cities are conceptualized as complex and dynamic yet commonly used epidemiological methods have failed to address this complexity and dynamism head on due to their narrow problem definitions and linear analytical representations. Scholars from a variety of disciplines have also long conceptualized cities as systems, but few have modeled urban health issues as problems within a system. Systems thinking in general and system dynamics in particular are re...

  7. Alternative dispute resolution: methods to address workplace conflict in health services organizations.

    DeSouza, J R

    1998-01-01

    As healthcare organizations become increasingly complex, healthcare administrators and human resource managers face the cost and challenges of employment-related disputes. Litigation and legal costs associated with employment disputes are escalating at a significant rate. Additionally, litigation procedures are drawn out and damage the employer-employee relationship. Alternative dispute resolution (ADR) programs such as mediation and arbitration alleviate the burden of litigation and preserve positive employment relationships between the organization and its employees. A proposed ADR program is presented is a guideline for health services organizations considering the adoption of such programs. PMID:10182933

  8. Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

    Sekandi Juliet

    2011-03-01

    Full Text Available Abstract Background Mulago National Referral Hospital (MNRH, Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. Methods Key informant interviews (n=23 and focus group discussions (n=7 were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. Results Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies, staff inadequacies (knowledge, motivation, and professionalism, overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications. Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism

  9. Developing a Gap Taxonomy to Address Crew Health Risks in NASA's Human Research Program

    Kundrot, Craig E.; Edwards, J. Michelle

    2009-01-01

    The mission of NASA's Human Research Program (HRP) is to understand and reduce the risk to crew health and performance in exploration missions. The HRP addresses 27 specific risks by identifying and then filling gaps in understanding the risks and in the ability to disposition the risks. The primary bases for identifying gaps have been past experience and requirements definition. This approach has been very effective in identifying some important, relevant gaps, but may be inadequate for identifying gaps outside the past experience base. We are exploring the use of a gap taxonomy as a comprehensive, underlying conceptual framework that allows a more systematic identification of gaps. The taxonomy is based on these stages in medical care: prediction, prevention, detection/diagnosis, treatment, monitoring, rehabilitation, and lifetime surveillance. This gap taxonomy approach identifies new gaps in HRP health risks. Many of the new gaps suggest risk reduction approaches that are more cost effective than present approaches. A major benefit of the gap taxonomy approach is to identify new, economical approaches that reduce the likelihood and/or consequence of a risk.

  10. An addressable conducting network for autonomic structural health management of composite structures

    The electrical resistance change method (ERCM) has long been an area of interest as an in-service health monitoring system. To apply the ERCM to existing structures, a new concept, the addressable conducting network (ACN), is proposed for autonomic structural health management of graphite/polymer composites. The ACN consists of two sets of conducting lines normal to each other, where one set resides on the top surface of the laminate and the other on the bottom surface. Damage can be detected by monitoring the resistance change 'through the laminate thickness' between two lines. By using a thermally mendable polymer as the matrix, the same conducting lines can be used to supply the electric current needed for resistive heating, thereby allowing the detected damage to be healed. As shown experimentally, the electrical resistance change method using an ACN distinguishes between laminates made of properly and improperly cured prepreg as well as revealing damage generated during three-point bending tests. Finite element analysis was performed to examine the feasibility of the ACN and indicated that the damage can be easily located from the spatial distribution of resistance changes and that the damaged area can be locally heated by supplying a large amount of current to selected conducting lines

  11. An addressable conducting network for autonomic structural health management of composite structures

    Takahashi, Kosuke; Park, Jong Se; Hahn, H. Thomas

    2010-10-01

    The electrical resistance change method (ERCM) has long been an area of interest as an in-service health monitoring system. To apply the ERCM to existing structures, a new concept, the addressable conducting network (ACN), is proposed for autonomic structural health management of graphite/polymer composites. The ACN consists of two sets of conducting lines normal to each other, where one set resides on the top surface of the laminate and the other on the bottom surface. Damage can be detected by monitoring the resistance change 'through the laminate thickness' between two lines. By using a thermally mendable polymer as the matrix, the same conducting lines can be used to supply the electric current needed for resistive heating, thereby allowing the detected damage to be healed. As shown experimentally, the electrical resistance change method using an ACN distinguishes between laminates made of properly and improperly cured prepreg as well as revealing damage generated during three-point bending tests. Finite element analysis was performed to examine the feasibility of the ACN and indicated that the damage can be easily located from the spatial distribution of resistance changes and that the damaged area can be locally heated by supplying a large amount of current to selected conducting lines.

  12. Paraprofessional Home Visitors' Perspectives on Addressing Poor Mental Health, Substance Abuse, and Domestic Violence: A Qualitative Study

    Tandon, S. Darius; Mercer, Constance D.; Saylor, Elizabeth L.; Duggan, Anne K.

    2008-01-01

    This research was conducted to understand paraprofessional home visitors' perceptions of their training in addressing poor mental health, substance abuse, and domestic violence, and their actions in working with families in addressing these issues. Five focus groups were conducted with a total of 28 paraprofessional home visitors. Three main…

  13. Consensus Statement on Electronic Health Predictive Analytics: A Guiding Framework to Address Challenges

    Amarasingham, Ruben; Audet, Anne-Marie J.; Bates, David W.; Glenn Cohen, I.; Entwistle, Martin; Escobar, G. J.; Liu, Vincent; Etheredge, Lynn; Lo, Bernard; Ohno-Machado, Lucila; Ram, Sudha; Saria, Suchi; Schilling, Lisa M.; Shahi, Anand; Stewart, Walter F.; Steyerberg, Ewout W.; Xie, Bin

    2016-01-01

    Context: The recent explosion in available electronic health record (EHR) data is motivating a rapid expansion of electronic health care predictive analytic (e-HPA) applications, defined as the use of electronic algorithms that forecast clinical events in real time with the intent to improve patient outcomes and reduce costs. There is an urgent need for a systematic framework to guide the development and application of e-HPA to ensure that the field develops in a scientifically sound, ethical, and efficient manner. Objectives: Building upon earlier frameworks of model development and utilization, we identify the emerging opportunities and challenges of e-HPA, propose a framework that enables us to realize these opportunities, address these challenges, and motivate e-HPA stakeholders to both adopt and continuously refine the framework as the applications of e-HPA emerge. Methods: To achieve these objectives, 17 experts with diverse expertise including methodology, ethics, legal, regulation, and health care delivery systems were assembled to identify emerging opportunities and challenges of e-HPA and to propose a framework to guide the development and application of e-HPA. Findings: The framework proposed by the panel includes three key domains where e-HPA differs qualitatively from earlier generations of models and algorithms (Data Barriers, Transparency, and Ethics) and areas where current frameworks are insufficient to address the emerging opportunities and challenges of e-HPA (Regulation and Certification; and Education and Training). The following list of recommendations summarizes the key points of the framework: Data Barriers: Establish mechanisms within the scientific community to support data sharing for predictive model development and testing.Transparency: Set standards around e-HPA validation based on principles of scientific transparency and reproducibility.Ethics: Develop both individual-centered and society-centered risk-benefit approaches to evaluate

  14. To what extent do Australian child and youth health policies address the social determinants of health and health equity?: a document analysis study

    Phillips, Clare; Fisher, Matt; Baum, Fran; MacDougall, Colin; Newman, Lareen; McDermott, Dennis

    2016-01-01

    Background There is a significant body of evidence that highlights the importance of addressing the social determinants of child and youth health. In order to tackle health inequities Australian governments are being called upon to take action in this area at a policy level. Recent research suggests that the health and well-being of children and youth in Australia is ‘middle of the road’ when compared to other OECD countries. To date, there have been no systematic analyses of Australian child...

  15. Risk of Anal Cancer in People Living with HIV: Addressing Anal Health in the HIV Primary Care Setting.

    Walker, Crystal Martin; Likes, Wendy; Bernard, Marye; Kedia, Satish; Tolley, Elizabeth

    2016-01-01

    Anal health and anal cancer are rarely addressed in HIV primary care. We sought to understand factors that impeded or promoted addressing anal health in HIV primary care from providers' perspectives. In this exploratory study, HIV primary care providers from the Mid-South region of the United States participated in brief individual interviews. We analyzed transcribed data to identify barriers and facilitators to addressing anal health. Our study sample included five physicians and four nurse practitioners. The data revealed a number of barriers such as perception of patient embarrassment, provider embarrassment, external issues such as time constraints, demand of other priorities, lack of anal complaints, lack of resources, and gender discordance. Facilitators included awareness, advantageous circumstances, and the patient-provider relationship. Anal health education should be prioritized for HIV primary care providers. Preventive health visits should be considered to mitigate time constraints, demands for other priorities, and unequal gender opportunities. PMID:27080925

  16. DEFINING THE “COMMUNITY” FOR A COMMUNITY-BASED PUBLIC HEALTH INTERVENTION ADDRESSING LATINO IMMIGRANT HEALTH DISPARITIES: AN APPLICATION OF ETHNOGRAPHIC METHODS

    Edberg, Mark; Cleary, Sean; Simmons, Lauren B.; Cubilla-Batista, Idalina; Andrade, Elizabeth L.; Gudger, Glencora

    2015-01-01

    Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance ab...

  17. Complexity and dynamism from an urban health perspective: a rationale for a system dynamics approach.

    Tozan, Yesim; Ompad, Danielle C

    2015-06-01

    In a variety of urban health frameworks, cities are conceptualized as complex and dynamic yet commonly used epidemiological methods have failed to address this complexity and dynamism head on due to their narrow problem definitions and linear analytical representations. Scholars from a variety of disciplines have also long conceptualized cities as systems, but few have modeled urban health issues as problems within a system. Systems thinking in general and system dynamics in particular are relatively new approaches in public health, but ones that hold immense promise as methodologies to model and analyze the complexity underlying urban processes to effectively inform policy actions in dynamic environments. This conceptual essay reviews the utility of applying the concepts, principles, and methods of systems thinking to the study of complex urban health phenomena as a complementary approach to standard epidemiological methods using specific examples and provides recommendations on how to better incorporate systems thinking methods in urban health research and practice. PMID:25952137

  18. Addressing Student Mental Health Needs by Providing Direct and Indirect Services and Building Alliances in the Community

    Kaffenberger, Carol J.; O'Rorke-Trigiani, Judith

    2013-01-01

    Given that 20% of students experience mental health issues that interfere with school performance and most of these students will turn first to their school for help, school counselors need to consider how they can best serve this population. This article describes how school counselors can address the mental health needs of students by providing…

  19. Enhancing readiness of health profession students to address tobacco cessation with patients through online training

    Anne Maynard

    2012-03-01

    Full Text Available Objectives: To evaluate effectiveness of an online training program in preparing health care students to address tobacco use with patients. Methods: The program was evaluated on knowledge, attitude, self-efficacy, intended behavior, and user satisfaction. Participants consisted of 4,180 medical, nursing, dentistry, pharmacy, and other allied health professions students. Multiple choice questions assessed knowledge before and after the educational experience. Likert scales were used for self-reporting of attitude, self-efficacy, and intended behaviors towards tobacco cessation treatments in both a pre-module and post-module survey condition. Likert scores for satisfaction were recorded in a post-module survey. Two sample paired t-tests were used to measure statistical significance. Results: The knowledge increased significantly for all modules across users. Attitude, self-efficacy, and intended behavior scores increased. The Overview course's knowledge score increased from 59to 89(t[sub](649[/sub] = 61.9; p < 0.0001. Mean knowledge scores for all modules combined increased from 51.5to 74.0post-test. Satisfaction with the curriculum was high, with a mean score of 4.6 out of 5. Conclusions: The success of this program is evident by overall satisfaction, and increases in knowledge, self-efficacy, attitudes, and behaviors, as well as the ease with which it was deployed to thousands of students. Results of this study demonstrate that online training in tobacco cessation is an efficient and effective method of teaching students skills in tobacco cessation counseling, and can fill a vital gap in existing curricula.

  20. Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia

    Utomo Budi

    2011-11-01

    Full Text Available Abstract Introduction Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.

  1. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

    Elmusharaf, Khalifa

    2015-09-01

    Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.

  2. Ecosystem services and cooperative fisheries research to address a complex fishery problem

    The St. Louis River represents a complex fishery management problem. Current fishery management goals have to be developed taking into account bi-state commercial, subsistence and recreational fisheries which are valued for different characteristics by a wide range of anglers, as...

  3. ADDRESSING COMPLEX SPATIAL DECISION PROBLEMS IN MOUNTAINOUS AREAS: THE INTELLIGENT SPATIAL DECISION SUPPORT SYSTEMS (SDSS) APPROACH

    Kostas Tolidis; Efi Dimopoulou

    2012-01-01

    This paper discusses the issue of land use planning and land policy making for mountain regions, considered as regions with specific characteristics (natural, cultural, etc.), but also development constraints. Spatial decision making in such regions is characterized by complexity (semi-structured spatial decision problems) and multiplicity of problems. These indicate the need for qualitative information in support of the decision-making process, in order to improve effectiveness in decision m...

  4. Addressing the Complexities of Boundary Work in Sustainability Science through Communication

    Linda Silka; Laura Lindenfeld; Hollie Smith; Karen Hutchins; Bridie McGreavy

    2013-01-01

    Sustainability science seeks to identify and implement workable solutions to complex problems. This transdisciplinary approach advances a commitment to work across boundaries that occur among individuals, disciplines, and institutions to build capacities for informed and innovative decision making in the face of uncertainty and change. The concept of boundary work and related discussions of boundary objects and organizations are important, expanding focal areas within sustainability science. ...

  5. The forgotten D : challenges of addressing forest degradation in complex mosaic landscapes under REDD

    Mertz, O.; Muller, D.; Sikor, T.; Hett, C.; Heinimann, A.; Castella, Jean-Christophe; Lestrelin, Guillaume; Ryan, C. M.; D. S. Reay; Schmidt-Vogt, D.; Danielsen, F.; Theilade, I.; van Noordwijk, M.; L. V. Verchot; Burgess, N.D.

    2012-01-01

    International climate negotiations have stressed the importance of considering emissions from forest degradation under the planned REDD+ (Reducing Emissions from Deforestation and forest Degradation + enhancing forest carbon stocks) mechanism. However, most research, pilot-REDD+ projects and carbon certification agencies have focused on deforestation and there appears to be a gap in knowledge on complex mosaic landscapes containing degraded forests, smallholder agriculture, agroforestry and p...

  6. Addressing the Complexities of Big Data Analytics in Healthcare: The Diabetes Screening Case

    Daswin De Silva

    2015-09-01

    Full Text Available The healthcare industry generates a high throughput of medical, clinical and omics data of varying complexity and features. Clinical decision-support is gaining widespread attention as medical institutions and governing bodies turn towards better management of this data for effective and efficient healthcare delivery and quality assured outcomes. Amass of data across all stages, from disease diagnosis to palliative care, is further indication of the opportunities and challenges to effective data management, analysis, prediction and optimization techniques as parts of knowledge management in clinical environments. Big Data analytics (BDA presents the potential to advance this industry with reforms in clinical decision-support and translational research. However, adoption of big data analytics has been slow due to complexities posed by the nature of healthcare data. The success of these systems is hard to predict, so further research is needed to provide a robust framework to ensure investment in BDA is justified. In this paper we investigate these complexities from the perspective of updated Information Systems (IS participation theory. We present a case study on a large diabetes screening project to integrate, converge and derive expedient insights from such an accumulation of data and make recommendations for a successful BDA implementation grounded in a participatory framework and the specificities of big data in healthcare context.

  7. Mental Health Assessment and Intervention for People with Complex Communication Needs Associated with Developmental Disabilities

    Di Marco, Mark; Iacono, Teresa

    2007-01-01

    This paper addresses the issues of assessment and psychological interventions of mental health in people with complex communication needs of people with intellectual disability and/or cerebral palsy. The literature indicates that research data have been lacking in this area, with a dearth of appropriate assessment tools and information on how to…

  8. Canada: a land of missed opportunity for addressing the social determinants of health.

    Bryant, Toba; Raphael, Dennis; Schrecker, Ted; Labonte, Ronald

    2011-06-01

    The first 25 years of universal public health insurance in Canada saw major reductions in income-related health inequalities related to conditions most amenable to medical treatment. While equity issues related to health care coverage and access remain important, the social determinants of health (SDH) represent the next frontier for reducing health inequalities, a point reinforced by the work of the World Health Organization's Commission on Social Determinants of Health. In this regard, Canada's recent performance suggests a bleak prognosis. Canada's track record since the 1980s in five respects related to social determinants of health: (a) the overall redistributive impact of tax and transfer policies; (b) reduction of family and child poverty; (c) housing policy; (d) early childhood education and care; and (e) urban/metropolitan health policy have reduced Canada's capacity to reduce existing health inequalities. Reasons for this are explored and means of advancing this agenda are outlined. PMID:20888059

  9. Investigating hypoxia in aquatic environments: diverse approaches to addressing a complex phenomenon

    Friedrich, J.; Janssen, F.; Aleynik, D.; Bange, H. W.; Boltacheva, N.; Çagatay, M. N.; Dale, A. W.; Etiope, G.; Erdem, Z.; Geraga, M.; Gilli, A.; Gomoiu, M. T.; Hall, P. O. J.; Hansson, D.; He, Y.; Holtappels, M.; Kirf, M. K.; Kononets, M.; Konovalov, S.; Lichtschlag, A.; Livingstone, D. M.; Marinaro, G.; Mazlumyan, S.; Naeher, S.; North, R. P.; Papatheodorou, G.; Pfannkuche, O.; Prien, R.; Rehder, G.; Schubert, C. J.; Soltwedel, T.; Sommer, S.; Stahl, H.; Stanev, E. V.; Teaca, A.; Tengberg, A.; Waldmann, C.; Wehrli, B.; Wenzhöfer, F.

    2014-02-01

    In this paper we provide an overview of new knowledge on oxygen depletion (hypoxia) and related phenomena in aquatic systems resulting from the EU-FP7 project HYPOX ("In situ monitoring of oxygen depletion in hypoxic ecosystems of coastal and open seas, and landlocked water bodies", http://www.hypox.net). In view of the anticipated oxygen loss in aquatic systems due to eutrophication and climate change, HYPOX was set up to improve capacities to monitor hypoxia as well as to understand its causes and consequences. Temporal dynamics and spatial patterns of hypoxia were analyzed in field studies in various aquatic environments, including the Baltic Sea, the Black Sea, Scottish and Scandinavian fjords, Ionian Sea lagoons and embayments, and Swiss lakes. Examples of episodic and rapid (hours) occurrences of hypoxia, as well as seasonal changes in bottom-water oxygenation in stratified systems, are discussed. Geologically driven hypoxia caused by gas seepage is demonstrated. Using novel technologies, temporal and spatial patterns of water-column oxygenation, from basin-scale seasonal patterns to meter-scale sub-micromolar oxygen distributions, were resolved. Existing multidecadal monitoring data were used to demonstrate the imprint of climate change and eutrophication on long-term oxygen distributions. Organic and inorganic proxies were used to extend investigations on past oxygen conditions to centennial and even longer timescales that cannot be resolved by monitoring. The effects of hypoxia on faunal communities and biogeochemical processes were also addressed in the project. An investigation of benthic fauna is presented as an example of hypoxia-devastated benthic communities that slowly recover upon a reduction in eutrophication in a system where naturally occurring hypoxia overlaps with anthropogenic hypoxia. Biogeochemical investigations reveal that oxygen intrusions have a strong effect on the microbially mediated redox cycling of elements. Observations and

  10. Investigating hypoxia in aquatic environments: diverse approaches to addressing a complex phenomenon

    J. Friedrich

    2013-08-01

    Full Text Available In this paper we synthesize the new knowledge on oxygen and oxygen-related phenomena in aquatic systems, resulting from the EU-FP7 project HYPOX ("In situ monitoring of oxygen depletion in hypoxic ecosystems of coastal and open seas, and land-locked water bodies", www.hypox.net. In view of the anticipated oxygen loss in aquatic systems due to eutrophication and climate change, HYPOX was set up to improve capacities to monitor hypoxia as well as to understand its causes and consequences. Temporal dynamics and spatial patterns of hypoxia were analysed in field studies in various aquatic environments, including the Baltic Sea, the Black Sea, Scottish and Scandinavian fjords, Ionian Sea lagoons and embayments, and in Swiss lakes. Examples of episodic and rapid (hours occurrences of hypoxia as well as seasonal changes in bottom-water oxygenation in stratified systems are discussed. Geologically-driven hypoxia caused by gas seepage is demonstrated. Using novel technologies, temporal and spatial patterns of water-column oxygenation, from basin-scale seasonal patterns to meter-scale submicromolar oxygen distributions were resolved. Existing multi-decadal monitoring data were used to demonstrate the imprint of climate change and eutrophication on long-term oxygen distributions. Organic and inorganic proxies were used to extend investigations on past oxygen conditions to centennial and even longer timescales not resolved by monitoring. The effects of hypoxia on faunal communities and biogeochemical processes were also addressed in the project. An investigation of benthic fauna is presented as an example of hypoxia-devastated benthic communities that slowly recover upon a reduction in eutrophication in a system where natural and anthropogenic hypoxia overlap. Biogeochemical investigations reveal that oxygen intrusions have a strong effect on microbially-mediated redox cycling of elements. Observations and modeling studies of the sediments demonstrate the

  11. Addressing the Complexity of Tourette's Syndrome through the Use of Animal Models

    Nespoli, Ester; Rizzo, Francesca; Boeckers, Tobias M.; Hengerer, Bastian; Ludolph, Andrea G.

    2016-01-01

    Tourette's syndrome (TS) is a neurodevelopmental disorder characterized by fluctuating motor and vocal tics, usually preceded by sensory premonitions, called premonitory urges. Besides tics, the vast majority—up to 90%—of TS patients suffer from psychiatric comorbidities, mainly attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The etiology of TS remains elusive. Genetics is believed to play an important role, but it is clear that other factors contribute to TS, possibly altering brain functioning and architecture during a sensitive phase of neural development. Clinical brain imaging and genetic studies have contributed to elucidate TS pathophysiology and disease mechanisms; however, TS disease etiology still is poorly understood. Findings from genetic studies led to the development of genetic animal models, but they poorly reflect the pathophysiology of TS. Addressing the role of neurotransmission, brain regions, and brain circuits in TS disease pathomechanisms is another focus area for preclinical TS model development. We are now in an interesting moment in time when numerous innovative animal models are continuously brought to the attention of the public. Due to the diverse and largely unknown etiology of TS, there is no single preclinical model featuring all different aspects of TS symptomatology. TS has been dissected into its key symptomst hat have been investigated separately, in line with the Research Domain Criteria concept. The different rationales used to develop the respective animal models are critically reviewed, to discuss the potential of the contribution of animal models to elucidate TS disease mechanisms. PMID:27092043

  12. Addressing the Complexity of Tourette's Syndrome through the Use of Animal Models.

    Nespoli, Ester; Rizzo, Francesca; Boeckers, Tobias M; Hengerer, Bastian; Ludolph, Andrea G

    2016-01-01

    Tourette's syndrome (TS) is a neurodevelopmental disorder characterized by fluctuating motor and vocal tics, usually preceded by sensory premonitions, called premonitory urges. Besides tics, the vast majority-up to 90%-of TS patients suffer from psychiatric comorbidities, mainly attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The etiology of TS remains elusive. Genetics is believed to play an important role, but it is clear that other factors contribute to TS, possibly altering brain functioning and architecture during a sensitive phase of neural development. Clinical brain imaging and genetic studies have contributed to elucidate TS pathophysiology and disease mechanisms; however, TS disease etiology still is poorly understood. Findings from genetic studies led to the development of genetic animal models, but they poorly reflect the pathophysiology of TS. Addressing the role of neurotransmission, brain regions, and brain circuits in TS disease pathomechanisms is another focus area for preclinical TS model development. We are now in an interesting moment in time when numerous innovative animal models are continuously brought to the attention of the public. Due to the diverse and largely unknown etiology of TS, there is no single preclinical model featuring all different aspects of TS symptomatology. TS has been dissected into its key symptomst hat have been investigated separately, in line with the Research Domain Criteria concept. The different rationales used to develop the respective animal models are critically reviewed, to discuss the potential of the contribution of animal models to elucidate TS disease mechanisms. PMID:27092043

  13. Using a complex system approach to address world challenges in Food and Agriculture

    van Mil, H G J; Windhab, E J; Perrot, N; van der Linden, E

    2013-01-01

    World food supply is crucial to the well-being of every human on the planet in the basic sense that we need food to live. It also has a profound impact on the world economy, international trade and global political stability. Furthermore, consumption of certain types and amounts foods can affect health, and the choice of livestock and plants for food production can impact sustainable use of global resources. There are communities where insufficient food causes nutritional deficiencies, and at the same time other communities eating too much food leading to obesity and accompanying diseases. These aspects reflect the utmost importance of agricultural production and conversion of commodities to food products. Moreover, all factors contributing to the food supply are interdependent, and they are an integrative part of the continuously changing, adaptive and interdependent systems in the world around us. The properties of such interdependent systems usually cannot be inferred from the properties of its parts. In a...

  14. Exploring the Utilization of Complex Algal Communities to Address Algal Pond Crash and Increase Annual Biomass Production for Algal Biofuels

    Hamilton, Cyd E. [Dept. of Energy (DOE), Washington DC (United States).

    2014-03-25

    This white paper briefly reviews the research literature exploring complex algal communities as a means of increasing algal biomass production via increased tolerance, resilience, and resistance to a variety of abiotic and biotic perturbations occurring within harvesting timescales. This paper identifies what data are available and whether more research utilizing complex communities is needed to explore the potential of complex algal community stability (CACS) approach as a plausible means to increase biomass yields regardless of ecological context and resulting in decreased algal-based fuel prices by reducing operations costs. By reviewing the literature for what we do and do not know, in terms of CACS methodologies, this report will provide guidance for future research addressing pond crash phenomena.

  15. Vertical leadership in highly complex and unpredictable health systems.

    Till, Alex; Dutta, Nina; McKimm, Judy

    2016-08-01

    This article explores how the concept of vertical leadership development might help health organizations cope with and thrive within highly complex and unpredictable health systems, looking at concepts of VUCA (volatility, uncertainty, complexity and ambiguity) and RUPT (rapid, unpredictable, paradoxical and tangled). PMID:27487058

  16. Gold(I) biscarbene complexes derived from vascular-disrupting combretastatin A-4 address different targets and show antimetastatic potential.

    Muenzner, Julienne K; Biersack, Bernhard; Kalie, Hussein; Andronache, Ion C; Kaps, Leonard; Schuppan, Detlef; Sasse, Florenz; Schobert, Rainer

    2014-06-01

    Gold N-heterocyclic carbene (NHC) complexes are an emerging class of anticancer drugs. We present a series of gold(I) biscarbene complexes with NHC ligands derived from the plant metabolite combretastatin A-4 (CA-4) that retain its vascular-disrupting effect, yet address different cellular and protein targets. Unlike CA-4, these complexes did not interfere with tubulin, but with the actin cytoskeleton of endothelial and cancer cells. For the highly metastatic 518A2 melanoma cell line this effect was accompanied by a marked accumulation of cells in the G1 phase of the cell cycle and a suppression of active prometastatic matrix metalloproteinase-2. Despite these mechanistic differences the complexes were as strongly antivascular as CA-4 both in vitro in tube formation assays with human umbilical vein endothelial cells, and in vivo as to blood vessel disruption in the chorioallantoic membrane of chicken eggs. The antiproliferative effect of the new gold biscarbene complexes in a panel of six human cancer cell lines was impressive, with low sub-micromolar IC50 values (72 h) even against CA-4-refractory HT-29 colon and multidrug-resistant MCF-7 breast carcinoma cells. In preliminary studies with a mouse melanoma xenograft model the complexes led to significant decreases in tumor volume while being very well tolerated. PMID:24648184

  17. Beyond supply and demand: addressing the complexities of workforce exclusion in Australia

    Ian Goodwin-Smith

    2015-09-01

    Full Text Available Workforce exclusion is a complex and enduring problem in Australia, with some groups of job seekers more likely to be disadvantaged in the labour market than others. We identify a dominant ‘work first’ unemployment intervention narrative that ignores the nature of disadvantage and its relationship to workforce exclusion. This narrative reduces unemployment to a simple matter of labour market supply and demand, and privileges immediate economic productivity and exit from welfare payments over sustainable attachment to quality jobs. We examine fourteen programs for disadvantaged job seekers under one national provider network. Data was gathered from eleven semi-structured telephone interviews and eight evaluation reports and analysed using thematic analysis supported by NVivo. Our findings challenge the dominant narrative and stress the importance of a partnership- orientated and capacity building focus on the unemployed person, and the significance of quality employment with long term support. We identify the importance of acknowledging job seekers’ strengths, aspirations and preferences, and of job seekers having agency to determine their own pathways with support from service providers.

  18. Nanotechnology for sustainability: what does nanotechnology offer to address complex sustainability problems?

    Nanotechnology is widely associated with the promise of positively contributing to sustainability. However, this view often focuses on end-of-pipe applications, for instance, for water purification or energy efficiency, and relies on a narrow concept of sustainability. Approaching sustainability problems and solution options from a comprehensive and systemic perspective instead may yield quite different conclusions about the contribution of nanotechnology to sustainability. This study conceptualizes sustainability problems as complex constellations with several potential intervention points and amenable to different solution options. The study presents results from interdisciplinary workshops and literature reviews that appraise the contribution of the selected nanotechnologies to mitigate such problems. The study focuses exemplarily on the urban context to make the appraisals tangible and relevant. The solution potential of nanotechnology is explored not only for well-known urban sustainability problems such as water contamination and energy use but also for less obvious ones such as childhood obesity. Results indicate not only potentials but also limitations of nanotechnology’s contribution to sustainability and can inform anticipatory governance of nanotechnology in general, and in the urban context in particular.

  19. Nanotechnology for sustainability: what does nanotechnology offer to address complex sustainability problems?

    Wiek, Arnim, E-mail: arnim.wiek@asu.edu; Foley, Rider W. [Arizona State University, School of Sustainability (United States); Guston, David H. [Arizona State University, Center for Nanotechnology in Society, Consortium for Science, Policy and Outcomes (United States)

    2012-09-15

    Nanotechnology is widely associated with the promise of positively contributing to sustainability. However, this view often focuses on end-of-pipe applications, for instance, for water purification or energy efficiency, and relies on a narrow concept of sustainability. Approaching sustainability problems and solution options from a comprehensive and systemic perspective instead may yield quite different conclusions about the contribution of nanotechnology to sustainability. This study conceptualizes sustainability problems as complex constellations with several potential intervention points and amenable to different solution options. The study presents results from interdisciplinary workshops and literature reviews that appraise the contribution of the selected nanotechnologies to mitigate such problems. The study focuses exemplarily on the urban context to make the appraisals tangible and relevant. The solution potential of nanotechnology is explored not only for well-known urban sustainability problems such as water contamination and energy use but also for less obvious ones such as childhood obesity. Results indicate not only potentials but also limitations of nanotechnology's contribution to sustainability and can inform anticipatory governance of nanotechnology in general, and in the urban context in particular.

  20. Ten Years of Addressing Children’s Health through Regulatory Policy at the U.S. Environmental Protection Agency

    Payne-Sturges, Devon; Kemp, Debra

    2008-01-01

    Background Executive Order (EO) 13045, Protection of Children From Environmental Health Risks and Safety Risks, directs each federal agency to ensure that its policies, programs, activities, and standards address disproportionate environmental health and safety risks to children. Objectives We reviewed regulatory actions published by U.S. Environmental Protection Agency (EPA) in the Federal Register from April 1998 through December 2006 to evaluate applicability of EO 13045 to U.S. EPA action...

  1. Addressing Health Inequities: Coronary Heart Disease Training within Learning Disabilities Services

    Holly, Deirdre; Sharp, John

    2014-01-01

    People with learning disabilities are at increased risk of coronary heart disease (CHD). Research suggests this may be due to inequalities in health status and inequities in the way health services respond to need. Little is known about the most effective way to improve health outcomes for people with learning disabilities. A previously developed…

  2. Learning from communities in the USA and England to promote equity and address the social determinants of health.

    Blanchard, Claire; Gibbs, Martin; Narle, Ginder; Brookes, Chris

    2013-12-01

    This commentary contextualises and documents the process of a twinning learning exchange between the US Racial and Ethnic Approaches to Community Health initiative and the Communities for Health initiative in England to enable the transfer and adaptation of ideas for similar community-focused initiatives in various contexts globally. The multi-partner twinning exchange built on and shared knowledge around community health promotion interventions, targeting 'marginalised' populations and focused on addressing the social determinants of health to effectively reduce health inequalities. This commentary presents the methodology of the exchange; provides key themes, outcomes and lessons learnt that arose from discussions and the experience; and provides insights, considerations and recommendations for adaptation. Finally, it highlights the importance of such exchanges in the current global context and the need for their replication and adaptation. These experiences contribute to building the evidence base on successful interventions and identifying strategies that work for improving health outcomes and reducing health inequalities. They strengthen the need for all governments to address the social determinants of health as a priority whilst providing insights to inform successful policy. PMID:24722749

  3. Teaching lesbian, gay, bisexual and transgender health in a South African health sciences faculty: addressing the gap

    Müller, Alexandra

    2013-01-01

    Background People who identity as lesbian, gay, bisexual and transgender (LGBT) have specific health needs. Sexual orientation and gender identity are social determinants of health, as homophobia and heteronormativity persist as prejudices in society. LGBT patients often experience discrimination and prejudice in health care settings. While recent South African policies recognise the need for providing LGBT specific health care, no curricula for teaching about LGBT health related issues exist...

  4. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

    Monaghan M

    2016-04-01

    Full Text Available Maureen Monaghan,1,2 Katherine Baumann2 1Center for Translational Science, Children's National Health System, 2George Washington University School of Medicine, Washington, DC, USA Abstract: Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care. However, challenges remain and evidence-based practices for preparing youth for adult health care are still emerging. Qualitative research suggests that adolescent and young adult patients rely on health care providers to guide them through the transition process and appreciate a gradual approach to preparing for adult-oriented health care, keeping parents in supportive roles into young adulthood. Patients also benefit from specific referrals and contact information for adult care providers. Promising models of transition care include provision of transition navigators, attendance at a young adult bridge clinic, or joint visits with pediatric and adult care providers. However, much of this research is in its early stages, and more rigorous trials need to be conducted to evaluate health outcomes during transition into adult health care. The purpose of this review is to provide an overview of the transition process, patient and health care provider perceptions of transition care, and emerging evidence of successful models of care for engagement in adult-oriented health care. Recommendations and resources for health care providers are also presented. Keywords: type 1 diabetes

  5. The Evidence Base for Mental Health Consultation in Early Childhood Settings: Research Synthesis Addressing Staff and Program Outcomes

    Brennan, Eileen M.; Bradley, Jennifer R.; Allen, Mary Dallas; Perry, Deborah F.

    2008-01-01

    Research Findings: One strategy to support early childhood providers' work with children exhibiting challenging behavior is offering mental health consultation services in order to build staff skills and confidence and reduce staff stress and turnover. Through systematic search procedures, 26 recent studies were identified that addressed the…

  6. Time to address gender discrimination and inequality in the health workforce

    Newman, Constance

    2014-01-01

    Gender is a key factor operating in the health workforce. Recent research evidence points to systemic gender discrimination and inequalities in health pre-service and in-service education and employment systems. Human resources for health (HRH) leaders’ and researchers’ lack of concerted attention to these inequalities is striking, given the recognition of other forms of discrimination in international labour rights and employment law discourse. If not acted upon, gender discrimination and in...

  7. Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

    Ruhago George M; Ngalesoni Frida N; Norheim Ole F

    2012-01-01

    Abstract Background Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. Methods We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortal...

  8. CDC Grand Rounds: Addressing Preparedness Challenges for Children in Public Health Emergencies.

    Hinton, Cynthia F; Griese, Stephanie E; Anderson, Michael R; Chernak, Esther; Peacock, Georgina; Thorpe, Phoebe G; Lurie, Nicole

    2015-01-01

    Recent public health emergencies including Hurricane Katrina (2005), the influenza H1N1 pandemic (2009), and the Ebola virus disease outbreak in West Africa (2014–2015) have demonstrated the importance of multiple-level emergency planning and response. An effective response requires integrating coordinated contributions from community-based health care providers, regional health care coalitions, state and local health departments, and federal agency initiatives. This is especially important when planning for the needs of children, who make up 23% of the U.S. population (1) and have unique needs that require unique planning strategies. PMID:26356838

  9. A conceptual framework for addressing complexity and unfolding transition dynamics when developing sustainable adaptation strategies in urban water management

    Farné Fratini, Chiara; Elle, Morten; Jensen, Marina Bergen;

    2012-01-01

    of standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the base of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize...... processes addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research processes aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and......To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a “more sustainable and integrated urban water management...

  10. A Critical Examination and Revisioning of Minority Health Frameworks, Research Methodologies, and Intervention Models Addressing South Asian American Health Disparities

    Mukherjea, Arnab

    2010-01-01

    Public health focuses on promoting health and preventing disease at the population level. More recently, the enterprise of public health in the United States has emphasized the importance of understanding and eliminating disparities in health indicators among racial and ethnic minority populations. Federal surveillance systems often aggregate all ethnic groups originating from Asia into a singular category, despite tremendous diversity of cultural features, demographic characteristics, and ...

  11. Time to address gender discrimination and inequality in the health workforce.

    Newman, Constance

    2014-01-01

    Gender is a key factor operating in the health workforce. Recent research evidence points to systemic gender discrimination and inequalities in health pre-service and in-service education and employment systems. Human resources for health (HRH) leaders' and researchers' lack of concerted attention to these inequalities is striking, given the recognition of other forms of discrimination in international labour rights and employment law discourse. If not acted upon, gender discrimination and inequalities result in systems inefficiencies that impede the development of the robust workforces needed to respond to today's critical health care needs.This commentary makes the case that there is a clear need for sex- and age-disaggregated and qualitative data to more precisely illuminate gender-related trends and dynamics in the health workforce. Because of their importance for measurement, the paper also presents definitions and examples of sex or gender discrimination and offers specific case examples.At a broader level, the commentary argues that gender equality should be an HRH research, leadership, and governance priority, where the aim is to strengthen health pre-service and continuing professional education and employment systems to achieve better health systems outcomes, including better health coverage. Good HRH leadership, governance, and management involve recognizing the diversity of health workforces, acknowledging gender constraints and opportunities, eliminating gender discrimination and equalizing opportunity, making health systems responsive to life course events, and protecting health workers' labour rights at all levels. A number of global, national and institution-level actions are proposed to move the gender equality and HRH agendas forward. PMID:24885565

  12. Barriers to Addressing Adolescent Substance Use: Perceptions of New York School-Based Health Center Providers

    Harris, Brett; Shaw, Benjamin; Lawson, Hal; Sherman, Barry

    2016-01-01

    Background: Adolescent substance use is associated with chronic health conditions, accidents, injury, and school-related problems, including dropping out. Schools have the potential to provide students with substance use prevention and intervention services, albeit with confidentiality challenges. School-based health centers (SBHCs) provide…

  13. "The L Pack": Addressing the Sexual Health Needs of Young Lesbians

    McAlister, Siobhan; Neill, Gail

    2009-01-01

    Concerns about the sexual health of women who identify as other than heterosexual have been highlighted in numerous research reports, yet access to information, advice and services remains limited within Northern Ireland. In response to this, a group of young women have produced a sexual health resource ("The L Pack") specifically for those who…

  14. Addressing individual behaviours and living conditions: Four Nordic public health policies

    Vallgårda, Signild

    : Analyses of recent public health programmes in Denmark, Finland, Norway, and Sweden. Results: Focus is on either, or both, individual behaviour and living conditions as causes of ill health; the remedies are classical liberal as well as social democratic policies. None of the programmes is consistent with...... approach to public health exists. All programmes contain contradictory policies and ideological statements with differences regarding the emphasis on individual behaviour versus choice and living conditions and political responsibility. The policies are not entirely predictable from the political stance of......Aims: To identify characteristics of the public health policies of four Nordic countries concerning how they present the causes of ill health, the best ways to deal with these causes, and where to place responsibility; additionally, to investigate whether there is a common Nordic policy. Methods...

  15. Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico.

    Page-Reeves, Janet; Kaufman, Will; Bleecker, Molly; Norris, Jeffrey; McCalmont, Kate; Ianakieva, Veneta; Ianakieva, Dessislava; Kaufman, Arthur

    2016-01-01

    Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients. PMID:27170801

  16. The role of Violence Against Women Act in addressing intimate partner violence: a public health issue.

    Modi, Monica N; Palmer, Sheallah; Armstrong, Alicia

    2014-03-01

    Intimate partner violence (IPV) is defined as violence committed by a current or former boyfriend or girlfriend, spouse or ex-spouse. Each year, 1.3 to 5.3 million women in the United States experience IPV. The large number of individuals affected, the enormous healthcare costs, and the need for a multidisciplinary approach make IPV an important healthcare issue. The Violence Against Women Act (VAWA) addresses domestic violence, dating violence, sexual assault, and stalking. It emphasizes development of coordinated community care among law enforcement, prosecutors, victim services, and attorneys. VAWA was not reauthorized in 2012 because it lacked bipartisan support. VAWA 2013 contains much needed new provisions for Native Americans; lesbian, gay, bisexual, transgender, gay, and queer (LGBTQ) individuals; and victims of human trafficking but does not address the large amount of intimate partner violence in America's immigrant population. There are important remaining issues regarding intimate partner violence that need to be addressed by future legislation. This review examines the role of legislation and addresses proposals for helping victims of IPV. PMID:24299159

  17. Addressing the "Global Health Tax" and "Wild Cards": Practical Challenges to Building Academic Careers in Global Health.

    Palazuelos, Daniel; Dhillon, Ranu

    2016-01-01

    Among many possible benefits, global health efforts can expand the skills and experience of U.S. clinicians, improve health for communities in need, and generate innovations in care delivery with relevance everywhere. Yet, despite high rates of interest among students and medical trainees to include global health opportunities in their training, there is still no clear understanding of how this interest will translate into viable and sustained global health careers after graduation. Building on a growing conversation about how to support careers in academic global health, this Perspective describes the practical challenges faced by physicians pursuing these careers after they complete training. Writing from their perspective as junior faculty at one U.S. academic health center with a dedicated focus on global health training, the authors describe a number of practical issues they have found to be critical both for their own career development and for the advice they provide their mentees. With a particular emphasis on the financial, personal, professional, and logistical challenges that young "expat" global health physicians in academic institutions face, they underscore the importance of finding ways to support these career paths, and propose possible solutions. Such investments would not only respond to the rational and moral imperatives of global health work and advance the mission of improving human health but also help to fully leverage the potential of what is already an unprecedented movement within academic medicine. PMID:26244256

  18. The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review

    Gray Selena

    2011-11-01

    Full Text Available Abstract Background Spatial planning affects the built environment, which in turn has the potential to have a significant impact on health, for good or ill. One way of ensuring that spatial plans take due account of health is through the inclusion of health considerations in the statutory and non statutory appraisal processes linked to plan-making processes. Methods A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010. Results A total of 6161 citations were identified: 6069 from electronic databases, 57 fromwebsite searches, with a further 35 citations from grey literature, of which 20 met the inclusion criteria. These 20 citations reported on a total of 135 different case studies: 11 UK HIA; 11 non UK high income countries HIA, 5 UK SEA or other integrated appraisal; 108 non UK high income SEA or other integrated appraisal. All studies were in English. No relevant studies were identified reporting on low or middle income countries. The studies were limited by potential bias (no independent evaluation, with those undertaking the appraisal also responsible for reporting outcomes, lack of detail and a lack of triangulation of results. Health impact assessments generally covered the four specified health domains (physical activity, mental health and wellbeing, environmental health issues such as pollution and noise, injury more comprehensively than SEA or other integrated appraisals, although mental health and wellbeing was an underdeveloped area. There was no evidence available on the incorporation of health in Sustainability Appraisal, limited evidence that the recommendations from any type of appraisal were implemented, and almost no evidence that the recommendations had led to the anticipated outcomes or improvements in health postulated. Conclusion Research is needed to assess (i the degree to which statutory plan appraisal processes (SA in the UK

  19. Towards a Unified Theory of Health-Disease: I. Health as a complex model-object

    Naomar Almeida-Filho

    2013-06-01

    Full Text Available Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

  20. Public health agendas addressing violence against rural women - an analysis of local level health services in the State of Rio Grande do Sul, Brazil

    Marta Cocco da Costa

    2015-05-01

    Full Text Available This study analyses health managers' perceptions of local public health agendas addressing violence against rural women in municipalities in the southern part of the State Rio Grande do Sul in Brazil. It consists of an exploratory descriptive study utilizing a qualitative approach. Municipal health managers responsible for planning actions directed at women's health and primary health care were interviewed. The analysis sought to explore elements of programmatic vulnerability related to violence in the interviewees' narratives based on the following dimensions of programmatic vulnerability: expression of commitment, transformation of commitment into action, and planning and coordination. It was found that local health agendas directed at violence against rural women do not exist. Health managers are therefore faced with the challenge of defining lines of action in accordance with the guidelines and principles of the SUS. The repercussions of this situation are expressed in fragile comprehensive services for these women and programmatic vulnerability.

  1. NIH Research Addresses Aging Issues and Disparities in Oral Health | NIH MedlinePlus the Magazine

    ... maintain oral health. The research is evaluating motivational interviewing, counseling, and oral hygiene skills-building to establish which approach(es) is most effective. We are also in active discussions with NIH ...

  2. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

    Monaghan M; Baumann K

    2016-01-01

    Maureen Monaghan,1,2 Katherine Baumann2 1Center for Translational Science, Children's National Health System, 2George Washington University School of Medicine, Washington, DC, USA Abstract: Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in li...

  3. Addressing the American health-care cost crisis: Role of the oncology community

    Ramsey, SD; Ganz, PA; Shankaran, V; Peppercorn, J; Emanuel, E.

    2013-01-01

    Health-care cost growth is unsustainable, and the current level of spending is harming our economy and our patients. This commentary describes the scope of the health-care spending problem and the particular factors in cancer care that contribute to the problem, reflecting in part presentations and discussions from an Institute of Medicine National Cancer Policy Forum Workshop held in October 2012. Presenters at the workshop identified a number of steps that the oncology community can take to...

  4. Assembling GHERG: Could “academic crowd–sourcing” address gaps in global health estimates?

    Rudan, Igor; Campbell, Harry; Marušić, Ana; Sridhar, Devi; Nair, Harish; Adeloye, Davies; Theodoratou, Evropi; Chan, Kit Yee

    2015-01-01

    In recent months, the World Health Organization (WHO), independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER), which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG)’s successful work model, we would like to propose a new initiative – “Global Health Epidemiology Reference Group” (GHERG). We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines – a form of “academic crowd–sourcing”. The main focus of GHERG will be to identify the “gap areas” where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts. PMID:26445671

  5. Assembling GHERG: Could "academic crowd-sourcing" address gaps in global health estimates?

    Rudan, Igor; Campbell, Harry; Marušić, Ana; Sridhar, Devi; Nair, Harish; Adeloye, Davies; Theodoratou, Evropi; Chan, Kit Yee

    2015-06-01

    In recent months, the World Health Organization (WHO), independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER), which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG)'s successful work model, we would like to propose a new initiative - "Global Health Epidemiology Reference Group" (GHERG). We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines - a form of "academic crowd-sourcing". The main focus of GHERG will be to identify the "gap areas" where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts. PMID:26445671

  6. Assembling GHERG: Could “academic crowd–sourcing” address gaps in global health estimates?

    Igor Rudan

    2015-06-01

    Full Text Available In recent months, the World Health Organization (WHO, independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER, which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG’s successful work model, we would like to propose a new initiative – “Global Health Epidemiology Reference Group” (GHERG. We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines – a form of “academic crowd–sourcing”. The main focus of GHERG will be to identify the “gap areas” where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts.

  7. Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India

    Nandi, Sulakshana; Schneider, Helen

    2014-01-01

    The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling prog...

  8. A health-in-all-policies approach addresses many of Richmond, California's place-based hazards, stressors.

    Corburn, Jason; Curl, Shasa; Arredondo, Gabino

    2014-11-01

    Poor and minority residents of Richmond, California, have faced a host of place-based hazards and stressors such as pollution, gun violence, and a dearth of economic opportunities, all of which have likely contributed to their poor health outcomes. In this article we describe the city's efforts to reverse its fortunes by embracing a health-in-all-policies strategy for community development. Starting in 2007, the city organized a series of participatory planning projects with residents, community activists, school officials, and other stakeholders to ensure that the city took health equity into account when devising each phase of its new community development strategy. The result was an approach designed to address the social determinants of health by directing development resources toward vulnerable communities and by adopting a health-in-all-policies ordinance. Specific projects focused on improving the built environment and community safety and redirecting government funds to areas of social need. The process has contributed to rising levels of resident satisfaction about personal health, the direction the city is taking, and the quality of neighborhood development. Richmond's experience suggests that adopting a health-in-all-policies strategy is one way to promote health equity in distressed cities. PMID:25367984

  9. Governors' priorities for public health and chronic disease prevention: a qualitative analysis of State of the State addresses.

    Eyler, Amy A; Zwald, Marissa L

    2015-09-01

    Governors use State of the State speeches to publicly outline state status, progress, and policy priorities. The purpose of this study was to qualitatively analyze the public health content of State of the State addresses from 2009 to 2013. Speech transcripts were collected and uploaded into NVivo10. Speeches were coded using a priori, general thematic codes followed by detailed sub-coding of public health text. Data was organized by emergent thematic patterns. From 2009 to 2013, 48 governors presented 72 speeches with public health messages. Framing current public health problems and outlining strategies were two of the three main themes that emerged. Problems were often framed using data or emphasizing economic costs. Governors outlined prevention strategies on tobacco, nutrition, or physical activity through increased funding, policies, or partnerships. Speech content provides information on priorities and trends and can be used to inform advocacy efforts. Future research should link these priorities to outcomes of legislation. PMID:26327940

  10. The simplicity complex: exploring simplified health messages in a complex world.

    Zarcadoolas, Christina

    2011-09-01

    A challenge in individual and public health at the start of the 21st century is to effectively communicate health and science information about disease and complex emergencies. The low health literacy of millions of adults in the USA has been referred to as a 'silent killer'. A popular approach to improving health communication and health promotion to low health literate consumers has been to simplify the language of health information. The expected result has been that individuals and groups will better understand information and will then make informed decisions about their health and behaviors. This expectation has grown to include the belief that the public will be better prepared to take appropriate action in complex natural and man-made emergencies. Demonstrating the efficacy of this approach remains, in large part, uninvestigated. And it is becoming more evident that health literacy itself is complex and multifaceted. This article applies linguistic and sociolinguistic models in order to better articulate the role of simplification in health communication and health promotion. Focusing on two models from sociolinguistics-pragmatics and text theory-the article discusses their usefulness in rethinking message simplification. The discussion proposes that a richer, more theory-based understanding of text structures and functions, along with other powerful constructs, including cultural appropriateness, relevancy and context, are needed to close the gaps between health messages, health messengers and patients/the public. The article concludes by making recommendations for future study to empirically test the strengths and limitations of these models and constructs. PMID:21149317

  11. A taxonomy characterizing complexity of consumer eHealth Literacy.

    Chan, Connie V; Matthews, Lisa A; Kaufman, David R

    2009-01-01

    There are a range of barriers precluding patients from fully engaging in and benefiting from the spectrum of eHealth interventions developed to support patient access to health information, disease self-management efforts, and patient-provider communication. Consumers with low eHealth literacy skills often stand to gain the greatest benefit from the use of eHealth tools. eHealth skills are comprised of reading/writing/numeracy skills, health literacy, computer literacy, information literacy, media literacy, and scientific literacy [1]. We aim to develop an approach to characterize dimensions of complexity and to reveal knowledge and skill-related barriers to eHealth engagement. We use Bloom's Taxonomy to guide development of an eHealth literacy taxonomy that categorizes and describes each type of literacy by complexity level. Illustrative examples demonstrate the utility of the taxonomy in characterizing dimensions of complexity of eHealth skills used and associated with each step in completing an eHealth task. PMID:20351828

  12. The Role of Public Health in Addressing Racial and Ethnic Disparities in Mental Health and Mental Illness

    Annelle B. Primm, MD, MPH

    2010-01-01

    Full Text Available Racial/ethnic minority populations are underserved in the American mental health care system. Disparity in treatment between whites and African Americans has increased substantially since the 1990s. Racial/ethnic minorities may be disproportionately affected by limited English proficiency, remote geographic settings, stigma, fragmented services, cost, comorbidity of mental illness and chronic diseases, cultural understanding of health care services, and incarceration. We present a model that illustrates how social determinants of health, interventions, and outcomes interact to affect mental health and mental illness. Public health approaches to these concerns include preventive strategies and federal agency collaborations that optimize the resilience of racial/ethnic minorities. We recommend strategies such as enhanced surveillance, research, evidence-based practice, and public policies that set standards for tracking and reducing disparities.

  13. A responsive evaluation of mental health treatment in Cambodia: Intentionally addressing poverty to increase cultural responsiveness in therapy.

    Seponski, Desiree M; Lewis, Denise C; Megginson, Maegan C

    2014-01-01

    Mental health issues are significant contributors to the global burden of disease with the highest incidence in resource poor countries; 90% of those in need of mental health treatment reside in low resource countries but receive only 10% of the world's resources. Cambodia, the eighth least developed country in the world, serves as one example of the need to address mental health concerns in low-income, resource poor countries. The current study utilises responsive evaluation methodology to explore how poverty-stricken Cambodian clients, therapists and supervisors experience Western models of therapy as culturally responsive to their unique needs. Quantitative and qualitative data were triangulated across multiple stakeholders using numerous methods including a focus group, interviews, surveys, case illustrations and live supervision observation and analysed using constant comparative analysis. Emerging findings suggest that poverty, material needs, therapy location and financial situations greatly impact the daily lives and mental health conditions of Cambodians and hinder clients' therapeutic progress. The local community needs and context of poverty greatly hinder clients' therapeutic progress in therapy treatment and when therapy does not directly address the culture of poverty, clients did not experience therapy as valuable despite some temporary decreases in mental health symptoms. PMID:25204750

  14. Building diversity in a complex academic health center.

    South-Paul, Jeannette E; Roth, Loren; Davis, Paula K; Chen, Terence; Roman, Anna; Murrell, Audrey; Pettigrew, Chenits; Castleberry-Singleton, Candi; Schuman, Joel

    2013-09-01

    For 30 years, the many diversity-related health sciences programs targeting the University of Pittsburgh undergraduate campus, school of medicine, schools of the health sciences, clinical practice plan, and medical center were run independently and remained separate within the academic health center (AHC). This lack of coordination hampered their overall effectiveness in promoting diversity and inclusion. In 2007, a group of faculty and administrators from the university and the medical center recognized the need to improve institutional diversity and to better address local health disparities. In this article, the authors describe the process of linking the efforts of these institutions in a way that would be successful locally and applicable to other academic environments. First, they engaged an independent consultant to conduct a study of the AHC's diversity climate, interviewing current and former faculty and trainees to define the problem and identify areas for improvement. Next, they created the Physician Inclusion Council to address the findings of this study and to coordinate future efforts with institutional leaders. Finally, they formed four working committees to address (1) communications and outreach, (2) cultural competency, (3) recruitment, and (4) mentoring and retention. These committees oversaw the strategic development and implementation of all diversity and inclusion efforts. Together these steps led to structural changes within the AHC and the improved allocation of resources that have positioned the University of Pittsburgh to achieve not only diversity but also inclusion and to continue to address the health disparities in the Pittsburgh community. PMID:23886998

  15. Strengthening Indonesia's Field Epidemiology Training Programme to address International Health Regulations requirements

    I Nyoman Kandun

    2010-03-01

    Full Text Available PROBLEM: According to the International Health Regulations (IHR, countries need to strengthen core capacity for disease surveillance and response systems. Many countries are establishing or enhancing their field epidemiology training programmes (FETPs to meet human resource needs but face challenges in sustainability and training quality. Indonesia is facing these challenges, which include limited resources for field training and limited coordination in a newly decentralized health system. APPROACH: A national FETP workplan was developed based on an evaluation of the existing programme and projected human resource needs. A Ministry of Health Secretariat linking universities, national and international partners was established to oversee revision and implementation of the FETP. LOCAL SETTING: The FETP is integrated into the curriculum of Indonesian universities and field training is conducted in district and provincial health offices under the coordination of the universities and the FETP Secretariat. RELEVANT CHANGES: The FETP was included in the Ministry of Health workforce development strategy through governmental decree. Curricula have been enhanced and field placements strengthened to provide trainees with better learning experiences. To improve sustainability of the FETP, links were established with the Indonesian Epidemiologists' Association, local governments and donors to cultivate future FETP champions and maintain funding. Courses, competitions and discussion forums were established for field supervisors and alumni. These changes have increased the geographic distribution of students, intersectoral and international participation and the quality of student performance. LESSONS LEARNT: The main lesson learnt is that linkages with universities, ministries and international agencies such as the World Health Organization are critical for building a sustainable high-quality programme. The most critical factors were development of trusting

  16. Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

    Ruhago George M

    2012-12-01

    Full Text Available Abstract Background Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. Methods We used the Lives Saved Tool (LiST to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. Results In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of −0.11 (maternal and −0.12 (children to a more equitable concentration index of −0,03 and −0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Conclusions Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.

  17. Antecedents and Consequences of Consumer's Response to Health Information Complexity

    Hansen, Torben; Uth Thomsen, Thyra; Beckmann, Suzanne C.

    2013-01-01

    This study develops and empirically tests a model for understanding food consumers' health information seeking behaviour. Data were collected from 504 food consumers using a nationally representative consumer panel. The obtained Lisrel results suggest that consumers' product-specific health...... information seeking is positively affected by general food involvement and by usability of product-specific health information. Moreover, product-specific health information seeking and product-specific health information complexity are both positively related to post-purchase health-related dissonance. This...... link between information complexity and post-purchase dissonance has implications for marketers of food products since our results suggest that consumers might avoid purchasing the same food item again if post-purchase dissonance is experienced....

  18. An Intersectoral Response to Children with Complex Health Care Needs

    Young, Wendy; Earle, Jasmin; Dadebo, Mark

    2004-01-01

    The purpose of this paper is to stimulate debate on how to define and enact public responsibility to children with complex health care needs and their families. We present a program, developed using the Auditor General's framework for accountability that involves Community Care Access Centres, schools and Saint Elizabeth Health Care, a complex…

  19. Computer mediated communication and disability support: addressing barriers to study for undergraduate distance learners with long-term health problems

    Debenham, Margaret

    1990-01-01

    This work explores barriers to study encountered by undergraduate distance learners with long-term health problems. It considers ways in which problems identified in an Exploratory Study might be addressed. These include fatigue, difficulties with handwriting, academic and social isolation, together with a need for better interactive communication with support agencies. The student perspective is explored in depth. The essential finding is that the adoption of an Autonomy approach when using ...

  20. Climate Change and Health on the U.S. Gulf Coast: Public Health Adaptation is Needed to Address Future Risks

    Elisaveta P. Petkova

    2015-08-01

    Full Text Available The impacts of climate change on human health have been documented globally and in the United States. Numerous studies project greater morbidity and mortality as a result of extreme weather events and other climate-sensitive hazards. Public health impacts on the U.S. Gulf Coast may be severe as the region is expected to experience increases in extreme temperatures, sea level rise, and possibly fewer but more intense hurricanes. Through myriad pathways, climate change is likely to make the Gulf Coast less hospitable and more dangerous for its residents, and may prompt substantial migration from and into the region. Public health impacts may be further exacerbated by the concentration of people and infrastructure, as well as the region’s coastal geography. Vulnerable populations, including the very young, elderly, and socioeconomically disadvantaged may face particularly high threats to their health and well-being. This paper provides an overview of potential public health impacts of climate variability and change on the Gulf Coast, with a focus on the region’s unique vulnerabilities, and outlines recommendations for improving the region’s ability to minimize the impacts of climate-sensitive hazards. Public health adaptation aimed at improving individual, public health system, and infrastructure resilience is urgently needed to meet the challenges climate change may pose to the Gulf Coast in the coming decades.

  1. Addressing Health Disparities in the Undergraduate Curriculum: An Approach to Develop a Knowledgeable Biomedical Workforce

    Benabentos, Rocio; Ray, Payal; Kumar, Deepak

    2014-01-01

    Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health…

  2. Keep Calm and Contracept! Addressing Young Women's Pleasure in Sexual Health and Contraception Consultations

    Hanbury, Ali; Eastham, Rachael

    2016-01-01

    Clinical sexual health consultations with young women often focus on avoiding "risks;" namely pregnancy and sexually transmitted infection transmission. They also typically fail to explore how contraception use can impact on the capacity to enjoy sexual relationships. In contrast, this paper argues that sexual pleasure should be a…

  3. Identifying and Addressing the Mental Health Needs of Online Students in Higher Education

    Barr, Bonny

    2014-01-01

    89% of colleges and universities in the United States offer online courses and of those institutions 58% offer degree programs that are completely online (Parker, Lenhart & Moore, 2011).Providing online student services is an important component of these distance programs and is often required by accrediting bodies. Health and wellness…

  4. Emotional Congruence in Learning and Health Encounters in Medicine: Addressing an Aspect of the Hidden Curriculum

    O'Callaghan, Anne

    2013-01-01

    This paper aims to draw attention to and provide insights into an area that is of educational significance for clinical teachers, namely the need to acknowledge and respond appropriately to the emotional context of both learning and health encounters in order to improve the outcomes of both. This need has been highlighted by recent calls for more…

  5. Addressing Younger Workers’ Needs: The Promoting U through Safety and Health (PUSH Trial Outcomes

    Diane S. Rohlman

    2016-08-01

    Full Text Available Most younger workers, less than 25 years old, receive no training in worker safety. We report the feasibility and outcomes of a randomized controlled trial of an electronically delivered safety and health curriculum for younger workers entitled, PUSH (Promoting U through Safety and Health. All younger workers (14–24 years old hired for summer work at a large parks and recreation organization were invited to participate in an evaluation of an online training and randomized into an intervention or control condition. Baseline and end-of-summer online instruments assessed acceptability, knowledge, and self-reported attitudes and behaviors. One-hundred and forty participants (mean age 17.9 years completed the study. The innovative training was feasible and acceptable to participants and the organization. Durable increases in safety and health knowledge were achieved by intervention workers (p < 0.001, effect size (Cohen’s d 0.4. However, self-reported safety and health attitudes did not improve with this one-time training. These results indicate the potential utility of online training for younger workers and underscore the limitations of a single training interaction to change behaviors. Interventions may need to be delivered over a longer period of time and/or include environmental components to effectively alter behavior.

  6. Life Before Tests: A District's Coordinated Health Approach for Addressing Children's Full Range of Needs

    Cooper, Patrick

    2005-01-01

    Chronic illnesses, depression, abuse of drugs, alcohol and tobacco. Sugary snacks and drinks, vending machines, obesity and bullying. Guns, gang violence, school shootings and test scores. Teen-age birth rates, one-parent households, lack of health or dental care, and, dropouts. All of these issues are interconnected and intertwined with education…

  7. Ethnographic methods for process evaluations of complex health behaviour interventions

    Morgan-Trimmer, Sarah; Wood, Fiona

    2016-01-01

    This article outlines the contribution that ethnography could make to process evaluations for trials of complex health-behaviour interventions. Process evaluations are increasingly used to examine how health-behaviour interventions operate to produce outcomes and often employ qualitative methods to do this. Ethnography shares commonalities with the qualitative methods currently used in health-behaviour evaluations but has a distinctive approach over and above these methods. It is an overlooke...

  8. Addressing the Sexual and Reproductive Health Needs of Young People in Ethiopia: An Analysis of the Current Situation.

    Muntean, Nigina; Kereta, Worknesh; Mitchell, Kirstin R

    2015-09-01

    Young people in Ethiopia face a number of risks to their sexual and reproductive health, including adolescent pregnancy, sexual violence, and unmet need for family planning. This study explores the extent to which current service provision addresses the SRH needs of young Ethiopians . Methods included a comprehensive review of the academic and policy literature on young people's SRH and service provision in Ethiopia; and 14 semi-structured Key Informant Interviews. Factors affecting utilization of sexual and reproductive services by young people include: limited SRH knowledge, lack of open discussion of sexual matters, low status of women, cultural and logistical barriers, competing priorities among community health professionals, limited resources for health facilities, and negative attitudes of providers towards unmarried youth. While the antenatal needs of young married women are somewhat addressed, gaps exist in terms of services for unmarried youth, young men, rural youth and vulnerable groups. The national policy platform has created an enabling environment for addressing youth SRH needs but challenges to implementing these policies still persist. The way forward requires a focus on reducing barriers to utilization of services, and attention to underserved groups. It also requires resource mobilization, strong leadership and effective coordination between stakeholders and donors. PMID:26897917

  9. How Effective Is Peer Education in Addressing Young People's Sexual and Reproductive Health Needs in Developing Countries?

    Price, Neil; Knibbs, Sarah

    2009-01-01

    This review article questions the assumptions at the core of peer education interventions adopted in young people's sexual and reproductive health programmes in developing countries. Peer education is a more complex and problematic approach than its popularity with development agencies and practitioners implies. Its rise to prominence is more…

  10. [Proposal to address the mental health problems detected after the February 27, 2010 earthquake].

    Figueroa, Rodrigo A; Cortés, Paula F

    2016-02-01

    One of the most important topics mentioned by people from places affected by the February 27th, 2010 earthquake to the Presidential Delegation for the Reconstruction, was the urgent need of mental health care. Given the enormous individual and social burden of mental health sequelae after disasters, its treatment becomes a critical issue. In this article, we propose several actions to be implemented in Chile in the context of the process of recovery and reconstruction, including optimization of social communication and media response to disasters; designing and deployment of a national strategy for volunteer service; training of primary care staff in screening and initial management of post-traumatic stress reactions; and training, continuous education and clinical supervision of a critical number of therapists in evidence-based therapies for conditions specifically related to stress. PMID:27092680

  11. Five Topics Health Care Simulation Can Address to Improve Patient Safety

    Sollid, Stephen J M; Dieckmann, Peter; Aase, Karina;

    2016-01-01

    OBJECTIVES: There is little knowledge about which elements of health care simulation are most effective in improving patient safety. When empirical evidence is lacking, a consensus statement can help define priorities in, for example, education and research. A consensus process was therefore......-day consensus meeting at the Utstein Abbey in Norway. The goals of stage 4 were to agree on the top 5 topics in health care simulation that contribute the most to patient safety, identify the patient safety problems they relate to, and suggest solutions with implementation strategies for these...... problems. RESULTS: The expert group agreed on the following topics: technical skills, nontechnical skills, system probing, assessment, and effectiveness. For each topic, 5 patient safety problems were suggested that each topic might contribute to solve. Solutions to these problems and implementation...

  12. A Proposed Legal Framework for Addressing Privacy for Patient Controlled Health Records in Pediatrics

    Bourgeois, Fabienne; Taylor, Patrick; Mandl, Kenneth

    2006-01-01

    Summary Patient controlled health records (PCHRs) provide widespread and flexible access to integrated medical information. Unique legal challenges arise where the patient is a minor. Variations in laws and statutes concerning minor’s rights to privacy and confidentiality, and institutions’ local interpretations of them, need to be integrated in the principles governing PCHRs. We propose a legal framework to guide the development of access policies for PCHRs to ensure appropriate privacy and confidentiality protection surrounding minors. PMID:17238481

  13. The Role of Translational Research in Addressing Health Disparities: a Conceptual Framework

    Fleming, Erik S.; Perkins, James; Easa, David; Conde, Jose G.; Richard S. Baker; Southerland, William M.; Dottin, Robert; Benabe, Julio E.; Ofili, Elizabeth O.; Bond, Vincent C; McClure, Shelia A.; Sayre, Michael H.; Beanan, Maureen J.; Norris, Keith C.

    2008-01-01

    Translational research has tremendous potential as a tool to reduce health disparities in the United States, but a lack of common understanding about the scope of this dynamic, multidisciplinary approach to research has limited its use. The term “translational research” is often associated with the phrase “bench to bedside,” but the expedited movement of biomedical advances from the laboratory to clinical trials is only the first phase of the translational process. The second phase of transla...

  14. Evaluating Health Risks from Inhaled Polychlorinated Biphenyls: Research Needs for Addressing Uncertainty

    Lehmann, Geniece M.; Christensen, Krista; Maddaloni, Mark; Phillips, Linda J.

    2014-01-01

    Background: Indoor air concentrations of polychlorinated biphenyls (PCBs) in some buildings are one or more orders of magnitude higher than background levels. In response to this, efforts have been made to assess the potential health risk posed by inhaled PCBs. These efforts are hindered by uncertainties related to the characterization and assessment of source, exposure, and exposure-response. Objectives: We briefly describe some common sources of PCBs in indoor air and estimate the contribut...

  15. Motherhood in childhood: addressing reproductive health hazards among adolescent married women in India

    Patra, Shraboni

    2016-01-01

    Background In India, due to the high prevalence of child marriage, most adolescent pregnancies occur within marriage. Pregnancy and childbirth complications are among the leading causes of death in girls aged 15 to 19 years. Hence, adolescent pregnancy is a serious health threat to young women in India. Methods The study focuses on the level and trends of adolescent pregnancy rate (per thousand currently married adolescent women) in India in the last two decades, based on cross-sectional data...

  16. A Framework to Address Challenges in Communicating the Developmental Origins of Health and Disease.

    Winett, Liana; Wallack, Lawrence; Richardson, Dawn; Boone-Heinonen, Janne; Messer, Lynne

    2016-09-01

    Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts "upstream" to sufficiently combat the fundamental causes of disease. To translate these findings into improved public health, however, the distance between scientific discovery and population application will need to be bridged by conversations across a breadth of disciplines and social roles. And importantly, those involved will likely begin without a shared vocabulary or conceptual starting point. The purpose of this paper is to support and inform the translation of DOHaD findings from the bench to population-level health promotion and disease prevention, by: (1) discussing the unique communication challenges inherent to translation of DOHaD for broad audiences, (2) introducing the First-hit/Second-hit Framework with an epidemiologic planning matrix as a model for conceptualizing and structuring communication around DOHaD, and (3) discussing the ways in which patterns of communicating DOHaD findings can expand the range of solutions considered and encourage discussion of population-level solutions in relation to one another, rather than in isolation. PMID:27449924

  17. Addressing the socioeconomic determinants of adolescent health: experiences from the WHO/HBSC Forum 2007

    Koller, Theadora; Morgan, Antony; Guerreiro, Ana; Currie, Candace; Ziglio, Erio; Due, Pernille

    translation of research into action, the Forum series focuses on increasing know-how to scale up intersectoral policies and interventions; reduce health inequities; and involve young people in the design, implementation and evaluation of policies and interventions. Interviews with selected participants in the...... ensure systematic, appropriate and meaningful youth involvement; maximization of the usefulness of the European consultation; and definition of a budget line and framework for evaluation of the process' impact at country level....

  18. Iron deficiency anemia among children: Addressing a global public health problem within a Canadian context

    Christofides, Anna; Schauer, Claudia; Zlotkin, Stanley H.

    2005-01-01

    Despite current Canadian pre- and perinatal nutrition programs, the prevalence of both iron deficiency and iron deficiency anemia (IDA) is very high among young Aboriginal children from Canada’s remote north. The major risk factors for IDA include prolonged consumption of evaporated cow’s milk, chronic infection and prolonged exclusive breastfeeding. In the present article, the authors discuss IDA as a significant public health problem in Canadian Aboriginal communities. Whereas the prevalenc...

  19. Cluster randomized controlled trial protocol: addressing reproductive coercion in health settings (ARCHES)

    Tancredi, Daniel J.; Silverman, Jay G.; Michele R Decker; McCauley, Heather L.; Anderson, Heather A.; Jones, Kelley A.; Ciaravino, Samantha; Hicks, Angela; Raible, Claire; Zelazny, Sarah; James, Lisa; Miller, Elizabeth

    2015-01-01

    Background Women ages 16–29 utilizing family planning clinics for medical services experience higher rates of intimate partner violence (IPV) and reproductive coercion (RC) than their same-age peers, increasing risk for unintended pregnancy and related poor reproductive health outcomes. Brief interventions integrated into routine family planning care have shown promise in reducing risk for RC, but longer-term intervention effects on partner violence victimization, RC, and unintended pregnancy...

  20. Challenges faced by multidisplinary new investigators on addressing grand challenges in global health

    Logie, Carmen; Dimaras, Helen; Fortin, Anny; Ramón-García, Santiago

    2014-01-01

    Background The grand challenges approach aims to spark innovative and transformative strategies to overcome barriers to significant global health issues. Grand Challenges Canada endorses an ‘Integrated Innovation™’ approach that focuses on the intersection of scientific/technological, social and business innovation. In this article we explore themes emerging from a dialogue between the authors, who are multidisciplinary recipients of the ‘Rising Stars in Global Health’ award from Grand Challe...

  1. Addressing Younger Workers' Needs: The Promoting U through Safety and Health (PUSH) Trial Outcomes.

    Rohlman, Diane S; Parish, Megan; Elliot, Diane L; Hanson, Ginger; Perrin, Nancy

    2016-01-01

    Most younger workers, less than 25 years old, receive no training in worker safety. We report the feasibility and outcomes of a randomized controlled trial of an electronically delivered safety and health curriculum for younger workers entitled, PUSH (Promoting U through Safety and Health). All younger workers (14-24 years old) hired for summer work at a large parks and recreation organization were invited to participate in an evaluation of an online training and randomized into an intervention or control condition. Baseline and end-of-summer online instruments assessed acceptability, knowledge, and self-reported attitudes and behaviors. One-hundred and forty participants (mean age 17.9 years) completed the study. The innovative training was feasible and acceptable to participants and the organization. Durable increases in safety and health knowledge were achieved by intervention workers (p change behaviors. Interventions may need to be delivered over a longer period of time and/or include environmental components to effectively alter behavior. PMID:27517968

  2. Addressing underutilization of consumer health information resource centers: a formative study*

    Kennedy, May G.; Kiken, Laura; Shipman, Jean P.

    2008-01-01

    Problem: Four consumer health information centers in Richmond, Virginia, provide one-on-one assistance in accessing health information. Because they may not be fully utilized at present, an exploratory marketing study of factors affecting usage of the centers was conducted. Method: Observers counted center passers-by and tracked their paths. Also, brief intercept interviews were conducted with people who had just used a center, people nearby who could have used one but did not, and people on the street. Finally, in-depth individual interviews were conducted with key informants. Results: There was a high degree of satisfaction with the centers among users. Nonusers universally endorsed the center concept. However, most passers-by did not even glance at the centers, and intercept interviewees suggested better signage and promoting the resource centers through various media channels. Key informants added suggestions about interpersonal strategies (e.g., physician referrals) for center usage promotion but cautioned that a large increase in traffic could not be accommodated without increasing staff size or shifting from a model of individualized service. Conclusions: Triangulating findings from multiple data collection methods can provide useful guidance for efforts to promote center utilization. At minimum, steps should be taken to make the largest centers more noticeable. Because center utilization is not only associated with consumer satisfaction with hospitals, but may also foster health literacy, both hospital-based and community-based usage promotion strategies may be warranted. All such promotional strategies should be audience-tested before they are adopted. PMID:18219380

  3. World Health Considerations in Airborne Pollution with Special Reference to Radioactive Wastes (Opening Address)

    The World Health Organization is concerned with the promotion of health and human well-being throughout the world. For this reason, it is as closely concerned with the problem of pollution as it is with other better defined problems such as malaria, plague, influenza, cancer, mental illness, and all other killing and debilitating diseases of man. At this meeting we are concerned specifically with the cleaning of airborne radioactive waste and the operation and developmental experience acquired from the management of these wastes in the past. We can view the present and future with reasonable confidence, and this is justifiable since the experience of the past 20 years has been reassuring. Despite many residual uncertainties we probably know a great deal more of the risks of radiation exposure than we do of almost any other actual or potential atmospheric contaminants. The World Health Organization is also concerned with this problem, but I wish to emphasize that the question of radioactive waste is only part, and maybe a very small part, of the problem of pollution as a whole. Indeed, it is probably unwise, except in very exceptional circumstances, to treat and view radioactive waste, either airborne or waterborne, as a single series of contaminants posing a single problem in their own right

  4. Health and environmental effects of complex chemical mixtures: proceedings

    1985-01-01

    The Office of Health and Environmental Research (OHER) of the Department of Energy supports a broad long-term research program on human health and environmental effects from potential exposure to energy-related complex chemical mixtures. The program seeks basic mechanistic data on the effects of complex mixtures at the cellular, molecular, and whole animal levels to aid in predicting human health effects and seeks ecological data on biological and physical transformations in the mixtures, concentrations of the mixtures in various compartments of the environment, and potential routes for human exposure to these mixtures (e.g., food chain). On June 17-18, 1985, OHER held its First Annual Technical Meeting on the Complex Chemical Mixtures Program in Chicago, IL. The primary purpose of the meeting was to enable principal investigators to report the research status and accomplishments of ongoing complex chemical mixture studies supported by OHER. To help focus future research directions round table discussions were conducted.

  5. An innovative electronic health records system for rare and complex diseases

    Faria-Campos, Alessandra C; Hanke, Lucas A; Batista, Paulo HS; Garcia, Vinicius; Campos, Sérgio VA

    2015-01-01

    Background There exists a large number of rare and complex diseases that are neglected due to the difficulty in diagnosis and treatment. Being rare, they normally do not justify the costs of developing an especialized Electronic Health Record (EHR) system to assist doctors and patients of these diseases. In this work we propose the use of Computer applications known as Laboratory Information Management Systems (LIMS) to address this issue. Results In this work we describe a fully customizable...

  6. Constructing Pragmatic Socioeconomic Status Assessment Tools to Address Health Equality Challenges

    Tajik, Parvin; Majdzadeh, Reza

    2014-01-01

    Background: A key challenge for equality evaluation and monitoring, mainly in developing countries, is assessing socioeconomic status (SES) of individuals. This difficulty along with low technical competency, have resulted in many health information collected in these countries which are devoid of suitable SES indices. However, simplifying data collection requirements for estimating economic parameters seems to guarantee their wide adoption by survey and health information system (HIS) designers, resulting in immediate production of equity-oriented policy-relevant information. The goal of this study is obtaining adequate number of variables, which their combination can provide a valid assessment of SES in Iranian population. Methods: The data source was Living Standards Measurement Study of Iran (2006). Data of 27,000 households on the ownership of 33 household assets was used for this analysis. Households of this study were divided into 5 groups in terms of SES status using principle component analysis. Then selection was made among the 33 variables so that a combination with minimum necessary number for obtaining SES status is reached. Agreement of the new combination (including minimum number of variables) with full variable combination (including all 33 variables) was assessed using weighted kappa. Results: A minimum set of six variables including having kitchen, bathroom, vacuum cleaner, washing machine, freezer and personal computer could successfully discriminate SES of the population. Comparing this 6 item-index with the whole 33 item-index revealed that 65% of households were in the same quintiles, with a weighted kappa statistics of 0.76. For households in different quintiles, movement was generally limited to one quintile, with just 2% of households moving two or more quintiles. Conclusions: The proposed simple index is completely applicable in current Iran's society. It can be used in different survey and studies. The development is quite simple and can

  7. Keynote address at the Fifth Congress of the International Association for Adolescent Health.

    Ransome-Kuti, O

    1992-07-01

    This Nigerian Ministry of Health speech reiterates the importance of focusing on the problems of youth and adolescents which was 1st identified in 1989 at a World Health Assembly. Every stage of the life cycle is important because mental, physical, psychological, and social scars are carried into the future. It is important to make the transition to adulthood as smooth as possible. Of the 30% (1.5 billion) of the World's population that are adolescents 10-24 years old, 80% live in developing countries. 50% of the world population is 25 years. In the preparation for adulthood, age-old customs, culture, and tradition have ensured the stability and survival of societies, but great changes have taken place due to colonialism, modern education, urban migration, rapid travel an communication, tourism, and trade. There is weakening of traditional marriage. Foreign cultural influence has armed youths to challenge community cultural norms and parental authority to direct their development. There is social tension, disruption, an instability. Adults as role models have sometimes failed to represent integrity and honesty. There is a need for sensitive support and guidance from adults. Peer pressure operates for both good or ill. Some will react to this stress to conform in unhealthy ways. The health care system may not fill adolescent needs because they are too old for the pediatrician and too young for the physician. Girls are particularly vulnerable to the problems of premarital pregnancy, induced abortion, out-of-wedlock births, and sexually transmitted diseases. The pressure is to grow up fast, particularly in polygamous societies where the woman has security only in her children. Opportunities for dialogue degenerate into sessions of being "talked at" and forced compliance. Unemployment is very high which can lead to loss of self-esteem, psychological stress, and hopelessness and sometimes street fighting, thuggery, drug pushing, and armed robbery. Attempts worldwide are

  8. Constructing pragmatic socioeconomic status assessment tools to address health equality challenges

    Parvin Tajik

    2014-01-01

    Full Text Available Background: A key challenge for equality evaluation and monitoring, mainly in developing countries, is assessing socioeconomic status (SES of individuals. This difficulty along with low technical competency, have resulted in many health information collected in these countries which are devoid of suitable SES indices. However, simplifying data collection requirements for estimating economic parameters seems to guarantee their wide adoption by survey and health information system (HIS designers, resulting in immediate production of equity-oriented policy-relevant information. The goal of this study is obtaining adequate number of variables, which their combination can provide a valid assessment of SES in Iranian population. Methods: The data source was Living Standards Measurement Study of Iran (2006. Data of 27,000 households on the ownership of 33 household assets was used for this analysis. Households of this study were divided into 5 groups in terms of SES status using principle component analysis. Then selection was made among the 33 variables so that a combination with minimum necessary number for obtaining SES status is reached. Agreement of the new combination (including minimum number of variables with full variable combination (including all 33 variables was assessed using weighted kappa. Results: A minimum set of six variables including having kitchen, bathroom, vacuum cleaner, washing machine, freezer and personal computer could successfully discriminate SES of the population. Comparing this 6 item-index with the whole 33 item-index revealed that 65% of households were in the same quintiles, with a weighted kappa statistics of 0.76. For households in different quintiles, movement was generally limited to one quintile, with just 2% of households moving two or more quintiles. Conclusions: The proposed simple index is completely applicable in current Iran′s society. It can be used in different survey and studies. The development is

  9. Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure

    Moan, Johan; Porojnicu, Alina Carmen; Dahlback, Arne; Setlow, Richard B.

    2008-01-01

    Solar radiation is the main cause of skin cancers. However, it also is a main source of vitamin D for humans. Because the optimal status of vitamin D protects against internal cancers and a number of other diseases, a controversy exists: Will increased sun exposure lead to net health benefits or risks? We calculated the relative yield of vitamin D photosynthesis as a function of latitude with a radiative transfer model and cylinder geometry for the human skin surface. The annual yield of vita...

  10. Health care policies addressing transgender inmates in prison systems in the United States.

    Brown, George R; McDuffie, Everett

    2009-10-01

    Inmates with gender identity disorders (GID) pose special challenges to policy makers in U.S. prison systems. Transgender persons are likely overrepresented in prisons; a reasonable estimate is that at least 750 transgender prisoners were in custody in 2007. Using the Freedom of Information Act, requests were mailed to each state, the District of Columbia, and the Federal Bureau of Prisons in 2007. The requests were for copies of policies, directives, memos, or other documents concerning placement and health care access of transgender inmates. By April 2008, 46 responses were received; 6 states did not reply. Information was qualitatively analyzed and summarized. There was substantial disparity in transgender health care for inmates with GID or related conditions. Most systems allowed for diagnostic evaluations. There was wide variability in access to cross-sex hormones, with some allowing for continuation of treatment and others allowing for both continuation and de novo initiation of treatment. There was uniformity in denial of surgical treatments for GID. PMID:19635927

  11. Challenges in researching violence affecting health service delivery in complex security environments.

    Foghammar, Ludvig; Jang, Suyoun; Kyzy, Gulzhan Asylbek; Weiss, Nerina; Sullivan, Katherine A; Gibson-Fall, Fawzia; Irwin, Rachel

    2016-08-01

    Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research

  12. Sports Complexes, Located during MicroData field address collection 2004-2006. Kept in Spillman database for retrieval., Published in 2004, Vilas County Land Information/Mapping.

    NSGIC GIS Inventory (aka Ramona) — This Sports Complexes dataset, was produced all or in part from Field Observation information as of 2004. It is described as 'Located during MicroData field address...

  13. Addressing the human resource for health crisis in Tanzania: the lost in transition syndrome.

    Sirili, Nathanael; Kiwara, Angwara; Nyongole, Obadia; Frumence, Gasto; Semakafu, Avemaria; Hurtig, Anna-Karin

    2014-04-01

    Tanzania is experiencing a serious Human Resource for Health (HRH) crisis. Shortages are 87.5% and 67% in private and public hospitals, respectively. Mal-distribution and brain drain compound the shortage. The objective of this study was to improve knowledge on the HRH status in Tanzania by analyzing what happens to the number of medical doctors (MD) and doctor of dental surgery (DDS) degree graduates during the transition period from graduation, internship to appointment. We analyzed secondary data to get the number of MDs and DDS; who graduated from 2001 to 2010, the number registered for internship from 2005 to 2010 and the number allowed for recruitment by government permits from 2006 to 2010. Self administered questionnaires were provided to 91 MDs and DDS who were pursuing postgraduate studies at Muhimbili University of Health and Allied Sciences during this study who went through the graduation-internship-appointment (GIA) period to get the insight of the challenges surrounding the MDs and DDS during the GIA period. From 2001 to 2010 a total of 2,248 medical doctors and 198 dental surgeons graduated from five local training institutions and abroad. From 2005 to 2010 a total of 1691 (97.13%) and 186 (126.53%) of all graduates in MD and DDS, respectively, registered for internship. The 2007/2008 recruitment permit allowed only 37.7% (80/218) and 25.0% (7/27) of the MDs and DDS graduated in 2006, respectively. The 2009/20 10 recruitment permit allowed 265 MDs (85.48%) out of 310 graduates of 2008. In 2010/2011 permission for MDs was 57.58% (190/ 330) of graduates of 2009 and in 2011/2012 permission for MDs was for 61.03% ((249/408) graduates of 2010. From this analysis the recruitment permits in 2007/2008, 2009/2010, 2010/2011 1nd 2011/2012 could not offer permission for employment of 482 (38.10%) of all MDs graduated in the subsequent years. Major challenges associated with the GIA period included place of accommodation, allowance (for internship) or salary

  14. Addressing health inequalities in the delivery of the human papillomavirus vaccination programme: examining the role of the school nurse.

    Tammy Boyce

    increase uptake and address health inequalities in childhood and adolescent vaccination programmes.

  15. User-Centric eHealth Tool to Address the Psychosocial Effects of Sickle Cell Disease.

    Issom, David-Zacharie; Hartvigsen, Gunnar; Bonacina, Stefano; Koch, Sabine; Lovis, Christian

    2016-01-01

    Sickle cell disease (SCD) is the most prevalent blood inherited disorder in the world. Patients suffer from several chronic issues, comorbidities and high-mortality rates. Despite its prevalence, the disease remains largely ignored. A literature review was conducted and a questionnaire was sent to patients in order to understand the potential of e-health tools to support people with SCD. Additionally, focus groups have been conducted to detail respondents' answers. The results showed that patients felt isolated and misunderstood. They also highlighted patients' wishes for a social network able to make them feel less scattered. Using participatory-design techniques, we designed a prototype of user-centric interface for an online self-supportive SCD patient community. The mock-ups include chatrooms, forums and videoconferences capabilities. They illustrate how SCD patients' social networking and caregivers-patient relationship needs could be met. Future work will focus on the implementation and evaluation of the system. PMID:27332283

  16. Facilitative governance: transforming global health through complexity theory.

    Haffeld, Just

    2012-01-01

    Any initiative to coordinate actions, plans, or initiatives to improve the interaction between global health stakeholders finds itself feeding into a vastly complex global system. By utilising complexity theory as part of a new scientific paradigm, complex adaptive behaviour can emerge to create coherence. A suggested global health convention facilitating incremental regime development could be a way to create good governance processes. Minimum specifications could provide wide space for innovation and encourage shared action. Such specifications would be both a product of, and a facilitator for, future generative relationships. The potential empowerment of individuals as a result of this has the potential to transform global health by creating an arena for continual cooperation, interaction and mutual dependence among global stakeholders. PMID:22248181

  17. Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India.

    Nandi, Sulakshana; Schneider, Helen

    2014-09-01

    The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling programmatic and organizational factors. A qualitative comparative case study of successful action by Mitanin was conducted in two 'blocks', purposefully selected as positive exemplars in two districts of Chhattisgarh. One case focused on malnutrition and the other on gender-based violence. Data collection involved 17 in-depth interviews and 10 group interviews with the full range of stakeholders in both blocks, including community members and programme team. Thematic analysis was done using a broad conceptual framework that was further refined. Action on social determinants involved raising awareness on rights, mobilizing women's collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The factors underpinning successful action on social determinants were identified as the significance of the original intent and vision of the programme, and how this was carried through into all aspects of programme design, the role of the Mitanins and their identification with village women, ongoing training and support, and the relative autonomy of the programme. Although the results are not narrowly generalizable and do not necessarily represent the situation of the Mitanin Programme as a whole, the

  18. Critical complexity in environmental health practice: simplify and complexify

    Keune Hans

    2012-01-01

    Abstract The magic word ‘complexity’ has been buzzing around in science, policy and society for quite some time now. There seems to be a common feel for a ‘new way’ of doing things, for overcoming the limits of tradition. From the combined perspective of critical complexity thinking and environment and health practice we want to contribute to the development of alternative routines that may help overcome the limitations of traditional environment and health science. On the one hand traditiona...

  19. Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development.

    Aboud, Frances E; Singla, Daisy R; Nahil, Md Imam; Borisova, Ivelina

    2013-11-01

    A stratified cluster design was used to evaluate a 10-month parenting program delivered to mothers of children in rural Bangladesh. Intervention mothers through a combination of group meetings and home visits received messages along with an illustrative card concerning hygiene, responsive feeding, play, communication, gentle discipline, and nutritious foods. Control mothers received the standard government care. Three months prior, 463 children between 4 and 14 months in a subdistrict of western Bangladesh were administered the cognitive, receptive language and expressive language Bayley III subtests, their length was taken and past week illness recorded. Gross motor milestones were reported by the mother and verified through observation. Mothers were interviewed concerning their practices: preventive health practices, dietary diversity, home stimulation, and knowledge about development milestones. Maternal depressive symptoms were assessed as a measure of emotional availability. Family sociodemographic variables included maternal education, family assets, decision-making and mobility autonomy. One month after the end of the program, mothers and their children were again assessed. Comparisons were made between intervention and control children who were under-12 months vs. 12 months and older at the start of the program. This may be a critical age, when children begin to be upright and mobile enough to explore on their own and be less dependent on parenting stimulation. Analyses yielded strong intervention effects on the three Bayley subtests and on parenting practices related to stimulation and knowledge of development milestones. Age effects were found only for dietary diversity in that younger children in the program benefited more than older ones. However, all children became more stunted. Findings are discussed in terms of theories of behaviour change and parenting, critical ages for parenting programs, and implications for program delivery. PMID:23871435

  20. The role of in-depth reproductive health counseling in addressing reproductive health concerns in female survivors of nongynecologic cancers.

    Shah, M S; Letourneau, J M; Niemasik, E E; Bleil, M; McCulloch, Charles E; Rosen, M P

    2016-01-01

    The purpose of this study was to characterize reproductive concerns among female cancer survivors and determine the role of targeted counseling in improving overall reproductive quality of life (QOL). A survey was administered to women from the California Cancer Registry, ages 18-40, with nongynecologic cancers diagnosed from 1993 to 2007, who received fertility-compromising treatments. In total, 356 women completed the survey, which included questions regarding their reproductive health counseling history and the reproductive concerns scale (RCS), a validated reproductive QOL tool. Factors independently associated with higher RCS scores included a desire for children at the time of diagnosis, posttreatment infertility, treatment with chemoradiation or bone marrow transplant, and income less than $100,000 per year at diagnosis. Among the highest reported reproductive concerns were those related to loss of control over one's reproductive future and concerns about the effect of illness on one's future fertility. Across our population and independent of age, in-depth reproductive health counseling prior to cancer treatment was associated with significantly lower RCS scores. Our findings highlight the importance of early counseling and targeting high-risk groups for additional counseling after completion of cancer treatment. This approach may be an effective strategy for optimizing long-term reproductive QOL in this vulnerable population. PMID:27144587

  1. Using community-based participatory research to address Chinese older women’s health needs: Toward sustainability

    Chang, E-Shien; Simon, Melissa A.; Dong, XinQi

    2016-01-01

    ABSTRACT Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study—a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach. Working with Chinese older women requires trust, respect, and understanding of their unique historical, social, and cultural positions. We also discuss implications for developing impact-driven research partnerships that meet the needs of this vulnerable population. PMID:27310870

  2. Integrated Strategies to Address Maternal and Child Health and Survival in Low-Income Settings: Implications for Haiti.

    Bhutta, Zulfiqar A

    2016-01-01

    The Millennium Development Goals for improving maternal and child health globally were agreed on in 2000, and several monitoring and evaluation strategies were put in place, including "Countdown to 2015" for monitoring progress and intervention coverage to reach the goals. However, progress in achieving the goals has been slow, with only 13 of the 75 participating Countdown countries on track to reach the targets for reducing child mortality.An overview of child mortality rates in low-income countries is presented, followed by a discussion of evidenced-based interventions that can bridge the equity gaps in global health. Finally, comments are included on the companion article in this issue, "Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care" (page 59), and what is needed for that new project to succeed. PMID:27065474

  3. [The dimension of the paradigm of complexity in health systems].

    Fajardo-Ortiz, Guillermo; Fernández-Ortega, Miguel Ángel; Ortiz-Montalvo, Armando; Olivares-Santos, Roberto Antonio

    2015-01-01

    This article presents elements to better understand health systems from the complety paradigm, innovative perspective that offers other ways in the conception of the scientific knowledge prevalent away from linear, characterized by the arise of emerging dissociative and behaviors, based on the intra and trans-disciplinarity concepts such knowledges explain and understand in a different way what happens in the health systems with a view to efficiency and effectiveness. The complexity paradigm means another way of conceptualizing the knowledge, is different from the prevalent epistemology, is still under construction does not separate, not isolated, is not reductionist, or fixed, does not solve the problems, but gives other bases to know them and study them, is a different strategy, a perspective that has basis in the systems theory, informatics and cybernetics beyond traditional knowledge, the positive logics, the newtonian physics and symmetric mathematics, in which everything is centered and balanced, joint the "soft sciences and hard sciences", it has present the Social Determinants of Health and organizational culture. Under the complexity paradigm the health systems are identified with the following concepts: entropy, neguentropy, the thermodynamic second law, attractors, chaos theory, fractals, selfmanagement and self-organization, emerging behaviors, percolation, uncertainty, networks and robusteness; such expressions open new possibilities to improve the management and better understanding of the health systems, giving rise to consider health systems as complex adaptive systems. PMID:25982615

  4. Health monitoring display system for a complex plant

    Ridolfo, Charles F.; Harmon, Daryl L.; Colin, Dreyfuss

    2006-08-08

    A single page enterprise wide level display provides a comprehensive readily understood representation of the overall health status of a complex plant. Color coded failure domains allow rapid intuitive recognition of component failure status. A three-tier hierarchy of displays provide details on the health status of the components and systems displayed on the enterprise wide level display in a manner that supports a logical drill down to the health status of sub-components on Tier 1 to expected faults of the sub-components on Tier 2 to specific information relative to expected sub-component failures on Tier 3.

  5. A mismatch between population health literacy and the complexity of health information

    Rowlands, Gillian; Protheroe, Joanne; Winkley, John;

    2015-01-01

    BACKGROUND: Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health. AIM: To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population...... skills in relation to these. DESIGN AND SETTING: An English observational study comparing health materials with national working-age population skills. METHOD: Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified....... The proportion of the population above and below these thresholds, and the sociodemographic variables associated with a greater risk of being below the thresholds, were described. RESULTS: Sixty-four health materials were sampled. Two competency thresholds were identified: text (literacy) only, and text...

  6. Evaluating the Science of Discovery in Complex Health Systems

    Norman, Cameron D.; Best, Allan; Mortimer, Sharon; Huerta, Timothy; Buchan, Alison

    2011-01-01

    Complex health problems such as chronic disease or pandemics require knowledge that transcends disciplinary boundaries to generate solutions. Such transdisciplinary discovery requires researchers to work and collaborate across boundaries, combining elements of basic and applied science. At the same time, calls for more interdisciplinary health…

  7. Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV

    Avni Amin

    2015-12-01

    Full Text Available Introduction: Globally, women constitute 50% of all persons living with HIV. Gender inequalities are a key driver of women's vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV. Discussion: There are several pathways by which gender inequalities shape the sexual and reproductive health and wellbeing of women living with HIV. First, gender norms that privilege men's control over women and violence against women inhibit women's ability to practice safer sex, make reproductive decisions based on their own fertility preferences and disclose their HIV status. Second, women's lack of property and inheritance rights and limited access to formal employment makes them disproportionately vulnerable to food insecurity and its consequences. This includes compromising their adherence to antiretroviral therapy and increasing their vulnerability to transactional sex. Third, with respect to stigma and discrimination, women are more likely to be blamed for bringing HIV into the family, as they are often tested before men. In several settings, healthcare providers violate the reproductive rights of women living with HIV in relation to family planning and in denying them care. Lastly, a number of countries have laws that criminalize HIV transmission, which specifically impact women living with HIV who may be reluctant to disclose because of fears of violence and other negative consequences. Conclusions: Addressing gender inequalities is central to improving the sexual and reproductive health outcomes and more broadly the wellbeing of women living with HIV. Programmes that go beyond a narrow biomedical/clinical approach and address the social and structural context of women's lives can also maximize the benefits of HIV prevention, treatment, care and support.

  8. Complexity Science: New Emerging Approach for Health Professionals

    N Keshavarz

    2005-10-01

    Full Text Available Complexity science is about complex adaptive systems (CAS and provides important concepts and tools for responding to challenge of health care in 21st century and as Holland describes, it is the science of 21st century. In this presentation, I will discuss some of the potential advantages of applying complexity science in my research in school health promotion. Complexity science originates from systems thinking and has been applied in biology, behaviour science, management, business, computer science and mathematics, physics and more recently, in health care. There are few reports about application of this theory in health but they look promising or at least challenging. A CAS is a collection of autonomous, interactive, and adaptive agents that act freely in diverse ways, which are unpredictable and, non-linear but interconnected. It is an ever-changing system, typically with fuzzy boundaries, built of multi-layer nested systems. The evolution of one system influences and influenced by that of other systems. Organisms such as human beings and organizations like health care organizations are good examples of these systems having Variation and non-linear pattern of cause and effect, interactions and change as concepts of CAS. One of the key benefits of the complex adaptive system approach is that it helps you see yourself in the context of a population of agents and helps you see your actions in the context of a population of strategies. In designing my research, I am able to choose from among a range of strategies, otherwise called research methods. I selected semi-structured interviews, participant observation and document analysis. I am interviewing, I meet and interact with teachers who are autonomous agents who make choices what strategies in a context of departmental and school policies described in documents.

  9. Critical complexity in environmental health practice: simplify and complexify.

    Keune, Hans

    2012-01-01

    The magic word 'complexity' has been buzzing around in science, policy and society for quite some time now. There seems to be a common feel for a 'new way' of doing things, for overcoming the limits of tradition. From the combined perspective of critical complexity thinking and environment and health practice we want to contribute to the development of alternative routines that may help overcome the limitations of traditional environment and health science. On the one hand traditional environment and health science is too self-confident with respect to potential scientific insight in environment and health problems: complexity condemns us to limited and ambiguous knowledge and the need for simplification. A more modest attitude would be more realistic from that point of view. On the other hand from a problem solving perspective more boldness is required. Waiting for Godot (perfect undisputed knowledge) will not help us with respect to the challenges posed to society by environment and health problems. A sense of urgency is legitimate: the paralysis by traditional analysis should be resolved. Nevertheless this sense of urgency should not withhold us from investing in the problem solving quality of our endeavour; quality takes time, fastness from a quality perspective often leads us to a standstill. We propose the concept of critical complexification of environment and health practice that will enable the integration of relevant actors and factors in a pragmatic manner. We will illustrate this with practical examples and especially draw attention to the practical complexities involved, confronting us not only with fundamental questions, but also with fundamental challenges. PMID:22759501

  10. Junior Doctors of Health©: an interprofessional service-learning project addressing childhood obesity and encouraging health care career choices.

    Buff, Scotty M; Gibbs, Pamella Y; Oubré, O'karsamaa L; Ariail, Jane C; Blue, Amy V; Greenberg, Raymond S

    2011-01-01

    While much literature describes programmatic success of clinical service-learning opportunities, this initiative integrates student learning across a comprehensive discipline set (Dental Medicine, Graduate Studies, Health Administration, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy, and Physician Assistant), providing preventive health education and role modeling to low-income elementary-school children. Junior Doctors of Health© (JDOH), a health education curriculum taught by Medical University of South Carolina students, addresses childhood obesity and encourages child interest in health professional (HP) and biomedical science (BS) careers. Of the 78 surveyed HP/BS students, over 80% agreed JDOH was worthwhile for their professional development, increased their appreciation and ability as an interprofessional team member, improved their understanding and interest in underserved communities, and provided them with valuable childhood-obesity prevention information. With the increased need for childhood-obesity prevention and team building among students of various health and science professions, recommendations are offered to others interested in creating or collaborating to build similar service-learning initiatives. PMID:21927772

  11. Addressing the Needs of the Whole Child: What Public Health Can Do to Answer the Education Sector’s Call for a Stronger Partnership

    Diane Allensworth, PhD

    2011-03-01

    Full Text Available Although the overall level of child health in the United States remains high, public health professionals know that racial and ethnic disparities in child and adolescent health persist and that lifestyle choices related to chronic disease in adults are often established in childhood and adolescence. And yet, those health needs are not the public health sector’s alone to resolve. We have natural partners among educators. Improving graduation rates is one of the most cost-effective ways to reduce health disparities. This article provides strategies for how public health professionals can answer this call by educators to address the needs of the whole child.

  12. The potential role of health impact assessment in tackling the complexity of climate change adaptation for health.

    Brown, Helen L; Proust, Katrina; Spickett, Jeffery; Capon, Anthony

    2011-12-01

    Managing an issue of the magnitude, scope and complexity of climate change is a daunting prospect, yet one which nations around the world must face. Climate change is an issue without boundaries--impacts will cut across administrative and geographical borders and be felt by every sector of society. Responses to climate change will need to employ system approaches that take into account the relationships that cross organisational and sectoral boundaries. Solutions designed in isolation from these interdependencies will be unlikely to succeed, squandering opportunities for long-term effective adaptation. Health Impact Assessment (HIA) provides a structural approach to identify, evaluate and manage health impacts of climate change that is inclusive of a wide range of stakeholders. Climate change will affect decision-making across every government level and sector and the health implications of these decisions can also be addressed with HIA. Given the nature of the issue, HIA of climate change will identify a large number of variables that influence the type and extent of health impacts and the management of these impacts. In order to implement the most effective adaptation measures, it is critica that an understanding of the interactions between these variables is developed. The outcome of HIA of climate change can therefore be strengthened by the introduction of system dynamics tools, such as causal loop diagrams, that are designed to examine interactions between variables and the resulting behaviour of complex systems. PMID:22518921

  13. The public health aspects of complex emergencies and refugee situations.

    Toole, M J; Waldman, R J

    1997-01-01

    Populations affected by armed conflict have experienced severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons have experienced high mortality rates during the period immediately following their migration. In Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrheal diseases, measles, acute respiratory infections, and malaria. High prevalences of acute malnutrition have contributed to high case fatality rates. In conflict-affected European countries, such as the former Yugoslavia, Georgia, Azerbaijan, and Chechnya, war-related injuries have been the most common cause of death among civilian populations; however, increased incidence of communicable diseases, neonatal health problems, and nutritional deficiencies (especially among the elderly) have been documented. The most effective measures to prevent mortality and morbidity in complex emergencies include protection from violence; the provision of adequate food rations, clean water and sanitation; diarrheal disease control; measles immunization; maternal and child health care, including the case management of common endemic communicable diseases; and selective feeding programs, when indicated. PMID:9143721

  14. Staff perceptions of addressing lifestyle in primary health care: a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool

    Carlfjord Siw; Lindberg Malou; Andersson Agneta

    2012-01-01

    Background: Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC) has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool fo...

  15. Is food allergen analysis flawed? Health and supply chain risks and a proposed framework to address urgent analytical needs.

    Walker, M J; Burns, D T; Elliott, C T; Gowland, M H; Mills, E N Clare

    2016-01-01

    above recommendations from food authorities, business organisations and National Measurement Institutes is important; however transparent international coordination is essential. Thus our recommendations are primarily addressed to the European Commission, the Health and Food Safety Directorate, DG Santé. A global multidisciplinary consortium is required to provide a curated suite of data including genomic and proteomic data on key allergenic food sources, made publically available on line. PMID:26536312

  16. Strengthening the Paediatricians Project 2: The effectiveness of a workshop to address the Priority Mental Health Disorders of adolescence in low-health related human resource countries

    Russell Paul SS

    2010-02-01

    Full Text Available Abstract Background Paediatricians can be empowered to address the Priority Mental Health Disorders at primary care level. To evaluate the effectiveness of a collaborative workshop in enhancing the adolescent psychiatry knowledge among paediatricians. Methods A 3-day, 27-hours workshop was held for paediatricians from different regions of India under the auspices of the National Adolescent Paediatric Task Force of the Indian Academy of Paediatrics. A 5-item pretest-posttest questionnaire was developed and administered at the beginning and end of the workshop to evaluate the participants' knowledge acquisition in adolescent psychiatry. Bivariate and multivariate analyses were performed on an intention-to-participate basis. Results Forty-eight paediatricians completed the questionnaire. There was significant enhancement of the knowledge in understanding the phenomenology, identifying the psychopathology, diagnosing common mental disorder and selecting the psychotropic medication in the bivariate analysis. When the possible confounders of level of training in paediatrics and number of years spent as paediatrician were controlled, in addition to the above areas of adolescent psychiatry, the diagnostic ability involving multiple psychological concepts also gained significance. However, both in the bivariate and multivariate analyses, the ability to refer to appropriate psychotherapy remained unchanged after the workshop. Conclusions This workshop was effective in enhancing the adolescent psychiatry knowledge of paediatricians. Such workshops could strengthen paediatricians in addressing the priority mental health disorders at the primary-care level in countries with low-human resource for health as advocated by the World Health Organization. However, it remains to be seen if this acquisition of adolescent psychiatry knowledge results in enhancing their adolescent psychiatry practice.

  17. Conceptualising population health: from mechanistic thinking to complexity science

    Jayasinghe Saroj

    2011-01-01

    Full Text Available Abstract The mechanistic interpretation of reality can be traced to the influential work by René Descartes and Sir Isaac Newton. Their theories were able to accurately predict most physical phenomena relating to motion, optics and gravity. This paradigm had at least three principles and approaches: reductionism, linearity and hierarchy. These ideas appear to have influenced social scientists and the discourse on population health. In contrast, Complexity Science takes a more holistic view of systems. It views natural systems as being 'open', with fuzzy borders, constantly adapting to cope with pressures from the environment. These are called Complex Adaptive Systems (CAS. The sub-systems within it lack stable hierarchies, and the roles of agency keep changing. The interactions with the environment and among sub-systems are non-linear interactions and lead to self-organisation and emergent properties. Theoretical frameworks such as epi+demos+cracy and the ecosocial approach to health have implicitly used some of these concepts of interacting dynamic sub-systems. Using Complexity Science we can view population health outcomes as an emergent property of CAS, which has numerous dynamic non-linear interactions among its interconnected sub-systems or agents. In order to appreciate these sub-systems and determinants, one should acquire a basic knowledge of diverse disciplines and interact with experts from different disciplines. Strategies to improve health should be multi-pronged, and take into account the diversity of actors, determinants and contexts. The dynamic nature of the system requires that the interventions are constantly monitored to provide early feedback to a flexible system that takes quick corrections.

  18. Conceptualising population health: from mechanistic thinking to complexity science.

    Jayasinghe, Saroj

    2011-01-01

    The mechanistic interpretation of reality can be traced to the influential work by René Descartes and Sir Isaac Newton. Their theories were able to accurately predict most physical phenomena relating to motion, optics and gravity. This paradigm had at least three principles and approaches: reductionism, linearity and hierarchy. These ideas appear to have influenced social scientists and the discourse on population health. In contrast, Complexity Science takes a more holistic view of systems. It views natural systems as being 'open', with fuzzy borders, constantly adapting to cope with pressures from the environment. These are called Complex Adaptive Systems (CAS). The sub-systems within it lack stable hierarchies, and the roles of agency keep changing. The interactions with the environment and among sub-systems are non-linear interactions and lead to self-organisation and emergent properties. Theoretical frameworks such as epi+demos+cracy and the ecosocial approach to health have implicitly used some of these concepts of interacting dynamic sub-systems. Using Complexity Science we can view population health outcomes as an emergent property of CAS, which has numerous dynamic non-linear interactions among its interconnected sub-systems or agents. In order to appreciate these sub-systems and determinants, one should acquire a basic knowledge of diverse disciplines and interact with experts from different disciplines. Strategies to improve health should be multi-pronged, and take into account the diversity of actors, determinants and contexts. The dynamic nature of the system requires that the interventions are constantly monitored to provide early feedback to a flexible system that takes quick corrections. PMID:21247500

  19. The Exposome: Embracing the Complexity for Discovery in Environmental Health

    Cui, Yuxia; Balshaw, David M.; Kwok, Richard K.; Thompson, Claudia L.; Collman, Gwen W.; Birnbaum, Linda S.

    2016-01-01

    Summary: Environmental exposures are ubiquitous and play a fundamental role in the development of complex human diseases. The exposome, which is defined as the totality of environmental exposures over the life course, allows for systematic evaluation of the relationship between exposures and associated biological consequences, and represents a powerful approach for discovery in environmental health research. However, implementing the exposome concept is challenged by the ability to accurately assess multiple exposures and the ability to integrate information across the exposure–disease continuum. On 14–15 January 2015, the National Institute of Environmental Health Sciences (NIEHS) held the Exposome Workshop where a group of international and U.S. scientists from different disciplines gathered to review the state of the science in research areas related to the exposome and to provide recommendations for incorporating the exposome concept into each research area. To move the field forward, the NIEHS is establishing a Children’s Health Exposure Analysis Resource (CHEAR) to provide infrastructure support for access to laboratory and statistical analyses to children’s health studies. It is recognized that incorporating the exposome concept into exposure and environmental health research will be a long journey and will require significant collaborative efforts from different scientific disciplines, nations, and stakeholders. PMID:27479988

  20. Health status transitions in community-living elderly with complex care needs: a latent class approach

    Béland François

    2009-02-01

    Full Text Available Abstract Background For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Methods Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164, we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. Results We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Conclusion Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical

  1. A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka

    Rathnayake, Vajira Sampath; Lim, Gentatsu; Panchapakesan, Chitra; Foo, Schubert; Wijayamuni, Ruwan; Wimalaratne, Prasad; Fernando, Owen Noel Newton

    2016-01-01

    Background Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management. Objective To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems. Methods One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches. Results Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components

  2. Modelling the dynamics of the health-production complex in livestock herds

    Sørensen, J.T.; Enevoldsen, Carsten

    1992-01-01

    reproductive animals in a manner which could be related to health problems. Direct effects of diseases on growth or milk production were, however, addressed in only a few models and were confined to a few basic relations if modelled. The lack of effects on individual animal production in the models may relate...... to difficulties in obtaining valid parameters for these effects. We recommend: (1) that disease-production relations be based on mechanistic, reasonable hypotheses at the animal level; or (2) that groups of animals be specified that have different disease-production relations. These relations and......This paper reviews how the dynamics of the health-production complex in livestock herds is mimicked by livestock herd simulation models. Twelve models simulating the dynamics of dairy, beef, sheep and sow herds were examined. All models basically included options to alter input and output of...

  3. Addressing the "other" health literacy competencies--knowledge, dispositions, and oral/aural communication: development of TALKDOC, an intervention assessment tool.

    Helitzer, Deborah; Hollis, Christine; Sanders, Margaret; Roybal, Suzanne

    2012-01-01

    Most health literacy assessments evaluate literacy skills including reading, writing; numeracy and interpretation of tables, graphs, diagrams and charts. Some assess understanding of health systems, and the ability to adequately apply one's skills to specific health-related tasks or demands in health situations. However, to achieve functional health literacy, the ability to "obtain, process, and understand basic health information and services needed to make appropriate health decisions," other health literacy dimensions should be assessed: a person's knowledge and attitudes about a health issue affects his or her ability to and interest in participating in his or her own care. In patient care settings, the abilities to listen, ask questions and check one's understanding are crucial to making appropriate decisions and carrying out instructions. Although literacy is a skill associated with educational attainment and therefore difficult to change in a short time, health education interventions can address health literacy domains such as knowledge, attitudes and oral communication skills. For this reason, an instrument that can assess these constructs is a valuable part of a health educator's toolbox. The authors describe the development and process and outcomes of testing a novel instrument targeted to assess HPV and cervical cancer health literacy competencies, TALKDOC, including its validation with the Health Activities Literacy Scale. PMID:23030568

  4. Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease.

    Kramer, Betty J

    2013-01-01

    This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life. PMID:24295099

  5. From theory to practice: a Canadian case study of the utility of climate change adaptation frameworks to address health impacts

    Clarke, Kaila-Lea; Berry, Peter

    2011-01-01

    Objective It is now recognized that climate change affects human health. The question is how to adapt. This article examines mainstreaming climate considerations into public health programs and the utility of climate change and health adaptation frameworks, using Ontario, Canada, as a case study. Methods A literature review identified climate change and health adaptation frameworks for comparison with the Ontario Public Health Standards. Key informant interviews gauged the extent to which cli...

  6. The nuclear weapons complex: Management for health, safety, and the environment

    The Department of Energy (DOE) operates 17 major facilities to develop and produce nuclear weapons. The facilities, which together are termed the ''weapons complex,'' include laboratores that design and test the weapons and components; materials for use in weapons; and weapons production facilities that either produce various components or assemble them into completed weapons, or both. This report, which was requested of the National Research Council by DOE at the direction of Congress, sets out an assessment of various management, environmental, health, and safety issues melting to the operation of the complex. An examination of the weapons complex is an immense undertaking. The facilities are located throughout the United States, and each of the major facilities is a huge and sophisticated operation. The total budget of the complex for FY 1990 amounts to some $10 billion and involves a staff of some 80,000 people working for the Department and its contractors. The Department confronts a variety of problems in connection with its stewardship of the complex. Many of the facilities are old, and maintenance over the years has been inadequate. There is a legacy of environmental contamination that must be addressed. Moreover, DOE must be prepared to operate under close public scrutiny and in compliance with environmental and safety standards that have become increasingly stringent over time. 42 refs., 8 figs., 4 tabs

  7. Opening address

    Full text: Honourable Representatives of His Majesty King Mohammed VI and of the Government of Morocco, representatives of sponsoring organizations, distinguished participants, on behalf of the Director General of the IAEA, it is my pleasure and privilege to welcome you to this International Conference on National Infrastructures for Radiation Safety: Towards Effective and Sustainable Systems. I would like to express my sincere appreciation to His Majesty King Mohammed VI for his patronage, to the Government of Morocco and the University Mohammed V, Agdal, for hosting this conference in the beautiful and historic city of Rabat, and to the local organizers for their diligent planning and gracious hospitality. I would also like to thank the four organizations that are co-operating with the IAEA in holding this conference: the World Health Organization, the Pan American Health Organization, the International Labour Organization, the European Commission and the OECD/Nuclear Energy Agency. National infrastructure for radiation safety has emerged as an issue of international concern over the last two decades. Systematic and strategic consideration of infrastructure has become widely recognized as an essential prerequisite for safety. The first IAEA conference to address the topic was in Munich, Germany, in 1990. The 1996 edition of the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (known as the Basic Safety Standards or BSS) highlighted the issue, and the IAEA's technical co-operation Model Project for Upgrading Radiation Protection Infrastructure was introduced to help address it. The Model Project has helped, and continues to help, more than 85 IAEA Member States to work towards the goal of a radiation safety infrastructure in accordance with the Basic Safety Standards. A great deal has been achieved, but this work is not complete. Furthermore, not all States are members of the IAEA or the Model

  8. Human Health and the Biological Effects of Tritium in Drinking Water: Prudent Policy Through Science - Addressing the ODWAC New Recommendation.

    Dingwall, S; Mills, C E; Phan, N; Taylor, K; Boreham, D R

    2011-01-01

    Tritium is a radioactive form of hydrogen and is a by-product of energy production in Canadian Deuterium Uranium (CANDU) reactors. The release of this radioisotope into the environment is carefully managed at CANDU facilities in order to minimize radiation exposure to the public. However, under some circumstances, small accidental releases to the environment can occur. The radiation doses to humans and non-human biota from these releases are low and orders of magnitude less than doses received from naturally occurring radioisotopes or from manmade activities, such as medical imaging and air travel. There is however a renewed interest in the biological consequences of low dose tritium exposures and a new limit for tritium levels in Ontario drinking water has been proposed. The Ontario Drinking Water Advisory Council (ODWAC) issued a formal report in May 2009 in response to a request by the Minister of the Environment, concluding that the Ontario Drinking Water Quality Standard for tritium should be revised from the current 7,000 Bq/L level to a new, lower 20 Bq/L level. In response to this recommendation, an international scientific symposium was held at McMaster University to address the issues surrounding this change in direction and the validity of a new policy. Scientists, regulators, government officials, and industrial stakeholders were present to discuss the potential health risks associated with low level radiation exposure from tritium. The regulatory, economic, and social implications of the new proposed limit were also considered.The new recommendation assumed a linear-no-threshold model to calculate carcinogenic risk associated with tritium exposure, and considered tritium as a non-threshold chemical carcinogen. Both of these assumptions are highly controversial given that recent research suggests that low dose exposures have thresholds below which there are no observable detrimental effects. Furthermore, mutagenic and carcinogenic risk calculated from

  9. A conceptual framework for addressing complexity and unfolding transition dynamics when developing sustainable adaptation strategies in urban water management

    Fratini, Chiara; Elle, Morten; Jensen, M. B.;

    2012-01-01

    To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a 'more sustainable and integrated urban water management...... for standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the basis of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize...

  10. Megacities in the coastal zone: Using a driver-pressure-state-impact-response framework to address complex environmental problems

    Sekovski, Ivan; Newton, Alice; Dennison, William C.

    2012-01-01

    The purpose of this study was to elaborate on the role of coastal megacities in environmental degradation and their contribution to global climate change. Although only less than 4 percent of the total world's population resides in coastal megacities, their impact on environment is significant due to their rapid development, high population densities and high consumption rate of their residents. This study was carried out by implementing a Drivers-Pressures-States-Impacts-Responses (DPSIR) framework. This analytical framework was chosen because of its potential to link the existing data, gathered from various previous studies, in causal relationship. In this text, coastal megacities have been defined as cities exceeding 10 million inhabitants, situated in "near-coastal zone". Their high rates of the consumption of food, water, space and energy were observed and linked to the high performance rates of related economic activities (industry, transportation, power generation, agriculture and water extraction). In many of the studied coastal megacities, deteriorated quality of air and water was perceived, which can, in combination with global warming, lead to health problems and economic and social disturbance among residents. The extent of problems varied between developing and developed countries, showing higher rates of population growth and certain harmful emissions in megacities of developing countries, as well as more problems regarding food and water shortages, sanitation, and health care support. Although certain projections predict slowdown of growth in most coastal megacities, their future impact on environment is still unclear due to the uncertainties regarding future climate change and trajectories of consumption patterns.