The death of Muammar Gaddafi marks a new era for Libya.It also poses a huge challenge for Libyan authorities dealing with tribal conflicts.He Wenping,a researcher with the Institute of West-Asian and African Studies at the Chinese Academy of Social Sciences,believes that Libya is in danger of falling into a period of internal strife and tribal conflict.
Rigotto, Raquel Maria; Carneiro, Fernando Ferreira; Marinho, Alice Maria Correia Pequeno; Rocha, Mayara Melo; Ferreira, Marcelo José Monteiro; Pessoa, Vanira Matos; Teixeira, Ana Cláudia de Araújo; da Silva, Maria de Lourdes Vicente; Braga, Lara de Queiroz Viana; Teixeira, Maiana Maia
In this paper, we ask ourselves who should, can and has the will to promote health in the rural zone today. The fields of science and public policy were chosen as our primary focus of dialogue conducted from the perspective of the right to health and a healthy environment. Seven lessons emerged: (1) in addition to the surveillance of isolated chemical risks, the relation between agrochemicals and health should be investigated in the context of conservative agricultural modernization; (2) it is mandatory and urgent to discover the health problems related to the use of agrochemicals; (3) the State has been successful in its support of agribusiness, but highly inefficient at enforcing policies to safeguard social rights; (4) sectors of society linked to rural organizations have played an important role in the public policies combating agrochemicals and protecting health; (5) studies must help deconstruct the myths surrounding the Green Revolution model; (6) we are faced with the challenge of contributing to the construction of an emerging scientific paradigm founded on an ethical-political commitment to the most vulnerable social elements; (7) rural communities are creating agro-ecological alternatives for life in semiarid areas.
Eremeeva, Marina E.; Dasch, Gregory A.
Rickettsiae are obligately intracellular bacteria that are transmitted to vertebrates by a variety of arthropod vectors, primarily by fleas and ticks. Once transmitted or experimentally inoculated into susceptible mammals, some rickettsiae may cause febrile illness of different morbidity and mortality, and which can manifest with different types of exhanthems in humans. However, most rickettsiae circulate in diverse sylvatic or peridomestic reservoirs without having obvious impacts on their vertebrate hosts or affecting humans. We have analyzed the key features of tick-borne maintenance of rickettsiae, which may provide a deeper basis for understanding those complex invertebrate interactions and strategies that have permitted survival and circulation of divergent rickettsiae in nature. Rickettsiae are found in association with a wide range of hard and soft ticks, which feed on very different species of large and small animals. Maintenance of rickettsiae in these vector systems is driven by both vertical and horizontal transmission strategies, but some species of Rickettsia are also known to cause detrimental effects on their arthropod vectors. Contrary to common belief, the role of vertebrate animal hosts in maintenance of rickettsiae is very incompletely understood. Some clearly play only the essential role of providing a blood meal to the tick while other hosts may supply crucial supplemental functions for effective agent transmission by the vectors. This review summarizes the importance of some recent findings with known and new vectors that afford an improved understanding of the eco-epidemiology of rickettsiae; the public health implications of that information for rickettsial diseases are also described. Special attention is paid to the co-circulation of different species and genotypes of rickettsiae within the same endemic areas and how these observations may influence, correctly or incorrectly, trends, and conclusions drawn from the surveillance of
Rudolph, Dieter; Kroken, Ingjerd; Latyshev, Eduard; Griffith, Andrew
The purpose of this paper is to provide an overview of the challenges posed by retired Russian nuclear submarines, review current U.S. and International efforts and provide an assessment of the success of these efforts.
Schlesinger, Mark; Gray, Bradford H
As contemporary health policy promotes evidence-based practices using targeted incentives, policy makers may lose track of vital aspects of care that are difficult to measure. For more than a half century, scholars have recognized that these latter aspects play a crucial role in high-quality care and equitable health system performance but depend on the potentially frail reed of providers' trustworthiness: that is, their commitment to facets and outcomes of care not easily assessed by external parties. More recently, early experience with pay for performance in health settings suggests that enhancing financial rewards for the measurable undermines providers' commitment to the unmeasurable, degrading the trustworthiness of their practices. Reformers have looked to revised professional norms or reorganized practice arrangements to bolster the intrinsic motivations required for trustworthiness. We suggest here that these responses are likely to prove inadequate. We propose that they be complemented by a renewed policy-making commitment to nonprofit ownership among health care providers, insurers, and integrated delivery systems. We identify some of the concerns raised in the past with ownership-based policies and propose a set of responses. If these are pursued in combination, they hold the promise of a sustainable ownership-based policy reform for the United States.
... Products For Consumers Home For Consumers Consumer Updates "Light" Tobacco Products Pose Heavy Health Risks Share Tweet ... Feed A federal law is restricting the words “light,” “low,” and “mild” from tobacco products now on ...
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Maciej J. Bogusz
Full Text Available New psychoactive substances (NPS are defined as substances of abuse, either in a pure form or a preparation, that are not controlled by the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances, but which may pose a public health threat. In this context, the term “new” does not necessarily refer to new inventions but to substances that have recently become available or popular in a given society or country. This definition indicates that the problem of NPS is not new; however, the availability of any information via new communication technologies in the 21st century has enabled the spread of unwanted and socially harmful information, like information on the commercial availability of various NPS, offered in rising amounts and brands.
Full Text Available Chronic illness prevalence has rapidly increased in low or middle income countries (LMIC and with it, the need for medical rehabilitation for adults with acquired conditions that stem from aging and long-term conditions. While Western medical rehabilitation programs have had at least two generations to develop, in LMIC, post-acute health care delivery change has been much more rapid. As a result, there has been little opportunity for models of medical rehabilitation to deliberately emerge in LMIC that reflect societal values. While adaptation of an independence-foremost model of medical rehabilitation may succeed in non-Western societies, there is a risk that adaptation of such a model will be ineffective where many value collectivism more than individualism. The rapid change in medical rehabilitation service delivery in LMIC gives Christian providers and organizations an opportunity to pause and reflect whether the dominant Western medical rehabilitation paradigm serves LMIC cultures and reflects Biblical principles.
Mulder, Machiel; Auger, Jean-François; Bouma, Jaap; Kunneke, Rolf
It’s a matter of fact that smart grids form a challenge for energy distribution operators, but, the question is, do they also form a challenge for the regulator? Should the regulation of networks be adapted in order to facilitate the development of smart grids? This chapter argues that only in
Full Text Available Self-expandable esophageal stents are being commonly used for palliative treatment in advanced esophageal cancer patients to relieve dysphagia, prevent tracheoesophageal fistula, and facilitate symptomatic betterment. The modern covered stents reduce the ingrowth of the tumor but have seen an increase in the incidence of stent migrations. We report a rather complicated presentation of an esophageal stent for esophageal dilatation and a challenging management of a difficult tracheostomy.
Moore, Catherine R; Doherty, John; Howell, Stephen; Erriah, Leon
Coal measures (coal bearing rock strata) can contain large reserves of methane. These reserves are being exploited at a rapidly increasing rate in many parts of the world. To extract coal seam gas, thousands of wells are drilled at relatively small spacing to depressurize coal seams to induce desorption and allow subsequent capture of the gas. To manage this process effectively, the effect of coal bed methane (CBM) extraction on regional aquifer systems must be properly understood and managed. Groundwater modeling is an integral part of this management process. However, modeling of CBM impacts presents some unique challenges, as processes that are operative at two very different scales must be adequately represented in the models. The impacts of large-scale gas extraction may be felt over a large area, yet despite the significant upscaling that accompanies construction of a regional model, near-well conditions and processes cannot be ignored. These include the highly heterogeneous nature of many coal measures, and the dual-phase flow of water and gas that is induced by coal seam depressurization. To understand these challenges, a fine-scale model was constructed incorporating a detailed representation of lithological heterogeneity to ensure that near-well processes and conditions could be examined. The detail of this heterogeneity was at a level not previously employed in models built to assess groundwater impacts arising from CBM extraction. A dual-phase reservoir simulator was used to examine depressurization and water desaturation processes in the vicinity of an extractive wellfield within this fine-scale model. A single-phase simulator was then employed so that depressurization errors incurred by neglecting near-well, dual-phase flow could be explored. Two models with fewer lithological details were then constructed in order to examine the nature of depressurization errors incurred by upscaling and to assess the interaction of the upscaling process with the
Full Text Available Gloria Valdés, Jenny CorthornCentro de Investigaciones Médicas y Departamento Nefrología, Escuela Medicina, Pontificia Universidad Católica, Santiago, ChileAbstract: In primates, adequate growth of the fetus depends on the development of the uteroplacental unit. On the fetal side, this is achieved by the creation of the vascular network of the placenta. On the maternal side, the transformation of the spiral arteries into saccular nonreactive vessels by the trophoblast provides high blood flow to the intervillous space. Apart from the changes in the uterine arteries, the mother expands her plasma volume – at the expense of stimulating the renin-angiotensin-aldosterone system – and her cardiac output. In the maintaining of normotension in the face of an increased cardiac output and plasma volume, the renin-angiotensin-aldosterone system requires an enhanced vasodilator synthesis. Finally, in the late stages of pregnancy, a normal endothelial function is required to provide an ample margin to the activation provoked by deportation of syncytiotrophoblast fragments/factors to the maternal circulation. These four adaptative processes require various interrelated vasodilator systems. Deficient adaptations cause isolated or proteinuric arterial hypertension, intrauterine growth restriction, preterm delivery, and stillbirths, among others. Moreover, a normal or a defective adaptation to pregnancy influences maternal cardiovascular health in later life, as evidenced by various studies, most of them epidemiological; thus, pregnancy is now considered a stress test to the maternal cardiovascular system. Because of this, women planning to become pregnant should be screened for clinical and biochemical cardiovascular risks. Inversely, women presenting with hypertension in pregnancy should be thoroughly studied to detect and correct cardiovascular risks. The incorporation of the predictive value of a hypertensive pregnancy should help reduce
Kumar, Ashutosh; Zhang, Kam Y. J.
Evaluation of ligand three-dimensional (3D) shape similarity is one of the commonly used approaches to identify ligands similar to one or more known active compounds from a library of small molecules. Apart from using ligand shape similarity as a virtual screening tool, its role in pose prediction and pose scoring has also been reported. We have recently developed a method that utilizes ligand 3D shape similarity with known crystallographic ligands to predict binding poses of query ligands. Here, we report the prospective evaluation of our pose prediction method through the participation in drug design data resource (D3R) Grand Challenge 2015. Our pose prediction method was used to predict binding poses of heat shock protein 90 (HSP90) and mitogen activated protein kinase kinase kinase kinase (MAP4K4) ligands and it was able to predict the pose within 2 Å root mean square deviation (RMSD) either as the top pose or among the best of five poses in a majority of cases. Specifically for HSP90 protein, a median RMSD of 0.73 and 0.68 Å was obtained for the top and the best of five predictions respectively. For MAP4K4 target, although the median RMSD for our top prediction was only 2.87 Å but the median RMSD of 1.67 Å for the best of five predictions was well within the limit for successful prediction. Furthermore, the performance of our pose prediction method for HSP90 and MAP4K4 ligands was always among the top five groups. Particularly, for MAP4K4 protein our pose prediction method was ranked number one both in terms of mean and median RMSD when the best of five predictions were considered. Overall, our D3R Grand Challenge 2015 results demonstrated that ligand 3D shape similarity with the crystal ligand is sufficient to predict binding poses of new ligands with acceptable accuracy.
Diaz, James H
The lionfish, Pterosis volitans, a native of Indo-Pacific oceans, is a popular saltwater aquarium fish despite venomous spines on its fins. Lionfish were inadvertently introduced into the western Atlantic from Florida in the early 1990s and have overpopulated and dispersed widely into the Caribbean Sea and Gulf of Mexico. Initiatives to control lionfish populations were launched, including the National Oceanographic and Atmospheric Administration (NOAA)-sponsored "Lionfish as Food Campaign".2 Recently, scientists from the Food and Drug Administration (FDA) reported that lionfish caught off the US Virgin Islands contained ciguatoxins and could cause ciguatera fish poisoning (CFP); a seafood-borne poisoning without an antidote or any specific treatment, and a potential for prolonged neurotoxicity. Lionfish pose several public health threats. New strategies to control the lionfish population explosion in coastal waters and offshore fisheries are needed now to ensure seafood safety and public health. The lionfish, Pterosis volitans, is native to the reefs of the western Indian and Pacific Oceans (Figure 1). Brightly colored with red, white, and black stripes and adorned with feathery fins, the lionfish is a popular saltwater aquarium fish despite venomous spines on its fins (Figure 2). Lionfish were introduced into the western North Atlantic from Florida in the early 1990s after some specimens were discarded by dissatisfied amateur aquarists and others escaped from hurricane-flooded public aquariums.1 Since lionfish are voracious carnivores, have few natural predators, and reproduce prolifically, they have overpopulated and dispersed widely from Cape Hatteras to Florida, throughout the Caribbean Sea, and into the Gulf of Mexico.1 The population density of lionfish in its new, invaded territory now exceeds that of its native habitat.1 As a result, campaigns to control lionfish populations were launched in Florida and the Caribbean. Lionfish now pose several public
Gathiaka, Symon; Liu, Shuai; Chiu, Michael; Yang, Huanwang; Stuckey, Jeanne A.; Kang, You Na; Delproposto, Jim; Kubish, Ginger; Dunbar, James B.; Carlson, Heather A.; Burley, Stephen K.; Walters, W. Patrick; Amaro, Rommie E.; Feher, Victoria A.; Gilson, Michael K.
The Drug Design Data Resource (D3R) ran Grand Challenge 2015 between September 2015 and February 2016. Two targets served as the framework to test community docking and scoring methods: (1) HSP90, donated by AbbVie and the Community Structure Activity Resource (CSAR), and (2) MAP4K4, donated by Genentech. The challenges for both target datasets were conducted in two stages, with the first stage testing pose predictions and the capacity to rank compounds by affinity with minimal structural data; and the second stage testing methods for ranking compounds with knowledge of at least a subset of the ligand-protein poses. An additional sub-challenge provided small groups of chemically similar HSP90 compounds amenable to alchemical calculations of relative binding free energy. Unlike previous blinded Challenges, we did not provide cognate receptors or receptors prepared with hydrogens and likewise did not require a specified crystal structure to be used for pose or affinity prediction in Stage 1. Given the freedom to select from over 200 crystal structures of HSP90 in the PDB, participants employed workflows that tested not only core docking and scoring technologies, but also methods for addressing water-mediated ligand-protein interactions, binding pocket flexibility, and the optimal selection of protein structures for use in docking calculations. Nearly 40 participating groups submitted over 350 prediction sets for Grand Challenge 2015. This overview describes the datasets and the organization of the challenge components, summarizes the results across all submitted predictions, and considers broad conclusions that may be drawn from this collaborative community endeavor.
Full Text Available Abstract The cluster randomized trial (CRT is used increasingly in knowledge translation research, quality improvement research, community based intervention studies, public health research, and research in developing countries. However, cluster trials raise difficult ethical issues that challenge researchers, research ethics committees, regulators, and sponsors as they seek to fulfill responsibly their respective roles. Our project will provide a systematic analysis of the ethics of cluster trials. Here we have outlined a series of six areas of inquiry that must be addressed if the cluster trial is to be set on a firm ethical foundation: 1. Who is a research subject? 2. From whom, how, and when must informed consent be obtained? 3. Does clinical equipoise apply to CRTs? 4. How do we determine if the benefits outweigh the risks of CRTs? 5. How ought vulnerable groups be protected in CRTs? 6. Who are gatekeepers and what are their responsibilities? Subsequent papers in this series will address each of these areas, clarifying the ethical issues at stake and, where possible, arguing for a preferred solution. Our hope is that these papers will serve as the basis for the creation of international ethical guidelines for the design and conduct of cluster randomized trials.
Full Text Available In the future liquid biofuels will need to be renewable, sustainable, as well as technically and economically viable. This paper provides an overview of the challenges that the biochemical production of cellulosic ethanol process still faces. The main emphasis of the paper is on challenges that emerge from the scale of liquid biofuel production. These challenges include raw material availability, other consumables, and side stream handling. The pretreatment, C5 fermentation, and concentration of sugars in processing need improvements, too. Sustainability issues and greenhouse gas reduction also pose a challenge for implementation and require development of internationally recognized sustainability principles and standards, and certification of sustainable operation. Economics of cellulosic ethanol processes are still also an area under development and debate. Yet, the Energy Independence and Security Act mandate together with the European Union Renewable Energy Directive and other local targets are driving the development and implementation forward towards more significant contribution of biofuels in the transportation sector.
Ratnapradipa, Dhitinut; Ritzel, Dale O.; Haramis, Linn D.; Bliss, Kadi R.
In recent years, reported cases of bed bug infestations in the U.S. and throughout the world have escalated dramatically, posing a global public health problem. Although bed bugs are not known to transmit disease to humans, they pose both direct and indirect public health challenges in terms of health effects, treatment, cost, and resource…
... page: https://medlineplus.gov/news/fullstory_160250.html Zika Won't Pose Risks at the Olympics: Health ... Brazil won't trigger a global spread of Zika virus, with little risk of potentially infected competitors ...
Evans, John R
It is not easy to fit an introductory address to the topics of AIDS, transplantation, women's health, reproductive health, national health insurance and epidemiology and public health. I have been asked to speak on international challenges and opportunities in health care in the hope that the global context might frame your specific discussions in the broadest possible perspective. I will speak primarily about the widening gap in health status between rich and poor people and rich and poor nations -- a gap which poses great risks for the poor but increasing risks for all of us as well.
Cox, R.; Drennen, T.E.; Gilliom, L.; Harris, D.L.; Kunsman, D.M.; Skroch, M.J.
The telecommunications sector plays a pivotal role in the system of increasingly connected and interdependent networks that make up national infrastructure. An assessment of the probable structure and function of the bit-moving industry in the twenty-first century must include issues associated with the surety of telecommunications. The term surety, as used here, means confidence in the acceptable behavior of a system in both intended and unintended circumstances. This paper outlines various engineering approaches to surety in systems, generally, and in the telecommunications infrastructure, specifically. It uses the experience and expectations of the telecommunications system of the US as an example of the global challenges. The paper examines the principal factors underlying the change to more distributed systems in this sector, assesses surety issues associated with these changes, and suggests several possible strategies for mitigation. It also studies the ramifications of what could happen if this sector became a target for those seeking to compromise a nation`s security and economic well being. Experts in this area generally agree that the U. S. telecommunications sector will eventually respond in a way that meets market demands for surety. Questions remain open, however, about confidence in the telecommunications sector and the nation`s infrastructure during unintended circumstances--such as those posed by information warfare or by cascading software failures. Resolution of these questions is complicated by the lack of clear accountability of the private and the public sectors for the surety of telecommunications.
Van Balen, K.
This contribution examines the challenges posed to the cultural heritage documentation community (the CIPA community and others) in implementing a preventive conservation approach of the built heritage in today's society. The "DNA" of Preventive Conservation. Various authors so far support the argument that preventive conservation is an effective way to respond to the challenges society faces with the preservation of its Cultural Heritage (Van Balen, 2013). A few decades of experiences with the application of preventive conservation in the field of immovable heritage in the form of Monumentenwacht in The Netherland and in Flanders have shown that a good monitoring of the state of preservation with a strong push for maintenance activities contributes to more preservation of authenticity, to more cost-effective preservation and to empowering society in dealing with heritage preservation. (Cebron, 2008) An analysis of these and similar experiences demonstrates that these "Monumentenwacht" activities represent only a part of what could be named a preventive conservation system. Other fields in which prevention is advocated for its higher efficiency, show the importance of system thinking in the development of improved strategies. Applying this approach to the field of the immovable heritage, referring to the initial results shown by the Monumentenwacht practices, it becomes clear that different dimension are at stake simultaneously: the preservation of authenticity or integrity, the management of resources and the connection with society. It shows that the analysis of challenges in heritage preservation and the development of strategies is à priori multifaceted and therefor has a certain level of complexity. The sustainability of the preservation of cultural heritage buildings and sites can be measured according to its multiple economic, social, environmental and cultural support. The Cultural Heritage Counts for Europe report shows that the more diverse the support
K. Van Balen
Full Text Available This contribution examines the challenges posed to the cultural heritage documentation community (the CIPA community and others in implementing a preventive conservation approach of the built heritage in today’s society. The “DNA” of Preventive Conservation. Various authors so far support the argument that preventive conservation is an effective way to respond to the challenges society faces with the preservation of its Cultural Heritage (Van Balen, 2013. A few decades of experiences with the application of preventive conservation in the field of immovable heritage in the form of Monumentenwacht in The Netherland and in Flanders have shown that a good monitoring of the state of preservation with a strong push for maintenance activities contributes to more preservation of authenticity, to more cost-effective preservation and to empowering society in dealing with heritage preservation. (Cebron, 2008 An analysis of these and similar experiences demonstrates that these “Monumentenwacht” activities represent only a part of what could be named a preventive conservation system. Other fields in which prevention is advocated for its higher efficiency, show the importance of system thinking in the development of improved strategies. Applying this approach to the field of the immovable heritage, referring to the initial results shown by the Monumentenwacht practices, it becomes clear that different dimension are at stake simultaneously: the preservation of authenticity or integrity, the management of resources and the connection with society. It shows that the analysis of challenges in heritage preservation and the development of strategies is à priori multifaceted and therefor has a certain level of complexity. The sustainability of the preservation of cultural heritage buildings and sites can be measured according to its multiple economic, social, environmental and cultural support. The Cultural Heritage Counts for Europe report shows that the
The US Food Security Scale (USFSS) measures household and child food insecurity (CFI) separately. Our goal was to determine whether CFI increases risks posed by household food insecurity (HFI) to child health and whether the Food Stamp Program (FSP) modifies these effects. From 1998 to 2004, 17,158 ...
Wenning, Richard J; Apitz, Sabine E; Backhaus, Thomas; Barnthouse, Lawrence; Batley, Graeme; Brooks, Bryan; Chapman, Peter M; Griffin, Michael; Kapustka, Lawrence; Landis, Wayne; Leung, Kenneth M Y; Linkov, Igor; Seager, Thomas P; Suter, Glenn; Tannenbaum, Lawrence
The recent accident at the Fukushima I nuclear power plant in Japan (also known as Fukushima Daiichi) captured the world's attention and re-invigorated concerns about the safety of nuclear power technology. The Editors of Integrated Environmental Assessment and Management invited experts in the field to describe the primary issues associated with the control and release of radioactive materials to the environment, particularly those that are of importance to the health of the human populations and the ecological systems that populate our planet. This collection of invited short commentaries aims to inform on the safety of nuclear power plants damaged by natural disasters and provide a primer on the potential environmental impacts. The intent of these invited commentaries is not to fuel the excitement and fears about the Fukushima Daiichi incident; rather, it is to collect views and comments from some of the world's experts on the broad science and policy challenges raised by this event, and to provide high-level views on the science issues that surround this situation in order to improve our collective ability to avoid or at least minimize the consequences of future events.
Full Text Available This original research confronted challenges to environmental management and sustainability posed by veld fires in the Bulilima and Mangwe Districts of Matabeleland in the South Province in southern Zimbabwe. Veld fires have affected the fauna and flora, polluted air and water, and destroyed livelihoods. The study aimed at establishing challenges to environmental sustainability posed by veld fires, identifying the type of environment upon which veld fires have impacted, analysing legal issues and other interventions surrounding the control of veld fires and suggesting new control measures for veld fires. A qualitative research design and quota sampling were used. The study involved 30 participants. Data was collected through a questionnaire, an interview guide and participant observation. Challenges to environmental management and sustainability posed by veld fires include property damage, reduced soil fertility, destruction of vegetation, air and water pollution and destruction of wildlife. Most veld fires are a result of human actions that emanate from the disposal of cigarettes, the burning of vegetation when preparing fields, the use of fire by hunters, smoking out bees and the making of fires by motorists along highways. The government should consider reviewing the current environmental statues. Fireguards should be wide enough to lessen veld-fire impact. Lastly, veld-fire campaigns and rehearsals should be run on a regular basis. It is hoped that this work would make a significant contribution through improving the current thinking about environmental management and sustainability, thereby benefiting policy makers, practitioners and stakeholders.
The number and size of moraine-dammed supraglacial and proglacial lakes is increasing as a result of contemporary climatic change. Moraine-dammed lakes are capable of impounding volumes of water in excess of 107 m3, and often represent a very real threat to downstream communities and infrastructure, should the bounding moraine fail and produce a catastrophic Glacial Lake Outburst Flood (GLOF). Modelling the individual components of a GLOF, including a triggering event, the complex dam-breaching process and downstream propagation of the flood is incredibly challenging, not least because direct observation and instrumentation of such high-magnitude flows is virtually impossible. We briefly review the current state-of-the-art in numerical GLOF modelling, with a focus on the theoretical and computational challenges associated with reconstructing or predicting GLOF dynamics in the face of rates of cryospheric change that have no historical precedent, as well as various implications for researchers and professionals tasked with the production of hazard maps and disaster mitigation strategies.
Full Text Available Generation Y is starting to represent a significant proportion of the labor force and adds to the diversity challenges faced by companies, especially those operating in a global market. Although many characteristics of Generation Y with regard to work and employment have been identified through research, most comes from developed Western countries. We explored the employment expectations of business students in Poland, Slovenia, the UK and South Korea from the psychological contract perspective. We aimed to identify and explain differences between anticipated employee and employer obligations of future entrants to the labor market. Overall, students expect more relational and balanced dimensions of a psychological contract than transactional. However, there are significant differences in the elements, dimensions and types of psychological contract between countries. Polish and Slovenian responses show more elements of a transactional contract than the UK and Korean. The differences can be explained by taking into account economic context and national culture characteristics. The implications of the results for employers’ approach to managing young talent are also discussed.
Esqueda, Vincent; Montoya, Julian A.
As semiconductor devices shrink in size to accommodate faster processing speeds, the need for higher resolution beam-based metrology equipment and beam-based writing equipment will increase. The electron and ion beams used within these types of equipment are sensitive to very small variations in magnetic force applied to the beam. This phenomenon results from changes in Alternating Current (AC) and Direct Current (DC) magnetic flux density at the beam column which causes deflections of the beam that can impact equipment performance. Currently the most sensitive beam-based microscope manufacturers require an ambient magnetic field environment that does not have variations that exceed 0.2 milli-Gauss (mG). Studies have shown that such low levels of magnetic flux density can be extremely difficult to achieve. As examples, scissor lifts, vehicles, metal chairs, and doors moving in time and space under typical use conditions can create distortions in the Earth's magnetic field that can exceed 0.2 mG at the beam column. In addition it is known that changes in the Earth's magnetic field caused by solar flares, earthquakes, and variations in the Earth's core itself all cause changes in the magnetic field that can exceed 0.2 mG. This paper will provide the reader with the basic understanding of the emerging problem, will discuss the environmental and facility level challenges associated in meeting such stringent magnetic field environments, will discuss some of the mitigation techniques used to address the problem, and will close by discussing needs for further research in this area to assure semiconductor and nanotechnology industries are pre-positioned for even more stringent magnetic field environmental requirements.
Markus, Keith A
Nesselroade and Molenaar presented the ideographic filter as a proposal for analyzing lawful regularities in behavioral research. The proposal highlights an inconsistency that poses a challenge for behavioral research more generally. One can distinguish a broadly Humean approach from a broadly non-Humean approach as they relate to variables and to causation. Nesselroade and Molenaar rejected a Humean approach to latent variables that characterizes them as nothing more than summaries of their manifest indicators. By contrast, they tacitly accepted a Humean approach to causes characterized as nothing more than summaries of their manifest causal effects. A non-Humean treatment of variables coupled with a Humean treatment of causation creates a theoretical tension within their proposal. For example, one can interpret the same model elements as simultaneously representing both variables and causes. Future refinement of the ideographic filter proposal to address this tension could follow any of a number of strategies.
Full Text Available All health systems across the world have faced new challenges, which is primarily referable to increasing the cost of health care services as well as growing demands for new and expensive health technologies. The aim of this study is to analyse the main challenges facing the Iranian health system. A review of available governmental and relevant publications about Iranian health care system was undertaken to assess the direction of future healthcare policy. Electronic news agencies, newspapers, and parliament’s electronic news also reviewed to realise policy-makers points of view about the health system. Healthcare services in Iran have had a great success in primary healthcare services in last 25 years, which is mainly attributable to National Health Networks policy. Between 1979 and 2003, average life expectancy at birth increased from 57 to 70 and infant mortality rate fell from 104 to 26 per thousand live births. Active vaccination system, very good distribution and coverage, free end point services, family planning, maternal teaching, and primary referral system are of strong advantages of health networks in Iran. However, the healthcare system is now subject to a range of new pressures that must be addressed. Many of these pressures are common to all health services (rising consumer demands and expectations for expensive new technologies, changing disease patterns, and resources shortage, but some are largely specific to Iran. Financial fairness contribution of the population to health system, responsiveness of health system, overusing new technologies, inadequate integration of health services, and inequitable distribution of the resources are of the main challenges of health system in Iran. In addition, considering demographic changes of the Iranian population in recent decades, which made Iranian population young, potential pressures due to an aging population will reveal in coming years. Many of these pressures relate to policies and
Dodge, David G; Beck, Barbara D
We examined the development of knowledge concerning the risks posed by asbestos to seamen working aboard merchant ships at sea (i.e. commercial, rather than naval vessels). Seamen were potentially exposed to "in-place" asbestos on merchant ships by performing intermittent repair and maintenance tasks. We reviewed studies measuring airborne asbestos onboard merchant ships and health outcomes of merchant seamen, as well as studies, communications, and actions of U.S. organizations with roles in maritime health and safety. Up to the 1970s, most knowledge of the health risks of asbestos was derived from studies of workers in asbestos product manufacturing and asbestos mining and milling industries, and certain end-users of asbestos products (particularly insulators). We found that attention to the potential health risks of asbestos to merchant seamen began in the mid- to late 1970s and early 1980s. Findings of pleural abnormalities in U.S. seamen elicited some concern from governmental and industry/labor organizations, but airborne asbestos concentrations aboard merchant ships were found to be <1 f/cc for most short-term repair and maintenance tasks. Responses to this evolving information served to warn seamen and the merchant shipping industry and led to increased precautions regarding asbestos exposure. Starting in the 1990s, findings of modest increases in lung cancer and/or mesothelioma in some epidemiology studies of seamen led some authors to propose that a causal link between shipboard exposures and asbestos-related diseases existed. Limitations in these studies, however, together with mostly unremarkable measures of airborne asbestos on merchant ships, preclude definitive conclusions in this regard.
Thompson, Debbe; Canada, Ashanti; Bhatt, Riddhi; Davis, Jennifer; Plesko, Lisa; Baranowski, Tom; Cullen, Karen; Zakeri, Issa
Little is known about effective eHealth recruitment methods. This paper presents recruitment challenges associated with enrolling African-American girls aged 8-10 years in an eHealth obesity prevention program, their effect on the recruitment plan, and potential implications for eHealth research. Although the initial recruitment strategy was literature-informed, it failed to enroll the desired number of girls within a reasonable time period. Therefore, the recruitment strategy was reformulated to incorporate principles of social marketing and traditional marketing techniques. The resulting plan included both targeted, highly specific strategies (e.g., selected churches), and more broad-based approaches (e.g., media exposure, mass mailings, radio advertisements). The revised plan enabled recruitment goals to be attained. Media appeared to be particularly effective at reaching the intended audience. Future research should identify the most effective recruitment strategies for reaching potential eHealth audiences.
Gadit, A A Muhammad
Mental health practitioners often come across a number of challenges in their clinical practice. One such challenge that posed a management dilemma presented with the history of reincarnation. This subject has been discussed in non-scientific literature at length but there is an absolute paucity in scientific literature. This paper describes a case where a boy presented with memories of previous life that started haunting him and caused significant anxiety. The subject of reincarnation needs extensive research in order to understand and manage the resultant clinical challenges.
da Silva Figueiredo Celestino Gomes, Priscila; Da Silva, Franck; Bret, Guillaume; Rognan, Didier
A novel docking challenge has been set by the Drug Design Data Resource (D3R) in order to predict the pose and affinity ranking of a set of Farnesoid X receptor (FXR) agonists, prior to the public release of their bound X-ray structures and potencies. In a first phase, 36 agonists were docked to 26 Protein Data Bank (PDB) structures of the FXR receptor, and next rescored using the in-house developed GRIM method. GRIM aligns protein-ligand interaction patterns of docked poses to those of available PDB templates for the target protein, and rescore poses by a graph matching method. In agreement with results obtained during the previous 2015 docking challenge, we clearly show that GRIM rescoring improves the overall quality of top-ranked poses by prioritizing interaction patterns already visited in the PDB. Importantly, this challenge enables us to refine the applicability domain of the method by better defining the conditions of its success. We notably show that rescoring apolar ligands in hydrophobic pockets leads to frequent GRIM failures. In the second phase, 102 FXR agonists were ranked by decreasing affinity according to the Gibbs free energy of the corresponding GRIM-selected poses, computed by the HYDE scoring function. Interestingly, this fast and simple rescoring scheme provided the third most accurate ranking method among 57 contributions. Although the obtained ranking is still unsuitable for hit to lead optimization, the GRIM-HYDE scoring scheme is accurate and fast enough to post-process virtual screening data.
Samet, Jonathan M
This commentary addresses some of the diverse questions of current interest with regard to the health effects of air pollution, including exposure-response relationships, toxicity of inhaled particles and risks to health, multipollutant mixtures, traffic-related pollution, accountability research, and issues with susceptibility and vulnerability. It considers the challenges posed to researchers as they attempt to provide useful evidence for policy-makers relevant to these issues. This commentary accompanies papers giving the results from the ESCALA project, a multi-city study in Latin America that has an overall goal of providing policy-relevant results. While progress has been made in improving air quality, driven by epidemiological evidence that air pollution is adversely affecting public health, the research questions have become more subtle and challenging as levels of air pollution dropped. More research is still needed, but also novel methods and approaches to address these new questions.
Full Text Available This article presents the problem of evolutionary changes of zoonotic pathogens responsible for human diseases. Everyone is exposed to the risk of zoonotic infection, particularly employees having direct contact with animals, i.e. veterinarians, breeders, butchers and workers of animal products’ processing industry. The article focuses on pathogens monitored by the European Centre for Disease Prevention and Control (ECDC, which has been collecting statistical data on zoonoses from all European Union countries for 19 years and publishing collected data in annual epidemiological reports. Currently, the most important 11 pathogens responsible for causing human zoonotic diseases are being monitored, of which seven are bacteria: Salmonella spp., Campylobacter spp., Listeria monocytogenes, Mycobacterium bovis, Brucella spp., Coxiella burnetti and Verotoxin- producing E. coli (VTEC / Shiga-like toxin producing E. coli (STEC. As particularly important are considered foodborne pathogens. The article also includes new emerging zoonotic bacteria, which are not currently monitored by ECDC but might pose a serious epidemiological problem in a foreseeable future: Streptococcus iniae, S. suis, S. dysgalactiae and staphylococci: Staphylococcus intermedius, S. pseudintermedius. Those species have just crossed the animal-human interspecies barrier. The exact mechanism of this phenomenon remains unknown, it is connected, however, with genetic variability, capability to survive in changing environment. These abilities derive from DNA rearrangement and horizontal gene transfer between bacterial cells. Substantial increase in the number of scientific publications on this subject, observed over the last few years, illustrates the importance of the problem. Med Pr 2014;65(6:819–829
Full Text Available Bufadienolide-type cardiac glycosides have a worldwide distribution and are mainly synthesized by plants, but there are also animal sources. In South Africa, members of three genera of the Crassulaceae (Cotyledon, Tylecodon and Kalanchoe cause a unique chronic form of cardiac glycoside poisoning, predominantly in small stock. This paretic/paralytic condition is referred to as “krimpsiekte”, cotyledonosis or “nenta”. “Krimpsiekte” is a plant poisoning only reported from South Africa and is regarded as the most important plant poisoning of small stock in the semi-arid Little Karoo and southern fringes of the Great Karoo. The toxicosis is caused by cumulative bufadienolides which have neurotoxic properties. Four types of cumulative neurotoxic bufadienolides, namely cotyledoside, and the tyledosides, orbicusides and lanceotoxins, have been isolated. Based on the structure activity relationships and certain toxicokinetic parameters possible reasons for their accumulation are presented. Consumption of edible tissues from animals that have ingested these plants poses a potential risk to humans.
Cristiani Vieira Machado
Full Text Available The article analyzes Federal funding of health policy in Brazil in the 2000s, focusing on the Ministry of Health’s budget implementation. Federal spending on health was less unstable between 2000 and 2002 and has expanded since 2006. However, it fluctuated as a share of both the Gross Domestic Product and Gross National Revenue. Federal intergovernmental transfers increased, exceeding 70% in 2007. Meanwhile, the proportion of Federal investments remained low, varying from 3.4% to 6.3%. The highest absolute amount of spending was on specialized outpatient and hospital care. The decade showed a proportionally greater increase in spending on pharmaceutical care. The growing allocation of Federal funds to States in the North and Northeast, especially for primary care and epidemiological surveillance, failed to offset the sharp regional inequalities in per capita Federal spending. The main characteristics of health funding limit Federal health policy governance and pose several challenges for the Brazilian Unified National Health System.
Full Text Available Higher demands of food production for human consumption increased uses of fertilizers and other chemicals that arise in a major public problem and heavy-metal pollution. Levels of Aluminum and Nickel which affect mankind health in exact doses, were determined in fresh and dried samples of Jumbo Cot, Tom Cot, Gold Strike, Gold Bar, Bergeron, Bergarouge, Sweet Cot, Yellow cot and Zebra apricot cultivars to assess possible health risk of apricot (Prunus armeniaca L. consumption. Highest content of Al and Ni among all cultivars, where 9.71 and 2.14 mg/kg of dehydrated apricot samples. Fresh fruit samples maximally contain 2.9 and 0.425 mg/kg of Aluminum and Nickel respectively. Data analysis showed significant differences between cultivars for Al and Ni. Furthermore, to reveal the health-risk possibility of dried and fresh fruit consumption daily intake of elements and health-risk index were calculated and compared.
Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja
The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.
Warming, Marlies; Hansen, Mette G.; Holm, Peter E.
This study investigates the potential health risk from urban gardening. The concentrations of the trace elements arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), lead (Pb), nickel (Ni), and zinc (Zn) in five common garden crops from three garden sites in Copenhagen were measured. Concentra......This study investigates the potential health risk from urban gardening. The concentrations of the trace elements arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), lead (Pb), nickel (Ni), and zinc (Zn) in five common garden crops from three garden sites in Copenhagen were measured...... soil ingestion, vegetable consumption, measured trace element concentrations and tolerable intake levels. The HQs for As, Cd, Cr, Cu, Ni, and Zn do not indicate a health risk through urban gardening in Copenhagen. Exposure to Pb contaminated sites may lead to unacceptable risk not caused by vegetable...
Ratzan, S C; Filerman, G L; Lesar, J W
This issue of the Population Bulletin examines health trends in both developed and developing regions using health measures such as mortality and morbidity and the disability-adjusted life year. It also assesses the challenge of improving health worldwide. The authors proposed the following common denominators in the global challenge to improve health: 1) an individual's health status reflects the interplay of many factors such as the physical environment, political stability, and community structure; 2) direct correlation between the population's level of health and educational levels within that population; 3) prudent use of existing resources may contribute to a healthier public; 4) both public sector and private sector resources are vital for obtaining the best health possible; 5) effective infrastructure for health delivery requires fundamental changes in how governments and health system operate; and 6) policies to promote health are key components of community health efforts.
Warming, Marlies; Hansen, Mette G; Holm, Peter E; Magid, Jakob; Hansen, Thomas H; Trapp, Stefan
This study investigates the potential health risk from urban gardening. The concentrations of the trace elements arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), lead (Pb), nickel (Ni), and zinc (Zn) in five common garden crops from three garden sites in Copenhagen were measured. Concentrations (mg/kg dw) of As were 0.002-0.21, Cd 0.03-0.25, Cr gardening in Copenhagen. Exposure to Pb contaminated sites may lead to unacceptable risk not caused by vegetable consumption but by unintentional soil ingestion.
Full Text Available Presently, water contamination issues are of great concern worldwide. Mexico has not escaped this environmental problem, which negatively affects aquifers, water bodies and biodiversity; but most of all, public health. The objective was to determine the level of water contamination in six tributaries of the Conchos River and to relate their levels to human health risks. Bimonthly samples were obtained from each location during 2005 and 2006. Physical-chemical variables (temperature, pH, electrical conductivity (EC, Total solids and total nitrogen as well as heavy metals (As, Cr, Cu, Fe, Mn, Ni, V, Zn, and Li were determined. The statistical analysis considered yearly, monthly, and location effects, and their interactions. Temperatures differed only as a function of the sampling month (P < 0.001 and the pH was different for years (P = 0.006, months (P < 0.001 and the interaction years x months (P = 0.018. The EC was different for each location (P < 0.001, total solids did not change and total nitrogen was different for years (P < 0.001, months (P < 0.001 and the interaction years x months (P < 0.001. The As concentration was different for months (P = 0.008 and the highest concentration was detected in February samples with 0.11 mg L-1. The Cr was different for months (P < 0.001 and the interaction years x months (P < 0.001, noting the highest value of 0.25 mg L-1. The Cu, Fe, Mn, Va and Zn were different for years, months, and their interaction. The highest value of Cu was 2.50 mg L-1; forFe, it was 16.36 mg L-1; forMn it was 1.66 mg L-1; V was 0.55 mg L-1; and Zn was 0.53 mg L-1. For Ni, there were differences for years (P = 0.030, months (P < 0.001, and locations (P = 0.050, with the highest Ni value being 0.47 mg L-1. The Li level was the same for sampling month (P < 0.001. This information can help prevent potential health risks in the communities established along the river watershed who use this natural resource for swimming and fishing
Full Text Available The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Alma-Ata, which was adopted at the International Conference on Primary Health Care convened in Kazakhstan in 1978, facilitating population-wide lifestyle and behavioral change to reduce risk factors for chronic and communicable diseases, as well as injuries, remains a high priority for emerging health care reforms and the new public health. This paper reviews the current public health challenges in Kazakhstan and describes five priorities for building public health capacity that are now being developed and undertaken at the Kazakhstan School of Public Health to strengthen population health in the country and the Central Asian Region.
Recently, awareness has developed of the environmental consequences of drug waste and disposal. These residues are identified as coming from either diffuse sources, the most significant of which is via the discharge of these residues in urine and feces, and thus the sewage system and water contains these drug remnants and their metabolites, or from point sources, sometimes with very high levels of concentration in waste from chemical and pharmaceutical industries, health care settings, but also from intensive livestock farming and aquaculture. Depending on their physical chemistry properties, these substances are more or less naturally biodegradable and easily treated in sewage purification plants. The effectiveness of these treatment processes is highly random and unpredictable, but is overall around 60%, nevertheless with variations of 2-99% according to the molecules. The silt from these treatment plants, sometimes very rich in lipophilic substances is on occasion reused for agricultural application as fertilizer, paving the way for a possible contamination of crops. Furthermore, the use of veterinary drugs in animals can lead to soil contamination either directly or through manure and slurry. The contamination can equally reach and affect surface water, groundwater and sometimes the water intended for human consumption. The National academy of Pharmacy has established some general recommendations on the proper use of drugs, environmental monitoring and surveillance, risk assessment for humans and the environment, prevention and the need for prevention. Several categories of drugs are more worrying: cancer treatments, antibiotics as well as transfers of anti-bio-resistance, and hormonal derivatives which has been previously demonstrated to contribute, along with other molecules, to detrimental effects on endocrines.
McCuaig, Louise; Carroll, Kristie; Macdonald, Doune
The teaching of health literacy in school-based health education (SBHE) is of international interest, yet there is less ready access to how conceptions of health literacy can be operationalised in school programmes. More specifically, while articulated in curriculum documents such as the incoming Australian Curriculum: Health and Physical…
Zhai, Yuanzheng; Lei, Yan; Wu, Jin; Teng, Yanguo; Wang, Jinsheng; Zhao, Xiaobing; Pan, Xiaodong
Nitrate pollution has pervaded many parts of the world, especially in developing countries such as China. Based on the available groundwater nitrate data sets in China (2000-2015), the groundwater pollution levels at the provincial scale are evaluated which contains 33 provinces (units) except for Macau because of lacking data. Then, the potential risks posed to human health in national scale are quantified. In order to make the results more precise and systematical, both drinking and dermal contact exposure pathways are considered, and the influenced crowd are more finely divided into four groups to study the impacts of age and gender on the outcome, which include infants (0-6 months), children (7 months-17 years old), adult males (18 years old-), and adult females (18 years old-). Results indicate that there are seven units whose groundwater nitrate concentrations exceed the standard value with Shaanxi being a seriously poor condition. Facing the same level of nitrate, the health risk level changes in the order of infants > children > adult males > adult females. That is to say, minors and males are more vulnerable compared with adults and females, respectively. There is no adverse effect on adult females of the whole country, while gender really impacts on the health risk assessment result. Adult males, children, and infants face various degrees of health risk respectively in Shaanxi and Shandong, which are needed to pay more attention to.
Adam T Craig
Full Text Available Objective: To assess the public health risk posed by the ongoing Ebola virus disease (EVD epidemic in West Africa to Pacific island countries and areas and to highlight priority risk management actions for preparedness and response. Method: The likelihood of EVD importation and the magnitude of public health impact in Pacific island countries and areas were assessed to determine overall risk. Literature about the hazard, epidemiology, exposure and contextual factors associated with EVD was collected and reviewed. Epidemiological information from the current EVD outbreak was assessed. Results: As of 11 March 2015, there have been more than 24 200 reported cases of EVD and at least 9976 deaths in six West African countries. Three EVD cases have been infected outside of the West African region, and all have epidemiological links to the outbreak in West Africa. Pacific island countries’ and areas’ relative geographic isolation and lack of travel or trade links between countries with transmission means that EVD importation is very unlikely. However, should a case be imported, the health and non-health consequences would be major. The capacity of Pacific island countries and areas to respond adequately varies greatly between (and within states but in general is limited. Discussion: This risk assessment highlights the needs to enhance preparedness for EVD in the Pacific by strengthening the capacities outlined in the World Health Organization Framework for Action on Ebola. Priority areas include the ability to detect and respond to suspected EVD cases quickly, isolation and management of cases in appropriately resourced facilities and the prevention of further cases through infection prevention and control. These efforts for Ebola should enhance all-hazards public health preparedness in line with the International Health Regulations (2005.
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Jailton Carreteiro Damasceno
Full Text Available The relationship between metrology, nanotechnology and nanoscience and sanitary regulation is discussed from the point of view of its importance and the interrelationship between the themes for the development of products and services involving nanotech-nology. The discussion involves the main techniques for measuring dimensional, chemical and biological properties of materials, and presents some of the challenges for the future. Issues such as processes of standardization and regulation in Europe, U.S. and Brazil are also addressed, providing an overview of how these processes are related to sanitary regulation.
The purpose of this report is to characterize the seeps identified at the Shiprock UMTRA Project site during the prelicensing custodial care inspection conducted in December of 1990, to evaluate the relationship between the seeps and uranium processing activities or tailings disposal, and to evaluate the risk posed by the seep water to human health and the environment. The report provides a brief description of the geology, groundwater hydrology, and surface water hydrology. The locations of the seeps and monitor wells are identified, and the water quality of the seeps and groundwater is discussed in the context of past activities at the site. The water quality records for the site are presented in tables and appendices; this information was used in the risk assessment of seep water.
Full Text Available The growth of computing technology during the previous three decades has resulted in a large amount of content being created in digital form. As their creators retire or pass away, an increasing number of personal data collections, in the form of digital media and complete computer systems, are being offered to the academic institutional archive. For the digital curator or archivist, the handling and processing of such digital material represents a considerable challenge, requiring development of new processes and procedures. This paper outlines how digital forensic methods, developed by the law enforcement and legal community, may be applied by academic digital archives. It goes on to describe the strategic and practical decisions that should be made to introduce forensic methods within an existing curatorial infrastructure and how different techniques, such as forensic hashing, timeline analysis and data carving, may be used to collect information of a greater breadth and scope than may be gathered through manual activities.
Grudinin, Sergei; Kadukova, Maria; Eisenbarth, Andreas; Marillet, Simon; Cazals, Frédéric
The 2015 D3R Grand Challenge provided an opportunity to test our new model for the binding free energy of small molecules, as well as to assess our protocol to predict binding poses for protein-ligand complexes. Our pose predictions were ranked 3-9 for the HSP90 dataset, depending on the assessment metric. For the MAP4K dataset the ranks are very dispersed and equal to 2-35, depending on the assessment metric, which does not provide any insight into the accuracy of the method. The main success of our pose prediction protocol was the re-scoring stage using the recently developed Convex-PL potential. We make a thorough analysis of our docking predictions made with AutoDock Vina and discuss the effect of the choice of rigid receptor templates, the number of flexible residues in the binding pocket, the binding pocket size, and the benefits of re-scoring. However, the main challenge was to predict experimentally determined binding affinities for two blind test sets. Our affinity prediction model consisted of two terms, a pairwise-additive enthalpy, and a non pairwise-additive entropy. We trained the free parameters of the model with a regularized regression using affinity and structural data from the PDBBind database. Our model performed very well on the training set, however, failed on the two test sets. We explain the drawback and pitfalls of our model, in particular in terms of relative coverage of the test set by the training set and missed dynamical properties from crystal structures, and discuss different routes to improve it.
Thompson, George R; Stevens, David A; Clemons, Karl V; Fierer, Josh; Johnson, Royce H; Sykes, Jane; Rutherford, George; Peterson, Michael; Taylor, John W; Chaturvedi, Vishnu
Coccidioidomycosis ('Valley Fever'), caused by the inhalation of the fungus Coccidioides, remains a recalcitrant health problem in large parts of California. The incidence and severity of the disease continues to rise in many parts of the state. In this manuscript, we highlight unanswered questions about the disease. Specifically, the extent of disease burden, genetic determinants of host susceptibility, diagnostic and treatment guidelines, natural reservoirs of the pathogens, antifungal drug resistance, and fungal determinants of mild or severe disease are all areas awaiting in depth investigations. We also recommend establishment of a California Coccidioidomycosis Registry to improve clinical care and translational research.
Dietrich, C F; Riemer-Hommel, P
The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate.
Full Text Available During the last decades huge amounts of data have been collected in clinical databases representing patients’ health states (e.g., as laboratory results, treatment plans, medical reports. Hence, digital information available for patient-oriented decision making has increased drastically but is often scattered across different sites. As as solution, personal health record systems (PHRS are meant to centralize an individual’s health data and to allow access for the owner as well as for authorized health professionals. Yet, expert-oriented language, complex interrelations of medical facts and information overload in general pose major obstacles for patients to understand their own record and to draw adequate conclusions. In this context, recommender systems may supply patients with additional laymen-friendly information helping to better comprehend their health status as represented by their record. However, such systems must be adapted to cope with the specific requirements in the health domain in order to deliver highly relevant information for patients. They are referred to as health recommender systems (HRS. In this article we give an introduction to health recommender systems and explain why they are a useful enhancement to PHR solutions. Basic concepts and scenarios are discussed and a first implementation is presented. In addition, we outline an evaluation approach for such a system, which is supported by medical experts. The construction of a test collection for case-related recommendations is described. Finally, challenges and open issues are discussed.
Wiesner, Martin; Pfeifer, Daniel
During the last decades huge amounts of data have been collected in clinical databases representing patients' health states (e.g., as laboratory results, treatment plans, medical reports). Hence, digital information available for patient-oriented decision making has increased drastically but is often scattered across different sites. As as solution, personal health record systems (PHRS) are meant to centralize an individual's health data and to allow access for the owner as well as for authorized health professionals. Yet, expert-oriented language, complex interrelations of medical facts and information overload in general pose major obstacles for patients to understand their own record and to draw adequate conclusions. In this context, recommender systems may supply patients with additional laymen-friendly information helping to better comprehend their health status as represented by their record. However, such systems must be adapted to cope with the specific requirements in the health domain in order to deliver highly relevant information for patients. They are referred to as health recommender systems (HRS). In this article we give an introduction to health recommender systems and explain why they are a useful enhancement to PHR solutions. Basic concepts and scenarios are discussed and a first implementation is presented. In addition, we outline an evaluation approach for such a system, which is supported by medical experts. The construction of a test collection for case-related recommendations is described. Finally, challenges and open issues are discussed.
Ferrater, Marta; Ortuño, Maria; Masana, Eulàlia; Pallàs, Raimon; Perea, Hector; Baize, Stephane; García-Meléndez, Eduardo; Martínez-Díaz, José J.; Echeverria, Anna; Rockwell, Thomas; Sharp, Warren D.; Arrowsmith, Ramon; Medialdea, Alicia; Rhodes, Edward
The Alhama de Murcia fault (AMF) is a 87 km-long left-lateral slow moving fault and is responsible for the 5.1 Mw 2011 Lorca earthquake. The characterization of the seismic potential of seismogenic strike-slip slow moving faults is necessary but raises huge methodological challenges, as most paleoseismological and active tectonic techniques have been designed on and for fast moving faults. The AMF is used here as a pilot study area to adapt the traditional geomorphological and trenching analyses, especially concerning the precise quantification of offset channels. We: 1) adapted methodologies to slow moving faults, 2) obtained, for the first time, the slip rate of the AMF, and 3) updated its recurrence period and maximum expected magnitude. Morphotectonic studies aim to use the measured tectonic offset of surface channels to calculate seismic parameters. However, these studies lack a standard criterion to score the analysed features. We improved this by differentiating between subjective and objective qualities, and determining up to three objective parameters (lithological changes, associated morphotectonics and shape, and three shape sub-parameters; all ranging from 0 to 1). By applying this methodology to the AMF, we identified and characterized 138 offset features that we mapped on a high-resolution (0.5 × 0.5 m pixel size) Digital Elevation Model (DEM) from a point cloud acquired in 2013 by airborne light detection and ranging (lidar). The identified offsets, together with the ongoing datings, are going to be used to calculate the lateral slip rate of the AMF. In three-dimensional trenches, we measured the offsets of a buried channel by projecting the far-field tendency of the channel onto the fault. This procedure is inspired by the widespread geomorphological procedure and aims to avoid the diffuse deformation in the fault zone associated with slow moving faults. The calculation of the 3D tendency of the channel and its projection onto the fault permitted
Blumberg, Moderators Fran C; Burke, Lauren C; Hodent, Participants Celia; Evans, Michael A; Lane, H Chad; Schell, Jesse
As articles in this journal have demonstrated over the past 3 years, serious game development continues to flourish as a vehicle for formal and informal health education. How best to characterize a "serious" game remains somewhat elusive in the literature. Many researchers and practitioners view serious games as capitalizing on computer technology and state-of-the-art video graphics as an enjoyable means by which to provide and promote instruction and training, or to facilitate attitude change among its players. We invited four distinguished researchers and practitioners to further discuss with us how they view the characteristics of serious games for health, how those characteristics differ from those for academic purposes, the challenges posed for serious game development among players of different ages, and next steps for the development and empirical examination of the effectiveness of serious games for players' psychological and physical well-being.
Silva, Kênia Lara; de Sena, Roseni Rosângela; Belga, Stephanie Marques Moura Franco; Silva, Paloma Morais; Rodrigues, Andreza Trevenzoli
OBJECTIVE To examine successful practices of health promotion in health, education, culture, welfare and sport, leisure, identifying the elements of success and challenges in the field. METHODS A qualitative study with data obtained from in-depth analysis that included participant observation, interviews with managers, coordinators, professionals and participants from 29 practices reported as successful for promoting health in six municipalities of the metropolitan region of Belo Horizonte, MG, Southeastern Brazil, in 2011. The variables of the study were concept, dimension, dissemination and ease of access, identified in practices guided by content analysis. RESULTS The results indicate a conceptual and methodological uncertainty about health promotion as evidenced by conflicting objects and contradictory purposes. The practices differ in size, coverage and ease of access, determined by inter-sector coordination and political and financial investment. CONCLUSIONS We identified challenges to health promotion focusing on vulnerable populations, limits to financing and intersectoral partnerships. PMID:24789640
Avčin, Bojana Avguštin; Kučina, Andrea Užmah; Sarotar, Brigita Novak; Radovanović, Mirjana; Plesničar, Blanka Kores
The global financial and economic crisis starting in 2007 led to a deterioration of several socio-economic determinants of mental health. The aim of this cross-sectional study was to examine the impact of the present economic crisis on the depression and anxiety levels of the employed in the private and public sector in Slovenia. Altogether 1592 employees completed an internet based self-reported questionnaire. Data about perceived impact of the economic crisis, several socio-demographic, socioeconomic, and health parameters were collected. Depression symptoms were assessed by the Center for Epidemiological Studies-Depression Scale and anxiety symptoms by the Spielberger State-Inventory. Regression models were used 1) to explore the associations of the economic crisis with the level of depression and anxiety symptoms while controlling for some sociodemographic and work characteristic variables, and 2) to understand the relationship between some potentially important socioeconomic variables and the perception of the economic crisis. Depressive and anxiety scores were significantly increased among 590 (46.6%) employees being affected by the economic crisis. The level of depressive symptoms was significantly associated with perceived impact by the crisis, recent sick leave, reported injuries sustained at work, benzodiazepine and analgesic use, the lack of emotional support, and trust in crisis telephone lines. The level of anxiety symptoms yielded the robust association with the level of depression symptoms, reported injuries sustained on the way to work and education. The economic crisis poses an additional risk factor for mental health problems which clinicians should internalize and become more aware of them. Symptoms of depression and anxiety can be masked in high-utilizers of medical care with physical complaints or psychoactive drug use.
Full Text Available Abstract This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems. The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce.
Burgard, Sarah A; Chen, Patricia V
Health disparities are increasingly studied in and across a growing array of societies. While novel contexts and comparisons are a promising development, this commentary highlights four challenges to finding appropriate and adequate health measures when making comparisons across groups within a society or across distinctive societies. These challenges affect the accuracy with which we characterize the degree of inequality, limiting possibilities for effectively targeting resources to improve health and reduce disparities. First, comparisons may be challenged by different distributions of disease and second, by variation in the availability and quality of vital events and census data often used to measure health. Third, the comparability of self-reported information about specific health conditions may vary across social groups or societies because of diagnosis bias or diagnosis avoidance. Fourth, self-reported overall health measures or measures of specific symptoms may not be comparable across groups if they use different reference groups or interpret questions or concepts differently. We explain specific issues that make up each type of challenge and show how they may lead to underestimates or inflation of estimated health disparities. We also discuss approaches that have been used to address them in prior research, note where further innovation is needed to solve lingering problems, and make recommendations for improving future research. Many of our examples are drawn from South Africa or the United States, societies characterized by substantial socioeconomic inequality across ethnic groups and wide disparities in many health outcomes, but the issues explored throughout apply to a wide variety of contexts and inquiries.
Mass shootings, such as the 2012 Newtown massacre, have repeatedly led to political discourse about limiting access to guns for individuals with serious mental illness. Although the political climate after such tragic events poses a considerable challenge to mental health advocates who wish to minimize unsympathetic portrayals of those with mental illness, such media attention may be a rare opportunity to focus attention on risks of victimization of those with serious mental illness and barriers to obtaining psychiatric care. Current federal gun control laws may discourage individuals from seeking psychiatric treatment and describe individuals with mental illness using anachronistic, imprecise, and gratuitously stigmatizing language. This article lays out potential talking points that may be useful after future gun violence.
The field of mobile health ("m-Health") is evolving rapidly and there is an explosive growth of psychological tools on the market. Exciting high-tech developments may identify symptoms, help individuals manage their own mental health, encourage help seeking, and provide both preventive and therapeutic interventions. This development has the potential to be an efficient cost-effective approach reducing waiting lists and serving a considerable portion of people globally ("g-Health"). However, few of the mobile applications (apps) have been rigorously evaluated. There is little information on how valid screening and assessment tools are, which of the mobile intervention apps are effective, or how well mobile apps compare to face-to-face treatments. But how feasible is rigorous scientific evaluation with the rising demands from policy makers, business partners, and users for their quick release? In this paper, developments in m-Health tools-targeting screening, assessment, prevention, and treatment-are reviewed with examples from the field of trauma and posttraumatic stress disorder. The academic challenges in developing and evaluating m-Health tools are being addressed. Evidence-based guidance is needed on appropriate research designs that may overcome some of the public and ethical challenges (e.g., equity, availability) and the market-driven wish to have mobile apps in the "App Store" yesterday rather than tomorrow.
Fifty years of nuclear weapons production and energy research in the United States during the Cold War generated large amounts of radioactive wastes, spent nuclear fuel (SNF), excess plutonium and uranium, thousands of contaminated facilities, and contaminated soil and groundwater. During most of that half century, the Nation did not have the environmental regulatory structure or nuclear waste cleanup technologies that exist today. The result was a legacy of nuclear waste that was stored and disposed of in ways now considered unacceptable. Cleaning up and ultimately disposing of these wastes is the responsibility of the U.S. Department of Energy (DOE). In 1989, DOE established the Office of Environmental Management (EM) to solve the large scale and technically challenging risks posed by the world's largest nuclear cleanup. This required EM to build a new nuclear cleanup infrastructure, assemble and train a technically specialized workforce, and develop the technologies and tools required to safely decontaminate, disassemble, stabilize, disposition, and remediate unique radiation hazards. The sites where nuclear activities produced legacy waste and contamination include the original Manhattan Project sites--Los Alamos, New Mexico; Hanford, Washington; and Oak Ridge, Tennessee--as well as major Cold War sites, such as Savannah River Site, South Carolina; the Idaho National Laboratory, Idaho; Rocky Flats Plant, Colorado; and Fernald, Ohio. Today EM has responsibility for nuclear cleanup activities at 21 sites covering more than two million acres in 13 states, and employs more than 30,000 Federal and contractor employees, including scientists, engineers and hazardous waste technicians. This cleanup poses unique, technically complex problems, which must be solved under the most hazardous of conditions, and which will require billions of dollars a year for several more decades. The EM program focus during its first 10 years was on managing the most urgent risks and
Subpart D of the Common Rule establishes 4 categories of research that may be conducted on children. One category, 45 CFR 46.406, permits research posing a minor increase over minimal risk and no prospect of direct benefit but expected to yield vital knowledge about the subjects' disorder or condition. To include other children in research posing a minor increase over minimal risk and no prospect of direct benefit requires federal review and approval of the Secretary of Health and Human Services under 45 CFR 46.407. It is widely held that children generally should not be exposed to more than minimal risk in research without the prospect of direct benefit. To justify deviating from this norm, as 406 allows, two claims must be true: (1) When there is vital knowledge to be gained from studying children, it is permissible to expose some children to a minor increase over minimal risk with no prospect of direct benefit; (2) It is permissible for locally reviewed and approved research to expose only children with the disorder or condition under investigation to greater risk with no prospect of direct benefit. The justification for (1) appears to be grounded in the magnitude of benefit to society combined with the need to study children. This article demonstrates that, even if the necessity and magnitude of benefit to society justify exposing children to increased risk, the decision to categorically restrict participation in such research to children with the disorder or condition under investigation (unless the study is federally reviewed and approved) is not justified. Subpart D should be revised.
McInnes, Colin; Kamradt-Scott, Adam; Lee, Kelley; Reubi, David; Roemer-Mahler, Anne; Rushton, Simon; Williams, Owain David; Woodling, Marie
With the emergence of global health comes governance challenges which are equally global in nature. This article identifies some of the initial limitations in analyses of global health governance (GHG) before discussing the focus of this special supplement: the framing of global health issues and the manner in which this impacts upon GHG. Whilst not denying the importance of material factors (such as resources and institutional competencies), the article identifies how issues can be framed in different ways, thereby creating particular pathways of response which in turn affect the potential for and nature of GHG. It also identifies and discusses the key frames operating in global health: evidence-based medicine, human rights, security, economics and development.
Laurie Schwab Zabin
@@ The field of reproductive health has had long experience negotiating challenging environments in ways that other health fields have not -- perhaps because other health fields usually deal with illness which everyone agrees is not a good thing. Or maybe because we have all been born, we all think we know something about reproduction. Whatever the reason,we have over the years seen bitter political and ideological debates over population and family planning, abortion, the treatment of HIV/AIDS, in vitro fertilization, new contraceptive technologies--and now adolescent reproductive health. We shouldn't be surprised.But just as we have had to prevail in those debates in the past, they are crucial today: the numbers of young people entering their reproductive years throughout the world, especially the developing world, make it essential that youth be reached not only with messages and services crafted in the last 40 years but also with new messages, new ideas and new services.
Full Text Available Global health networks, webs of individuals and organizations with a shared concern for a particular condition, have proliferated over the past quarter century. They differ in their effectiveness, a factor that may help explain why resource allocations vary across health conditions and do not correspond closely with disease burden. Drawing on findings from recently concluded studies of eight global health networks—addressing alcohol harm, early childhood development (ECD, maternal mortality, neonatal mortality, pneumonia, surgically-treatable conditions, tobacco use, and tuberculosis—I identify four challenges that networks face in generating attention and resources for the conditions that concern them. The first is problem definition: generating consensus on what the problem is and how it should be addressed. The second is positioning: portraying the issue in ways that inspire external audiences to act. The third is coalition-building: forging alliances with these external actors, particularly ones outside the health sector. The fourth is governance: establishing institutions to facilitate collective action. Research indicates that global health networks that effectively tackle these challenges are more likely to garner support to address the conditions that concern them. In addition to the effectiveness of networks, I also consider their legitimacy, identifying reasons both to affirm and to question their right to exert power.
Martin, Paul; Duffy, Tim; Johnston, Brian; Banks, Pauline; Harkess-Murphy, Eileen; Martin, Colin R
The European Family Health Nursing Project is a revitalized World Health Organization initiative led by the University of the West of Scotland. Partner countries include Armenia, Austria, Germany, Italy, Poland, Portugal, Romania, Slovenia, and Spain. European Union Lifelong Learning funding was received in 2011 to facilitate a consistency of approach in the development of a definition of family health nursing, required core competencies and capabilities, and consequent education and training requirements. Global health challenges have informed the development of the project: increasingly aging populations, the increasing incidence in noncommunicable diseases that are currently the main cause of death, and the significant progress made in the way health systems have developed to meet the demands in relation to access and equality of health services. Governments and policy makers should develop a health workforce based on the principles of teamwork and interdisciplinarity while recognizing the core contribution of the "specialist generalist" role in the primary care setting.
Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Dharamsi, Shafik
Medical tourism-the practice where patients travel internationally to privately access medical care-may limit patients' regular physicians' abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors' typical involvement in patients' informed decision-making is challenged when their patients engage in medical tourism. Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants' perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians' abilities to support medical tourists' informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician's role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician's reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians' concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Medical tourism is creating new challenges for
Janice Katherine Kopinak, MHSc, MSc., RN
Full Text Available Background: Despite decades of disagreement among mental health practitioners and researchers in the Western world pertaining to the causation, classification and treatment of mental disorders there is an ongoing push to implement western mental health models in developing countries. Little information exists on the adaptability of western mental health models in developing countries. Method: This paper presents a review of the attempt to implement a western-oriented mental health system into a different culture, specifically a developing country such as Uganda. It draws upon an extensive literature review and the author’s work in Uganda to identify the lessons learned as well as the challenges of introducing a western-oriented mental health system in a totally new cultural milieu. Results: There is recognition by the national government that the challenges faced in mental health services poses serious public health and development concerns. Efforts have and are being made to improve services using the Western model to diagnose and treat, frequently with practitioners who are unfamiliar with the language, values and culture. Conclusions and Global Health Implications: Uganda can continue to implement the Western mental health practice model which emanates from a different cultural base, based on the medical model and whose tenets are currently being questioned, or establish a model based on their needs with small baseline in-country surveys that focus on values, beliefs, resiliency, health promotion and recovery. The latter approach will lead to a more efficient mental health system with improved care, better outcomes and overall mental health services to Ugandan individuals and communities.
Ohiozebau, Ehimai; Tendler, Brett; Codling, Garry; Kelly, Erin; Giesy, John P; Jones, Paul D
Polycyclic aromatic hydrocarbons (PAHs) are released to the environment from oil sands operations and from natural sources in Alberta, Canada. Concentrations of 16 USEPA priority PAHs were measured in tissues of fishes collected from three locations on the Athabasca River in Alberta and two downstream locations on the Slave River in the Northwest Territories, Canada. A total of 425 individual fish were collected including 89 goldeye (Hiodon alosoides), 93 whitefish (Coregonus clupeaformis), 104 northern pike/jackfish (Esox lucius), 96 walleye (Sander vitreus) and 43 burbot/loche mariah/mariah (Lota lota). Fish were sampled during the summer and fall of 2011 and spring of 2012. Dorsal muscle of fishes from upstream reaches of the Athabasca River, close to oil sands extraction and upgrading activities, contained greater concentrations of individual PAHs than concentrations in muscle of fishes from further downstream in the Slave River. Concentrations of the sum of USEPA indicator PAHs (∑PAHs) in fishes collected in the vicinity of Fort McKay, closest to oil sands activities, varied among seasons with average concentrations ranging from 11 (burbot, summer) to 1.2 × 10(2) ng/g, wm (burbot, spring) with a mean of 48 ng/g, wm. Concentrations of ∑PAHs in fishes collected in the vicinity of Fort Resolution, the location most distant from oil sands activities, also varied among species and seasons, with average concentrations ranging from 4.3 (whitefish, summer) to 33 ng/g, wm (goldeye, summer) with a mean of 13 ng/g, wm. Significant differences in concentrations of ∑PAHs in muscle were observed within goldeye, jackfish, walleye and whitefish among sites. Health risks posed by PAHs to humans were assessed probabilistically using a B[a]P equivalents approach (B[a]Peq). The average lifetime risk of additional cancers for humans who consumed fish was deemed to be within an 'acceptable' range of risk (i.e., less than 10(-6)).
Full Text Available The field of mobile health (“m-Health” is evolving rapidly and there is an explosive growth of psychological tools on the market. Exciting high-tech developments may identify symptoms, help individuals manage their own mental health, encourage help seeking, and provide both preventive and therapeutic interventions. This development has the potential to be an efficient cost-effective approach reducing waiting lists and serving a considerable portion of people globally (“g-Health”. However, few of the mobile applications (apps have been rigorously evaluated. There is little information on how valid screening and assessment tools are, which of the mobile intervention apps are effective, or how well mobile apps compare to face-to-face treatments. But how feasible is rigorous scientific evaluation with the rising demands from policy makers, business partners, and users for their quick release? In this paper, developments in m-Health tools—targeting screening, assessment, prevention, and treatment—are reviewed with examples from the field of trauma and posttraumatic stress disorder. The academic challenges in developing and evaluating m-Health tools are being addressed. Evidence-based guidance is needed on appropriate research designs that may overcome some of the public and ethical challenges (e.g., equity, availability and the market-driven wish to have mobile apps in the “App Store” yesterday rather than tomorrow.
Adambekov, Shalkar; Kaiyrlykyzy, Aiym; Igissinov, Nurbek; Linkov, Faina
The Central Asian region, which encompasses Kazakhstan, Uzbekistan, Tajikistan, Turkmenistan and Kyrgyzstan, is an interesting geographic region with a rich history dating back to the Silk Road, Mongol conquests and expansion of the Russian Empire. However, from a public health viewpoint, the Central Asian region is under-investigated, and many public health challenges exist, as countries of Central Asia inherited the centralised medical systems practiced in the Soviet Union, and are currently undergoing rapid transitions. A large number of low and middle-income countries around the world, including countries of Central Asia, face a double burden of chronic and infectious disease. This essay focuses on the exploration of the most important public health challenges in the Central Asian region, including limited scientific productivity, the double burden of chronic and infectious disease, the need for healthcare reform and the reduction in care variation. Central Asia has a large number of medical schools, medical centres, and emerging research institutes that can be used to foster a change in medical and public health practice in the region.
Martin, Graeme; Beech, Nic; MacIntosh, Robert; Bushfield, Stacey
The discourse of leaderism in health care has been a subject of much academic and practical debate. Recently, distributed leadership (DL) has been adopted as a key strand of policy in the UK National Health Service (NHS). However, there is some confusion over the meaning of DL and uncertainty over its application to clinical and non-clinical staff. This article examines the potential for DL in the NHS by drawing on qualitative data from three co-located health-care organisations that embraced DL as part of their organisational strategy. Recent theorising positions DL as a hybrid model combining focused and dispersed leadership; however, our data raise important challenges for policymakers and senior managers who are implementing such a leadership policy. We show that there are three distinct forms of disconnect and that these pose a significant problem for DL. However, we argue that instead of these disconnects posing a significant problem for the discourse of leaderism, they enable a fantasy of leadership that draws on and supports the discourse.
Mackey, Tim K; Nayyar, Gaurvika
Amidst the rise of e-commerce, there has been a proliferation of illicit online pharmacies that threaten global patient safety by selling drugs without a prescription directly to the consumer. Despite this clear threat, little is known about the key risk characteristics, central challenges and current legal, regulatory and law enforcement responses. A review was conducted of the English literature with search terms 'online pharmacies', 'Internet pharmacies', 'cyber pharmacies', 'rogue pharmacies', and 'e-pharmacies' using PubMed, JSTOR, and Google Scholar from 1999-2005. Illicit online pharmacies are a rapidly growing public health threat and are characterized by a number of complex and interrelated risk factors. Solutions are varied and are of questionable utility in the face of evolving technology that enables this form of transnational cybercrime. Legal, regulatory and technology solutions must address the entire illicit online pharmacy ecosystem in order to be effective. There is a critical need to build international consensus, conduct additional research and develop technology to combat illicit online pharmacies. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Mackey, Tim K.; Nayyar, Gaurvika
Background Amidst the rise of e-commerce, there has been a proliferation of illicit online pharmacies that threaten global patient safety by selling drugs without a prescription directly to the consumer. Despite this clear threat, little is known about the key risk characteristics, central challenges and current legal, regulatory and law enforcement responses. Sources of data A review was conducted of the English literature with search terms ‘online pharmacies’, ‘Internet pharmacies’, ‘cyber pharmacies’, ‘rogue pharmacies’, and ‘e-pharmacies’ using PubMed, JSTOR, and Google Scholar from 1999–2005. Areas of agreement Illicit online pharmacies are a rapidly growing public health threat and are characterized by a number of complex and interrelated risk factors. Areas of controversy Solutions are varied and are of questionable utility in the face of evolving technology that enables this form of transnational cybercrime. Growing points Legal, regulatory and technology solutions must address the entire illicit online pharmacy ecosystem in order to be effective. Areas timely for developing research There is a critical need to build international consensus, conduct additional research and develop technology to combat illicit online pharmacies. PMID:27151957
Alami, Hassane; Gagnon, Marie-Pierre; Fortin, Jean-Paul
Information and communication technologies have transformed all sectors of society. The health sector is no exception to this trend. In light of "digital health", we see multiplying numbers of web platforms and mobile health applications, often brought by new unconventional players who produce and offer services in non-linear and non-hierarchal ways, this by multiplying access points to services for people. Some speak of a "uberization" of healthcare. New realities and challenges have emerged from this paradigm, which question the abilities of health systems to cope with new business and economic models, governance of data and regulation. Countries must provide adequate responses so that digital health, based increasingly on disruptive technologies, can benefit for all.
Achievements and Challenges of Resource Allocation for Health in a ... and challenges of a resource allocation process in a decentralized health system in ... planning and management aspects for the allocation of financial resources from the ...
Vitolo, Claudia; Bella Gazdiyeva, Bella; Tucker, Allan; Russell, Andrew; Ali, Maged; Althonayan, Abraham
Kazakhstan has witnessed a remarkable economic development in the past 15 years, becoming an upper-middle-income country. However it is still widely regarded as a developing nation, partially because of its population's low life expectancy which is 5 years below the average in similar economies. The environment is in a rather fragile state, affected by soil, water, air pollution, radioactive contamination and climate change. However, Kazakhstan's government is moving towards clean energy and environmental protection and calling on scientists to help prioritise investments. The British Council-funded "Kazakhstan's Environment-Health Risk Analysis (KEHRA)" project is one of the recently launched initiatives to support Kazakhstan healthier future. The underlying hypothesis of this research is that the above mentioned factors (air/water/soil pollution, etc.) affecting public health almost certainly do not act independently but rather trigger and exacerbate each other. Exploring the environment-health links in a multi-dimensional framework is a typical Big Data problem, in which the volume and variety of the data needed poses technical as well as scientific challenges. In Kazakhstan, the complexities related to managing and analysing Big Data are worsened by a number of obstacles at the data acquisition step: most of the data is not in digital form, spatial and temporal attributes are often ambiguous and the re-use and re-purpose of the information is subject to restrictive licenses and other mechanisms of control. In this work, we document the first steps taken towards building an understanding of the complex environment-health system in Kazakhstan, using interactive visualisation tools to identify and compare hot-spots of pollution and poor health outcomes, Big Data and web technologies to collect, manage and explore available information. In the future, the knowledge acquired will be modelled to develop evidence-based recommendation systems for decision makers in
Full Text Available This paper highlights and discusses issues associated with transdisciplinary teaching and suggests ways to overcome the challenges posed by different epistemologies, methods, and ethical positions. Our own transdisciplinary teaching experience in public health helped us identify some important questions including (i what is transdisciplinary research in practice, and does methods triangulation yield more valid results?, (ii from a teaching perspective, how do biopsychosocial and medical research differ?, (iii what is the difference between deductive and inductive research, and does each discipline represent a different ethical position?, and (iv does pure inductive research lack theories, and does it require a hypothesis—a “rule of thumb”—on how to proceed? We also suggest ways to facilitate and enhance transdisciplinary teaching, focusing on what unites us and not on what sets us apart, openly underlining and highlighting our differences. Using diverse methodologies, a newly educated transdisciplinary workforce will likely extend current knowledge and facilitate solutions for complex public health issues.
Zheng, Dan; Jiao, Haifeng; Zhong, Huiying; Qiu, Jishi; Yan, Xiaojun; Duan, Qingyuan; Chai, Liyue
The composition of chlorophenols in marine organisms from the southern coast of Hangzhou Bay, China, was analyzed and the health risks posed to humans assessed. A total of 19 chlorophenols from 16 types of marine organism were analyzed across nine survey sections in Hangzhou Bay. The chlorophenols were analyzed by gas chromatography-mass spectrometry using a DB-5MS quartz capillary column. The concentrations of monochlorophenol, dichlorophenol, trichlorophenol, tetrachlorophenol, and pentachlorophenol ranged from below the detection limit (ND) to 132 μg/kg, ND-51.0 μg/kg, ND-42.5 μg/kg, ND-69.0 μg/kg, and ND-9.06 μg/kg, respectively. Additionally, concentration differences between each type of chlorophenol were not signifi cant (P>0.05). However, signifi cant differences were found between monochlorophenol (F=8.13, Prisk indices were risk was posed by 2-chlorophenol, 2,4-dichlorophenol, 2,4,6-trichlorophenol, 2,4,5-trichlorophenol, 2,3,4,6-tetrachlorophenol, and pentachlorophenol to humans consuming marine organisms from the study area. Furthermore, the carcinogenic risks posed by 2,4,6-trichlorophenol and pentachlorophenol were lower than limits set by the International Commission on Radiological Protection and the US Environmental Protection Agency. However, the noncarcinogenic and carcinogenic risks posed by chlorophenols in marine organisms from four of the survey sections (Sizaopu, Niluoshan, Longshan Town and Xinhong zha) were higher than the other survey sections.
As nursing pushes further into the realm of primary health care in Australia, an understanding of the challenges to achieving reasonable federal funding of nursing services needs to be understood. This understanding is underpinned by a comprehensive understanding of the concept of universal health care, how the concept relates to the Australian health care context, and the resultant challenges to innovation in health care service delivery in Australia. Universal health care is a global mission and was the most recent theme for the International Council of Nurses Congress in Australia. Universal health care as a concept represents a fundamental shift from the development and funding of discrete interventions or programmes, to that of developing systems of health care. The three critical elements required are a clear definition of what is considered health care and funded for who, how the system is financed, and evaluation. Australia has a system of universal health care and all three elements are addressed. Organised medicine, a key objector to the introduction of the current approach to universal health care in Australia, soon adapted to it, and now fiercely resists change. Medico centricity poses challenges to sustainability as innovation is inhibited. This challenge is illustrated through consideration of the implementation of the financial policy that gave Nurse Practitioners access as providers and prescribers within Medicare funded services.
... medlineplus.gov/news/fullstory_162882.html Flameless Candle Batteries Pose Risk to Kids If swallowed, serious damage ... WEDNESDAY, Jan. 4, 2017 (HealthDay News) -- Tiny button batteries that light up flameless "tea candles" pose a ...
Full Text Available Introduction: The goal of this article is to present that innovating in health care begins to become an imperative in present time. Innovating will enable the achievement of the highest quality health care results and the patients' satisfaction with the least amount of financial resources.Methods: The thorough literature review of multifaceted sources was conducted including: studies, books, monographies and peer – reviewed journals with the goal of achieving the clearer picture of today's modern challenges in the complex fi eld of health care innovation.Discussion: Theoretical and empirical studies clearly indicate that the innovation is one of the key factors in the competitiveness of the organization and its survival in the market. Developed countries of the world today are making significant efforts in order for innovation to become a national priority, with special emphasis placed on measuring innovation performance. Results of theoretical and practical studies show that in the future, treatment of the most diffi cult and complex diseases of our time, through the entirely new discoveries and results, derived from the process of innovation, will project entirely new positive forms and outcomes in the health care.Conclusion: There is no doubt that the humanity and medical science will through innovation succeed to win the battles against the majority of the most complex contemporary diseases. Malignant neoplasm of tomorrow, through the application of a new, innovative approaches to research, processes and treatments will become a chronic diseases. Among many, the particular problem in the process of innovation will represent the cost of research and development (R&D, production and the safety of prescription drugs.
Massimo, Luisa M; Wiley, Thomas J; Caprino, Daniela
For the past 10 years European states have experienced an increasing flow of emigrating families from developing countries seeking better medical care for their sick children. For Italian paediatricians this has become a new challenge, considering the cultural differences in customs regarding the illness. The onset of a life-threatening disease has a strong impact on the family. The natural bond between the patient and the family must be preserved and strengthened; parents should be encouraged to entertain their child during hospitalization. The inclusion of art therapy may facilitate communication, especially for children of a different language and culture. This approach can help medical staff to understand better both the child's and the parents' anxieties and feelings. This article discusses facets of the now well-known phenomenon of ;health emigration', that is, when a family searches abroad in the hope of finding the most advanced medical treatment possible for their sick child.
Psychosocial health challenges of the elderly in Nigeria: a narrative review. ... affect psychosocial health status of elderly Nigerians, namely: changes in family ... as the educational system, health services, community-based initiatives, local or ...
Minhas Gunjeet S
Full Text Available Abstract Background Experience with public engagement activities regarding the risks and benefits of science and technology (S&T is growing, especially in the industrialized world. However, public engagement in the developing world regarding S&T risks and benefits to explore health issues has not been widely explored. Methods This paper gives an overview about public engagement and related concepts, with a particular focus on challenges and benefits in the developing world. We then describe an Internet-based platform, which seeks to both inform and engage youth and the broader public on global water issues and their health impacts. Finally, we outline a possible course for future action to scale up this and similar online public engagement platforms. Results The benefits of public engagement include creating an informed citizenry, generating new ideas from the public, increasing the chances of research being adopted, increasing public trust, and answering ethical research questions. Public engagement also fosters global communication, enables shared experiences and methodology, standardizes strategy, and generates global viewpoints. This is especially pertinent to the developing world, as it encourages previously marginalized populations to participate on a global stage. One of the core issues at stake in public engagement is global governance of science and technology. Also, beyond benefiting society at large, public engagement in science offers benefits to the scientific enterprise itself. Conclusion Successful public engagement with developing world stakeholders will be a critical part of implementing new services and technologies. Interactive engagement platforms, such as the Internet, have the potential to unite people globally around relevant health issues.
Lowenstein, Jacob H.; Burger, Joanna; Jeitner, Christian W.; Amato, George; Kolokotronis, Sergios-Orestis; Gochfeld, Michael
Excessive ingestion of mercury—a health hazard associated with consuming predatory fishes—damages neurological, sensory-motor and cardiovascular functioning. The mercury levels found in Bigeye Tuna (Thunnus obesus) and bluefin tuna species (Thunnus maccoyii, Thunnus orientalis, and Thunnus thynnus), exceed or approach levels permissible by Canada, the European Union, Japan, the US, and the World Health Organization. We used DNA barcodes to identify tuna sushi samples analysed for mercury and demonstrate that the ability to identify cryptic samples in the market place allows regulatory agencies to more accurately measure the risk faced by fish consumers and enact policies that better safeguard their health. PMID:20410032
Marley, Justin; Farooq, Saeed
Smartphones are used by patients and clinicians alike. Vast numbers of software applications (apps) run on smartphones and carry out useful functions. Clinician- and patient-oriented mental health apps have been developed. In this article, we provide an overview of apps that are relevant for mental health. We look at clinician-oriented apps that support assessment, diagnosis and treatment as well as patient-oriented apps that support education and self-management. We conclude by looking at the challenges that apps pose with a discussion of possible solutions.
Giepmans. P.; Dussault, G.; Batenburg, R.; Frich, J.; Olivers, R.; Sermeus, W.
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
Baker, R.; Candresse, T.; Dormannsné Simon, E.
The Panel on Plant Health has delivered a scientific opinion on the different risks posed by European and non-European populations of the potato cyst nematodes (PCN) Globodera pallida and Globodera rostochiensis to solanaceous plants in the EU and on the effectiveness of current control measures...... control measures to reduce the spread of PCN within the EU. A thorough and well-coordinated EU-wide survey using standardized methods would be necessary to evaluate the need to maintain these measures. The monitoring of PCN populations should exploit new diagnostic techniques (e.g. mitochondrial DNA...
@@ That iguana in your son's bedroom isn't just a reptile.It's also a deadly-germ machine. So says the American Academy of Pediatrics,which warns parents that many of the"easy"pets-the ones that don't shed,don't need to be walked,and don't throw up on the sofa-pose serious health threats to young children.And here I was so ready to convince my daughter that lizards are almost as cuddly as a Beverly Hills Chihuahua.
Man, Yu Bon; Wu, Sheng Chun; Wong, Ming Hung
There is a lack of information concerning human health risks due to exposure to mercury contained in shark fins, through dietary intake. Health risk assessment of shark fins, collected from 5 cities in China: Hong Kong (HK), Beijing, Shanghai (SH), Haikou (HN) and Wenzhou (WZ), was conducted, based on total mercury and methylmercury, and analyzed by a cold vapor atomic fluorescence spectrometry equipped with high-performance liquid chromatography, respectively. The results showed that 16.8 % samples from HK, 8.3 % from SH, 33.3 % from HN, and 16.8 % from WZ were regarded as unsafe for human consumption. Extremely high consumption rates of shark fins for an adult and a child (0.150 and 0.0807 kg/day, respectively), at 95th centile, samples from WZ demonstrated high non-cancer risks (adverse health effects) (Hazard Quotient = 16.0) on adults (aged 25-65), and samples from SH, HN and WZ also showed high non-cancer risks (Hazard Quotient = 12.9, 21.0, and 34.4, respectively) on children (aged 1-7). Consumption of shark fins may be detrimental to human health.
Nemec, Patricia B; Chan, Steven
This column describes challenges for hiring, training, and supervising psychiatric rehabilitation service providers for positions that involve the use of digital health technology. Adoption and implementation of any new technology or technique requires workforce development. This article outlines considerations for policymakers, funders, and service agency administrators as digital health technologies become more widespread. The article discusses issues based on professional experience of the authors and available literature. The literature on adoption of innovations in general, and the adoption of psychiatric evidence-based practices in particular, indicates that funding and adoption of new techniques and technologies are not adequate to ensure full and sustained implementation. The use of any new treatment or technology requires training and other supports to ensure that users have the competencies needed to make it work and that the workplace supports its use. As new digital health technologies become available, considerations of their cost and effectiveness need to include an examination of the required competencies of the service providers who will use them and the added cost of developing, enhancing, and maintaining those competencies. Specific attitudes, knowledge, and skills will be relevant to hiring decisions. Relevant preservice and on-the-job training opportunities, technical assistance, and supervision will be needed. Implementation needs to be monitored, not assumed, and the rights of the people who use technology-supported services must be fully protected. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Lezhnin, V L; Konshina, L G; Sergeyeva, M V
With the aim of determination of the levels of children's health risk from chemical air pollution caused by vehicle emissions, on the territory of the municipal district of the city of Salekhard there was carried out the work on the study of the intensity and the chemical structure of traffic-related air pollution in the locations of 16 children's preschool institutions. There was used the technique of the counting campaign for the structure and intensity of road traffic flows, children's health detriment was calculated according to the method of risk assessment. The main danger in the emissions of vehicles is belonged to nitrogen dioxide (43.6%), benzo(a)pyrene (37.4%), carbon monoxide (6.57%), formaldehyde (4.43%). Being detected at the level of I0(-4)-10(-5) and corresponding to the maximum permissible risk estimated cancer risk is a subject for continuous monitoring.
to the Millennium Development Goals (MDGs). ... primary goal of the Health Sector Development Program .... occurred after the first week of life when it is most .... Human. Resource Development for Health in Ethiopia: Challenges of Achieving ...
Describes health problems experienced by the 12,000 migrants in New Jersey. Illustrates the needs for more attention and resources from the medical community. New Jersey programs, including school health services, are relatively advanced in protecting the rights and health of migrant workers, but a lack of resources limits the delivery of…
Jansà, Josep M; García de Olalla, Patricia
The new social and demographic framework in Spain that has appeared since the arrival of new migrant populations, raises the need to improve the knowledge of their health status and to identify preventive measures and priorities in heath services.A bibliographic review of the available information on migration and health in Spain is performed, together with an analysis of their contents from a Public Health point of view. The high proportion of new borns from foreign mothers, the mental needs, deficits in oral and dental health, and the increase of tuberculosis in migrants, together with limited vaccine coverage in children, define the main health needs of these populations. The analysis of health services, reveals a high use of pediatric, obstetric and gynecologic resources by migrant populations. Conclusions; although no particular health needs have been identified for migrants, special attention for tuberculosis, mother and child health and health promotion and prevention, have to be funded for specific migrant populations. Health resources and services have to be reinforced with health agents, human resources, and specialized education for health professionals.
Lurie, Nicole; Somers, Stephen A; Fremont, Allen; Angeles, January; Murphy, Erin K; Hamblin, Allison
The authors consider the challenges to quantifying both the business case and the social case for addressing disparities, which is central to achieving equity in the U.S. health care system. They describe the practical and methodological challenges faced by health plans exploring the business and social cases for undertaking disparity-reducing interventions. Despite these challenges, sound business and quality improvement principles can guide health care organizations seeking to reduce disparities. Place-based interventions may help focus resources and engage health care and community partners who can share in the costs of-and gains from-such efforts.
Daniel N. Qekwana
Full Text Available In African societies, traditional slaughter is linked to celebrations like weddings or births, as well as funerals and ancestor veneration. Participants in traditional slaughter of goats are at risk of exposure to hazards during slaughter, food preparation and consumption of goat meat. For risk mitigation strategies to be implemented, identification of the population at risk is required. This study is based on the premise that the demographic profile of people involved in traditional slaughter of goats is important for risk communication. Both structured and informal interviews were recorded and analysed using a thematic analysis. A total of 105 people were interviewed at taxi ranks in Tshwane, Gauteng. Of these, 48 were women and 57 men. The median age of women and men was 40.6 years and 44.3 years, respectively. The majority of respondents (61.9%, n = 65 interviewed were from the Gauteng Province. Sixty percent (n = 63 of respondents had a secondary education, whilst less than 4.81% (n = 5 of respondents had no formal education. This study demonstrated that interviewing commuters at taxi ranks gave access to a cross section of gender, age, language and origin. It was found that both genders were involved in traditional slaughter of goats. Risk communication strategies should thus target women as well as men. Communication strategies to mitigate the risks of traditional slaughter of goats should take into consideration the dynamic nature of demographic and cultural norms. In light of the wide demographic profile of the respondents, it was concluded that it should be possible to use taxi ranks for successful dissemination of food safety and occupational health risk mitigation messages.
Tânia Regina Barbosa de Oliveira
Full Text Available A brief revision of some important aspects of the interdisciplinarity in the health is presented. Besides, some are described concepts on: inter, pluri, multi, goal and transdisciplinarity; the process health disease; the paradigm change in the teaching of the course of the health according to the beginnings and guidelines of SUS and the completeness of the attendance to the health. Finally, the author presents a proposal innovator of didactic-pedagogic teaching strategy, accomplished by the Department of Collective Health of the Center of Sciences of the Health of the Federal University of Big Rio of the North, that you/he/she seeks to promote the completeness and the interdisciplinarity, through integrated actions of teaching, she researches and extension, starting from the promotion of the health and citizenship in the communities.
Emergence of the concept of reproductive health over the past decade was stimulated by distinct currents in the fields of health and of feminist theory. The broadened concept represents a reaction to the essentially demographic justification offered for population policies and their principal instrument of action, family planning, since the 1970s. The new focus is more affirmative, and its discourse promotes the right to health, to improved access to services, and to health services offering quality and respect for women. Social justice aspects, especially nondiscrimination against the poor and other specific groups, and free selection of contraceptive options and services have assumed greater importance. Reproductive health is viewed as encompassing psychological aspects and power relations within marital unions. Very general provisional definitions of the concept of reproductive health are acceptable for the moment. But it is important to arrive at a definition that will be clear and specific and will combine the preoccupations of the health field with feminist concerns. The problem of measurement is related to the problem of definition. Satisfactory indicators of reproductive health are lacking. Existing indicators such as maternal mortality, fertility measures, or contraceptive prevalence continue to be used despite their narrow focus. Several priority areas of research in reproductive health have been identified, including aspects and determinants of sexual behavior, roles of men and women in reproductive health, the dynamics of contraceptive usage, undesired pregnancy, determinants and consequences of induced abortion, lactation and spacing and their relationship to sterilization, and maternal morbidity and mortality.
Shrivastava, Saurabh Rambiharilal; Shrivastava, Prateek Saurabh; Ramasamy, Jegadeesh
Mental health is an integral and essential component of health. The World Health Organization (WHO) constitution states: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." More than 450 million people suffer from mental disorders worldwide. In India, mental health services, especially for children and adolescents, are limited both in terms of number of facilities as well as trained professionals. The majority of mental health services are restricted to urban areas, that is, medical colleges or regional mental health institutes. Mere presence of a treatment facility does not guarantee that all children/adolescents suffering from mental illness will utilize such services. In fact, most of the time there is a significant delay from the patient side in accessing mental health services either because of lack of awareness or associated stigma. It is high time to promote positive mental health in children, adolescents and their parents through health education. Parental counseling is of utmost importance in order to avoid the delay in treatment seeking.
Norton, D; Ridenour, N
Women represent an ever-increasing percentage of the homeless population. Often children accompany their mothers. Care of homeless women and their children presents a challenge to all health care providers. This article describes the benefits and obstacles to the adoption of health promotion behaviors in these populations. Nurse practitioners are challenged to balance the emergent crisis-oriented needs of many health care encounters with the homeless with the profound need for these populations to develop healthy living habits.
Suppliers, in particular small innovative firms, is an important contributor not only for innovation in health-tech, but also a component to consider in the light of the emerging policy interest for using public procurement as a means to stimulate innovation. Research on barriers preventing...... these firms from providing innovations to public health authorities is therefore easily justified. Although substantive knowledge already prevails on the topic, it appears to be a lack in the literature concerning small innovative firms. To help to overcome this gap the paper discusses preliminary case study...... findings collected in the context of the Baltic Sea Health Region HealthPort project. The overall aim with the project was to facilitate ‘business acceleration’ by providing support, training and bridging innovative SMEs and health care organisations ultimately to strengthen the Baltic Sea Region health...
Narro Robles, José; Zepeda Tena, Carolina
In recent decades, Mexico has come a long way in health care matters, which has influenced the standard of living of the population and the development of the country. However, much remains to be done and changes should happen faster. Some of the main challenges Mexico faces currently are presented in this document and include: the challenge of reducing poverty in order to improve the health status of society; the development of health services that affect the slowdown in the pace of evolution of demographic indicators, life expectancy at birth and infant mortality; the challenge of reducing inequality; the challenge of great infrastructure available in the country for health care and the limited performance obtained in terms of organization, management and financing; the challenge resulting from human resources training systems, both undergraduate and postgraduate; the challenge that relates to academic and scientific productivity; the challenge of diabetes as an example of a serious public health problem; and the challenge of ethical implications in the organization and administration of health services, specifically, the allocation of public resources to them.
Kristensen, Kasper Andreas
. Hence, I will argue for the concept of conduct of life as an important concept for health psychology. The concept of conduct of life enables an analysis of how people conduct their activities and of their access to life possibilities, within social settings and societal power systems. The concept can......This contribution explores the connection between health and subjectivity. Up until recently a marginally discussed topic in health theories, recent critical research in health psychology introduces notions of subjectivity to theories of health. These notions can be linked to phenomenology......, embodied subjectivity, and psychosocial theories that have moved away from a partial, internal understanding of subjectivity. These recent theories tend to define subjectivity as a coherence of concrete, embodied and situated subjectivity that extends capabilities and activities towards a world of social...
Bonalumi, N; Fisher, K
Nursing administrators facing reorganization understand the difficulties and resistance that accompany organizational change. This article discusses resilience, a critical character trait for successfully managing change. Understanding the change process can assist those charged with the challenge of leading organizational change to manage the journey more effectively.
Full Text Available Many LGBT forced migrants have significant and sometimesincapacitating psychological scars. Mental health providers can assistin documenting the psychological impact of anti-LGBT persecutionand its impact on the ability to secure refugee status.
Lafferty, Kevin D.
A recent series of studies on tagged sea otters (Enhydra lutris nereis) challenges the hypothesis that sea otters are sentinels of a dirty ocean, in particular, that pet cats are the main source of exposure to Toxoplasma gondii in central California. Counter to expectations, sea otters from unpopulated stretches of coastline are less healthy and more exposed to parasites than city-associated otters. Ironically, now it seems that spillover from wildlife, not pets, dominates spatial patterns of disease transmission.
There have been significant developments in health education over recent years. Focusing on France, the purpose of this paper is to examine the role of health education in reducing social inequalities based on the example of the Atelier santé ville de Cahors (Cahors Health Workshop). The paper addresses the following questions: What are the results and outcomes of the workshop? What kind of health education issues are at stake in the territorial approach to policy-making in an urban context? We examined the methods underlying the health education measures taken in the Cahors Health Workshop, which involve project-based approaches and the promotion of community health. Health education aimed at improving health is central to issues such as listening and speaking, the development of autonomy and the responsibilization of urban actors. Based on a rigorous methodology and the underlying values, health education in the Cahors Health Workshop places local residents, elected representatives and health professionals at the heart of the health care process (from the diagnostic process to the assessment process) and contributes to the reduction of social inequalities in health while facilitating access to information and health care. The goal of health education is to encourage individuals to be responsible for their own health in order to empower them to make informed choices adapted to the demands of their environment.
Carney, Timothy Jay; Kong, Amanda Y
Informaticians are challenged to design health information technology (IT) solutions for complex problems, such as health disparities, but are achieving mixed results in demonstrating a direct impact on health outcomes. This presentation of collective intelligence and the corresponding terms of smart health, knowledge ecosystem, enhanced health disparities informatics capacities, knowledge exchange, big-data, and situational awareness are a means of demonstrating the complex challenges informatics professionals face in trying to model, measure, and manage an intelligent and smart systems response to health disparities. A critical piece in our understanding of collective intelligence for public and population health rests in our understanding of public and population health as a living and evolving network of individuals, organizations, and resources. This discussion represents a step in advancing the conversation of what a smart response to health disparities should represent and how informatics can drive the design of intelligent systems to assist in eliminating health disparities and achieving health equity. Copyright © 2017. Published by Elsevier Inc.
Full Text Available Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for ‘fake news’ and ‘alternative facts’ with the intention of inciting fear and hatred of ‘the other’ and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism.
Speed, Ewen; Mannion, Russell
Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for ‘fake news’ and ‘alternative facts’ with the intention of inciting fear and hatred of ‘the other’ and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism. PMID:28812811
Corrarino, Jane E
This article describes the impact of health literacy on women's health and provides strategies for addressing this public health issue. A comprehensive literature review was conducted of peer-reviewed journals. Multiple electronic databases were used, including CINAHL, MEDLINE, PubMed, and Google Scholar. Key words were used to identify articles and were combined to include health literacy, health behavior, women's health, patient education, and professional role. Additional articles were identified as a result of reviewing reference lists found during the electronic search. Health literacy is a complex issue that affects many women and can adversely affect women's knowledge, ability to adhere to clinical plans of care, and health outcomes for women and their children. It is estimated that 36% of adults in the United States possess limited health literacy skills. Effective strategies can be used by health care providers to address this serious problem, including clear and effective communication, development of health education materials, professional education, and development of community partnerships. Health literacy is a serious problem. Effective approaches can be employed to blunt the adverse effect on women's health. Health care providers are well positioned to demonstrate leadership within the health care system regarding health literacy. © 2013 by the American College of Nurse-Midwives.
Garnelo, Luiza; Sousa, Amandia Braga Lima; Silva, Clayton de Oliveira da
This paper analyses the health services regionalization process in the State of Amazonas through a case study covering the health sub-region Manaus Surroundings. This is a qualitative, descriptive and analytical research, which data were collected using interviews, documents and Internet reviews, oriented by the guiding concept of health regionalization. Study findings revealed a social setting dominated by asymmetry, verticality, competitiveness and fragile multilateral relations among municipalities, associated to a bureaucratic profile of local institutions operating in the region under study. The political agents have limited acknowledgement of the sociopolitical and institutional conditions in which they operate. They usually impute healthcare networks' management and operational issues to the natural and geographical characteristics of the Amazon region, but their financing, governance and technical capacity are insufficient to overcome them.
Full Text Available Healthcare providers are facing growing challenges in patient diagnostics and information gathering due to in-adequate infrastructure and insufficient number of health-care professionals to perform such operations. The traditional way of patient...
This paper examines nutritional and health challenges facing pastoralists who ... Global acute malnutrition rates for the last five years ranged from 10 to 28%. ... during droughts, which have been worsened by increasing climate change.
Frankish, C James; Kwan, Brenda; Ratner, Pamela A; Higgins, Joan Wharf; Larsen, Craig
Citizen participation has been included as part of health reform, often in the form of lay health authorities. In Canada, these authorities are variously known as regional health boards or councils. A set of challenges is associated with citizen participation in regional health authorities. These challenges relate to: differences in opinion about whether there should be citizen participation at all; differences in perception of the levels and processes of participation; differences in opinion with respect to the roles and responsibilities of health authority members; differences in opinion about the appropriate composition of the authorities; differences in opinion about the requisite skills and attributes of health authority members; having a good support base (staff, good information, board development); understanding and operationalizing various roles of the board (governance and policy setting) versus the board staff (management and administration); difficulties in ensuring the accountability of the health authorities; and measuring the results of the work and decisions of the health authorities. Despite these challenges, regional health authorities are gaining support as both theoretically sound and pragmatically based approaches to health-system reform. This review of the above challenges suggests that each of the concerns remains a significant threat to meaningful public participation.
Thomas, Susan; Beh, LooSee; Nordin, Rusli Bin
Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH), being the main provider of health services, may need to manage and mobilize better health care services by providing better health care financing mechanisms. It is recommended that partnership between public and private sectors with the extension of traditional medicine complementing western medicine in medical therapy continues in the delivery of health care.
Full Text Available Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH, being the main provider of health services, may need to manage and mobilize better health care services by providing better health care financing mechanisms. It is recommended that partnership between public and private sectors with the extension of traditional medicine complementing western medicine in medical therapy continues in the delivery of health care.
Abuduwailil, Jilili; Zhaoyong, Zhang; Fengqing, Jiang
Recently, a large amount of research assessing pollution levels and the related health risks posed by atmosphere dust has been undertaken worldwide. However, little work has been done in the oases of the arid regions of Northwest China. In this paper, we studied the pollution and health risks over a year of seven heavy metals in the atmospheric dust of Ebinur Basin, a typical oasis in Northwest China. The results showed the following: (1) The annual amount of atmospheric deposition in Ebinur Basin was 298.23 g m(-2) and the average monthly atmospheric deposition was 25.06 g m(-2). The average and maximum values of the seven heavy metals measured were all below the National Soil Environmental Quality Standards (2nd). (2) Heavy metals of Cu, Cr, and As in the atmospheric deposition mainly originated from the natural geological background, while Zn came from human activity. This study also showed that among the seven measured heavy metals, the ratios of the no-pollution status of Pb, Cd, and Hg were higher than those of others with moderate degrees of pollution also accounting for a certain ratio. (3) The carcinogenic risks from As, Cd, and Cr were all lower than the corresponding standard limit values, and these metals are considered not harmful to the health of the basin. However, there is a relatively high risk of exposure for children from hand-to-mouth intake, which is worthy of attention. This research showed that both human activity and natural factors, such as wind and altitude, influenced the heavy metal contents in the atmospheric dust of the study area. Furthermore, recent human activity in the study area had the most negative influence on the accumulation of the heavy metals and the corresponding health risks, especially for Hg, Pb, and Cd, which is worthy of attention.
Kumanyika, Shiriki K.
This article presents comments and observations given by Dr. Shiriki K. Kumanyika as the Lautenberg Award Lecture at the commencement of the University of Medicine and Dentistry of New Jersey-Rutgers School of Public Health, May 20, 2013. The award is named after Senator Frank Lautenberg, who served as a U.S. Senator from New Jersey during 1982 to…
Kong, Weili; Wang, Feibing; Dong, Bin; Ou, Changbo; Meng, Demei; Liu, Jinhua; Fan, Zhen-Chuan
Influenza A virus (IAV) is characterized by eight single-stranded, negative sense RNA segments, which allows for gene reassortment among different IAV subtypes when they co-infect a single host cell simultaneously. Genetic reassortment is an important way to favor the evolution of influenza virus. Novel reassortant virus may pose a pandemic among humans. In history, three human pandemic influenza viruses were caused by genetic reassortment between avian, human and swine influenza viruses. Since 2009, pandemic (H1N1) 2009 (pdm/09 H1N1) influenza virus composed of two swine influenza virus genes highlighted the genetic reassortment again. Due to wide host species and high transmission of the pdm/09 H1N1 influenza virus, many different avian, human or swine influenza virus subtypes may reassert with it to generate novel reassortant viruses, which may result in a next pandemic among humans. So, it is necessary to understand the potential threat of current reassortant viruses between the pdm/09 H1N1 and other influenza viruses to public health. This study summarized the status of the reassortant viruses between the pdm/09 H1N1 and other influenza viruses of different species origins in natural and experimental conditions. The aim of this summarization is to facilitate us to further understand the potential threats of novel reassortant influenza viruses to public health and to make effective prevention and control strategies for these pathogens.
Ungar, Wendy J
With the growth in the use of health economic evaluation to inform healthcare resource allocation decisions, the challenges in applying standard methods to child health have become apparent. A unique limitation is the paucity of child-specific preference-based measures. A single, valid, preference-based measure of utility that can be used in children of all ages does not exist. Thus, the ability to derive a QALY for use in cost-utility analysis (CUA) is compromised. This paper presents and discusses existing and novel options for deriving utilities for paediatric health states for use in CUAs. While a direct elicitation may be preferred, a child's ability to complete a standard gamble or time trade-off task is hampered by cognitive and age limitations. The abstract notions contained in indirect instruments such as the EQ-5D and Health Utilities Index may also pose challenges for young children. Novel approaches to overcome these challenges include the development of age-appropriate instruments such as the EQ-5D-Y, the development of new child-specific utility instruments such as the Child Health Utility-9D and the re-calibration of existing adult instruments to derive preference weights for health states from children themselves. For children aged valuation. In a collective approach, health state utilities derived from multiple family members may be combined mathematically. Alternatively, in a unitary approach, a single utility estimate may be determined to represent the family's perspective. This may include deriving utilities through parent-child dyad estimation or by using a household model that combines the utility weights of the patient and family members, incorporating reciprocal QOL effects. While these various approaches to child health state valuation represent novel research developments, the measurement challenges and threats to validity persist. Given the importance of non-health benefits to child health, especially in the domains of education and
Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo
A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Bjerregaard, Peter; Mulvad, Gert; Olsen, Jørn
rapid epidemiological transition carries prospects of global significance. The Inuit are a genetically distinct people living under extreme physical conditions. Their traditional living conditions and diet are currently undergoing a transformation, which may approach their disease pattern...... to that of the industrialized world, while still including local outbreaks of tuberculosis. Health research in Greenland is logistically difficult and costly, but offers opportunities not found elsewhere in the world. A long tradition of registration enhances the possibilities for research. A number of research institutions...
Full Text Available Emerging infectious diseases comprise a substantial proportion of global morbidity and mortality. The world has been hit by Zika virus (ZIKV after it was able to surmount an effective public health response for its control. ZIKV disease is an emerging mosquitoborne disease which occurred as large outbreaks in Yap since 2007, Polynesia in 2013 and Brazil in 2015. ZIKV infection in pregnant women has been observed to be associated with congenital microcephaly with neurological and autoimmune sequelae in general population of Brazil. The incubation period of ZIKV varies from few days to weeks. Only 20% of infected cases have symptoms like any other arboviral illness. ZIKV is diagnosed using RT-PCR (reverse transcriptase-polymerase chain reaction and virus isolation from blood samples. The treatment comprises of relief of symptoms by conservative management with no specific vaccine being available. The prevention and control of ZIKV is based on reduction of vector density by Integrated Vector Management and personal protection measures. As per Indian scenario, Ministry of Health had issued guidelines based on effective surveillance, risk communication, laboratory and travel regulations. Approaches to such a potential global health security threat should be consistent, proactive, and should involve coordinated, multi-pronged, multilateral collaborative efforts since the concern is at the highest and immediate because of Global epidemic, Rio de Janeiro Olympic Games starting from Aug 5-21, 2016 and strong association with microcephaly. Most importantly the need of the hour is the development of vaccine for protection especially the young women who are in the reproductive age groups. The research for which is ongoing as far as the current situation of global epidemic response is concerned.
de Leon Siantz, Mary Lou
Demographers are slowly bringing the migration of women to the forefront as women become the majority of migrants worldwide. Migration can provide new opportunities for women on their own or jointly with their spouses to improve their lives, escape oppressive social relations, and support children and other family members who are left behind. It also can expose women to new vulnerabilities resulting from their precarious legal status, abusive working conditions, and health risks.(1) Migrant women are triply disadvantaged by race/ethnicity, their status as nonnationals, and gender inequalities.(2.)
Christiansen, Ellen K; Skipenes, Eva; Hausken, Marie F; Skeie, Svein; Østbye, Truls; Iversen, Marjolein M
Use of shared electronic health records opens a whole range of new possibilities for flexible and fruitful cooperation among health personnel in different health institutions, to the benefit of the patients. There are, however, unsolved legal and security challenges. The overall aim of this article is to highlight legal and security challenges that should be considered before using shared electronic cooperation platforms and health record systems to avoid legal and security "surprises" subsequent to the implementation. Practical lessons learned from the use of a web-based ulcer record system involving patients, community nurses, GPs, and hospital nurses and doctors in specialist health care are used to illustrate challenges we faced. Discussion of possible legal and security challenges is critical for successful implementation of shared electronic collaboration systems. Key challenges include (1) allocation of responsibility, (2) documentation routines, (3) and integrated or federated access control. We discuss and suggest how challenges of legal and security aspects can be handled. This discussion may be useful for both current and future users, as well as policy makers.
Ribera Casado, José Manuel
Main challenges that may appear in our country along next decade related with the aging process are discussed. First of these challenges must take into account demography changes. Absolute number and. rates of elderly people increases permanently and it will be so in the next future. To assume the UN slogan "active aging" could be a positive attitude, and in this way both, each individual and social collectives, must be involved. In relation with health challenges, chronic disease and disability are the two most important problems. Prevention and permanent searching attitude of efficient political health answers are two essential pillars. Challenges on the social field must be focussed on ageism. The main objective must be to fight against any form of age discrimination (ageism). Beside that educational policies oriented over professionals and citizens. Last group of challenges concerns to managers and politicians and must be focussed on the look for resources and educational promotion.
Vicki A Nejtek
Full Text Available Vicki A Nejtek, Sarah Hardy, Scott WinterUniversity of North Texas Health Science Center, Fort Worth, TX, USAAbstract: The leading cause of suicide ideation, attempts, and completion in adolescents is persistent and unresolved parental conflict. National statistics show extremely high rates of childhood neglect and abuse are perpetrated most often by single mothers. Psychiatric disorders arising from maternal–child dysfunction are well-documented. However, resources to prevent offspring victimization are lacking. Here, we report maternal neglect of a 15-year-old male brought to the psychiatric emergency room for suicidal ideation. An inpatient treatment plan including pharmacotherapy, family therapy and psychological testing was initiated. The patient’s mother failed to attend clinic appointments or family therapy sessions. Clinician attempts to engage the mother in the treatment plan was met with verbal assaults, aggression, and threatening behavior. The patient decompensated in relation to the mother’s actions. Child Protective Services were contacted and a follow-up assessment with the patient and mother is pending. Psychiatric treatment of the mother may be a necessary intervention and prevention regimen for both the adolescent and the mother. Without consistent Child Protective Services oversight, medical and psychosocial follow-up, the prognosis and quality of life for this adolescent is considered very poor. Stringent mental health law and institutional policies are needed to adequately intercede and protect adolescents with mental illness.Keywords: adolescent, suicide, maternal treatment noncompliance, maternal neglect
Consuelo Helena Aires de Freitas
Full Text Available Objective: To discuss the practice of mental health care performed by healthcare professionals from the Family Health Strategy in Fortaleza-CE, Brazil. Methods: This is a critical and reflective study conducted in six Basic Health Units in Fortaleza-Ce. The study subjects were 12 health workers of the following professions: doctor, nurse, community health agents and technical and/or nursing assistant. Semi-structured interviews, systematic observationand questionnaire were used for data collection. The empirical analysis was based on an understanding of the discourses through critical hermeneutics. Results: It was evident that the mental health services are developed by some health workers in the ESF, such as, matrix support, relational technologies, home visits and community group therapy. However, there is still deficiency in training/coaching by most professionals in primary care, due to anenduring model of pathological or curative health care. Conclusion: Mental health care is still occasionally held by some workers in primary care. However, some progresses are already present as matrix support, relational technologies in health care, home visits andcommunity therapy.
Coovadia, Hoosen; Jewkes, Rachel; Barron, Peter; Sanders, David; McIntyre, Diane
The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.
Rolka, Henry; Walker, David W; English, Roseanne; Katzoff, Myron J; Scogin, Gail; Neuhaus, Elizabeth
The root of effective disease control and prevention is an informed understanding of the epidemiology of a particular disease based on sound scientific interpretation of evidence. Such evidence must frequently be transformed from raw data into consumable information before it can be used for making decisions, determining policy, and conducting programs. However, the work of building such evidence in public health practice--doing the right thing at the right time--is essentially hidden from view. Surveillance involves acquiring, analyzing, and interpreting data and information from several sources across various systems. Achieving the goals and objectives of surveillance investments requires attention to analytic requirements of such systems. The process requires computer programming, statistical reasoning, subject matter expertise, often modeling, and effective communication skills.
Full Text Available The need for health professionals to address their human rights obligations has emerged in the last decade both internationally as well as nationally following the findings of South Africa’s Truth and Reconciliation Commission. Support for human rights norms has become a priority for institutions as well as practitioners within the health sector. Training plays a crucial role in shaping health professional practice. In addition to creating a clear understanding of the linkages between human rights and health, educators can role-model how health professionals should act to support human rights. This article explores human rights derived from the South African Constitution in relation to the obligation on health professionals to respect, protect, promote and fulfill human rights. The implications of this commitment to human rights training of nurses are discussed, drawing on the authors’ nine years of experience in running courses for South African health professional educators. Themes include: developing core competencies for human rights in health professional curricula, identifying appropriate instructional methodologies and assessment tools suited to the content and context of human rights, and engaging the institutional environment for human rights teaching, at both the level of institutional culture and strategic implementation. At a time when there are increasing demands on the nursing profession to assume greater responsibility and develop versatility in its scope of practice, key challenges are posed for teaching and realising human rights.
London, L; Baldwin-Ragaven, L
The need for health professionals to address their human rights obligations has emerged in the last decade both internationally as well as nationally following the findings of South Africa's Truth and Reconciliation Commission. Support for human rights norms has become a priority for institutions as well as practitioners within the health sector. Training plays a crucial role in shaping health professional practice. In addition to creating a clear understanding of the linkages between human rights and health, educators can role-model how health professionals should act to support human rights. This article explores human rights derived from the South African Constitution in relation to the obligation on health professionals to respect, protect, promote and fulfill human rights. The implications of this commitment to human rights training of nurses are discussed, drawing on the authors' nine years of experience in running courses for South African health professional educators. Themes include: developing core competencies for human rights in health professional curricula, identifying appropriate instructional methodologies and assessment tools suited to the content and context of human rights, and engaging the institutional environment for human rights teaching, at both the level of institutional culture and strategic implementation. At a time when there are increasing demands on the nursing profession to assume greater responsibility and develop versatility in its scope of practice, key challenges are posed for teaching and realising human rights.
Sánchez, Delia M
This paper describes the institutional background in Latin American integration in both the economy and health, and proposes a systematization of possible health integration modalities. Facilitating and inhibiting factors for integration according to each modality are identified, and their feasibility is discussed in the present context. The structure and functioning of MERCOSUR health structures (Ministerial Meeting and Sub-group 11) are briefly described, as well as the advances achieved to date, reflecting on the possible causes of uneven progress in different areas.
McCambridge, Jim; Hawkins, Benjamin; Holden, Chris
Background There has been insufficient research attention to alcohol industry methods of influencing public policies. With the exception of the tobacco industry, there have been few studies of the impact of corporate lobbying on public health policymaking more broadly. Methods We summarize here findings from documentary analyses and interview studies in an integrative review of corporate efforts to influence UK policy on minimum unit pricing (MUP) of alcohol 2007–10. Results Alcohol producers and retailers adopted a long-term, relationship-building approach to policy influence, in which personal contacts with key policymakers were established and nurtured, including when they were not in government. The alcohol industry was successful in achieving access to UK policymakers at the highest levels of government and at all stages of the policy process. Within the United Kingdom, political devolution and the formation for the first time of a Scottish National Party (SNP) government disrupted the existing long-term strategy of alcohol industry actors and created the conditions for evidence-based policy innovations such as MUP. Conclusions Comparisons between policy communities within the United Kingdom and elsewhere are useful to the understanding of how different policy environments are amenable to influence through lobbying. Greater transparency in how policy is made is likely to lead to more effective alcohol and other public policies globally by constraining the influence of vested interests. PMID:24261642
Mariana Cabral Schveitzer
Full Text Available Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage.
Benzein, Eva Gunilla; Hagberg, Margaretha; Saveman, Britt-Inger
This study describes the theoretical assumptions and the application for health-promoting conversations, as a communication tool for nurses when talking to patients and their families. The conversations can be used on a promotional, preventive and healing level when working with family-focused nursing. They are based on a multiverse, salutogenetic, relational and reflecting approach, and acknowledge each person's experience as equally valid, and focus on families' resources, and the relationship between the family and its environment. By posing reflective questions, reflection is made possible for both the family and the nurses. Family members are invited to tell their story, and they can listen to and learn from each other. Nurses are challenged to build a co-creating partnership with families in order to acknowledge them as experts on how to lead their lives and to use their own expert knowledge in order to facilitate new meanings to surface. In this way, family health can be enhanced.
Silva Luiz Jacintho da
Full Text Available The author discusses the challenges posed by emerging infectious diseases in 100 years of public health in the state of São Paulo, Brazil. With an advanced and organized public health system, São Paulo responded to the emergence of infectious diseases by creating research institutions and control programs. The late 19th century witnessed the first modern research institution in microbiology, in response to the bubonic plague. A changing economy led to constant changes in ecosystems. The late 20th century presents a wide array of both emerging and rapidly changing infectious diseases. The present situation calls for creative solutions. Ecosystem analysis and more agile epidemiological surveillance are seen as the best alternatives.
LaMontagne, A D; Needleman, C
In addition to more familiar research issues, intervention research projects in naturalistic settings present the investigator with a number of practical challenges including gaining access to potentially resistant populations, maximizing participation rates in the face of weak incentives for cooperation, getting valid answers to sensitive questions, and meeting ethical obligations when health or legal problems are discovered in the course of study. Generalizable approaches to these challenges are addressed in the context of a retrospective evaluation of the implementation of OSHA's 1984 ethylene oxide standard in Massachusetts hospitals. In the evaluation study, enthusiastic cooperation was secured, a 96% participation rate was realized, sensitive questions were posed successfully, and worker health risks discovered in the course of study received attention without having to wait for the write-up of the study results. Key elements in the study population's receptivity appear to have been (I) the investigator's familiarity with the hazard, its setting, respondent concerns and needs, and (2) reciprocity in the form of providing follow-up consulting services as an integral part of the research process, delivered to each hospital at the conclusion of data collection. Specific techniques used in the study are presented in the hopes of aiding other investigators facing similar practical challenges in occupational health and safety intervention research.
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Dear public health professionals, Honestly, isn’t it time to ask whether or not we are doing “the right things”in public health? Are our present public health strategies evidence-based? The public health agenda demands a vision that reaches beyond research to the application of public health and the determination of it’s impact. In this scenario what is the role of genomics? In the past twenty years, advances in genome research have revolutionised what is known about the role of inheritance in health and disease.
Nowadays,we know that our DNA determines not only the cause of single-gene disorders, but also determines our predisposition to common diseases.Whereas medicine is currently undergoing extraordinary developments from its morphological and phenotype orientation to a molecular and genotype orientation, promoting the importance of prognosis and prediction, public health practice has to date concerned itself with environmental determinants of health and disease and has paid scant attention to genetic variations within the population.
The advances brought about by genomics is changing these perceptions.[2,3] Many predict, that this knowledge will enable health promotion messages and disease prevention programmes to be specifically directed at susceptible individuals or at subgroups of the population, based on their genetic profile.[4,5]
The new technologies will allow researchers to examine genetic mutations at the functional genomic unit level, and to better understand the significance of environmental factors such as noxious agents, nutrition and personal behaviour in relation to the causation of diseases such as cardiovascular diseases, psychiatric disorders and infectious diseases.
Olyaeemanesh, Alireza; Doaee, Shila; Mobinizadeh, Mohammadreza; Nedjati, Mina; Aboee, Parisa; Emami-Razavi, Seyed Hassan
Various decisions have been made on technology application at all levels of the health system in different countries around the world. Health technology assessment is considered as one of the best scientific tools at the service of policy- makers. This study attempts to investigate the current challenges of Iran's health technology assessment and provide appropriate strategies to establish and institutionalize this program. This study was carried out in two independent phases. In the first, electronic databases such as Medline (via Pub Med) and Scientific Information Database (SID) were searched to provide a list of challenges of Iran's health technology assessment. The views and opinions of the experts and practitioners on HTA challenges were studied through a questionnaire in the second phase which was then analyzed by SPSS Software version 16. This has been an observational and analytical study with a thematic analysis. In the first phase, seven papers were retrieved; from which, twenty- two HTA challenges in Iran were extracted by the researchers; and they were used as the base for designing a structured questionnaire of the second phase. The views of the experts on the challenges of health technology assessment were categorized as follows: organizational culture, stewardship, stakeholders, health system management, infrastructures and external pressures which were mentioned in more than 60% of the cases and were also common in the views. The identification and prioritization of HTA challenges which were approved by those experts involved in the strategic planning of the Department of Health Technology Assessment will be a step forward in the promotion of an evidence- based policy- making and in the production of comprehensive scientific evidence.
Iyengar, Varun; Wolf, Alexander; Brown, Adam; Close, Kelly
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.
Holmes, John H.; Lehman, Amy; Hade, Erinn; Ferketich, Amy K.; Sarah, Gehlert; Rauscher, Garth H.; Abrams, Judith; Bird, Chloe E.
Numerous factors play a part in health disparities. Although health disparities are manifested at the level of the individual, other contexts should be considered when investigating the associations of disparities with clinical outcomes. These contexts include families, neighborhoods, social organizations, and healthcare facilities. This paper reports on health disparities research as a multilevel research domain from the perspective of a large national initiative. The Centers for Population Health and Health Disparities (CPHHD) program was established by the NIH to examine the highly dimensional, complex nature of disparities and their effects on health. Because of its inherently transdisciplinary nature, the CPHHD program provides a unique environment in which to perform multilevel health disparities research. During the course of the program, the CPHHD centers have experienced challenges specific to this type of research. The challenges were categorized along three axes: sources of subjects and data, data characteristics, and multilevel analysis and interpretation. The CPHHDs collectively offer a unique example of how these challenges are met; just as importantly, they reveal a broad range of issues that health disparities researchers should consider as they pursue transdisciplinary investigations in this domain, particularly in the context of a large team science initiative. PMID:18619398
Full Text Available The mental health of the child affects his physical health and the learning process. The present study was conducted to study the health status and etiological factors among 58 mentally challenged children in school for mentally challenged at Sangamner. Majority of mentally challenged children (68.0% were in 5-9 years age group. Most of them had moderate retardation. (43.0% In majority of children (70.68%no clinical syndrome was present. Most common clinical syndrome was Down’s syndrome (17.23%,followed by Fragile X syndrome (6.89%. More than sixty percent children were off springs of consanguineous marriages. Idiopathic causes (63.8% followed by genetic causes (29.31% were common etiological factor responsible for mental retardation. Mental handicap can be prevented by genetic counseling.
Bansler, Jørgen Peter; Havn, Erling C.
Objectives: This study aims to explore the issues and challenges involved in designing and organizing pilot implementations of health information systems (HIS). Pilot implementations are a widely used approach for identifying design flaws and implementation issues before full-scale deployment...... implementation of an electronic Pregnancy Record (ePR) in Denmark. Our primary data collection methods comprised participant observations, semi-structured interviews and document analyses. Results: Based on a comprehensive evaluation of the implementation process, we identify three major challenges...
Mohammadzadeh, Niloofar; Safdari, Reza
In most countries chronic diseases lead to high health care costs and reduced productivity of people in society. The best way to reduce costs of health sector and increase the empowerment of people is prevention of chronic diseases and appropriate health activities management through monitoring of patients. To enjoy the full benefits of E-health, making use of methods and modern technologies is very important. This literature review articles were searched with keywords like Patient monitoring, Mobile Health, and Chronic Disease in Science Direct, Google Scholar and Pub Med databases without regard to the year of publications. Applying remote medical diagnosis and monitoring system based on mobile health systems can help significantly to reduce health care costs, correct performance management particularly in chronic disease management. Also some challenges are in patient monitoring in general and specific aspects like threats to confidentiality and privacy, technology acceptance in general and lack of system interoperability with electronic health records and other IT tools, decrease in face to face communication between doctor and patient, sudden interruptions of telecommunication networks, and device and sensor type in specific aspect. It is obvious identifying the opportunities and challenges of mobile technology and reducing barriers, strengthening the positive points will have a significant role in the appropriate planning and promoting the achievements of the health care systems based on mobile and helps to design a roadmap for improvement of mobile health.
The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and “the rise of the rest” will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing s...
Full Text Available Maintaining a healthy ecosystem is essential for maximizing sustainable ecological services of the best quality to human beings. Ecological and conservation research has provided a strong scientific background on identifying ecological health indicators and correspondingly making effective conservation plans. At the same time, ecologists have asserted a strong need for spatially explicit and temporally effective ecosystem health assessments based on remote sensing data. Currently, remote sensing of ecosystem health is only based on one ecosystem attribute: vigor, organization, or resilience. However, an effective ecosystem health assessment should be a comprehensive and dynamic measurement of the three attributes. This paper reviews opportunities of remote sensing, including optical, radar, and LiDAR, for directly estimating indicators of the three ecosystem attributes, discusses the main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system, and provides some future perspectives. The main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system are: (1 scale issue; (2 transportability issue; (3 data availability; and (4 uncertainties in health indicators estimated from remote sensing data. However, the Radarsat-2 constellation, upcoming new optical sensors on Worldview-3 and Sentinel-2 satellites, and improved technologies for the acquisition and processing of hyperspectral, multi-angle optical, radar, and LiDAR data and multi-sensoral data fusion may partly address the current challenges.
Li, Zhaoqin; Xu, Dandan; Guo, Xulin
Maintaining a healthy ecosystem is essential for maximizing sustainable ecological services of the best quality to human beings. Ecological and conservation research has provided a strong scientific background on identifying ecological health indicators and correspondingly making effective conservation plans. At the same time, ecologists have asserted a strong need for spatially explicit and temporally effective ecosystem health assessments based on remote sensing data. Currently, remote sensing of ecosystem health is only based on one ecosystem attribute: vigor, organization, or resilience. However, an effective ecosystem health assessment should be a comprehensive and dynamic measurement of the three attributes. This paper reviews opportunities of remote sensing, including optical, radar, and LiDAR, for directly estimating indicators of the three ecosystem attributes, discusses the main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system, and provides some future perspectives. The main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system are: (1) scale issue; (2) transportability issue; (3) data availability; and (4) uncertainties in health indicators estimated from remote sensing data. However, the Radarsat-2 constellation, upcoming new optical sensors on Worldview-3 and Sentinel-2 satellites, and improved technologies for the acquisition and processing of hyperspectral, multi-angle optical, radar, and LiDAR data and multi-sensoral data fusion may partly address the current challenges.
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health conducted a pest risk assessment for Puccinia horiana Hennings (the causal agent of chrysanthemum white rust for the EU territory, identified risk management options and evaluated their effectiveness. The assessment was conducted taking into account current EU legislation. The Panel also provided an opinion on the effectiveness of the present EU requirements against this organism, listed in Council Directive 2000/29/EC. Two major pathways for entry were identified: plant material of susceptible hosts for propagation purposes and cut flowers of Chrysanthemum × morifolium. The probability of further entry of the pest was considered unlikely, as the existing certification schemes for propagation material should reduce the risk of importing infected cuttings. For cut flowers, pest transfer to susceptible hosts is associated with the potentially incorrect disposal of cut flower waste within the vicinity of places of production, which is considered a rare event. The probability of establishment and further spread were both considered very likely. The current overall impact in the risk assessment area was considered minor, with medium uncertainty, mainly because standard protective actions are taken in most EU production areas. Risk reduction options to reduce the probability of entry and spread and mitigate the impact were analysed. Council Directive 2000/29/EC addresses mainly the sanitary status of the propagation material. The Directive cannot prevent the entry, establishment and spread, or mitigate the impact, of the pathogen. Were the current regulation to be removed, the frequency of introduction would probably increase. This poses a risk because, although the pest is widespread in the risk assessment area, not all Member States are infested and not all pest pathotypes are present. If a statutory certification system, with associated import requirements for propagation material of host plants, were introduced, this
Bosi, Maria Lúcia Magalhães
This article provides an overview of the nuclear themes in the debate about the qualitative health research approach in the Brazilian scientific context and more specifically in the public health field. The author begins by defining some central concepts in the analysis conducted. Then, combining the literature on the subject with her academic praxis, she examines the current status of this research tradition, highlighting an extensive set of challenges. The discussion focuses on each challenge, moving between the different epistemic, ethical and operational planes in relation to the scientific status of this approach to public health. Considering various questions and based on empirical examples, analysis shows that, despite the expansion observed in qualitative research and its contributions to public health, this approach still faces many challenges before consolidating its status. The situation demands investments in dialogue with the other approaches which form the core area. Despite these challenges, the paper concludes by pointing to the possibility of new pacts in the public health field in order to incorporate innovations to address the diversity and complexity of this field.
The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and "the rise of the rest" will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing systems. The global health as well as the humanitarian system will have to prove their capacity to respond and reform. The challenge ahead is deeply political, especially for the rising political actors. They are confronted with the consequences of a model of development that has neglected sustainability and equity, and was built on their exploitation. Some direction has been given by the path breaking international conferences in 2015. Especially the agreement on the Sustainable Development Goals (SDGs) and the Paris agreement on climate change will shape action. Conceptually, we will need a different understanding of global health and its ultimate goals - the health of people can no longer be seen separate from the health of the planet and wealth measured by parameters of growth will no longer ensure health.
Full Text Available The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and “the rise of the rest” will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing systems. The global health as well as the humanitarian system will have to prove their capacity to respond and reform. The challenge ahead is deeply political, especially for the rising political actors. They are confronted with the consequences of a model of development that has neglected sustainability and equity, and was built on their exploitation. Some direction has been given by the path breaking international conferences in 2015. Especially the agreement on the Sustainable Development Goals (SDGs and the Paris agreement on climate change will shape action. Conceptually, we will need a different understanding of global health and its ultimate goals - the health of people can no longer be seen separate from the health of the planet and wealth measured by parameters of growth will no longer ensure health.
Full Text Available Nowadays, the electronic communications market is in a high development, and this trend will not be diminished even by the newly world economic crisis. Studies show a significant growth in people’s interest for Information Society (IS services, with emphasize on the mobility of the resources. On the other hand, Internet has become more than a “network of networks”, but a way of life, and user’s addict to computer systems and IS services often reveal interesting aspects and controversial in the same time. Modern forms of electronic communications rely more and more on the wireless Internet connections (Wi Fi, and this conclusion could be eventually based on the following realities: 1 Users continue to migrate to wireless technology; 2 Users prefer wireless connectivity; 3 Users are attracted by costless Internet connections; 4 Users are fascinated by the possibility of hiding their online activity and behaviour. Although certain security measures can be easily applied in order to prevent the spread of cyber related crimes, the wireless (Wi Fi connection to Internet also rise up a lot of controversial aspects, most of them about the legality of the connection itself, topic that the authors try to approach in this study.
Tong, Seng Fah; Low, Wah Yun; Ng, Chirk Jenn
Men's health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men compared to their female counterparts is well documented. A review of the epidemiological data from Malaysia noted a similar trend in which men die at higher rates in under 1 and above 15 years old groups and most disease categories compared to women. In Malaysia, the main causes of death in men are non-communicable diseases and injuries. Risk factors, such as risk-taking behaviour, smoking and hypertension, are prevalent and amenable to early interventions. Erectile dysfunction, premature ejaculation and prostate disorders are also prevalent. However, many of these morbidities go unreported and are not diagnosed early; therefore, opportunities for early intervention are missed. This reflects poor health knowledge and inadequate health-care utilisation among Malaysian men. Their health-seeking behaviour has been shown to be strongly influenced by family members and friends. However, more research is needed to identify men's unmet health-care needs and to develop optimal strategies for addressing them. Because the Malaysian population is aging and there is an increase in sedentary lifestyles, optimizing men's health will remain a challenge unless effective measures are implemented. The existing male-unfriendly health-care system and the negative influence of masculinity on men's health behaviour must be addressed. A national men's health policy based on a male-friendly approach to health-care delivery is urgently needed to provide a framework for addressing these challenges.
Cauchi, Daniel; Mamo, Julian
Tobacco is a major preventable cause of premature morbidity and mortality. Health professionals are uniquely positioned to provide targeted interventions and should be empowered to provide cessation counselling that influence patient smoking. A cross-sectional national survey was administered to all third year students in four disciplines at the University of Malta. The Global Health Professional Student Survey (GHPSS) questionnaire was distributed to collect standardised demographic, smoking prevalence, behavioural, and attitudinal data. 81.9% completed the questionnaire (n = 173/211). A positive significant association between tobacco smoke exposure at home and current smoking status was identified. Non-smokers regarded anti-tobacco policies more favourably than smokers, being more likely to agree with banning of tobacco sales to adolescents (OR 3.6; 95% CI: 2.5-5.3; p ≤ 0.001); and with a smoking ban in all public places (OR 8.9; 95% CI: 6.1-13.1; p ≤ 0.001). Non-smokers favoured a role for health professionals in promoting smoking cessation (OR 5.1; 95% CI: 3.1-8.5; p ≤ 0.001). Knowledge of antidepressants as tools for smoking cessation was also associated with a perceived role for skilled health professionals in cessation counselling (OR 4.9; 95% CI: 1.8-13.3; p = 0.002). Smoking negatively influences beliefs and attitudes of students toward tobacco control. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.
Full Text Available Tobacco is a major preventable cause of premature morbidity and mortality. Health professionals are uniquely positioned to provide targeted interventions and should be empowered to provide cessation counselling that influence patient smoking. A cross-sectional national survey was administered to all third year students in four disciplines at the University of Malta. The Global Health Professional Student Survey (GHPSS questionnaire was distributed to collect standardised demographic, smoking prevalence, behavioural, and attitudinal data. 81.9% completed the questionnaire (n = 173/211. A positive significant association between tobacco smoke exposure at home and current smoking status was identified. Non-smokers regarded anti-tobacco policies more favourably than smokers, being more likely to agree with banning of tobacco sales to adolescents (OR 3.6; 95% CI: 2.5–5.3; p ≤ 0.001; and with a smoking ban in all public places (OR 8.9; 95% CI: 6.1–13.1; p ≤ 0.001. Non-smokers favoured a role for health professionals in promoting smoking cessation (OR 5.1; 95% CI: 3.1–8.5; p ≤ 0.001. Knowledge of antidepressants as tools for smoking cessation was also associated with a perceived role for skilled health professionals in cessation counselling (OR 4.9; 95% CI: 1.8–13.3; p = 0.002. Smoking negatively influences beliefs and attitudes of students toward tobacco control. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.
Méndez, Claudio A
Omission of human resources from health policy development has been identified as a barrier in the health sector reform's adoption phase. Since 2002, Chile's health care system has been undergoing a transformation based on the principles of health as a human right, equity, solidarity, efficiency, and social participation. While the reform has set forth the redefinition of the medical professions, continuing education, scheduled accreditation, and the introduction of career development incentives, it has not considered management options tailored to the new setting, a human resources strategy that has the consensus of key players and sector policy, or a process for understanding the needs of health care staff and professionals. However, there is still time to undo the shortcomings, in large part because the reform's implementation phase only recently has begun. Overcoming this challenge is in the hands of the experts charged with designing public health strategies and policies.
Full Text Available The article proposes a critical reflection, based on national law, scholarly, scientific, on the current development of Networks of Health Care, as a strategy for strengthening the Single Health System (SUS. Are weighted inefficiency of traditional ways of organizing care and management, the challenge of Network Health Care for comprehensive care and management mechanisms used in this process. The work provides subsidies for the care practices and health management are reflected, pointing strategies that result in disruptions of paradigms through a refocusing of attention in existing models. For networks of health care can be consolidated, is fundamental to political sensitivity of health managers with a commitment to build a new model of care, through the struggle to consolidate the SUS and the realization of the principles of universality, comprehensiveness and equity.
Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader
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. The results point toward a common indicator that oral health-related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management.
Metcalf, C J E; Edmunds, W J; Lessler, J
The World Health Organisation's definition of public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole (World Health Organization, 2014). Mathematical modelling plays an increasingly important role in helping to guide the most high impact and cost-effective means of achieving these goals. Public health programmes are usually implemented over a long period of time with broad benefits to many in the community. Clinical trials are seldom large enough to capture these effects. Observational data may be used to evaluate a programme after it is underway, but have limited value in helping to predict the future impact of a proposed policy. Furthermore, public health practitioners are often required to respond to new threats, for which there is little or no previous data on which to assess the threat. Computational and mathematical models can help to assess potential threats and impacts early in the process, and later aid in interpreting data from complex and multifactorial systems. As such, these models can be critical tools in guiding public health action. However, there are a number of challenges in achieving a successful interface between modelling and public health. Here, we discuss some of these challenges. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.
Full Text Available The World Health Organisation's definition of public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole (World Health Organization, 2014. Mathematical modelling plays an increasingly important role in helping to guide the most high impact and cost-effective means of achieving these goals. Public health programmes are usually implemented over a long period of time with broad benefits to many in the community. Clinical trials are seldom large enough to capture these effects. Observational data may be used to evaluate a programme after it is underway, but have limited value in helping to predict the future impact of a proposed policy. Furthermore, public health practitioners are often required to respond to new threats, for which there is little or no previous data on which to assess the threat. Computational and mathematical models can help to assess potential threats and impacts early in the process, and later aid in interpreting data from complex and multifactorial systems. As such, these models can be critical tools in guiding public health action. However, there are a number of challenges in achieving a successful interface between modelling and public health. Here, we discuss some of these challenges.
Baker, R.; Candresse, T.; Dormannsné Simon, E.
The Panel on Plant Health has delivered a scientific opinion on the different risks posed by European and non-European populations of the potato cyst nematodes (PCN) Globodera pallida and Globodera rostochiensis to solanaceous plants in the EU and on the effectiveness of current control measures....
Khankeh, Hamidreza; Ranjbar, Maryam; Khorasani-Zavareh, Davoud; Zargham-Boroujeni, Ali; Johansson, Eva
Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.
The current staff curriculum vitae (CV) were reviewed to gather information on ... with the current and former NIMR Management to seek information on capacity development challenges. ... Cognizant of the situation, the global ministerial forum on research for health has emphasized the ..... future lead researchers. The NIMR ...
For the last 2 decades, researchers and practitioners dedicated to improving the health of gay and bisexual men have largely focused their work on the need to reduce the incidence of HIV infection. This is certainly warranted given the intensity of this particular epidemic in the gay community and the challenges it has presented to the nation's…
Harper, Kathleen A.; Etkina, Eugenia
As part of weekly reports,1 structured journals in which students answer three standard questions each week, they respond to the prompt, If I were the instructor, what questions would I ask or problems assign to determine if my students understood the material? An initial analysis of the results shows that some student-generated problems indicate fundamental misunderstandings of basic physical concepts. A further investigation explores the relevance of the problems to the week's material, whether the problems are solvable, and the type of problems (conceptual or calculation-based) written. Also, possible links between various characteristics of the problems and conceptual achievement are being explored. The results of this study spark many more questions for further work. A summary of current findings will be presented, along with its relationship to previous work concerning problem posing.2 1Etkina, E. Weekly Reports;A Two-Way Feedback Tool, Science Education, 84, 594-605 (2000). 2Mestre, J.P., Probing Adults Conceptual Understanding and Transfer of Learning Via Problem Posing, Journal of Applied Developmental Psychology, 23, 9-50 (2002).
Bredenkamp, Caryn; Evans, Timothy; Lagrada, Leizel; Langenbrunner, John; Nachuk, Stefan; Palu, Toomas
As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure "supply-side readiness", i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed. On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint. While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia - and across the world.
Full Text Available China has achieved impressive rapid development over the past 30 years. But China also faces the challenge of environmental change resulting from rapid economic growth and the attendant risks to human health. In this paper we described the environmental change and health risk in China from evident fluctuation of China’s climate, major changes in natural hydrological condition, raw materials and energy demand, changes of disease epidemic pattern related to climate change and ecosystem damage, new health risk raised by rapid urbanization and rural environmental quality degradation. The suggestion and countermeasures were discussed.
Gaggioli, Andrea; Riva, Giuseppe
The combination of smart phones, wearable sensor devices and social media offer new ways of monitoring and promoting mental and physical wellbeing. In this contribution, we describe recent developments in the field of mobile healthcare (or mHealth), by focusing in particular on mobile mental health applications. First, we examine the potential benefits associated with this approach, providing examples from existing projects. Next, we identify and explain possible differences in focus between mobile mental health and mobile wellbeing applications. Finally, we discuss some open challenges associated with the implementation of this vision, ranging from the lack of evidence-based validation to privacy, security and ethical concerns.
Shiva Raj Mishra
Full Text Available The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9% and rural (59% discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015, the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal.
Full Text Available Background The Nutrition and Health Claim Regulation 1924/2006/EC, together with EFSA guidances on the scientific requirements for different type of health claims, is setting the basis for health claim substantiation in the EU. Aim The aim of this presentation is to bring up the key challenges that the food industry and clinical research organizations are facing when meeting these requirements. Results and discussion Key issues in clinical research planning to meet the requirements set for the health claim substantiation are: (1 Selection of right outcome markers since the selection of outcome marker defines actually the formulation of the health claim to be used on food or food ingredient. (2 Selection of right target population since that determines the target consumer group for the food with a health claim. (3 Selection of dose regime and food matrices used since these largely determine the conditions set for the use of the health claim. One of the major challenges in health claim substantiation is the deviant approach to risk factors or biomarkers. From the regulation point of view, a single risk factor approach is emphasized, but from the clinical and scientific point of view the pattern of different risk markers or biomarkers could, in some cases, be a more relevant choice to reflect the final health outcome. This is especially the case in the nutrition and health area because we are often dealing with weak but multiple health effects of certain food items or ingredients. Also the lack of validated well-established biomarkers potent to be affected by diet is a challenge in health claim substantiation.The selection of right target population is often a compromise between choosing a more potential target group to obtain efficacy (i.e. risk factors elevated vs. patient groups and choosing a rationale to generalize the results to wider population (target consumer group.The selection of optimal dosing regime and matrices for a clinical study is
Herbert, Valerie M; Connors, Helen
Technology is increasing the complexity in the role of today's nurse. Healthcare organizations are integrating more health information technologies and relying on the electronic health record for data collection, communication, and decision making. Nursing faculty need to prepare graduates for this environment and incorporate an academic electronic health record into a nursing curriculum to meet student-program outcomes. Although the need exists for student preparation, some nursing programs are struggling with implementation, whereas others have been successful. To better understand these complexities, this project was intended to identify current challenges and success strategies of effective academic electronic health record integration into nursing curricula. Using Rogers' 1962 Diffusion of Innovation theory as a framework for technology adoption, a descriptive survey design was used to gain insights from deans and program directors of nursing schools involved with the national Health Informatics & Technology Scholars faculty development program or Cerner's Academic Education Solution Consortium, working to integrate an academic electronic health record in their respective nursing schools. The participants' experiences highlighted approaches used by these schools to integrate these technologies. Data from this project provide nursing education with effective strategies and potential challenges that should be addressed for successful academic electronic health record integration.
Salami, Bukola; Dada, Foluke O; Adelakun, Folake E
The emigration of sub-Saharan African health professionals to developed Western nations is an aspect of increasing global mobility. This article focuses on the human resources for health challenges in Nigeria and the emigration of nurses from Nigeria as the country faces mounting human resources for health challenges. Human resources for health issues in Nigeria contribute to poor population health in the country, alongside threats from terrorism, infectious disease outbreaks, and political corruption. Health inequities within Nigeria mirror the geographical disparities in human resources for health distribution and are worsened by the emigration of Nigerian nurses to developed countries such as the United States and the United Kingdom. Nigerian nurses are motivated to emigrate to work in healthier work environments, improve their economic prospects, and advance their careers. Like other migrant African nurses, they experience barriers to integration, including racism and discrimination, in receiving countries. We explore the factors and processes that shape this migration. Given the forces of globalization, source countries and destination countries must implement policies to more responsibly manage migration of nurses. This can be done by implementing measures to retain nurses, promote the return migration of expatriate nurses, and ensure the integration of migrant nurses upon arrival in destination countries.
Two decades of work delivering health care in poor communities provide a standpoint from which to challenge conventional doctrines in human rights and public health. These orthodoxies include the priority often assigned to civil and political rights over economic and social rights and a narrow concept of cost-effectiveness in public health policy. An analysis based on economic and social rights underscores, for example, that effectively treating infectious diseases in poor communities requires ensuring that people receive adequate food The challenge of maternal mortality in low-income settings similarly shows the need for an approach to rights that is simultaneously comprehensive and pragmatic. In many settings, paying community health workers for their efforts on behalf of their neighbors can also be seen as a critical strategy to realize right. Across contexts, the yield on the expanded and pragmatic view of health and human rights adumbrated here may be considerable. In forthcoming issues, Health and Human Rights will continue to investigate the conceptual, but above all the practical aspects of such issues, seeking to shift the health and rights agenda in a way that may make sense to the world's poor and marginalized, the chief victims of contemporary human rights violations.
Saltman Deborah C
Full Text Available Abstract Background In workforces that are traditionally mobile and have long lead times for new supply, such as health, effective global indicators of tertiary education are increasingly essential. Difficulties with transportability of qualifications and cross-accreditation are now recognised as key barriers to meeting the rapidly shifting international demands for health care providers. The plethora of mixed education and service arrangements poses challenges for employers and regulators, let alone patients; in determining equivalence of training and competency between individuals, institutions and geographical locations. Discussion This paper outlines the shortfall of the current indicators in assisting the process of global certification and competency recognition in the health care workforce. Using Organisation for Economic Cooperation and Development (OECD data we highlight how International standardisation in the tertiary education sector is problematic for the global health workforce. Through a series of case studies, we then describe a model which enables institutions to compare themselves internally and with others internationally using bespoke or prioritised parameters rather than standards. Summary The mobility of the global health workforce means that transportability of qualifications is an increasing area of concern. Valid qualifications based on workplace learning and assessment requires at least some variables to be benchmarked in order to judge performance.
Buttke, Danielle E; Decker, Daniel J; Wild, Margaret A
Numerous emerging infectious diseases (EIDs) have arisen from or been identified in wildlife, with health implications for both humans and wildlife. In the practice of wildlife conservation, to date most attention has focused on the threat EIDs pose to biodiversity and wildlife population viability. In the popular media and public eye, however, wildlife is often only portrayed as the cause of EIDs and resultant human health impacts. There is little coverage on the roles of human-induced habitat destruction or wildlife population stress in EID spread, nor the negative impacts of disease on wildlife. Here, we focus on a little-studied and seldom discussed concern: how real and perceived risks of wildlife-associated diseases for human and companion animal health might erode public support for wildlife conservation. We believe that wildlife-associated EIDs and public perceptions of these risks are among the most important threats to wildlife conservation. In light of this concern, we explore the challenges and opportunities for addressing this situation in a One Health context that emphasizes the interdisciplinary collaboration and the inextricable nature of human and animal health and disease.
Díez-Padrisa, Núria; Castellanos, Luis Gerardo
Viral hepatitis (VH) is an emergent concern in public health agendas worldwide. More than one million people die annually from hepatitis and 57% and 78% of global cirrhosis and hepatocellular carcinoma cases, respectively, are caused by VH. The burden of disease caused by hepatitis in Latin America and the Caribbean (LAC) is high. Data on hepatitis has been collected in several countries, but more accurate and comparable studies are needed. Hepatitis B vaccination and screening of donated blood are routine practices in the region. However, integrated policies covering prevention and control of disease caused by all types of hepatitis viruses are scarce. Existing preventive measures need to be reinforced. Attention must be paid to at-risk populations, awareness campaigns, and water and food safety. Affordable access to diagnosis and treatment, population screening, referral to health services and monitoring of positive cases are among the main challenges currently posed by VH in LAC. The World Health Organization framework and Pan American Health Organization regional strategy, defined in response to resolution WHA63.18 of the World Health Assembly, may help to overcome these difficulties. Successful experiences in the fight against hepatitis in some LAC countries may also provide very interesting solutions for the region.
Full Text Available Abscess formation following intramuscular injections is rare and they are most commonly seen in immunocompromised individuals. In this case series we present a cohort of three patients presented to us in a critically ill condition with an abscess due to intramuscular injection. Vancomycin resistant staphylococcus aureus was isolated from all three patients. These patients posed a major challenge to the healthcare system and the treating physician because of the: severity of illness, virulence and resistance of the organism, rarity of the situation, immune state of the patient, and lack of supporting evidence to properly guide management in the use of health resources. To the best of our knowledge, there is no report available in the English literature on vancomycin resistant staphylococcus aureus associated with intramuscular injection abscess.
Fresier C. Maseko
Full Text Available Background: Cervical cancer remains the leading cause of cancer death among women in sub-Saharan Africa. In Malawi, very few women have undergone screening and the incidence of cervical cancer is on the increase as is the case in most developing countries. We aimed at exploring and documenting health system gaps responsible for the poor performance of the cervical cancer prevention program in Malawi. Design: The study was carried out in 14 randomly selected districts of the 29 districts of Malawi. All cervical cancer service providers in these districts were invited to participate. Two semi-structured questionnaires were used, one for the district cervical cancer coordinators and the other for the service providers. The themes of both questionnaires were based on World Health Organization (WHO health system frameworks. A checklist was also developed to audit medical supplies and equipment in the cervical cancer screening facilities. The two questionnaires together with the medical supplies and equipment checklist were piloted in Chikwawa district before being used as data collection tools in the study. Quantitative data were analyzed using STATA and qualitative in NVIVO. Results: Forty-one service providers from 21 health facilities and 9 district coordinators participated in the study. Our findings show numerous health system challenges mainly in areas of health workforce and essential medical products and technologies. Seven out of the 21 health facilities provided both screening and treatment. Results showed challenges in the management of the cervical cancer program at district level; inadequate service providers who are poorly supervised; lack of basic equipment and stock-outs of basic medical supplies in some health facilities; and inadequate funding of the program. In most of the health facilities, services providers were not aware of the policy which govern their work and that they did not have standards and guidelines for cervical
Maseko, Fresier C; Chirwa, Maureen L; Muula, Adamson S
Cervical cancer remains the leading cause of cancer death among women in sub-Saharan Africa. In Malawi, very few women have undergone screening and the incidence of cervical cancer is on the increase as is the case in most developing countries. We aimed at exploring and documenting health system gaps responsible for the poor performance of the cervical cancer prevention program in Malawi. The study was carried out in 14 randomly selected districts of the 29 districts of Malawi. All cervical cancer service providers in these districts were invited to participate. Two semi-structured questionnaires were used, one for the district cervical cancer coordinators and the other for the service providers. The themes of both questionnaires were based on World Health Organization (WHO) health system frameworks. A checklist was also developed to audit medical supplies and equipment in the cervical cancer screening facilities. The two questionnaires together with the medical supplies and equipment checklist were piloted in Chikwawa district before being used as data collection tools in the study. Quantitative data were analyzed using STATA and qualitative in NVIVO. Forty-one service providers from 21 health facilities and 9 district coordinators participated in the study. Our findings show numerous health system challenges mainly in areas of health workforce and essential medical products and technologies. Seven out of the 21 health facilities provided both screening and treatment. RESULTS showed challenges in the management of the cervical cancer program at district level; inadequate service providers who are poorly supervised; lack of basic equipment and stock-outs of basic medical supplies in some health facilities; and inadequate funding of the program. In most of the health facilities, services providers were not aware of the policy which govern their work and that they did not have standards and guidelines for cervical cancer screening and treatment. Numerous health
Full Text Available ABSTRACTThis article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP and pre-exposure prophylaxis (PrEP, treatment as prevention (TASP and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.
Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia
This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.
Brush, Charles Adam; Kelly, Maggie M; Green, Denise; Gaffney, Marcus; Kattwinkel, John; French, Molly
We reflect on the proceedings of a symposium at a conference of the Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities. We present examples of bridging the gap between science and policy to achieve improvements in children's health through case studies in early hearing detection and intervention, folic acid fortification to prevent birth defects, sleep positioning recommendations to reduce infant mortality, and workplace lactation support programs. We discuss case studies that present different policy strategies (public health law and voluntary practices) for improving public health. These case studies demonstrate both the power of policy as a tool for improving children's health and the challenges of communicating public health research to policy decisionmakers.
Full Text Available Jalil Safaei Department of Economics, University of Northern British Columbia, Prince George, BC, CanadaBackground: There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM, patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care.Objective: This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries.Method: Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care.Results: Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature.Conclusion: Seeking deliberative democracy in health care is both challenging and rewarding. The
Retamal C, Pedro; Markkula, Niina; Peña, Sebastián
This article analyses and compares the epidemiology of mental disorders and relevant public policies in Chile and Finland. In Chile, a specific mental health law is still lacking. While both countries highlight the role of primary care, Finland places more emphasis on participation and recovery of service users. Comprehensive mental health policies from Finland, such as a successful suicide prevention program, are presented. Both countries have similar prevalence of mental disorders, high alcohol consumption and high suicide rates. In Chile, the percentage of total disease burden due to psychiatric disorders is 13% and in Finland 14%. However, the resources to address these issues are very different. Finland spends 4.5% of its health budget on mental health, while in Chile the percentage is 2.2%. This results in differences in human resources and service provision. Finland has five times more psychiatric outpatient visits, four times more psychiatrists, triple antidepressant use and twice more clinical guidelines for different psychiatric conditions. In conclusion, both countries have similar challenges but differing realities. This may help to identify gaps and potential solutions for public health challenges in Chile. Finlands experience demonstrates the importance of political will and long-term vision in the construction of mental health policies.
Community-based health promotion is poorly theorised and lacks an agreed evidence-base. This paper examines characteristics of community-based health promotion and the challenges they present to evaluation. A review of health promotion evaluation leads to an exploration of more recent approaches, drawing on ideas from complexity theory and developmental evaluation. A reflexive analysis of three program evaluations previously undertaken as an evaluation consultant is used to develop a conceptual model to help in the design and conduct of health promotion evaluation. The model is further explored by applying it retrospectively to one evaluation. Findings suggest that the context-contingent nature of health promotion programs; turbulence in the community context and players; multiple stakeholders, goals and strategies; and uncertainty of outcomes all contribute to the complexity of interventions. Bringing together insights from developmental evaluation and complexity theory can help to address some evaluation challenges. The proposed model emphasises recognising and responding to changing contexts and emerging outcomes, providing rapid feedback and facilitating reflexive practice. This will enable the evaluator to gain a better understanding of the influence of context and other implementation factors in a complex setting. Use of the model should contribute to building cumulative evidence and knowledge in order to identify the principles of health promotion effectiveness that may be transferable to new situations.
Full Text Available Abstract Background During the past three decades, Oman has made significant progress in controlling TB within it's borders. However, the national TB control program elimination target has yet to be reached. This study aims to explore the perceived roles played by the immigrant population and the private health sector in relation to TB control in Oman. Methods We conducted seventeen interviews with different health care providers. The verbatim transcripts were processed using content analysis. Results Three main themes emerged. Firstly the threat of repatriation faced by underprivileged expatriates, secondly the criticized and forgotten private health sector as a key player and thirdly the user and provider barriers faced by Omani patients in the Omani public health system. Conclusions The study has identified some of the challenges and barriers to TB control in Oman. These challenges are mainly related to unintended negative consequences arising from the current repatriation policy of immigrants and to and the lack of involvement of the private sector in TB control. TB control strategies designed to address these challenges are needed, for Oman to reach its TB elimination targets.
This article presents the results of a participatory exploration of male attitudes towards sexual and reproductive health issues in Nicaragua. Nicaraguan culture views men in a machismo concept. The study examined the knowledge, attitudes and behavior of men in relation to the social construction of masculinity: sexuality, reproduction, and fatherhood. Employing 90 men from both rural and urban communities, attitudes towards sexuality, reproduction, abortion and fatherhood were discussed. Several insights were gathered from the research, which explains men's behavior. Thus, it was deemed imperative that in empowering women by promoting sexual and reproductive health among men would require challenging male hegemony and persuading men to participate in health promotion. However, the setting and application of a men's agenda for sexual health promotion should not result in the curtailment of services for women because funds are being reallocated to men, nor should it give men the opportunity to more subtle forms of domination and exploitation.
Lee, Kelley; Brumme, Zabrina L
While there has been wide-ranging commitment to the One Health approach, its operationalisation has so far proven challenging. One Health calls upon the human, animal and environmental health sectors to cross professional, disciplinary and institutional boundaries, and to work in a more integrated fashion. At the global level, this paper argues that this vision is hindered by dysfunctions characterising current forms of global health governance (GHG), namely institutional proliferation, fragmentation, competition for scarce resources, lack of an overarching authority, and donor-driven vertical programmes. This has contributed, in part, to shortcomings in how One Health has been articulated to date. An agreed operational definition of One Health among key global institutions, efforts to build One Health institutions from the ground up, comparative case studies of what works or does not work institutionally, and high-level global support for research, training and career opportunities would all help to enable One Health to help remedy, and not be subsumed by, existing dysfunctions in GHG.
Kumar, A K Shiva; Chen, Lincoln C; Choudhury, Mita; Ganju, Shiban; Mahajan, Vijay; Sinha, Amarjeet; Sen, Abhijit
India's health financing system is a cause of and an exacerbating factor in the challenges of health inequity, inadequate availability and reach, unequal access, and poor-quality and costly health-care services. Low per person spending on health and insufficient public expenditure result in one of the highest proportions of private out-of-pocket expenses in the world. Citizens receive low value for money in the public and the private sectors. Financial protection against medical expenditures is far from universal with only 10% of the population having medical insurance. The Government of India has made a commitment to increase public spending on health from less than 1% to 3% of the gross domestic product during the next few years. Increased public funding combined with flexibility of financial transfers from centre to state can greatly improve the performance of state-operated public systems. Enhanced public spending can be used to introduce universal medical insurance that can help to substantially reduce the burden of private out-of-pocket expenditures on health. Increased public spending can also contribute to quality assurance in the public and private sectors through effective regulation and oversight. In addition to an increase in public expenditures on health, the Government of India will, however, need to introduce specific methods to contain costs, improve the efficiency of spending, increase accountability, and monitor the effect of expenditures on health.
Sun, Jing; Guo, Yutao; Wang, Xiaoning; Zeng, Qiang
The aging population with chronic and age-related diseases has become a global issue and exerted heavy burdens on the healthcare system and society. Neurological diseases are the leading chronic diseases in the geriatric population, and stroke is the leading cause of death in China. However, the uneven distribution of caregivers and critical healthcare workforce shortages are major obstacles to improving disease outcome. With the advancement of wearable health devices, cloud computing, mobile technologies and Internet of Things, mobile health (mHealth) is rapidly developing and shows a promising future in the management of chronic diseases. Its advantages include its ability to improve the quality of care, reduce the costs of care, and improve treatment outcomes by transferring in-hospital treatment to patient-centered medical treatment at home. mHealth could also enhance the international cooperation of medical providers in different time zones and the sharing of high-quality medical service resources between developed and developing countries. In this review, we focus on trends in mHealth and its clinical applications for the prevention and treatment of diseases, especially aging-related neurological diseases, and on the opportunities and challenges of mHealth in China. Operating models of mHealth in disease management are proposed; these models may benefit those who work within the mHealth system in developing countries and developed countries.
Paim, Jairnilson; Travassos, Claudia; Almeida, Celia; Bahia, Ligia; Macinko, James
Brazil is a country of continental dimensions with widespread regional and social inequalities. In this report, we examine the historical development and components of the Brazilian health system, focusing on the reform process during the past 40 years, including the creation of the Unified Health System. A defining characteristic of the contemporary health sector reform in Brazil is that it was driven by civil society rather than by governments, political parties, or international organisations. The advent of the Unified Health System increased access to health care for a substantial proportion of the Brazilian population, at a time when the system was becoming increasingly privatised. Much is still to be done if universal health care is to be achieved. Over the past 20 years, there have been other advances, including investments in human resources, science and technology, and primary care, and a substantial decentralisation process, widespread social participation, and growing public awareness of a right to health care. If the Brazilian health system is to overcome the challenges with which it is presently faced, strengthened political support is needed so that financing can be restructured and the roles of both the public and private sector can be redefined. Copyright © 2011 Elsevier Ltd. All rights reserved.
Full Text Available Extremes weather changes surpassing their usual statistical ranges and tumbling records in India could be an early warning bell of global warming. Extreme weather events like the recent record setting in western Indian city of Mumbai or all time high fatalities due to the heat wave in southern Indian states or increasing vulnerability of easten Indian states to flood could all be a manifestation of climate change in the Asian subcontinent. While the skeptics may be inclined to dismiss these events as simple local aberrations, when viewed in an epidemiological paradigm in terms of person, time and space couple with frequency, intensity and fatalities, it could well be an early manifestation of climate change. Global warming poses serious challenge to the health sector and hence warrants emergency health preparedness and response. Climate-sensitive diseases are among the largest global killers, hence major brunt of global climate change in terms of adverse health impact will be mostly borne by poor and developing countries in Asia, given the levels of poverty, nutional levels and poor public health infrastructure.
Fletcher-Lartey, Stephanie M; Caprarelli, Graziella
The uptake and acceptance of Geographic Information Systems (GIS) technology has increased since the early 1990s and public health applications are rapidly expanding. In this paper, we summarize the common uses of GIS technology in the public health sector, emphasizing applications related to mapping and understanding of parasitic diseases. We also present some of the success stories, and discuss the challenges that still prevent a full scope application of GIS technology in the public health context. Geographical analysis has allowed researchers to interlink health, population and environmental data, thus enabling them to evaluate and quantify relationships between health-related variables and environmental risk factors at different geographical scales. The ability to access, share and utilize satellite and remote-sensing data has made possible even wider understanding of disease processes and of their links to the environment, an important consideration in the study of parasitic diseases. For example, disease prevention and control strategies resulting from investigations conducted in a GIS environment have been applied in many areas, particularly in Africa. However, there remain several challenges to a more widespread use of GIS technology, such as: limited access to GIS infrastructure, inadequate technical and analytical skills, and uneven data availability. Opportunities exist for international collaboration to address these limitations through knowledge sharing and governance.
Assunção, Ada Avila; Belisário, Soraya Almeida; Campos, Francisco Eduardo; D'Avila, Luciana Souza
This article discusses several key concepts for human resources policy in health in the context of Latin America's regional integration efforts. The article focuses on different concepts of integration to emphasize the analytical distinction between regional and conceptual integration. It also presents labor and human resources concepts before discussing, in the final analysis, the challenges that a common research agenda faces in the context of current health sector reforms in Latin America. The conclusion emphasizes the need to develop a technology and research system capable of supporting the agenda for exchange between MERCOSUR member countries.
Bærentzen, Jakob Andreas; Hansen, Kristian Evers; Erleben, Kenny
In this paper, we propose a pose editing and animation method for triangulated surfaces based on a user controlled partitioning of the model into deformable parts and rigid parts which are denoted handles. In our pose editing system, the user can sculpt a set of poses simply by transforming...... the handles for each pose. Using Laplacian editing, the deformable parts are deformed to match the handles. In our animation system the user can constrain one or several handles in order to define a new pose. New poses are interpolated from the examples poses, by solving a small non-linear optimization...... problem in order to obtain the interpolation weights. While the system can be used simply for building poses, it is also an animation system. The user can specify a path for a given constraint and the model is animated correspondingly....
Kelley, Melessa; Lowe, John
Little is known about how Native American youth experience or manage stress. The purpose of this study was to describe the health challenge of stress experienced by Cherokee-Keetoowah adolescents and to identify approaches used to manage stress. All adolescents regardless of ethnicity face normative sources of stress, such as daily hassles and transition experiences like moving to a new school. Native American youth are known to have significantly greater stress, related to social and economic factors, than their white peers. They are exposed to a variety of continuous stressors including poverty and family disruption. A qualitative story-theory-guided approach was used to conduct a secondary analysis of existing data collected from a larger study where written stories of stress were gathered from 50 Cherokee-Keetoowah adolescents ranging in ages from 14 to 18 years. The data analysis was guided by the story inquiry method to identify dimensions of the health challenge of stress and approaches used to resolve the health challenge. Three health challenge groups were identified: burden of expectations, relationship disruption, and imposing feelings and the actions of others. The most frequently described stories of stress expressed were the burden of expectation of self or from others (n=33). Connecting with valued others, engaging in meaningful activities, and choosing a positive attitude about change were themes that characterized ways that these adolescents managed stress. It is essential to understand how Native American adolescents experience stress and what they do to manage it if we wish to deter the physical and mental consequences of stress. The development of stress-reducing culturally competent interventions that are built on a foundation such as story sharing is a culturally congruent approach for intervening with Native American adolescents. © 2012 Elsevier Inc. All rights reserved.
Solange Gould; Linda Rudolph
Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals a...
Medhanyie, Araya Abrha; Moser, Albine; Spigt, Mark; Yebyo, Henock; Little, Alex; Dinant, GeertJan; Blanco, Roman
Feasibility assessment of mobile health (mHealth) data collection at primary health care in Ethiopia. A total of 14 health workers were recruited from 12 primary health care facilities to use smartphones, installed with customized data collection application and electronic maternal health care forms for assessing pregnant women's health for 6 months. Qualitative approaches comprising in-depth interviews and field notes were used to document the users' perception and experience in using the application and forms. All health workers had never had previous exposure to smartphones and electronic forms, but they got used to them easily. Over 6 months, all health workers completed a total of 952 patient records using the forms on smartphones. Health workers' acceptability and demand for the application and forms were high. In introducing the application, nontechnical challenges were more difficult to solve than technical challenges. Introducing an mHealth application at primary health care for routine collection of health data relevant to maternal health at a small scale was feasible. Nonetheless, implementing a system of assigning unique and consistent patient identifier, standardization of health services, and improving mobile network coverage would be prerequisites for scaled-up usage of such an application. Copyright © 2015 Elsevier Inc. All rights reserved.
Background Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism. Methods Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants’ perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians’ abilities to support medical tourists’ informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Results Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician’s role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician’s reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians’ concerns that treatments sought abroad may not be based on the best available medical evidence on treatment
Grosz, Barbara J
... well" in a game he defines and calls "the imitation game," and which we know as the Turing test. The Turing test poses the challenge of constructing a computer system able to carry on a dialogue with a person, potentially ranging over any subject matter and many subject matters, well enough to be indistinguishable from a person. Turing conject...
Bórquez Polloni, B
Contrary to what one may think health and equity are not issues that have always gone hand in hand following the formal recognition of the former by the Universal Declaration of Human Rights (1948). It was not until the Alma Ata Declaration in 1978 when the close ties between both began to be seriously considered, and in 2000 this led to several international organizations formalizing their concern for the factors that determine whether a health system is fair or not. Since then, the term «equity in health» has taken on a special meaning when weighing up the strength or weaknesses of certain health systems. However, over the years, equity in health has gradually been identified almost exclusively with a financial issue that focuses on distributing health resources. As a result, one often forgets to provide the necessary care for those in other unfair situations, which, as regards access to and providing health care, leads to unfair situations that are not directly related to financial reasons and do not require investments, but consensus and the honest determination to make changes. This leads the Bioethics of the 21st century to face two challenges: to warn of these inequities and to promote initiatives that are able to make effective changes. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.
Giles-Corti, Billie; Vernez-Moudon, Anne; Reis, Rodrigo; Turrell, Gavin; Dannenberg, Andrew L; Badland, Hannah; Foster, Sarah; Lowe, Melanie; Sallis, James F; Stevenson, Mark; Owen, Neville
Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.
Vissandjee, B; Hemlin, I; Gravel, S; Roy, S; Dupéré, S
Increasing immigration to Quebec has brought to the surface the need for adapting its public health systems and services, particularly in the area of primary care. The challenge is to take the heterogeneous nature of the population into account and to integrate diverse values, experience and know-how into the development of programmes and delivery of services, whilst simultaneously respecting the values of the various care providers and the norms of the institutions in the host country. This article addresses the question of adaptation strategies for health services, and namely the development of prevention and heath promotion programmes in public health within the framework of primary health care services within the intercultural context of Montreal. The issue of adaptation falls within the perspective and mandate of the Quebec government's policy on health and well-being (La politique de santé et du bien-être, 1992). Furthermore, it is a response to frequent demands from various health professionals and groups concerned with the adaptation of public services with respect to intercultural relationships confronted with the emerging realities associated with immigration. The article provides a reflection on specific ways of adapting prevention and health promotion initiatives targeting cultural communities and those who are undergoing immigration procedures or transitions. It also examines the development of ethno-cultural or other indicators which make it possible to capture migration experiences and their health impact. Since the Quebec health and social services system is currently in the process of major reform, it is hoped that it will seize this opportunity in order to make health and social service centres accountable for the adaptation of their programmes and services to the diversity of the populations they serve.
Full Text Available South Africa’s struggle against apartheid discrimination, including struggles in the health sector, laid the basis for a vibrant engagement of staff and students in human rights research, teaching and outreach in the Health Sciences Faculty at the University of Cape Town (UCT. This article provides a brief overview of this background context, then shows how this engagement has continued with new challenges emerging in the post-apartheid democratic period. Teaching at undergraduate and postgraduate levels has been complemented by a programme of ‘Training the Trainers’ in health and human rights. The programme targets teachers of health professionals at institutions in South and Southern Africa, resulting in national adoption of human rights competencies as an essential component of health professionals’ skills base. Research has also extended lessons learnt from the apartheid period into work with vulnerable groups, such as rural farm workers and the deaf, and seeks to build the capacity of marginal populations to change the conditions of their vulnerability in order to realize their rights. Partnerships with civil society organisations have been a strong thread, creating new knowledge and new ways of joint work towards realizing the right to health, including advocacy engagement in civil society movements and regional networks. Further, a focus on health professionals’ practice, in terms of dealing with potential dual loyalty conflicts and their role as gatekeepers in the health services on matters of patients’ rights, has shaped the research agenda. This article illustrates how knowledge production for the public good extends beyond notions of enhancing economic productivity for national development and provides a base for transdisciplinary and transinstitutional engagement. Additionally, non-traditional forms of knowledge networking and transfer have also been explored, including engagement with policy-makers and health managers
van der Feltz-Cornelis, Christina M; van Os, Jim; Knappe, Susanne; Schumann, Gunter; Vieta, Eduard; Wittchen, Hans-Ulrich; Lewis, Shôn W; Elfeddali, Iman; Wahlbeck, Kristian; Linszen, Donald; Obradors-Tarragó, Carla; Haro, Josep Maria
Background The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders. Methods The research was conducted as an expert survey and expert panel discussion during a scientific workshop. Results Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The “subjectivity gap” between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required. Conclusion Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs. PMID:25061300
Choi, Heeseung; Hwang, Boyoung; Kim, Sungjae; Ko, Heesung; Kim, Sumi; Kim, Chanhee
In response to current challenges in psychiatric mental health nursing education, nursing schools have implemented new strategies in teaching undergraduate nursing students. The objectives of the study were to evaluate learning outcomes of a mental health nursing clinical practicum and to explore students' perceptions of the clinical practicum. This was a mixed-method study. Sixty-three undergraduate nursing students, who were undertaking their first mental health clinical practicum, completed a set of structured questionnaires and answered open-ended questions about the clinical practicum. Answers to open-ended questions were analyzed qualitatively, and learning outcomes (i.e., empathy, mental illness prejudice, simulation-related efficacy, and satisfaction) were measured at three time points: pre-clinical, post-simulation, and post-clinical. Students reported improvement in empathy and simulation-related self-efficacy after the clinical practicum, but no change was found in mental illness prejudice. Students' expectations for and evaluation of the clinical practicum are summarized. The observed improvement in learning outcomes of the clinical practicum may be attributed to the unique contribution of each component of the clinical practicum and the synergic effect of these diverse components. To manage emerging challenges in clinical settings and nursing education, it is critical to develop systematic and comprehensive mental health nursing clinical practicums for undergraduate nursing students. Copyright © 2016 Elsevier Ltd. All rights reserved.
Armstrong, Colin; Wolever, Ruth Q; Manning, Linda; Elam, Roy; Moore, Margaret; Frates, Elizabeth Pegg; Duskey, Heidi; Anderson, Chelsea; Curtis, Rebecca L; Masemer, Susan; Lawson, Karen
There is great need for cost effective approaches to increase patient engagement and improve health and well-being. Health and wellness coaching has recently demonstrated great promise, but the majority of studies to date have focused on individual coaching (ie, one coach with one client). Newer initiatives are bringing a group coaching model from corporate leadership development and educational settings into the healthcare arena. A group approach potentially increases cost-effective access to a larger number of clients and brings the possible additional benefit of group support. This article highlights some of the group coaching approaches currently being conducted across the United States. The group coaching interventions included in this overview are offered by a variety of academic and private sector institutions, use both telephonic and in-person coaching, and are facilitated by professionally trained health and wellness coaches as well as trained peer coaches. Strengths and challenges experienced in these efforts are summarized, as are recommendations to address those challenges. A working definition of "Group Health and Wellness Coaching" is proposed, and important next steps for research and for the training of group coaches are presented.
Barnard, Justin B
Response to public health emergencies on tribal lands poses a unique challenge for state and tribal public health officials. The complexity and intensely situation-specific nature of federal Indian jurisprudence leaves considerable question as to which government entity, state or tribal, has jurisdiction on tribal lands to undertake basic emergency measures such as closure of public spaces, quarantine, compulsory medical examination, and investigation. That jurisdictional uncertainty, coupled with cultural differences and an often troubled history of tribal-state relations, threatens to significantly impede response to infectious disease outbreaks or other public health emergencies on tribal lands. Given that tribal communities may be disproportionately impacted by public health emergencies, it is critical that tribal, state, and local governments engage with each other in coordinated planning for public health threats. This Article is offered as a catalyst for such planning efforts. The Article identifies some of the most pressing jurisdictional issues that may confront governments responding to a public health emergency on tribal lands, with the aim of highlighting the nature of the problem and the need for action. The Article goes on to examine the most promising means of addressing jurisdictional uncertainty: intergovernmental agreements. Already utilized in many areas of shared interest between tribe and state, intergovernmental agreements offer neighboring state, local, and tribal governments a vehicle for delineating roles and authorities in an emergency, and may lay the groundwork for sharing resources. The Article surveys various representative tribal public health intergovernmental agreements, and concludes with suggestions for tribes and state or local governments looking to craft their own agreements.
Full Text Available The ubiquity of mobile phones worldwide is generating an unprecedented amount of human behavioral data both at an individual and aggregated levels. The study of this data as a rich source of information about human behavior emerged almost a decade ago. Since then it has grown into a fertile area of research named computational social sciences with a wide variety of applications in different fields such as social networks, urban and transport planning, economic development, emergency relief and, recently, public health. In this paper we briefly describe the state of the art on using mobile phone data for public health, and present the opportunities and challenges that this kind of data presents for public health.
Weihs, Marla; Mertens, Frédéric
This article examines opportunities and limitations regarding knowledge generation in the field of environmental health. The contention is that understanding the complexity of factors that determine the health of humans and ecosystems requires a redefinition of the traditional distribution of roles and responsibilities in scientific research. These research practices involve inter and transdisciplinary approaches and the application of an ecosystemic approach (ecohealth). Challenges and opportunities associated to the application of inter and transdisciplinarity in environmental health problems are discussed and illustrated by two case studies that use an ecohealth approach: a project on the contamination and exposure to mercury in the Brazilian Amazon, and another on the urban transmission of echinococcosis in Nepal. In the conclusion, the potential benefits of using an ecohealth approach in overcoming the limitations of unidisciplinary practices and in taking advantage of local knowledge and participation is stressed.
Oliver, Nuria; Matic, Aleksandar; Frias-Martinez, Enrique
The ubiquity of mobile phones worldwide is generating an unprecedented amount of human behavioral data both at an individual and aggregated levels. The study of this data as a rich source of information about human behavior emerged almost a decade ago. Since then, it has grown into a fertile area of research named computational social sciences with a wide variety of applications in different fields such as social networks, urban and transport planning, economic development, emergency relief, and, recently, public health. In this paper, we briefly describe the state of the art on using mobile phone data for public health, and present the opportunities and challenges that this kind of data presents for public health.
Willhite, Calvin C; Karyakina, Nataliya A; Yokel, Robert A; Yenugadhati, Nagarajkumar; Wisniewski, Thomas M; Arnold, Ian M F; Momoli, Franco; Krewski, Daniel
Abstract Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007) . Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of "total Al"assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al(+3) to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)(+2) and Al(H2O)6 (+3)] that after complexation with O2(•-), generate Al superoxides [Al(O2(•))](H2O5)](+2). Semireduced AlO2(•) radicals deplete mitochondrial Fe and promote generation of H2O2, O2 (•-) and OH(•). Thus, it is the Al(+3)-induced formation of oxygen radicals that accounts for the
Allan Kah-Heng Pau
Full Text Available Oral health diseases are common in allregions of the world and their impact on anatomicaland social functioning is widely acknowledged.Their distributions are unequal between and withincountries, with the greatest burden falling ondisadvantaged and socially marginalized populations.The risk factors and social determinants for oral diseaseshave been comprehensively documented, and theevidence base for their prevention is growing. However,decisions on health care are still often made withouta solid grounding in research evidence. Translation ofresearch into policy and practice should be a priority forall. Both community and individual interventions needtailoring to achieve a more equal and person-centeredpreventive focus and reduce any social gradient in health.The major challenges of the future will be to translateknowledge and experiences in oral disease preventionand health promotion into action programmes.The international oral health research community needsto engage further in research capacity building and instrengthening the work so that research is recognized asthe foundation of oral health policy at global level.
Sohrabizadeh, Sanaz; Tourani PhD, Sogand; Khankeh, Hamid Reza
Disasters do not affect people equally; the impact of disasters on the lives of women is different from other groups of a community. Women's fundamental rights to health and safety are violated after disasters. The authors of this study aimed to explore various factors of women's health with reference to previous natural disasters in Iran. A qualitative approach using in-depth unstructured interviews and field observations was employed to explore women's health factors in the affected regions. A total of 22 participants affected by disasters, as well as key informants, were interviewed applying the purposeful sampling method. Data were collected in 2014 in three provinces, including East Azerbaijan, Bushehr, and Mazandaran. A content analysis using the Graneheim approach was performed for analyzing the transcribed interviews. Two themes and four categories were extracted from the data. The themes that emerged included psycho-physical effects and women's health status. Physical and psycho-emotional effects and reproductive and environmental health effects were the four emergent categories. The findings implied that managing women's health challenges may result in reducing the distressing effects of disaster. These findings support identification and application of the mechanisms by which women's well-being in physical, mental, reproductive, and environmental aspects can be protected after disasters.
Shroufi, Amir; Chowdhury, Rajiv; Aston, Louise M; Pashayan, Nora; Franco, Oscar H
With the current demographic shift being experienced by populations globally, almost linear increases in life expectancy have been seen and can be expected. However, increases in healthy life expectancy may not keep pace. Among older populations the proportion of time spent in less than full health tends to increase. As a result, the accurate valuation of life spent in states less than full health will become increasingly important. Different techniques and approaches have been used to measure health in populations. The use of summary measures of population health such as DALYs (Disability Adjusted Life Years) has become common, and is widely used to compare health between populations and to evaluate the potential impact of interventions in economic analyses. Most of the commonly used summary measures of health express some measure of life lived in full health and life lived with disability or in a state of sub-optimal health. Critical to the construction of summary health measures are values assigned to health states. Current tools used in determining these values include the standard gamble, time trade off, person trade off, and the visual analogue scale. However, these techniques all have the disadvantage of incorporating individual biases (derived from particular characteristics specific to individuals or populations) into the process through which health state valuations are derived. As a consequence health states are often not directly comparable between populations, since characteristics such as nationality and ethnicity can influence how health states are valued. Furthermore, health can be judged differently by those of different ages, with the young often assigning a lower value to life lived at less than full health compared to older people. The challenge of obtaining opinions which are not influenced by an individual's own circumstances is not new. This issue was encountered and described by the American philosopher John Rawls in 'A Theory of Justice
Speed, Ewen; Mannion, Russell
Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for 'fake news' and 'alternative facts' with the intention of inciting fear and hatred of 'the other' and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Zhao, Junping; Zhang, Zhenjiang; Guo, Huayuang; Li, Yi; Xue, Wanguo; Ren, Lianzhong; Chen, Yunqi; Chen, Shifu; Liu, Tongze; Jia, Ru; Zhao, Yi; Chai, Chang
China has been implementing regional collaborative medical service (also known as e-health) for >5 years, but is still facing the challenges of bridging different community health information systems (CHISs). The fact that different communities have different systems makes it difficult to share information and data between different CHISs. To explore a solution for addressing this problem, we constructed a demonstration CHIS in Beijing's Dongcheng District. This system is based on the Software-as-a-Service model, in which a central data center is used to store users' health records and to provide different services. This system provides a comprehensive platform combining disease prevention, health protection, medical care, rehabilitation, health education, and family planning. In this article, we first show the challenge of implementing e-health-oriented CHIS in China, then we briefly introduce our solution, and finally we share our experience learned from the modern CHIS implementation practice.
Full Text Available This paper is an attempt to understand the project of mainstreaming in India's health care system that has started with an aim to bring marginalized and alternative systems of medicine in mainstream. The project has gained much attention with the establishment of Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH in the year 2003, which is now a ministry. It has ushered some positive results in terms of growth of AYUSH hospitals and dispensaries. However, it has also raised challenges around the theory and practice of mainstreaming. With an emphasis on Ayurvedic practice in Delhi Government Health Institutions, this article has tried to analyze some of those challenges and intricacies. Drawing on Weber's theory of bureaucratization and Giddens's theory of structuration, the paper asks what happens to an alternative medical system when it becomes part of the bureaucratic set-up. Along with the questions of structures, it also tries to combine the question of the agency of both patients and doctors considered to be the cornerstone of the Ayurvedic medical system. Although our study recognizes some of the successes of the mainstreaming project, it also underlines the challenges and problems it faces by analyzing three points of view (institutions, doctors, and patients.
This paper is an attempt to understand the project of mainstreaming in India's health care system that has started with an aim to bring marginalized and alternative systems of medicine in mainstream. The project has gained much attention with the establishment of Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) in the year 2003, which is now a ministry. It has ushered some positive results in terms of growth of AYUSH hospitals and dispensaries. However, it has also raised challenges around the theory and practice of mainstreaming. With an emphasis on Ayurvedic practice in Delhi Government Health Institutions, this article has tried to analyze some of those challenges and intricacies. Drawing on Weber's theory of bureaucratization and Giddens's theory of structuration, the paper asks what happens to an alternative medical system when it becomes part of the bureaucratic set-up. Along with the questions of structures, it also tries to combine the question of the agency of both patients and doctors considered to be the cornerstone of the Ayurvedic medical system. Although our study recognizes some of the successes of the mainstreaming project, it also underlines the challenges and problems it faces by analyzing three points of view (institutions, doctors, and patients).
Victora, Cesar G; Aquino, Estela M L; do Carmo Leal, Maria; Monteiro, Carlos Augusto; Barros, Fernando C; Szwarcwald, Celia L
(coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women's health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.
Full Text Available Climate change has emerged as one of the most important environmental issues ever to confront humanity. Recent events have emphatically demonstrated our growing vulnerability to climate change, and health hazards are a major concern. Research pertaining to the effects of climate change on human health is the need of the hour. This paper discusses the broad challenges in health research in developing countries with specific reference to climate change.
Because health is the product of a combination of political, economic, social, cultural, technical factors, the values of the indicators of health are an observatory of the African continent and its billion people in all their dimensions. So, the reading of the program of the 9(th) French-speaking international Congress of the Society of Exotic Pathology is significant of the state of Africa in this second decade of the 21(th) century. The age-old infectious plagues go alongside to emergent fevers there, but the program also dedicates a wide time to the chronic pathologies. This kaleidoscope invites to discuss the concept of epidemiological transition chosen by the Congress. What is its meaning when the order of magnitude of the values of the indicators of health was distended never also and became the most contrasted by the world, in all the scales of observation? Which is its meaning when, in Black Africa, unlike the processes observed in the countries which formed the Third World in 1950, the evolution observed for the last five decades is chaotic, made by a succession of advances, by a progress, by blockings, even by walking back, original expression of the health transition, the process which includes the evolution of the health and the answers of States and societies. The geography of the values of indicators shows the socio-territorial dynamics in process, which place societies in more or less protective systems for their health. More than ever, diverse worlds are next to a sum of challenges, of which that to improve the knowledge of the needs for health, in relatively fine scale to avoid generalizations and amalgams, and target priorities of health according to the socio-territorial contexts.
AbdulKarim Said Al Makadma
Full Text Available This review article documents the evidence regarding the health status of adolescents aged between 10 and 19 years in the Arab region and the Gulf Cooperation Council countries (GCC and also considers the state of adolescent health care in the region compared to the recommended guidelines for such services. Adolescents make up more than 25% of the population of the GCC countries, a percentage that is far higher than that in other high-income countries, yet their health status and health care needs are not given proportional attention in the region. Thus, the burden of mortality and morbidity for adolescents in the region has shifted from communicable diseases to road traffic injuries, mental health issues, non-communicable diseases, and health-compromising behaviors and conditions that contribute to those issues. Whereas the sources of evidence are limited with respect to some issues, such as mental health issues, sexual and reproductive health, and alcohol use, other health issues, such as rising rates of tobacco use, low levels of physical activity, minimal consumption of fruit and vegetables, and high levels of obesity, are better-documented. Many health care providers see adolescents who have limited or no training in adolescent health care and adolescents who are transitioned to the adult care system at young ages without the necessary health care transition services, thus creating challenges for these individuals to access developmentally appropriate health care. Recommendations include prioritizing health care practice, health care facilities, clinical education, and adolescent health research to address key aspects of adolescent health and adolescent medical care in the GCC countries. This could be accomplished through the development of adolescent health care centers that bring together expert interdisciplinary care, excellent health provider training, and cutting-edge adolescent health research to provide leadership throughout the
Robinson, S M
Understanding the role and importance of nutrition in early postnatal life, as an influence on lifelong vulnerability to poor health, is an important part of current research. We need to be able to define optimal patterns of infant feeding, not just to support growth and development in infancy, but also as determinants of later health. To date, much of the focus on the long-term effects of infant nutrition has been on milk feeding, to compare breast and formula feeding and to evaluate the effects of exclusivity, timing and duration of feeding different types of milk in infancy; other aspects of infant feeding such as age at introduction of solid foods and type of weaning diet have received less attention, and relatively little is known about their links to later health. Contemporary data are needed to enable us to move beyond explanation of historical infant feeding data in order to understand and predict health outcomes in future generations. Ongoing and new population studies, that include infants from diverse settings, will be key to providing generalizable data that can be used to define optimal feeding practice. There are some methodological challenges ahead, although significant progress has already been made, and further progress is envisaged in the future. In particular, the opportunity to bring together epidemiological studies and new mechanistic insights that will help identify key aspects of infant nutrition and their causal effects offer great promise both in moving this field forward as well as the potential for health benefits for future generations.
Full Text Available Faced with increasing industrialization, high demands on production, and decreasing domestic participation in the labor force, dairy producers are employing an immigrant workforce to help meet operational demands. There is little data regarding the number of immigrant workers in the dairy industry, but the trend of hiring immigrant workers in some of the world’s highest producing countries is increasing. There are many challenges associated with managing immigrant workers includinghow to effectively train this workforce about safe and efficient work methods. Methods: Ethnographic methods from the anthropology field served as the primary tool to identify barriers and facilitators of safe work practices in large-herd dairy operations in the United States. Following the weeklong emersion by the research anthropologist at a selected dairy, focus groups were organized at three large-herd dairies. All focus group conversations were tape recorded, transcribed and translated into English. The focus group transcripts were coded for specific themes related to issues that participants felt were barriers or facilitators of worker health and safety. Results: Twenty-two Latino workers 18 to 58 years of age participated in the three focus groups conducted at one Colorado and two South Dakota dairies. Six major themes relating to barriers and facilitators of worker health and safety were identified and included: communication, integration owner and worker cultures, work organization, leadership, support for animal health, and attention to safety culture within the organization. Conclusions: Although not often considered by agricultural engineers, an anthropological perspective to challenges involving an immigrant workforce may assist with improved work methods and safe work practices. Through this approach, agricultural engineers may better understand the cultural challenges and complexities facing the dairy industry. Successful integration of immigrant
Background: People are moving more and it demands more of health care in the countries receiving people from cultures and countries different from their own. I wanted to write this essay to try to answer what are the challenges for healthcare staff, and how to solve those problems when it comes to female genital-mutilation which is a widespread practice in Africa and in Islam. Aim: Female genital mutilation is an important issue because it affects a woman's life, both mentally and physical...
Yeh, Mei Chang; Chao, Yu-Mei Yu; Chao, Co-Shi
An increasingly elderly population and prevalence of chronic health problems have transformed the healthcare landscape in Taiwan and necessitated a shift in the focus of healthcare toward chronic rather than acute illnesses. This is a challenge to the domestic healthcare system, which was initially designed to address and cure primarily acute illness. Traditional nursing education and training programs are no longer adequate to meet current population healthcare needs. The first part of this article highlights the challenges posed by changing healthcare needs, e.g., the rise in prevalence of age-related chronic conditions and the increased acuity of hospitalized patients. Such developments are making new demands and expectations of nurses in terms of education, skills and roles. The second part of this article explores the weaknesses of current nursing education. Recommendations for the future include: making high school graduation a minimum requirement for entering nursing college and university programs, restructuring the nursing master's education program to prepare advanced nurse practitioners, redesigning curriculum content, and teaching approaches based on public healthcare needs. Upgrading clinical competencies and increasing nursing school faculty numbers are issues of the most immediate priority.
Diagnostic performance of magnetic resonance imaging and pre-surgical evaluation in the assessment of traumatic intra-articular knee disorders in children and adolescents: what conditions still pose diagnostic challenges?
Gans, Itai; Ganley, Theodore J. [The Children' s Hospital of Philadelphia, Division of Orthopaedics, 34th and Civic Center Boulevard, Philadelphia, PA (United States); Bedoya, Maria A.; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)
-surgical evaluation was quite high. The traumatic intra-articular knee lesions that still pose a diagnostic challenge for MRI and pre-surgical evaluation are lateral discoid meniscus, lateral meniscal tears, intra-articular loose bodies and osteochondral injuries. Special attention should be given to those diagnoses when evaluating a pediatric knee MRI. In children with multiple intra-articular injuries, there is significantly more inaccuracy in pre-arthroscopic diagnosis of lateral meniscal tears on both MRI and pre-surgical evaluation. (orig.)
Doku, V C K; Wusu-Takyi, A; Awakame, J
Ghana successfully passed a Mental Health Act law in March 2012. The passing of the Act was a culmination of a lot of work by various individuals and institutions spanning several decades. Finally there is a raised prospect of the delivery of a better quality mental healthcare and also the protection of human rights of people with mental disorders in Ghana. This paper identifies and describes clusters of related potential problems referred to as 'challenges' involving different aspects of service delivery, which are anticipated to be encountered during the implementation of the law. Finally, it cautions against the risk of allowing the new mental health law to add a new 'legal' burden to a list of perennial 'burdens' including underfunding, serious levels of understaffing and plummeting staff morale, which bisected earlier attempts at implementing a similar law that laid fallow for forty years.
Ballester, Joan; Lowe, Rachel; Diggle, Peter J; Rodó, Xavier
After several decades of intensive research, steady improvements in understanding and modeling the climate system have led to the development of the first generation of operational health early warning systems in the era of climate services. These schemes are based on collaborations across scientific disciplines, bringing together real-time climate and health data collection, state-of-the-art seasonal climate predictions, epidemiological impact models based on historical data, and an understanding of end user and stakeholder needs. In this review, we discuss the challenges and opportunities of this complex, multidisciplinary collaboration, with a focus on the factors limiting seasonal forecasting as a source of predictability for climate impact models. © 2016 New York Academy of Sciences.
Yip, Winnie; Hanson, Kara
Purchasing has been promoted as a key policy instrument to improve health system performance. Despite its widespread adoption, there is little empirical evidence on how it works, the challenges surrounding its implementation, its impact, and the preconditions for it to function effectively, particularly in low- and middle-income settings. The objective of this chapter is to analyze critically the extent to which purchasing could be, and has been used strategically in China and to identify modifications that are needed for purchasing to be effective in assuring that the government's new funding for health care will result in efficient and effective health services. We present a conceptual framework for purchasing, which identifies three critical principal-agent relationships in purchasing. We draw on evidence from secondary data, results of other research studies, interviews, and the impact evaluation of a social experiment in rural China that explicitly used purchasing to improve quality and efficiency. This information is used to examine purchasing relationships in urban social health insurance (SHI), the rural medical insurance scheme, and purchasing of public health services. To date, use of strategic purchasing is limited in China. Both the urban and the rural health insurance schemes act as passive third-party payers, failing to take advantage of the opportunities to strengthen incentives to improve quality and efficiency. This may be because as government agencies, the extent to which the Ministries of Health and Labor and Social Security can act independently from provider interests, or act in the best interest of the population, is unclear. Other important challenges include ensuring adequate representation of the population's views and preferences and making better use of the leverage provided by purchasing to create appropriate provider incentives, through better integration of financing and improved coordination among purchasers. In designing purchasing
Aquino, E M; Menezes, G M; Marinho, L F
Despite the remarkable rise in women's participation in the labor market in Brazil, its consequences on health are still virtually unknown. This study aims to identify theoretical and methodological problems in the relationship between labor and women's health from a gender perspective. Characteristics of women's occupational placement are described and analyzed as resulting from their role in social reproduction. The study examines the development of several conciliatory strategies between paid work and housework which are discussed as potential determinants of health problems and support the need for a critical reappraisal of theoretical and methodological strategies to reach a better understanding of the complexity and specificities of women's living and working conditions. The author also stresses the role of women's recent participation in the trade union movements in defense of health, body rights, and women's issues in the workplace, as well as the need for a new framework embodied in the women's social movement. The study thus points to the challenge to produce knowledge on this subject in order to unveil the uniqueness of the national scenario marked by unemployment, informal jobs, low salaries, weak trade unions and other civil organizations, and traditional domestic and marriage relationships.
Pharow, Peter; Blobel, Bernd
Extended communication and advanced cooperation in a permanently growing healthcare and welfare domain require a well-defined set of security services provided by an interoperable security infrastructure based on international and European standards. Any communication and collaboration procedure requires a purpose. But such legal purpose-binding is definitely not the only aspect to carefully be observed and investigated. More and more, aspects of security, safety, privacy, ethics, and quality reach importance while discussing about future-proof health information systems and health networks - regardless whether local, regional or even pan-European networks. During the course of the current paradigm change from an organization-centered to a process-related and to a person-centered health system, different new technologies including mobile solutions need to be applied in order to meet challenges arising from both legal and technical circumstances. Beside the typical Information and Communication Technology systems and applications, the extended use of modern technologies includes large medical devices like, e.g., MRI and CT but also small devices like sensors worn by a person or included in clothing. Security and safety are on top of the priority list. The paper addresses the identification of some specific aspects like mobile technology and safety when moving both IT and people towards mobile health aiming at increasing citizens and patients awareness, confidence, and acceptance in future mobile care - a world often still beyond the horizon.
Merckx, Gert; Hermans, Jeroen; Vandermeulen, Dirk
In forensic authentication, one aims to identify the perpetrator among a series of suspects or distractors. A fundamental problem in any recognition system that aims for identification of subjects in a natural scene is the lack of constrains on viewing and imaging conditions. In forensic applications, identification proves even more challenging, since most surveillance footage is of abysmal quality. In this context, robust methods for pose estimation are paramount. In this paper we will therefore present a new pose estimation strategy for very low quality footage. Our approach uses 3D-2D registration of a textured 3D face model with the surveillance image to obtain accurate far field pose alignment. Starting from an inaccurate initial estimate, the technique uses novel similarity measures based on the monogenic signal to guide a pose optimization process. We will illustrate the descriptive strength of the introduced similarity measures by using them directly as a recognition metric. Through validation, using both real and synthetic surveillance footage, our pose estimation method is shown to be accurate, and robust to lighting changes and image degradation.
Huang Zheng, E-mail: email@example.com
The values, concepts and approaches of health impact assessment (HIA) were outlined in the Gothenburg consensus paper and some industrialized countries have implemented HIA for many years. HIA has played an important role in environmental protection in China, however, the emergence, progress and challenges of HIA in China have not been well described. In this paper, the evolution of HIA in China was analyzed and the challenges of HIA were presented based on the author's experiences. HIA contributed to decision-making for large capital construction projects, such as the Three Gorges Dam project, in its emergence stage. Increasing attention has been given to HIA in recent years due to supportive policies underpinning development of the draft HIA guidelines in 2008. However enormous challenges lie ahead in ensuring the institutionalization of HIA into project, program and policy decision-making process due to limited scope, immature tools and insufficient professionals in HIA practice. HIA should broaden its horizons by encompassing physical, chemical, biological and socio-economic aspects and constant attempts should be made to integrate HIA into the decision-making process, not only for projects and programs but also for policies as well.
The present volume is based on presentations at a symposium at the Royal Danish Academy of Sciences and Letters in September 2014 with the title Food, Population and Health – global Patterns and Challenges. Food has played a fundamental role in the history of all societies over the World. Availab......The present volume is based on presentations at a symposium at the Royal Danish Academy of Sciences and Letters in September 2014 with the title Food, Population and Health – global Patterns and Challenges. Food has played a fundamental role in the history of all societies over the World...... spongiform encephalopathy and tuberculosis have been passed on from animals to humans through food. Larsson traces the Swedish outbreak of smallpox and dysentery in the 18th century and Revuelta-Eugercios discusses the promises of individual level data analysis on a mass basis as approach to socioeconomic...... have been as low as in nineteenth century Scandinavian low infant mortality regions. Gardarsdóttir demonstrates how increased breastfeeding in Iceland during 1850–1920 reduced infant mortality, but was still viewed with scepticism by many mothers. Based on the Dutch experience of famine 1944–45 Lumey...
A cross-sectional analytical study was conducted amongst farm workers in the deciduous fruit industry in South Africa to assess levels of alcohol consumption and abuse, and to explore the impact of the DOP system, whereby farm workers are paid in part with alcohol, on indicators of alcohol consumption. High levels of alcohol consumption were found. On the CAGE and a shortened version of the MAST questionnaires, 87 and 65%, respectively, had responses indicating problem drinking. Close to half of the sample consumed more grams of alcohol per week than considered safe drinking (210 g) and 9.3% consumed amounts in excess of dangerous drinking (>490 g/week). Almost one-fifth (19.4%) of workers interviewed reported current use of the DOP system, and 47.8% of workers had experience of one or more farms in the past where the DOP system had been used. Workers with past experience of the DOP system were 9.8 times less likely to be asbstainers than colleagues without exposure to the DOP system. The pervasive effects of excessive alcohol consumption, and its relationship to past and current DOP practices pose substantial public health challenges to the transformation of health services currently underway in South Africa.
Francesco Cataldo; Giuseppe Montalto
In the past, celiac disease was believed to be a chronic enteropathy, almost exclusively affecting people of European origin. The availability of new, simple, very sensitive and specific serological tests (anti-gliadin, anti-endomysium and anti-transglutaminase antibody assays) have shown that celiac disease is common not only in Europe and in people of European ancestry but also in the developing countries where the major staple diet is wheat (Southern Asia, the Middle East, North West and East Africa, South America), both in the general population and in the groups at risk. Gluten intolerance thus appears to be a widespread public health problem and an increased level of awareness and clinical suspicion are needed in the New World where physicians must learn to recognize the variable clinical presentations (classical, atypical and silent forms) of celiac disease. In the developing countries, both serological screening in the general population and serological testing in groups at risk are necessary for an early identification of celiac patients. The gluten-free diet poses a challenging public health problem in the developing countries, especially since commercial gluten-free products are not available.
What kind of knowledges, skills and competences may be required by Techno-Anthropology engaging with health informatics? If we understand Techno-Anthropology to mean conducting anthropological analyses of the interwoven and mutually shaping relationship between organizing, technologies and actors in healthcare, such engagements and interventions can take many forms: Short-term consultancy work dedicated to achieving specific goals, long-term studies of broad changes in healthcare; management support within hospitals and public healthcare administration; or technology development with vendors of healthcare IT. The opportunities would seem to be manifold. Since the healthcare sector is a heterogeneous mix of interests, political agendas, professions et cetera, there is great merit in having people knowledgeable about this heterogeneity; able to facilitate meetings and processes between the various professions and organizations; and skilled in generating analyses and proposing new solutions. Also, people with insight into how action, technologies and organizing are interwoven and redistribute competences, responsibilities and risks are invaluable: Look at from afar, technologies seem to cause and determine social development, whereas detailed studies reveal that determinants and causes are both technical and social. The challenges include the one of making one's knowledge and skills legitimate and relevant to health informatics. Having a degree from arts or social sciences is not necessarily impressive for people with similar degrees in medicine, computer science, and business administration. Another challenge is to design an engagement with health informatics that will generate insights which often requires time, while also providing quick results for project sponsors or collaborators. The chapter points at three issues that seem to be central foundations for appropriate and quality-driven research and interventions of the 'quick and proper' kind: Modes of engagement
Paul, Vinod Kumar; Sachdev, Harshpal Singh; Mavalankar, Dileep; Ramachandran, Prema; Sankar, Mari Jeeva; Bhandari, Nita; Sreenivas, Vishnubhatla; Sundararaman, Thiagarajan; Govil, Dipti; Osrin, David; Kirkwood, Betty
India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and...
Murphy, Frederick A
The concept of new and emerging diseases has captured the public interest and has revitalized the public health infectious disease research community. This interest has also resulted in competition for funding and turf wars between animal health and public health scientists and public officials and, in some cases, has delayed and hindered progress toward effective prevention, control and biodefense. There is a dynamic list of outbreaks causing substantial morbidity and mortality in humans and often in the reservoir animal species. Some agents have the potential to grow into major epidemics. There are many determinants that influence the emergence of diseases of concern that require the use of current understanding of the nature of agent persistence and spread. Additional factors that are global must be added to plans for prevention and control. To this complex mix has been added the potential for accidental or malicious release of agents. The nature of emerging infectious agents and their impact is largely unpredictable. Models that strive to predict the dynamics of agents may be useful but can also blind us to increasing disease risks if it does not match a specific model. Field investigations of early events will be critical and should drive prevention and control actions. Many disease agents have developed strategies to overcome extremes of reservoir qualities like population size and density. Every infectious agent spreads easier when its hosts are closer together. Zoonoses must be dealt with at the interface of human and animal health by all available information. Lessons learned from the emergence of and response to agents like West Nile virus, H5N1 avian influenza, SARS and bovine spongiform encephalopathy, the cause of new-variant Creutzfeldt-Jakob disease in humans, must be used to create better plans for response and meet the challenge for public health and biodefense.
Full Text Available Susan M Carr1,2, Pauline Pearson1, Lesley Young-Murphy3, Barbara Cleghorn41Centre for Community Health & Education Studies Research & Enterprise, Northumbria University, Newcastle upon Tyne, UK; 2School of Health, University of New England, Armidale, New South Wales, Australia; 3NHS North of Tyne, Newcastle upon Tyne, UK, 4Newcastle PCT, Newcastle upon Tyne, UKAbstract: This paper presents an overview of the challenges and potential of lean implementation for the health visiting service in England and examines the rhetoric and the reality of the situation. It is coauthored by academic researchers and senior service providers so as to embrace the multidimensional issues impacting on this subject. If lean thinking is to be implemented in relation to health visiting, it is important to understand how it is likely to be viewed by practitioners and line managers in settings where it is used. In order to contextualize the discussion, an introduction to the roles, systems, and structures of health visiting are provided. The literature on what lean implementation is, what it means, and in particular the application and potential of the approach to primary care and public health services is reviewed. The process and findings from a focus group convened within a large primary care organization in the National Health Service during their lean implementation is reported. The paper concludes that it is important for staff at all levels to see a clear link between strategic aims and objectives and the planning processes operated by providers and commissioners. It appears that the successful introduction of lean thinking should focus more on productive working and thereby reducing waste. This has the potential to refresh workforce models to ensure that health visiting and other practitioners liberate the use of their specialist knowledge and skills. In a context of enhanced partnership working, the stage is then set for providers to add value to the whole
Sriram, Janani; Shin, Minho; Kotz, David; Rajan, Anand; Sastry, Manoj; Yarvis, Mark
Wearable, portable, and implantable medical sensors have ushered in a new paradigm for healthcare in which patients can take greater responsibility and caregivers can make well-informed, timely decisions. Health-monitoring systems built on such sensors have huge potential benefit to the quality of healthcare and quality of life for many people, such as patients with chronic medical conditions (such as blood-sugar sensors for diabetics), people seeking to change unhealthy behavior (such as losing weight or quitting smoking), or athletes wishing to monitor their condition and performance. To be effective, however, these systems must provide assurances about the quality of the sensor data. The sensors must be applied to the patient by a human, and the sensor data may be transported across multiple networks and devices before it is presented to the medical team. While no system can guarantee data quality, we anticipate that it will help for the system to annotate data with some measure of confidence. In this paper, we take a deeper look at potential health-monitoring usage scenarios and highlight research challenges required to ensure and assess quality of sensor data in health-monitoring systems.
Climate change issue concerning reduction of the greenhouse gas emission has drawn great attention throughout the world. By contrast, the impact on environment posed by climate change is not paid enough attention, not alone mentioning the impact of adaptation to climate change on the environmental law. The law related to climate change in China is mitigation-oriented, and there are few relevant laws and regulations on adaptation to climate change. The uncertainty, inevitability, irreversibility and universality of climate change bring new challenges to the assumption basis of environmental policy and laws, goals of environmental laws and existing environmental management system. What＇s most urgent is to find out the essential difference between climate change and traditional environmental issues and the feasibility of bringing climate change issues into existing environmental laws.%以温室气体减排为主要立足点的气候变化问题在国内外已经引起了广泛而热烈的关注,相比之下,气候变化对环境的影响还未被给予足够的关注,更不用谈气候变化适应性对环境法律的影响和挑战。我国气候变化的相关法律政策是以减缓为导向的,有关适应气候变化的法律法规还很少。气候变化的不确定性、不可避免性、不可逆转性和空间时间上的广泛性,对环境政策与法律的假定基础、环境法律目的和现行环境管理体制等都带来了全新的挑战。当务之急在于弄清气候变化与传统环境问题的本质区别,气候变化问题纳入现行环境法律的可行性等。
Urquieta-Salomón, José E; Villarreal, Héctor J
To consolidate an effective and efficient universal health care coverage requires a deep understanding of the challenges faced by the health care system in providing services demanded by population in need. This study analyses the dynamics of health insurance coverage and effective access coverage to some health interventions in Mexico. It examines the evolution of inequalities and heterogeneous performance of the insurance subsystems incorporated under the Mexican health care system. Two types of coverage indicators were selected: health insurance and effective access to preventive health interventions intended for normative population. Data were drawn from National Health and Nutrition Surveys 2006 and 2012. The economic inequality was estimated using the Standardized Concentration Index by household per capita consumption expenditure as socioeconomic-status indicator. Approximately 75% of the population reported being covered by one of the existing insurance schemes, representing a huge step forward from 2006, when as much as 51.62% of the population had no health insurance. About 87% of this growth was attributable to the expansion of Non Contributory Health Insurance whereas 7% emanated from the Social Security subsystem. The results revealed that inequality in access to health insurance was virtually eradicated; however, traces of unequal access persisted in some subpopulations groups. Coverage indicators of effective access showed a slight improvement in the period analysed, but prenatal care and interventions to prevent chronic disease still presented a serious shortage. Furthermore, there was no evidence that inequities in coverage of these interventions have decreased in recent years. The results provided a mixed picture, generalizable to the system as a whole, expansion of insurance status represents one of the most remarkable advances that have not been accompanied by a significant improvement in effective access. In addition, existing inequalities are
Lima-Camara, Tamara Nunes
ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country. PMID:27355468
Tamara Nunes Lima-Camara
Full Text Available ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country.
Full Text Available Genome sequencing is now a sufficiently mature and affordable technology for clinical use. Its application promises not only to transform clinicians’ diagnostic and predictive ability, but also to improve preventative therapies, surveillance regimes, and tailor patient treatment to an individual’s genetic make-up. However, as with any technological advance, there are associated fresh challenges. While some of the ethical, legal and social aspects resulting from the generation of data from genome sequencing are generic, several nuances are unique. Since the UK government recently announced plans to sequence the genomes of 100,000 Health Service patients, and similar initiatives are being considered elsewhere, a discussion of these nuances is timely and needs to go hand in hand with formulation of guidelines and public engagement activities around implementation of sequencing in clinical practice.
Nielsen, Rune K.L.; Aarseth, Espen; Poulsen, Arne
In this paper, we outline the proposed PhD project: "Challenges for Game Addiction as a Mental Health Diagnosis". The project aims to bridge gaps between the perspectives, theories and data of current research trajectories that engage with the concept of game addiction; from psychology, psychiatry......, cognitive neuroscience to media and game studies. The project has several proposed outcomes. Based on a review of the literature, the adequacy of 'game addiction' as a concept is questioned. The concept is further discussed in a historical perspective of game related pathologies and media/moral panics....... The validity of the prevalent instruments used to assess the prevalence of computer game addiction is examined in a cross-disciplinary context. The argument of the project is that research on computer game addiction is limited by mono-disciplinary approaches that fail to capture significant nuances at the cost...
Full Text Available There is increasing interest in the early years as a focus for reducing health inequalities as well as one that is important for the children themselves. This paper describes the introduction in England of Sure Start Local Programmes, which included home visiting within a community development approach, and an intensive home visiting programme, the Nurse-Family partnership, for disadvantaged teenage mothers. It reflects on changes and challenges in service provision to mothers and their pre-school children in England, explaining that a long tradition of home visiting was, paradoxically, reduced as attention focused on the newer initiatives. This is now being addressed, with attention to a range of evidence based programmes and a specific focus on heath visitor provision.
Hudson, C C; Gauvin, S; Tabanfar, R; Poffenroth, A M; Lee, J S; O'Riordan, A L
Interprofessional collaboration has consistently been associated with positive client-care outcomes. Role clarification is one facet of interprofessional collaboration that is thought to be crucial for effective interprofessional team functioning. Given the positive outcomes associated with interprofessional collaboration, educators have begun to integrate formal interprofessional education events into healthcare curricula. The Health Care Team Challenge (HCTC) is a collaborative competition designed to promote interprofessional competencies among students in healthcare fields. The current study empirically investigated whether this event promoted role clarification among participants. Sixteen participants in five healthcare professions (occupational therapy, physiotherapy, clinical psychology, nursing, and medicine) completed two questionnaires to assess role clarification before and after participating in this event. Results indicate that participants' understanding of their own and other professions' roles improved after participating in this team activity. These results suggest that the HCTC is effective in promoting role clarification and collaboration among healthcare students.
Full Text Available The study was carried out on 69 mentally challenged individuals. They were subjected to detailed clinical evaluation for dentofacial abnormalities and oral health status. Of the 69 mentally handicapped individuals 27 had Downs syndrome and 42 had cerebral palsy. Characteristic facial abnormalities were seen in children with Downs syndrome. In cerebral palsy, fracture maxillary anteriors were more evident. All the Downs syndrome cases had abnormal TMJ movements but in cerebral palsy only 35.7% of individuals had abnormal TMJ movements. In both the groups, submandibular lymph adenopathy was reported. Present study revealed dental caries in 56.0% of the individuals. Fair clinical level of oral hygiene in 60% of the individuals was seen.
Full Text Available Abstract Background Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA. Methods This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. Results At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. Conclusion Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated.
Gick, Mary L; Nicol, Jennifer J
The premise that singing is a health promoting activity for people with respiratory conditions of chronic obstructive pulmonary disease (COPD) and asthma is a growing area of interest being investigated by researchers from various disciplines. The preliminary evidence, a theoretical framework and identification of methodological challenges are discussed in this perspective article with an eye to recommendations for further research to advance knowledge. After a brief summary of main research findings on singing in healthy people to provide background context, research is reviewed on singing in people with COPD and asthma. Studies include published research and as yet unpublished work by the authors. Methodological challenges arising from the reviewed studies are identified such as attrition from singing or control groups based on weak and strong, respectively, beliefs about singing's effectiveness. Potential solutions for these problems are considered with further recommendations made for other singing research. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Brown, Stephen I
As a result of the editors' collaborative teaching at Harvard in the late 1960s, they produced a ground-breaking work -- The Art Of Problem Posing -- which related problem posing strategies to the already popular activity of problem solving. It took the concept of problem posing and created strategies for engaging in that activity as a central theme in mathematics education. Based in part upon that work and also upon a number of articles by its authors, other members of the mathematics education community began to apply and expand upon their ideas. This collection of thirty readings is a tes
Full Text Available Abstract The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career
Nagata, Jason M
In this commentary, I reflect on challenges with conducting global health research internationally as a lesbian, gay, bisexual, and transgender (LGBT) person, grapple with decisions related to coming out in regions with anti-LGBT laws, and outline the risks and benefits of different advocacy options related to the promotion of LGBT health globally. Despite significant advances in LGBT rights in many countries, homosexuality remains illegal in many others. Using a critical medical anthropology framework, I argue that anti-LGBT laws constitute structural violence and have many detrimental consequences including discrimination and violence; poorer mental and physical health outcomes; and risky sexual behaviors. As a global health provider, there are many options for the promotion of LGBT health worldwide.
Silva, Kênia Lara; Rodrigues, Andreza Trevenzoli
Qualitative study with the purpose of analyzing intersectorial actions for health promotion in the context of the Family Health Strategy, identifying experiences, facilitating and restricting factors to the process of building partnerships. Subjects were health managers and informers from social equipment in the territory covered by a local health service in Belo Horizonte/Minas Gerais, Brazil. The results indicate the existence of a wide social network. However, intersectorial health promoting actions are still incipient. Intersectorial actions are faced with the challenge of creating communication spaces that allow the resolution of complex problems. It is concluded that intersectorial actions constitute an innovative strategy which is still under construction, and the paths of which are still being unraveled.
Kanchanachitra, Churnrurtai; Lindelow, Magnus; Johnston, Timothy; Hanvoravongchai, Piya; Lorenzo, Fely Marilyn; Huong, Nguyen Lan; Wilopo, Siswanto Agus; dela Rosa, Jennifer Frances
In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues. Copyright © 2011
Gloyd, Stephen; Wagenaar, Bradley H; Woelk, Godfrey B; Kalibala, Samuel
HIV programme data from routine health information systems (RHIS) and personal health information (PHI) provide ample opportunities for secondary data analysis. However, these data pose unique opportunities and challenges for use in health system monitoring, along with process and impact evaluations. Analyses focused on retrospective case reviews of four of the HIV-related studies published in this JIAS supplement. We identify specific opportunities and challenges with respect to the secondary analysis of RHIS and PHI data. Challenges working with both HIV-related RHIS and PHI included missing, inconsistent and implausible data; rapidly changing indicators; systematic differences in the utilization of services; and patient linkages over time and different data sources. Specific challenges among RHIS data included numerous registries and indicators, inconsistent data entry, gaps in data transmission, duplicate registry of information, numerator-denominator incompatibility and infrequent use of data for decision-making. Challenges specific to PHI included the time burden for busy providers, the culture of lax charting, overflowing archives for paper charts and infrequent chart review. Many of the challenges that undermine effective use of RHIS and PHI data for analyses are related to the processes and context of collecting the data, excessive data requirements, lack of knowledge of the purpose of data and the limited use of data among those generating the data. Recommendations include simplifying data sources, analysis and reporting; conducting systematic data quality audits; enhancing the use of data for decision-making; promoting routine chart review linked with simple patient tracking systems; and encouraging open access to RHIS and PHI data for increased use.
Alfjorden, A.; Podolska, M.; Karaseva, T.
, but are not limited to, larval stages of the nematodes Anisakis simplex and Pseudoterranova decipiens. For them the risk to human health may occur in two ways: gastrointestinal infections with the possibility of sub-sequent peritonitis or the involvement of other sites in the body. Infections may also lead...
This article attempts to summarize the situations of gender-based violence, a major public health issue. Due to the unequal power relations between men and women, women are violated either in family, in the community or in the State. Gender-based violence takes different forms like physical, sexual or psychological/ emotional violence. The causes of gender-based violence are multidimensional including social, economic, cultural, political and religious. The literatures written in relation to the gender-based violence are accessed using electronic databases as PubMed, Medline and Google scholar, Google and other Internet Websites between 1994 and first quarter of 2013 using an internet search from the keywords such as gender-based violence, women violence, domestic violence, wife abuse, violence during pregnancy, women sexual abuse, political gender based violence, cultural gender-based violence, economical gender-based violence, child sexual abuse and special forms of gender-based violence in Nepal. As GBVs remain one of the most rigorous challenges of women's health and well-being, it is one of the indispensable issues of equity and social justice. To create a gender-based violence free environment, a lot works has to be done. Hence, it is suggested to provide assistance to the victims of violence developing the mechanism to support them.
Conscientious objection (CO) is the refusal to perform a legal role or responsibility because of personal beliefs. In health care, conscientious objection involves practitioners not providing certain treatments to their patients, based on reasons of morality or "conscience." The development of conscientious objection among providers is complex and challenging. While there may exist good reasons to accommodate COs of clinical providers, the exercise of rights and beliefs of the provider has an impact on a patient's health and/ or their access to care. For this reason, it is incumbent on the provider with a CO to minimize or eliminate the impact of their CO both on the delivery of care to the patients they serve and on the medical system in which they serve patients. The increasing exercise of CO, and its impact on large segments of the population, is made more complex by the provision of government-funded health care benefits by private entities. The result is a blurring of the lines between the public, civic space, where all people and corporate entities are expected to have similar rights and responsibilities, and the private space, where personal beliefs and restrictions are expected to be more tolerated. This paper considers the following questions: (1) What are the allowances or limits of the exercise a CO against the rights of a patient to receive care within accept practice? (2) In a society where there exist "private," personal rights and responsibilities, as well as "civil" or public/shared rights and responsibilities, what defines the boundaries of the public, civil, and private space? (3) As providers and patients face the exercise of CO, what roles, responsibilities, and rights do organizations and institutions have in this interaction?
Singh, Shiv Kumar; Kumar, Amit; Katyal, Surabhi
Multiple casualties and the complex set of injuries in survivors of a terrorist bomb blast poses a real challenge to health care providers. We are presenting three such cases, first case suffered a fracture of both bone lower limb bilaterally along with head injury (foreign bodies were impacted in the scalp and brain parenchyma). Following primary resuscitation, patient shifted to operation theatre after a quick computerized tomography scan and external fixator applied in general anesthesia using the rapid sequence induction. No active neurosurgical intervention was done. As this patient had acute post-traumatic stress response, he was subjected to low pressure hyperbaric oxygen therapy (pressure of 1.5 ATA for 60 min a day for 10 days) and group counseling. He had good recovery except one lost a limb because of extensive neurovascular damage due to blast. Second case had much more extensive damage involving multiple organ systems. He had blast lung, big cerebrovascular hemorrhage along with gut perforation. Despite best possible surgical and intensive care interventions, patent developed multiple organ failure and unfortunately we lost our patient. Third case was of a right sided globe rupture resulted from blast induced flying foreign bodies. After primary survey and initial resuscitation evisceration done for the damaged eye and patient later on discharged with necessary instruction (including warning signs) for follow-up.
Singh, Shiv Kumar; Kumar, Amit; Katyal, Surabhi
Multiple casualties and the complex set of injuries in survivors of a terrorist bomb blast poses a real challenge to health care providers. We are presenting three such cases, first case suffered a fracture of both bone lower limb bilaterally along with head injury (foreign bodies were impacted in the scalp and brain parenchyma). Following primary resuscitation, patient shifted to operation theatre after a quick computerized tomography scan and external fixator applied in general anesthesia using the rapid sequence induction. No active neurosurgical intervention was done. As this patient had acute post-traumatic stress response, he was subjected to low pressure hyperbaric oxygen therapy (pressure of 1.5 ATA for 60 min a day for 10 days) and group counseling. He had good recovery except one lost a limb because of extensive neurovascular damage due to blast. Second case had much more extensive damage involving multiple organ systems. He had blast lung, big cerebrovascular hemorrhage along with gut perforation. Despite best possible surgical and intensive care interventions, patent developed multiple organ failure and unfortunately we lost our patient. Third case was of a right sided globe rupture resulted from blast induced flying foreign bodies. After primary survey and initial resuscitation evisceration done for the damaged eye and patient later on discharged with necessary instruction (including warning signs) for follow-up. PMID:25886231
The number of technologies and consumer products that incorporate engineered nanomaterials (ENMs) has grown rapidly. Indeed, ENMs such as carbon nanotubes and nano-silver, are revolutionizing many commercial technologies and have already been incorporated into more than 800 commercial products, including polymer composites, cell phone batteries, sporting equipment and cosmetics. The global market for ENMs has grown steadily from 7.5 billion in 2003 to 12.7 billion in 2008. Over the next five years, their market value is expected to exceed $27 billion. This surge in demand has been responsible for a corresponding increase in the annual production rates of ENMs. For example, Bayer anticipates that single and multi-walled carbon nanotubes (SWNT and MWNT) production rates will reach 3,000 tons/yr by 2012. Inevitably, some of these synthetic materials will enter the environment either from incidental release during manufacture and transport, or following use and disposal. Consequently, intense scientific research is now being directed towards understanding the environmental, health and safety (EHS) risks posed by ENMs. I will highlight some of the key research challenges and needs in this area, include (i) developing structure-property relationships that will enable physicochemical properties of ENMs to be correlated with environmentally relevant behavior (e.g. colloidal properties, toxicity), (ii) determining the behavior of nanoproducts, and (iii) developing analytical techniques capable of detecting and quantifying the concentration of ENMs in the environment.
Collins Otieno Asweto
Full Text Available Background: Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health workers (CHWs. It is imperative that health care systems focus on improving access to quality continuous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness. Objective: To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries. Methods: Six databases were examined for quantitative, qualitative, and mixed-methods studies that included the integration of CHWs, their motivation and supervision, and CHW policy making and implementation in developing countries. Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs. Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized. Results: CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health. Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings. Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work, as well as financial and nonfinancial incentives, motivation, collaborative and supportive supervision, and a manageable workload. Conclusions: For sustainable integration of CHWs into health care systems, high-performing health systems with sound governance, adequate financing, well-organized service delivery, and adequate supplies and equipment are essential. Similarly, competent communities could contribute to better CHW performance through sound
Buschmann, Johanna; Berg, Michael; Stengel, Caroline; Winkel, Lenny; Sampson, Mickey L; Trang, Pham Thi Kim; Viet, Pham Hung
This study presents a transnational groundwater survey of the 62,000 km(2) Mekong delta floodplain (Southern Vietnam and bordering Cambodia) and assesses human health risks associated with elevated concentrations of dissolved toxic elements. The lower Mekong delta generally features saline groundwater. However, where groundwater salinity is drinking water in replacement of microbially contaminated surface water. In groundwater used as drinking water, arsenic concentrations ranged from 0.1-1340 microg L(-)(1), with 37% of the studied wells exceeding the WHO guidelines of 10 microg L(-)(1) arsenic. In addition, 50% exceeded the manganese WHO guideline of 0.4 mg L(-)(1), with concentrations being particularly high in Vietnam (range 1.0-34 mg L(-)(1)). Other elements of (minor) concern are Ba, Cd, Ni, Se, Pb and U. Our measurements imply that groundwater contamination is of geogenic origin and caused by natural anoxic conditions in the aquifers. Chronic arsenic poisoning is the most serious health risk for the ~2 million people drinking this groundwater without treatment, followed by malfunction in children's development through excessive manganese uptake. Government agencies, water specialists and scientists must get aware of the serious situation. Mitigation measures are urgently needed to protect the unaware people from such health problems.
Background Dealing with pregnancy, childbirth and the care of newborn babies is a challenge for female asylum seekers and their health care providers. The aim of our study was to identify reproductive health issues in a population of women seeking asylum in Switzerland, and to examine the care they received. The women were insured through a special Health Maintenance Organisation (HMO) and were attending the Women's Clinic of the University Hospital in Basel. We also investigated how the health professionals involved perceived the experience of providing health care for these patients. Methods A mixed methods approach combined the analysis of quantitative descriptive data and qualitative data obtained from semi-structured interviews with health care providers and from patients' files. We analysed the records of 80 asylum-seeking patients attending the Women's Clinic insured through an HMO. We conducted semi-structured interviews with 10 care providers from different professional groups. Quantitative data were analysed descriptively. Qualitative data analysis was guided by Grounded Theory. Results The principal health problems among the asylum seekers were a high rate of induced abortions (2.5 times higher than in the local population), due to inadequate contraception, and psychosocial stress due to the experience of forced migration and their current difficult life situation. The language barriers were identified as a major difficulty for health professionals in providing care. Health care providers also faced major emotional challenges when taking care of asylum seekers. Additional problems for physicians were that they were often required to act in an official capacity on behalf of the authorities in charge of the asylum process, and they also had to make decisions about controlling expenditure to fulfil the requirements of the HMO. They felt that these decisions sometimes conflicted with their duty towards the patient. Conclusion Health policies for asylum
Full Text Available Abstract Background Dealing with pregnancy, childbirth and the care of newborn babies is a challenge for female asylum seekers and their health care providers. The aim of our study was to identify reproductive health issues in a population of women seeking asylum in Switzerland, and to examine the care they received. The women were insured through a special Health Maintenance Organisation (HMO and were attending the Women's Clinic of the University Hospital in Basel. We also investigated how the health professionals involved perceived the experience of providing health care for these patients. Methods A mixed methods approach combined the analysis of quantitative descriptive data and qualitative data obtained from semi-structured interviews with health care providers and from patients' files. We analysed the records of 80 asylum-seeking patients attending the Women's Clinic insured through an HMO. We conducted semi-structured interviews with 10 care providers from different professional groups. Quantitative data were analysed descriptively. Qualitative data analysis was guided by Grounded Theory. Results The principal health problems among the asylum seekers were a high rate of induced abortions (2.5 times higher than in the local population, due to inadequate contraception, and psychosocial stress due to the experience of forced migration and their current difficult life situation. The language barriers were identified as a major difficulty for health professionals in providing care. Health care providers also faced major emotional challenges when taking care of asylum seekers. Additional problems for physicians were that they were often required to act in an official capacity on behalf of the authorities in charge of the asylum process, and they also had to make decisions about controlling expenditure to fulfil the requirements of the HMO. They felt that these decisions sometimes conflicted with their duty towards the patient. Conclusion
Full Text Available The growth of the Internet, mobile phones, social media and other digital technologies has changed our world in many ways. It has provided individuals with information that was previously only available to a select few. An example of the reach of technology is data that as of October 2012, there are over 6 billion phones worldwide (BBC, 2012. The availability of data in real time has presented hopes of intervening more efficiently and managing health problems by leveraging limited human resources. It also has an impact in changing the roles of providers and patients and in legal and ethical issues including privacy in digital health interactions. This paper will discuss why digital technology has received recent attention in the area of mental health, present some applications of technology for mental health to date, explore the challenges to full implementation in clinical settings, and present future opportunities for digital technologies.El crecimiento del Internet, los teléfonos móviles, las redes sociales y otras tecnologías digitales ha cambiado nuestro mundo de muchas maneras. Ha proporcionado a las personas con la información que antes sólo estaba disponible para un grupo selecto, por ejemplo a partir de octubre de 2012. Un ejemplo del alcance de la tecnología son los datos que dicen que hay más de 6 millones de teléfonos en todo el mundo (BBC, 2012. La disponibilidad de los datos en tiempo real a presentado la esperanza de intervenir de manera más eficiente y manejar los problemas de salud los recursos humanos limitados. También tiene un impacto en el cambio de los roles de los proveedores y los pacientes y en aspectos legales y éticos, incluyendo la privacidad en las interacciones de salud digital. Este artículo discutirá unas razones por cual la tecnología digital ha recibido atención recientemente en el área de salud mental, presentará algunas aplicaciones de la tecnología para mejorar la salud mental hasta la fecha
Bray, George A.
Sugar intake in the United States has increased by >40 fold since the American Revolution. The health concerns that have been raised about the amounts of sugar that are in the current diet, primarily as beverages, are the subject of this review. Just less than 50% of the added sugars (sugar and high-fructose corn syrup) are found in soft drinks and fruit drinks. The intake of soft drinks has increased 5-fold between 1950 and 2000. Most meta-analyses have shown that the risk of obesity, diabet...
DeLuca, D M
The ethical distribution of health care is a central issue now that AIDS has started to be a drain on health care resources. If the worst predictions are true, the next half century will be capitalized by a great stress of the health care delivery system in the Pacific. The critical challenges that face the current leadership are: sustaining commitment to all levels of administration to reduce social and health inequities; making sound decisions on policies, priorities and goals that are based on valid information; strengthen health infrastructure, based on the principle of primary health care, including appropriate distribution of staffing, skills, technology and resources. The goals of the Pacific Health Promotion and Development center must not focus exclusively on AIDs. Hepatitis B control measures, hypertension and diabetes, primary care in remote areas, and rehabilitation initiatives must be kept in place. Humanitarian interests for AIDs patients must be balanced with the pragmatic reality of saving children's hearing, or extending useful lives. The attributes of respect, accountability, leadership, judgement, fairness, integrity and honesty controlled by principles of social justice must be part of the administrative decision making process. The 2 major issues facing public health professional are: (1) the financial considerations involved with increasingly expensive technology, services and research, contrasted against the need to prioritize their use and development; (2) pragmatic and ideological needs must be balanced to maximize preventative and curative services and make them available to those who can benefit from them.
Maass, Juan; Mella, Cesar; Risco, Luis
The practices and systems of mental health in Latin America and the Caribbean are heterogeneous and are connected to dissociation between national macro systems and the complex quotidian that occurs in the daily attention of mental pathologies. The health care experiences in mental health are diverse and go back to the 1960s; these took a boost with the Caracas Declaration of 1990. The Health Care Reform has had several stages, lately focused in the strength that derives from a growing psychiatric epidemiology "base". In addition, it notes that the majority of countries have a National Plan of Mental Health, but they do not seem purposely deployed in local developmental plans or in other sectors. It is proposed the existence of a willing to discuss psychiatry, critical and bold; trans and intrasectoral face to the national and communal developments. Governments need to prioritize strategies in mental health as an integral part of another national project with regard for quality of life and productivity of citizens. The communication poses challenges for the next 15 years, with what is complete the first quarter of this century, proposing a series of measures even basic, but valid for this part of the continent.
Jiao HU,Xiufan LIU
Full Text Available The H9N2 and H5N1 avian influenza viruses (AIVs have been circulating in poultry in China and become endemic since 1998 and 2004, respectively. Currently, they are prevalent in poultry throughout China. This endemicity makes them actively involved in the emergence of the novel lineages of other subtypes of influenza viruses, such as the well-known viruses of the highly pathogenic avian influenza (HPAI H5N2 and the 2013 novel H7N7, H7N9 and H10N8 subtypes, thereby threatening both the poultry industry and public health. Here, we will review briefly the prevalence and evolution, pathogenicity, transmission, and disease control of these two subtypes and also discuss the possibility of emergence of potentially virulent and highly transmissible AIVs to humans.
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health assessed the risk to plant health of Strawberry crinkle virus (SCV for the European Union (EU territory, and evaluated the current EU legislation and possible risk reduction options. This virus is widely distributed both within and outside Europe and the same applies to its main vector, the strawberry aphid, Chaetosiphon fragaefolii. At-risk hosts (Fragaria spp. occur widely in Europe. Plants for planting were identified as the most significant entry pathway and the probability of entry is rated as unlikely to moderately likely with high uncertainty. The probability of establishment is rated as very likely with low uncertainty. The probability of local spread by natural means is moderately likely, with high uncertainty, whereas that of human-assisted long-distance spread is unlikely, with medium uncertainty. The potential consequences are rated as minimal to minor with medium uncertainty. Prohibition and restricting import or intra-EU trade to certified materials or to materials originating from pest-free areas or pest-free places of production are the options with highest effectiveness against the risks of introduction or against the risks of further spread. Prohibition and certification are also among the options of high or very high feasibility. In addition, it should be noted that the combination of options (cultural practices, certification, exclusion conditions, tolerant varieties has an overall high to very high level of effectiveness and feasibility. The current legislation has few weaknesses: the reliance on visual inspection, as well as the exceptions or derogations offered to some countries in which SCV is present. If the current legislation were removed, no major consequences would be expected unless the industry simultaneously ceased its widely adopted certification activity, which seems unlikely given the potential consequences.
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health assessed the risk to plant health from Phytophthora fragariae for the European Union and evaluated the current EU legislation and possible risk reduction options. The pest is present in most areas of Europe except southern Mediterranean regions. Entry through the plants for planting, but not seeds, pathway, is assessed as a major pathway, with the probability of entry rated as unlikely and the uncertainty as high. The probability of establishment is likely in the absence of existing disease control practices with low uncertainty. The probability of spread in the absence of a scheme for the production of certified plants for planting is considered to be very likely. With certification, spread is considered to be unlikely to moderately likely, depending on the inclusion of testing for the pathogen as part of certification. These ratings have medium uncertainty. Potential impact is rated as minor with medium uncertainty. The Panel evaluated the effectiveness of current EU legislation regarding the introduction and spread of P. fragariae. According to the regulation the import of Fragaria plants for planting, other than seeds, is prohibited from specified countries, whereas for import of these plants from other countries and for movement of these plants within the EU special requirements with respect to P. fragariae must be fulfilled. If the current legislation specific to P. fragariae were removed, no major consequences would be expected, unless the industry simultaneously ceased its voluntary certification activity. This is largely because of the important level of protection afforded to the industry by the widely used certification schemes for Fragaria, which significantly reduce the risks of entry, establishment, spread and impact. Certification schemes for the movement of Fragaria plants for planting offer the greatest efficiency and feasibility and the least uncertainty, especially if effective detection is
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health assessed the risk to plant health of Strawberry mild yellow edge virus (SMYEV for the European Union (EU territory, and evaluated the current EU legislation and possible risk reduction options. This virus is widely distributed both within and outside Europe and the same applies to its main vector, the strawberry aphid, Chaetosiphon fragaefolii. At-risk hosts (Fragaria spp. occur widely in Europe. Plants for planting were identified as the most significant entry pathway and the probability of entry is rated as unlikely to moderately likely with high uncertainty. The probability of establishment is rated very likely with low uncertainty. The probability of local spread by natural means is moderately likely to likely, with medium uncertainty, whereas that of human-assisted long-distance spread is unlikely, with medium uncertainty. The potential consequences are rated as minimal to minor with medium uncertainty. Prohibition and restricting import or intra-EU trade to certified materials or to materials originating from pest-free areas or pest-free places of production are the options with highest effectiveness against the risks of introduction or against the risks of further spread. Prohibition and certification are also among the options of high or very high feasibility. In addition, it should be noted that the combination of options (cultural practices, certification, exclusion conditions, tolerant varieties has an overall high to very high level of effectiveness and feasibility. The current legislation has few weaknesses: the reliance on inefficient visual inspection as well as the exceptions or derogations offered to some countries in which SMYEV is present. If the current legislation were removed, no major consequences would be expected unless the industry simultaneously ceased its widely adopted certification activity, which seems unlikely given the potential consequences.
Bray, George A
Sugar intake in the United States has increased by >40 fold since the American Revolution. The health concerns that have been raised about the amounts of sugar that are in the current diet, primarily as beverages, are the subject of this review. Just less than 50% of the added sugars (sugar and high-fructose corn syrup) are found in soft drinks and fruit drinks. The intake of soft drinks has increased 5-fold between 1950 and 2000. Most meta-analyses have shown that the risk of obesity, diabetes, cardiovascular disease, and metabolic syndrome are related to consumption of beverages sweetened with sugar or high-fructose corn syrup. Calorically sweetened beverage intake has also been related to the risk of nonalcoholic fatty liver disease, and, in men, gout. Calorically sweetened beverages contribute to obesity through their caloric load, and the intake of beverages does not produce a corresponding reduction in the intake of other food, suggesting that beverage calories are "add-on" calories. The increase in plasma triglyceride concentrations by sugar-sweetened beverages can be attributed to fructose rather than glucose in sugar. Several randomized trials of sugar-containing soft drinks versus low-calorie or calorie-free beverages show that either sugar, 50% of which is fructose, or fructose alone increases triglycerides, body weight, visceral adipose tissue, muscle fat, and liver fat. Fructose is metabolized primarily in the liver. When it is taken up by the liver, ATP decreases rapidly as the phosphate is transferred to fructose in a form that makes it easy to convert to lipid precursors. Fructose intake enhances lipogenesis and the production of uric acid. By worsening blood lipids, contributing to obesity, diabetes, fatty liver, and gout, fructose in the amounts currently consumed is hazardous to the health of some people.
Full Text Available Shiga toxin producing [i]Escherichia coli[/i] (STEC are the most virulent diarrhoeagenic [i]E. coli [/i]known to date. They can spread with alarming ease via the food chain, as recently demonstrated by the large outbreak of STEC O104:H4 borne by sprouted seeds in 2011, clustered in northern Germany, and subsequently affecting other countries. Indeed, a significant number of infections to verocytotoxin producing [i]Escherichia coli[/i] O104:H4 have been reported from the WHO European Region resulting in many cases of bloody diarrhoea and haemolytic uraemic syndrome in Germany, 15 other European countries and North America. Eventually, the European Food Standards Agency, (EFSA, identified the likely source to a single consignment of fenugreek seeds from an Egyptian exporter as being linked to the two outbreaks in Germany and France. The situation was closely monitored by the Chief Sanitary Inspectorate public health authority in Poland where actions undertaken ensured that the public was well informed about the dangers of STEC contamination of food, how to avoid infection, and what to do if infected. Tracing the fenugreek distributors also enabled the identification of suspected batches and their isolation. As a result, there were very few reported cases of STEC infection in Poland. Effective control over such outbreaks is therefore a vital public health task. This should include early detection and rapid identification of the contagion mode, followed by removing the foodstuff(s from the market, providing consumer advice, and preventing secondary spreading. As a mitigation measure, screening/monitoring those involved in food handling is also warranted to exclude carriers who can be asymptomatic.
Wolf, Klaus-Hendrik; Dehling, Tobias; Haux, Reinhold; Sick, Bernhard; Sunyaev, Ali; Tomforde, Sven
Health management in smart homes has advanced during the last years. With proactive health management in such environments further progress for health prevention and care is to be expected. Challenges for proactive health management in three areas are summarized and briefly discussed: pattern recognition and machine learning, information privacy and user-oriented design, and sensor-enhanced health information systems architectures.
Azétsop, Jacquineau; Ochieng, Michael
There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. This paper uses a secondary data analysis of existing documents by the Ministry of Public Health, Institut National de la Statistique, des Etudes Economiques et Démographiques (INSEED), the Ministry of Economy and Agence Française de Cooperation to analyze critically the shape and performance of health systems in Chad based on key concepts and components of the right to health contained in article 12 of the International Covenant on Economic, Social and Cultural Rights, and on General Comment 14. The non-realization of the right to health, even in a consistently progressive manner, raises concerns about the political commitment of state officials to public health, about the justice of social institutions in ensuring social well-being and about individual and public values that shape decision-making processes. Social justice, democratic rule, transparency, accountability and subsidiarity are important groundings for ensuring community participation in public affairs and for monitoring the performance of public institutions. The normative ideals of health systems development are essentially democratic in nature and are rooted in human rights and in ethical principles of human dignity, equality, non-discrimination and social justice. These ideals are grounded
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health conducted a pest risk assessment for the grapevine insect pest, Daktulosphaira vitifoliae (an aphid species commonly known as phylloxera, in the European Union, identified risk reduction options and evaluated the effectiveness of the phytosanitary measures listed in Council Directive 2000/29/EC. Entry was assessed as potentially very likely for plants intended for planting (although the pathway is closed by Article 15 of Annex III and very unlikely for fruit for consumption because transport and transfer would be very difficult, even though phylloxera has a moderate likelihood of association with the pathway. Establishment is very likely as the pest is already very widespread in the risk assessment area, occurring almost everywhere Vitis plants are present. Successful eradication is very unlikely and small populations can persist undetected in the soil. Spread within the EU is considered to be very likely because there are no effective barriers, it can disperse up to a few kilometres aided by the wind and it can readily be moved long distances with planting material. Grafting with resistant rootstocks throughout the EU ensures that the production of fruit and plants for planting is rarely affected by phylloxera infestations and, if so, only at a limited level. The Panel considers that the IIAII measures for D. vitifoliae do not assist in preventing entry and are ineffective in preventing spread because detection is so difficult. Restricting movements of plants for planting to cuttings grafted on resistant rootstocks, in combination with treatments (e.g. particularly fungicides and hot water treatments, was found to be the most effective risk reduction option. Limitations in the Cyprus protected zone regulations were identified.
EFSA Panel on Plant Health (PLH
Full Text Available The EFSA Panel on Plant Health conducted a pest risk assessment and an evaluation of risk reduction options for Xylella fastidiosa. X. fastidiosa has been detected in olive in the EU with a distribution restricted to the region of Apulia in Italy and is under official control. X. fastidiosa has a very broad host range, including many common cultivated and wild plants. All xylem fluid-feeding insects in Europe are considered to be potential vectors. Philaenus spumarius (Hemiptera: Aphrophoridae, a polyphagous spittlebug widespread in the whole risk assessment area, has been identified as a vector in Apulia. The probability of entry of X. fastidiosa from countries where X. fastidiosa is reported is very high with plants for planting and moderate with infectious insect vectors carried with plant commodities or travelling as stowaways. Establishment and spread in the EU is very likely. The consequences are considered to be major because yield losses and other damage would be high and require costly control measures. The systematic use of insecticides for vector control may create environmental impacts. With regard to risk reduction options, strategies for the prevention of introduction and for the containment of outbreaks should focus on the two main pathways (plants for planting and infectious insect vectors and combine the most effective options in an integrated approach. For plants for planting, these could be pest-free production areas, surveillance, certification, screened greenhouse production, vector control and testing for infection and, for some plant species, treatments (e.g. thermotherapy. To prevent entry of the infectious vectors, insecticide treatments and inspection of consignments and production sites are required. The Panel has also reviewed the effectiveness of risk reduction options for X. fastidiosa and its vectors listed in Directive 2000/29/EC and in the EU emergency measures. The Panel recommends the continuation and
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health conducted a pest risk assessment for Eutetranychus orientalis in the European Union (EU and evaluated the effectiveness of phytosanitary measures in Council Directive 2000/29/EC. Entry through the plants for planting pathway is assessed as very likely, while entry through other pathways is estimated as moderately likely to unlikely owing to the different probability of transfer to a suitable host. Establishment is rated as very likely in Mediterranean areas and from moderately likely to unlikely in non-Mediterranean areas, because of unfavourable environmental conditions. Spread is rated as very likely because of the many ways the pest can spread, its polyphagy and the wide distribution of hosts. Impact is rated as minor, with an expected increase in the damage when populations of natural enemies are severely affected by control measures and/or when environmental conditions are stressful for the host. However, the lack of information resulted in an overall medium level of uncertainty. The Panel evaluated the effectiveness of current EU phytosanitary measures and concluded that the removal of E. orientalis from Annex IIAII would not affect its probability of entry, because the importation from Third countries of some host plants regulated for this pest(Citrus, Fortunella, Poncirus species and their hybrids is prohibited in Annex III. However, spread could be affected since there would no longer be a requirement to inspect for this pest before issuing a plant passport (Annex V. However, since the regulated Rutaceae species constitute an extremely small proportion of the potential host plants of E. orientalis, the current phytosanitary measures are mostly ineffective in preventing further introduction and spread of E. orientalis in the EU. The Panel identified surveillance at the production site and treatment of the consignment as the most effective and technically feasible risk reduction options, particularly when
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health conducted a pest risk assessment for Parasaissetia nigra in the European Union (EU and identified and evaluated the phytosanitary measures listed in Council Directive 2000/29/EC. Entry through the principal pathways is assessed as moderately likely for plants for planting and very unlikely for living parts of plants, such as fruit and cut flowers with foliage, the discrepancy being mainly due to the difference in probability of transfer to a suitable host. Establishment is rated as very likely outdoors in Mediterranean areas and indoors in the whole risk assessment area (where the pest has been present for a long time, and unlikely outdoors in non-Mediterranean areas. Spread within the EU is considered to be moderately likely because the pest can readily be moved with plant material but is limited by climatic conditions. The magnitude of the potential consequences is rated as minor. The Panel evaluated the effectiveness of current EU phytosanitary measures and concluded that the removal of P. nigra from Annex IIAII would not affect its probability of entry, because the importation from Third countries of some host plants regulated for P. nigra (Citrus, Fortunella, Poncirus species and their hybrids is prohibited in Annex III. However, spread could be affected since there would no longer be a requirement to inspect for this pest before issuing a plant passport (Annex V. However, since the regulated Rutaceae species constitute only a very small proportion of the potential host plants of P. nigra,the current phytosanitary measures are mostly ineffective in preventing the further introduction and spread of P. nigra in the EU. The Panel identified surveillance at the production site and treatment of the consignment as the most effective and technically feasible risk reduction options, particularly when in combination.
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health conducted a pest risk assessment for Bemisia tabaci and the viruses it transmits, including an evaluation of risk reduction options and an assessment of the effectiveness of the special requirements linked to B. tabaci and the viruses listed in Council Directive 2000/29/EC. B. tabaci and a large number of viruses transmitted by this polyphagous insect occur in subtropical and tropical climates around the world. Five entry pathways for B. tabaci and associated viruses were identified, with the plants for planting pathway being most significant and rated for entry of insects and viruses as likely and moderately likely, respectively. The most invasive B. tabaci species and several of its associated viruses responsible for severe diseases in major European food crops are established outdoors in coastal Mediterranean regions. Because of similar climate requirements and host plant preferences, B. tabaci and associated viruses currently not present in Europe are likely to establish within the temperature limits set for B. tabaci. Trade between European Member States allows B. tabaci to reach greenhouses in northern Europe, including those in areas with protected zone status. Because of the cool climate, establishment and spread outdoors of B. tabaci is rated unlikely for northern Europe. This situation is likely to continue even under a climatic scenario with an increase in temperature of +2 °C. B. tabaci -transmitted viruses cause severe diseases with major negative impact on crop production when risk reduction measures are not used. Risk reduction options will also apply to B. tabaci and viruses new to Europe. Risk reductions options are evaluated in terms of reducing B. tabaci populations, crop infestations, virus incidence and the impact of diseases. © European Food Safety Authority, 2013
EFSA Panel on Plant Health (PLH
Full Text Available The Panel on Plant Health conducted a pest risk assessment for Phialophora cinerescens (Wollenweber van Beyma (the causal agent of Phialophora carnation wilt for the EU territory, identified risk management options and evaluated their effectiveness. The risk assessment was conducted taking into account current EU legislation. The Panel also provided an opinion on the effectiveness of the present EU requirements against this organism, listed in Council Directive 2000/29/EC. Four pathways for entry were identified. Plants for propagation (rooted and unrooted cuttings of host plants were considered as a major pathway. Entry via this pathway was rated as unlikely because of the effective disease prevention techniques for cuttings now in place in places of production. P. cinerescens has been found in most Member States but with few occurrences or restricted distribution. In some Member States the pest was eradicated. Owing to current cultural practices and control measures, establishment in areas in which the pest was not previously present is considered very unlikely. For the same reasons, the probability of infection of crops is strongly reduced and hence the probability of spread to areas where the pest was not previously present is very unlikely. Similarly, the impact on carnation is at the moment minimal and unlikely to increase in the future. Risk reduction options to reduce the probability of entry and spread and mitigate the impact were evaluated; those addressing the phytosanitary status of the propagation material were considered to be the most effective and feasible (e.g., the officially accepted carnation certification system for source planting material, including the current regulations laid down in Council Directive 2000/29/EC. If the current regulation were removed, a certification system could be just as effective as the existing regulation, provided it included practically all the prescriptions of the present regulation.
EFSA Panel on Plant Health (PLH
Full Text Available The EFSA Panel on Plant Health conducted a pest risk assessment for Burkholderia caryophylli for the EU territory under the scenario of current EU legislation and identified and evaluated risk reduction options. B. caryophylli is absent from the EU territory. The host range of B. caryophylli includes the genus Dianthus and three other incidental, minor, hosts (statice, lisianthus and gypsophila. Seven entry pathways were identified, with carnation cuttings and cut flowers being the most frequently traded. All pathways were considered unlikely as the pathogen is rarely associated with the pathways at origin mostly because of the high phytosanitary quality of the plant propagation material. The establishment is unlikely because outdoors the environmental conditions are not favourable to the pathogen and alternative hosts are not present, whereas in protected crops the cultural practices are very effective to keep the crop free from this bacterium. Only very short-distance spread within a crop is likely, and spread between different crops is unlikely. Risk reduction options addressing the sanitary status of the propagation material have the best effectiveness and feasibility. Effective control measures are based on healthy propagation materials (cuttings and hygiene practices. With the existing certification scheme of carnation plant propagation material, the probability of spread through infected cuttings is largely reduced. The high effectiveness of current measures is ensured by the absence of B. caryophylli in the EU, as in recent decades no findings of B. caryophylli have been reported.B. caryophylli is reported to be present in some third countries in Asia, where it still causes high crop losses. If the current regulation were to be removed, major consequences or changes in the potential impact of B. caryophylli are expected if no voluntary certification scheme were applied, together with good sanitation standards, along the crop
Maleche, Allan; Day, Emma
To what extent has the right to access generic HIV medication been implemented in Kenya for the 1.6 million people living with HIV? How does this relate to the right to health under international and national law? This paper examines a constitutional challenge brought to the High Court of Kenya in 2009 (the "Anti-Counterfeit Case") against the Anti-Counterfeit Act of 2008, which the petitioners, all of whom were living with HIV, argued would affect their ability to access affordable and generic antiretroviral medication. They argued that this would amount to a violation of their right to life, dignity, and health. This case is particularly interesting because the new Kenyan Constitution came into force in 2010, after the case had been filed, and specifically provided for the right to health for all of Kenya's citizens, as well as giving direct effect to all international laws ratified by the Kenyan government. This paper follows the Anti-Counterfeit Case, which includes amendments filed by the petitioners following the new constitutional changes, the arguments by the different parties in the case, and the inappropriateness of counterfeit laws as measures to control substandard and falsified medicine. The case has resulted in the suspension of significant parts of the Anti-Counterfeit Act that would pose a challenge to parallel importation, and to the court issuing a directive that the sections be amended. The judgment is examined in detail, as are the broader implications of this case for other countries in Eastern Africa.
... Vision 2025: Training and Deployment of Graduate Human Resource for Health. ... design in five training institutions for health and Ministry of Health and Social Welfare ... The deployment of graduate level HRH is affected by; limited budget, ...
Quintana, Yuri; Safran, Charles
People-centered health care seeks an active role for the patient while empowering all other members of the health care team. By promoting greater patient responsibility and optimal usage, patient-centered health care leads to improved health outcomes, quality of life and optimal value for health care investment. This paper reviews some definitions of people-centered health care and various e-health approaches around the world used to implement this vision. The barriers and enablers to implementation this type of approach are explored. This paper provides a proposed research agenda for future implementations of people-centered e-health.
Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J
Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.
Full Text Available BACKGROUND: Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs. Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. METHODS: The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. RESULTS: In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. CONCLUSIONS: Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so
Bauer, Greta R
Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation
Paul, Vinod Kumar; Sachdev, Harshpal Singh; Mavalankar, Dileep; Ramachandran, Prema; Sankar, Mari Jeeva; Bhandari, Nita; Sreenivas, Vishnubhatla; Sundararaman, Thiagarajan; Govil, Dipti; Osrin, David; Kirkwood, Betty
India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people's movement.
Guttman, Nurit; Gesser-Edelsburg, Anat; Aycheh, Seffefe
Knowing about one's health rights can be critical for obtaining equitable and appropriate health care. A model drawing on a culture-centered approach was used to develop and present health rights information materials for a disadvantaged cultural minority-the Ethiopian immigrant community in Israel. The model is based on the supposition that the design of health rights information materials should address both concerns and barriers identified by members of the cultural community and illustrate specific means to address them. Stories of community members' actual experiences served as the basis for several types of narratives presented in video clips, a photonovella, and an illustrated booklet. More than 100 people participated in the study in five focus groups and 50 personal interviews. Findings indicate participants felt the materials developed using this approach were informative and represented their concerns and cultural barriers to realizing these rights from their perspective and would help motivate them to realize their health rights. The analytic process, which involved members from the cultural community, resulted in the identification of dilemmas associated with the development of solution-oriented materials that draw on the culture-centered approach. These dilemmas pose additional theoretical challenges to the culture-centered approach.
Maxey, Hannah L.; Randolph, Courtney; Gano, Laura; Kochhar, Komal
Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce. PMID:27218701
Background The Personal Health Record (PHR) is an electronic record that allows patients to maintain, manage and access their health information in one secure location. However, despite these potential capabilities, the adoption rate of the PHR has been slow due to various challenges. Objectives This study, being the first of its kind in Saudi Arabia, investigates the perceived barriers and /or challenges for PHR adoption in the Ministry of National Guard Health Affairs (MNGHA). The study exp...
Full Text Available Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113 with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change’s health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities.
Gould, Solange; Rudolph, Linda
Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change's health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities.
Full Text Available The authors, key functionaries in the Kerala state public health system, review the communicable disease scenario of the state for the past 4 years, and in the background of the One Health concept, opines that the re-emerged discipline is perfectly in tune with the current challenges of the state. The unique model of Kerala state is witnessing newer challenges in its public health arena: The rapidly increasing migrant workforce from relatively poorer states of India, rapid urbanization and its consequent stress on public health, unsolved issues of urban waste disposal, reemergence of many communicable diseases like malaria, more so, the falciparum type, emergence of many zoonotic diseases like Lyme disease, scrub typhus, and Kyasanur forest disease etc. Conventional zoonotic infections such as anthrax and brucellosis remain potential threat for human health as well. Rabies continued to cause major concern from mortality point of view, as well as major drainer of state’s budget every year. Leptospirosis has remained major burden among the communicable disease for the past 10 years, and the annual incidence ranged from 2 to 7 per 100,000 population. Having a large section of its people working in various agriculture and animal rearing occupations, the state has all risk factors for propagation of Leptospirosis, but lacks interdisciplinary collaboration in its control and prevention area, the author highlights major avenues for collaboration. Japanese encephalitis appeared as an epidemic in 2011 in two of the southern districts in Kerala, one of the districts being famous tourist spot for both humans, as well as migrant birds. There is ample scope for collaborative research on the source of the virus, and in the subsequent years, the disease had been detected in more districts. Lyme disease was reported for the first time in India, from one of the districts in Kerala, promptly investigated by a joint team from Human Public Health and Veterinary
Lillemoen, Lillian; Pedersen, Reidar
Ethics support in primary health care has been sparser than in hospitals, the need for ethics support is probably no less. We have, however, limited knowledge about how to develop ethics support that responds to primary health-care workers' needs. In this article, we present a survey with a mixture of closed- and open-ended questions concerning: How frequent and how distressed various types of ethical challenges make the primary health-care workers feel, how important they think it is to deal with these challenges better and what kind of ethics support they want. Five primary health-care institutions participated. Ethical challenges seem to be prominent and common. Most frequently, the participants experienced ethical challenges related to scarce resources and lack of knowledge and skills. Furthermore, ethical challenges related to communication and decision making were common. The participants welcomed ethics support responding to their challenges and being integrated in their daily practices.
Chaves, Sônia Cristina Lima
This paper discusses adult oral health in Brazil according to three perspectives: 1) the available epidemiological evidence about the population's oral-health-related epidemiological situation, especially adults and the elderly population, in relation to two high prevalence oral injuries (dental caries and tooth loss), 2) the main health care models for dealing with this situation, by analyzing the related historical processes in order to reveal the likely social, political and epidemiological implications of the different models, and 3) lastly, the possible challenges to Brazilian dentistry or collective oral health in overcoming these obstacles. The main results of the study indicate that, from an epidemiological point of view, Brazil is undergoing a transition in dental caries and tooth loss, which is not yet reflected in the profile of the elderly, but which is tentatively evidenced in young adults. Tooth loss remains high. Certain aspects of society's economic and political superstructure have an important impact on oral health indicators and existing inequalities. Oral health care models have a relative importance and must not be neglected. Vestiges of ideological movements, like preventive medicine, may explain the current impasse in collective oral health practices, such as the preeminence of Finalized Treatment (FT) in clinics and of preventive care in schools fostered by community-based programs. It is therefore important to develop conceptual, theoretical reflections and to increase the objects of intervention, their purposes and their modus operandi. The practice of dentistry according to these alternative models is still being constructed. New studies related to the different formats of these new practices are recommended.
Holm, Preben; Petersen, Henrik Gordon
Automated industrial assembly today require that the 3D position and orientation (hereafter ''pose`) of the objects to be assembled are known precisely. Today this precision is mostly established by a dedicated mechanical object alignment system. However, such systems are often dedicated...... that enables direct assembly. Conventional vision systems and laser triangulation systems can locate randomly placed known objects (with 3D CAD models available) with some accuracy, but not necessarily a good enough accuracy. In this paper, we present a novel method for refining the pose accuracy of an object...... that has been located based on the appearance as detected by a monocular camera. We illustrate the quality of our refinement method experimentally....
Holm, Preben; Petersen, Henrik Gordon
Automated industrial assembly today require that the 3D position and orientation (hereafter ''pose`) of the objects to be assembled are known precisely. Today this precision is mostly established by a dedicated mechanical object alignment system. However, such systems are often dedicated to the p......Automated industrial assembly today require that the 3D position and orientation (hereafter ''pose`) of the objects to be assembled are known precisely. Today this precision is mostly established by a dedicated mechanical object alignment system. However, such systems are often dedicated...... to the particular object and in order to handle the demand for flexibility, there is an increasing demand for avoiding such dedicated mechanical alignment systems. Rather, it would be desirable to automatically locate and grasp randomly placed objects from tables, conveyor belts or even bins with a high accuracy...
.... This paper examines the opportunities for and constraints to India-EU relations in health services in the context of this agreement, focusing on the EU as a market for India's health services exports and collaboration...
Prussing, Erica; Newbury, Elizabeth
In 2012-13 the Ministry of Business, Innovation and Employment (MBIE) in New Zealand rapidly implemented a major restructuring of national scientific research funding. The "National Science Challenges" (NSC) initiative aims to promote greater commercial applications of scientific knowledge, reflecting ongoing neoliberal reforms in New Zealand. Using the example of health research, we examine the NSC as a key moment in ongoing indigenous Māori advocacy against neoliberalization. NSC rhetoric and practice through 2013 moved to marginalize participation by Māori researchers, in part through constructing "Māori" and "science" as essentially separate arenas-yet at the same time appeared to recognize and value culturally distinctive forms of Māori knowledge. To contest this "neoliberal multiculturalism," Māori health researchers reasserted the validity of culturally distinctive knowledge, strategically appropriated NSC rhetoric, and marshalled political resources to protect Māori research infrastructure. By foregrounding scientific knowledge production as an arena of contestation over neoliberal values and priorities, and attending closely to how neoliberalizing tactics can include moves to acknowledge cultural diversity, this analysis poses new questions for social scientific study of global trends toward reconfiguring the production of knowledge about health. Study findings are drawn from textual analysis of MBIE documents about the NSC from 2012 to 2014, materials circulated by Māori researchers in the blogosphere in 2014, and ethnographic interviews conducted in 2013 with 17 Māori health researchers working at 7 sites that included university-based research centers, government agencies, and independent consultancies.
Lima-Camara, Tamara Nunes
Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country's public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country. RESUMO A modificação do ambiente por ações antrópicas, o crescimento urbano desordenado, o processo de globalização do intercâmbio internacional e as mudanças climáticas são alguns fatores que vêm facilitando a emergência e disseminação de doenças infecciosas humanas transmitidas por vetores. Este comentário aborda a recente entrada de três arbovírus no Brasil, Chikungunya (CHIKV), West Nile (WNV) e Zika (ZIKV), com enfoque nos desafios para a Saúde Pública do País. Transmitidos por mosquitos vetores amplamente distribuídos no território nacional e associados ao homem, a população brasileira encontra-se exposta à infecção por esses três arbovírus. Na ausência de vacina eficaz e tratamento específico, são importantes a manutenção e integração de uma vigilância entomológica e epidemiológica contínua, a fim de direcionarmos métodos de controle e prevenção contra essas arboviroses no País.
Nigatu, Yeshambel Tesfa
Obesity and depression are widespread public health problems. Both problems often coexist, and can affect an individual’s health and productivity. We examine in this thesis the prospective association between obesity and depression, and their separate and combined effects on work and health outcomes
Thomas, Stephen B; Quinn, Sandra Crouse
The aim of this article is to examine the intersection of race and poverty, two critical factors fueling persistent racial and ethnic health disparities among urban populations. From the morass of social determinants that shape the health of racial and ethnic communities in our urban centers, we will offer promising practices and potential solutions to eliminating racial and ethnic health disparities.
The article deals with the issues of impact of globalization on population health and public health. The positive and negative aspects of this process are analyzed. The role of international organizations (UN, WHO, UNESCO, ILO, UNISEF) is demonstrated in the area of management of globalization impact on public health of different countries, Russia included.
As "health" climbs academic, policy, commercial, non-profit and societal agendas, it has become increasingly subject to scrutiny by geographers. Yet, while health geographers may explore the discursive production, operationalization, deployment and management of health; the role of pedagogical practices has been repeatedly overlooked…
Senedu B. Gebreegziabher
Full Text Available Background. Weak health systems pose many barriers to effective tuberculosis (TB control. This study aimed at exploring health worker’s and TB control program coordinator’s perspectives on health systems challenges facing TB control in West Gojjam Zone, Amhara Region, Ethiopia. Methods. This was a qualitative descriptive study. Eight in-depth interviews with TB control program coordinators and two focus group discussions among 16 health workers were conducted. Purposive sampling was used to recruit study participants. Thematic analysis was used to identify and analyse main themes. Results. We found that intermittent interruptions of laboratory reagents and anti-TB drugs supplies, absence of trained and motivated health workers, poor TB data documentation, lack of adherence to TB treatment guideline, and lack of access to TB diagnostic tools at peripheral health institutions were challenges facing the TB control program performance in the study zone. Conclusions. Ensuring uninterrupted supply of anti-TB drugs and laboratory reagents to all health institutions is essential. Continuous refresher training of health workers on standard TB care and data handling and developing and implementing a sound retention strategy to attract and motivate health professionals to work in rural areas are necessary interventions to improve the TB control program performance in the study zone.
Anil K Chillimuntha
Full Text Available Disadvantaged rural health reflected by significantly higher mortality rates in rural areas which indicate less attention paid by the government. The issue of health disadvantage to the rural area in the country is far from settled. The public expenditure on health in India is far too inadequate, less than 10% of the total health budget is allocated to rural area where 75% people live. In spite of rising budgetary provision, many of the rural populace dies without any medical attention. Access to high quality health care services plays an important part in the health of rural communities and individuals. Resolving the health problems of rural communities will require more than simply increasing the quality and accessibility of health services. Until governments begin to take an upside-down perspective, focusing on building healthy communities rather than simply on building hospitals to make communities healthy, the disadvantages faced by rural people will continue to be exacerbated. Underutilization of existing rural hospitals and health care facilities can be addressed by a market-centered approach, and more effective government intervention for horizontal and vertical hospital integration. Tele-healthcare, Mobile Health Units and Community-based health insurance are proven helpful in rural areas. Autonomy enjoyed by women and exposure to media also has a significant impact on maternal health care utilization. Accessibility to health facilities is a critical factor in effective health treatment for people in rural areas. Locationallocation models prescribe optimal configurations of health facilities in order to maximize accessibility. [Natl J of Med Res 2013; 3(1.000: 80-82
Mengiste, Shegaw Anagaw
This paper has analyzed the challenges of sustainability and scalability of HIS. The empirical analysis was conducted in a backward and disadvantaged region of Ethiopia. An ongoing process of HISP (Health Information System Program) was addressed and the main challenges in the implementation...... of sustainable and scalable district-based health information system in the context of Primary Health Care (PHC) sector in Ethiopia were identified. Human resource, infrastructure, and HIS related problems are the main challenges hindering the implementation of sustainable and scalable district-based health...... information systems in the region....
Full Text Available In this study new free-trade agreements are discussed, which are based on the breaking down of tariff and technical barriers and normally exclude most of the poorest countries in the world. Considering the current context of economic globalization and its health impacts, seven controversial points of these treaties and their possible implications for global public health are presented, mainly regarding health equity and other health determinants. Finally, this research proposes a greater social and health professionals participation in the formulation and discussion of these treaties, and a deeper insertion of Brazil in this important international agenda.
In this study new free-trade agreements are discussed, which are based on the breaking down of tariff and technical barriers and normally exclude most of the poorest countries in the world. Considering the current context of economic globalization and its health impacts, seven controversial points of these treaties and their possible implications for global public health are presented, mainly regarding health equity and other health determinants. Finally, this research proposes a greater social and health professionals participation in the formulation and discussion of these treaties, and a deeper insertion of Brazil in this important international agenda.
Saavedra Solano, Nayelhi; Berenzon Gorn, Shoshana; Galván Reyes, Jorge
To present the conditions that favour or limit the integration of mental health into health centres, based on the perceptions of health workers and on observations made by researchers. A study was conducted between April 2012 and February 2014 using a non-participant observation technique plus interviews with health professionals. Descriptive exploratory study conducted in 19 health centres in Mexico City. The selection of centres and participants was intentional, followed by the snowball technique in order to reach data saturation. Two guides were use, one for collecting information during the observation and the other one for interviews. The observations were registered in field notes, while the interviews were audio recorded. All collected information was stored in Word files. The analysis of field notes consisted of three levels of reading, and the interview analysis was based on "categorisation of meanings" proposed by Kvale (1996). The aspects that favour or limit the integration of mental health services involve three broad categories: a) programs and methods that organise services, b) infrastructure and material resources and, c) human and information resources. Actions targeted at including mental health into productivity reports and into already established goals, would contribute to the integration of mental health care, as well as promoting the idea that mental health is part of overall health, and to increase the public investment in health. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Gallagher, Jennifer E; Eaton, Kenneth A
Throughout the life course, oral diseases are some of the most common non-communicable diseases globally, and in Europe. Human resources for oral health are fundamental to healthcare systems in general and dentistry is no exception. As political and healthcare systems change, so do forms of governance. The aim of this paper is to examine human resources for oral health in Europe, against a workforce governance framework, using England as a case study. The findings suggest that neo-liberalist philosophies are leading to multiple forms of soft governance at professional, system, organisational and individual levels, most notably in England, where there is no longer professional self-regulation. Benefits include professional regulation of a wider cadre of human resources for oral health, reorientation of care towards evidence-informed practice including prevention, and consideration of care pathways for patients. Across Europe there has been significant professional collaboration in relation to quality standards in the education of dentists, following transnational policies permitting freedom of movement of health professionals; however, the distribution of dentists is inequitable. Challenges include facilitating employment of graduates to serve the needs and demands of the population in certain countries, together with governance of workforce production and migration across Europe. Integrated trans-European approaches to monitoring mobility and governance are urgently required. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Loss, J; Nagel, E
Health communication, e.g., mass media campaigns, patient information leaflets or websites, plays an important role in public health. It contributes to citizen empowerment and helps them make informed decisions in health matters. However, public health communication can lead to adverse effects on both individual and societal level, e.g., by inaccurate or partial information, discriminatory messages, scandalizing coverage or inadequate tailoring to relevant target groups. It seems important to suggest ethical criteria for health information, e.g., (1) accuracy, completeness and balance, (2) transparency, (3) participation of the target group, (4) respect for human dignity, (5) social justice and equity, (6) appropriateness. Thoughtfulness is important in order not to stigmatize population subgroups. In addition, it is laborious to comprehensively and correctly present benefits and risks of a certain health behavior. Marketing principles guide how to 'sell' a certain health behavior, but health campaigns should not manipulate target persons for the sake of a population health aim. It remains unclear, however, how the different providers of health information can be held ethically responsible.
Merhy Emerson E
Full Text Available Abstract Background We utilized our previous studies analyzing the reforms affecting the health sector developed in the 1990s by financial groups to frame the strategies implemented by the pharmaceutical industry to regain market positions and to understand the challenges that regulatory agencies are confronting. Methods We followed an analytical approach for analyzing the process generated by the disputes between the financial groups and the pharmaceutical corporations and the challenges created to governmental regulation. We analyzed primary and secondary sources using situational and discourse analyses. We introduced the concepts of biomedicalization and biopedagogy, which allowed us to analyze how medicalization was radicalized. Results In the 1990s, structural adjustment policies facilitated health reforms that allowed the entrance of multinational financial capital into publicly-financed and employer-based insurance. This model operated in contraposition to the interests of the medical industrial complex, which since the middle of the 1990s had developed silent reforms to regain authority in defining the health-ill-care model. These silent reforms radicalized the medicalization. Some reforms took place through deregulatory processes, such as allowing direct-to-consumer advertisements of prescription drugs in the United States. In other countries different strategies were facilitated by the lack of regulation of other media such as the internet. The pharmaceutical industry also has had a role in changing disease definitions, rebranding others, creating new ones, and pressuring for approval of treatments to be paid by public, employer, and private plans. In recent years in Brazil there has been a substantial increase in the number of judicial claims demanding that public administrations pay for new treatments. Conclusions We found that the dispute for the hegemony of the health sector between financial and pharmaceutical companies has deeply
Rachel C. Vreeman
Conclusions: Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV, particularly throughout lifespan changes from childhood to adolescence to adulthood. The lack of research and support for mental health needs in resource-limited settings presents an enormous burden for which cost-effective solutions are urgently needed.
Full Text Available Abstract Background There are numerous ethical challenges that can impact patients and families in the health care setting. This paper reports on the results of a study conducted with a panel of clinical bioethicists in Toronto, Ontario, Canada, the purpose of which was to identify the top ethical challenges facing patients and their families in health care. A modified Delphi study was conducted with twelve clinical bioethicist members of the Clinical Ethics Group of the University of Toronto Joint Centre for Bioethics. The panel was asked the question, what do you think are the top ten ethical challenges that Canadians may face in health care? The panel was asked to rank the top ten ethical challenges throughout the Delphi process and consensus was reached after three rounds. Discussion The top challenge ranked by the group was disagreement between patients/families and health care professionals about treatment decisions. The second highest ranked challenge was waiting lists. The third ranked challenge was access to needed resources for the aged, chronically ill, and mentally ill. Summary Although many of the challenges listed by the panel have received significant public attention, there has been very little attention paid to the top ranked challenge. We propose several steps that can be taken to help address this key challenge.
he recent Ebola crisis has caused approximately 20.000 deaths so far. Compared to other global health crises, including the deaths caused by armed conflicts and chronic diseases, this is still a small amount. Yet, from a global and domestic health law and governance perspective, this crisis raises a
Marcelle Aparecida de Barros
Full Text Available ABSTRACT: Epidemiological studies on drugs use point towards this phenomenon as a public health problem. Nowadays, the Family Health Program (FHP is presented by the Health Ministry as a model to restructure primary health care and aims to offer family-centered care, permeated by integrality, problem solving and community bonds. This article aims to discuss action possibilities of Family Health Care professionals involving drugs patients. It is evident that, as opposed to other actions already developed by FHP professionals in other health care areas, which has appeared clearly and objectively. This fact is observed in the daily activities of FHP professionals, which give little attention to drugs-related problems. However, research emphasizes that there exists a broad range of action possibilities for FHP professionals. Although other studies evidence this team’s fragilities in terms of care for drugs users, these can be overcome by investing in the training and valuation of these professionals. KEY WORDS: Family Health Program; Street drugs; Health Knowledge, Attitudes, Practice.
Full Text Available The economic downturn experienced by Nigeria and many sub-Saharan African countries led to the adoption of austerity to restore the country’s economy since the 1980s. Since austerity emphasizes privatization and commercialization, instead of restoration, it had, however, impacted especially the Nigerian health sector negatively. Nigeria has indeed continued to bear witness to some of the worst health and healthcare statistics in the world. Evidence from key health indicators in Nigeria also clearly shows that the country’s health situation has experienced massive deterioration. Given the above, the paper argues that austerity constitutes a major impediment to the attainment of a good state of health as well as effective and viable healthcare delivery to all in Nigeria. The paper, therefore suggests: (1 reframing and recognizing health as a human right issue; (2 integration of indigenous medicine into the Nigerian national health delivery systems; (3 recognition of State investment in social services as quite necessary and important such that budget allocation to health is increased as ways forward.
The history of the development of mental health services in Africa falls into four phases, ... ical process described above still prevails in almost all the rural areas in Africa ... most countries in the region have had a decentralisation policy for mental health ... Constant departure or brain drain of well-trained and spe- cialised ...
he recent Ebola crisis has caused approximately 20.000 deaths so far. Compared to other global health crises, including the deaths caused by armed conflicts and chronic diseases, this is still a small amount. Yet, from a global and domestic health law and governance perspective, this crisis raises a
Mayosi, Bongani M; Lawn, Joy E; van Niekerk, Ashley; Bradshaw, Debbie; Abdool Karim, Salim S; Coovadia, Hoosen M
Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous administration are being transformed. The change in leadership of the Ministry of Health has been key, but new momentum is inhibited by stasis within the health management bureaucracy. Specific policy and programme changes are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. South Africa now has the world's largest programme of antiretroviral therapy, and some advances have been made in implementation of new tuberculosis diagnostics and treatment scale-up and integration. HIV prevention has received increased attention. Child mortality has benefited from progress in addressing HIV. However, more attention to postnatal feeding support is needed. Many risk factors for non-communicable diseases have increased substantially during the past two decades, but an ambitious government policy to address lifestyle risks such as consumption of salt and alcohol provide real potential for change. Although mortality due to injuries seems to be decreasing, high levels of interpersonal violence and accidents persist. An integrated strategic framework for prevention of injury and violence is in progress but its successful implementation will need high-level commitment, support for evidence-led prevention interventions, investment in surveillance systems and research, and improved human-resources and management capacities. A radical system of national health insurance and re-engineering of primary health care will be phased in for 14 years to enable universal, equitable, and affordable health-care coverage. Finally, national consensus has been reached about seven priorities for health research with a commitment to
Roter, Debra L
Literacy deficits are widespread; one-quarter of the U.S. population has below basic literacy skills and the health consequences of literacy deficits are well-known and significant. While the need to simplify written health education print material is widely recognized, there has been little attempt to describe or reduce the literacy demand of health care dialogue. Patients with limited literacy complain they are not given information about their problems in ways they can understand, leaving them uninformed, frustrated, and distrustful. The purpose of this article is to review a conceptual approach to describing oral literacy demand in health care dialogue, to review several key studies that support the predictive validity of the conceptual framework in regard to patient satisfaction and recall of information, and to propose several practical ways to diminish literacy demand and facilitate more effective health care exchanges with patients.
Lester, Felicia; Benfield, Nerys; Fathalla, Mohamed M F
Women's health is closely linked to a nation's level of development, with the leading causes of death in women in resource-poor nations attributable to preventable causes. Unlike many health problems in rich nations, the cure relies not only on the discovery of new medications or technology but also getting basic services to the people who need them most and addressing underlying injustice. In order to do this, political will and financial resources must be dedicated to developing and evaluating a scaleable approach to strengthen health systems, support community-based programs, and promote widespread campaigns to address gender inequality, including promoting girls' education. The Millennium Development Goals (MDGs) have highlighted the importance of addressing maternal health and promoting gender equality for the overall development strategy of a nation. We must capitalize on the momentum created by this and other international campaigns and continue to advocate for comprehensive strategies to improve global women's health.
previous studies have documented increased mortality and morbidity (incidences) among seafarers, not only due to accidents but also to lifestyle like cardiovascular disease, lung cancer and diseases related to alcohol. These diseases are related to factors like alcohol consumption, obesity, physical...... inactivity and smoking, which for the latter three are factors highly represented in the maritime industry. The aim of this study is to identify the current health status of seafarers and to detect, strengths and weaknesses of health promotion interventions implemented in this target group. METHODS: A 1 year...... follow-up study was conducted within two Danish shipping companies aiming to collect information on the seafarers’ health, wellbeing, diet, smoking, alcohol and physical activity. Within this period, health promotion interventions were offered; health profile (physiological measurements/tests), smoking...
Rowland, Amy L.
Because of the unique health risks faced by the Hispanic population and the notoriously poor health habits of college students, this study examines the health challenges faced by Latino college students enrolled at an urban commuter institution. A thematic analysis reveals the top themes for males and females as healthy eating, weight management,…
Social media has become a major platform for debates on science and health. This commentary argues that while social media can present challenges to communicating important health matters, it can also provide health experts a unique opportunity to engage with and build trust among members of the public.
Mowafi, Hani; Nowak, Kristin; Hein, Karen
The human resources crisis in humanitarian health care parallels that seen in the broader area of health care. This crisis is exacerbated by the lack of resources in areas in which humanitarian action is needed--difficult environments that often are remote and insecure--and the requirement of specific skill sets is not routinely gained during traditional medical training. While there is ample data to suggest that health outcomes improve when worker density is increased, this remains an area of critical under-investment in humanitarian health care. In addition to under-investment, other factors limit the availability of human resources for health (HRH) in humanitarian work including: (1) over-reliance on degrees as surrogates for specific competencies; (2) under-development and under-utilization of national staff and beneficiaries as humanitarian health workers; (3) lack of standardized training modules to ensure adequate preparation for work in complex emergencies; (4) and the draining of limited available HRH from countries with low prevalence and high need to wealthier, developed nations also facing HRH shortages. A working group of humanitarian health experts from implementing agencies, United Nations agencies, private and governmental financiers, and members of academia gathered at Hanover, New Hampshire for a conference to discuss elements of the HRH problem in humanitarian health care and how to solve them. Several key elements of successful solutions were highlighted, including: (1) the need to develop a set of standards of what would constitute "adequate training" for humanitarian health work; (2) increasing the utilization and professional development of national staff; (3) "training with a purpose" specific to humanitarian health work (not simply relying on professional degrees as surrogates); (4) and developing specific health task-based competencies thereby increasing the pool of potential workers. Such steps would accomplish several key goals, such as
low-, middle- and high-income nations,3 compelling the ... sons as those persons over age 60 years.4 As the global population of older ... physical or cognitive function.9 However, the less dynam- ic nature of ... Similar to Nigeria, the population growth of elderly in .... children, adolescents and young adults about challenges.
Hmam, Hatem; Kim, Jijoong
This work presents a geometry based vision system for aircraft recognition and pose estimation using single images. Pose estimation improves the tracking performance of guided weapons with imaging seekers, and is useful in estimating target manoeuvres and aim-point selection required in the terminal phase of missile engagements. After edge detection and straight-line extraction, a hierarchy of geometric reasoning algorithms is applied to form line clusters (or groupings) for image interpretation. Assuming a scaled orthographic projection and coplanar wings, lateral symmetry inherent in the airframe provides additional constraints to further reject spurious line clusters. Clusters that accidentally pass all previous tests are checked against the original image and are discarded. Valid line clusters are then used to deduce aircraft viewing angles. By observing that the leading edges of wings of a number of aircraft of interest are within 45 to 65 degrees from the symmetry axis, a bounded range of aircraft viewing angles can be found. This generic property offers the advantage of not requiring the storage of complete aircraft models viewed from all aspects, and can handle aircraft with flexible wings (e.g. F111). Several aircraft images associated with various spectral bands (i.e. visible and infra-red) are finally used to evaluate the system's performance.
Tanenbaum, Sandra J
In health care, particularism asserts the primacy of the individual case. Moral particularists, such as Jonsen and Toulmin, reject deduction from universal moral principles and instead seek warrants for action from the multiple sources unique to a given patient. Another kind of health care particularism, here referred to as the knowledge of particulars, is offered as a corrective to evidence-based medicine (EBM), its influence on health care practice and policy, and specifically to EBM's reliance on the aggregate. This paper describes the knowledge of particulars and identifies strategies for its legitimation in health care policy and practice. First, the paper documents the ascendancy of the aggregate through EBM's definition of 'what works' in health care. Second, it delineates the limits of health care knowledge based on the analysis of aggregates, not only for the care of individual patients but for the formulation of policies about patient care. Third, the paper analyses prominent rejections of the particular in contemporary health policy discourse and relates them to larger political purposes. Finally, it depicts the knowledge of particulars as the basis for clinical prudence and offers three potential strategies for promoting particularism as essential to high-quality care.
Full Text Available Midwifery is rooted in public health, and most of its history has been community oriented. In India, midwifery evolved during the British rule; but over the years with changes in political and program priorities, the role and the capacity of midwives has changed substantially. The verticalization of national health programs has obscured the midwives′ community focus and inhibited its contribution to the wider public health. There is a global acceptance and recognition of the midwifery model of care and skilled delivery for ensuring effective maternal health outcomes. The approaches are in line with local needs and have proved its effectiveness in resource-constrained settings. It is important to recognize the substantial contribution they make to public health, working to promote the long-term well-being of women, their babies and families, by offering information and advice on nutrition, supplementation, breastfeeding, and immunization. There is considerable scope for developing the midwifery model through enhancing the extent of their involvement in assessing health needs of local populations, designing, managing and evaluating maternal and health services, making timely and effective referrals and developing family-centered care.
Challenges and opportunities: what can we learn from patients living with chronic musculoskeletal conditions, health professionals and carers about the concept of health literacy using qualitative methods of inquiry?
Full Text Available The field of health literacy continues to evolve and concern public health researchers and yet remains a largely overlooked concept elsewhere in the healthcare system. We conducted focus group discussions in England UK, about the concept of health literacy with older patients with chronic musculoskeletal conditions (mean age = 73.4 years, carers and health professionals. Our research posed methodological, intellectual and practical challenges. Gaps in conceptualisation and expectations were revealed, reiterating deficiencies in predominant models for understanding health literacy and methodological shortcomings of using focus groups in qualitative research for this topic. Building on this unique insight into what the concept of health literacy meant to participants, we present analysis of our findings on factors perceived to foster and inhibit health literacy and on the issue of responsibility in health literacy. Patients saw health literacy as a result of an inconsistent interactive process and the implications as wide ranging; healthcare professionals had more heterogeneous views. All focus group discussants agreed that health literacy most benefited from good inter-personal communication and partnership. By proposing a needs-based approach to health literacy we offer an alternative way of conceptualising health literacy to help improve the health of older people with chronic conditions.
These reflections from a Child Public Health perspective underline the dramatic changes in children's conditions in Europe over this last century, including a considerable improvement in health. However, we still face problems, disturbing facts and alarming signs. There are important gaps in our knowledge about essential areas of children's health panorama and about particularly vulnerable sub-groups of children, which are less healthy, less well cared for and not enjoying the good conditions of life. We also see an evident lack of the child's perspective, implying acknowledgement and action on the views of the children themselves. Moreover, in spite of the generally improving standard, societal inequity in economy, education and health is increasing and the recent economic crises have struck hard on families with children. There are many good signs implying continuing progress for children and their conditions and also an improved respect for their rights. But with the increasing segregation in our societies, the risk is imminent that the health problems will increase, and that some groups get left far behind. Although actions on this field are primarily a political responsibility, people working with children can make a difference. There are also many examples of projects, particularly on local levels, where professionals act to promote children's health, prevent their ill-health and facilitate their health behaviour, rather than to repair their diseases. Children's particular needs and protection is now generally accepted, and the growing concern for their rights opens a window to the future for a more powerful child health advocacy. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Lai, Karen; Guo, Sisi; Ijadi-Maghsoodi, Roya; Puffer, Maryjane; Kataoka, Sheryl H
School-based health centers (SBHCs) reduce access barriers to mental health care and improve educational outcomes for youths. This qualitative study evaluated the innovations and challenges of a unique network of SBHCs in a large, urban school district as the centers attempted to integrate health, mental health, and educational services. The 43 participants sampled included mental health providers, primary care providers, and care coordinators at 14 SBHCs. Semistructured interviews with each participant were audio recorded and transcribed. Themes were identified and coded by using Atlas.ti 5.1 and collapsed into three domains: operations, partnership, and engagement. Interviews revealed provider models ranging from single agencies offering both primary care and mental health services to colocated services. Sites where the health agency provided at least some mental health services reported more mental health screenings. Many sites used SBHC wellness coordinators and coordination team meetings to facilitate relationships between schools and health agency and community mental health clinic providers. Partnership challenges included confidentiality policies and staff turnover. Participants also highlighted student and parent engagement through culturally sensitive services, peer health advocates, and "drop-in" lunches. Staffing and operational models are critical in the success of integrating primary care, mental health care, and education. Among the provider models observed, the combined primary care and mental health provider model offered the most integrated services. Despite barriers, providers and schools have begun to implement novel solutions to operational problems and family engagement in mental health services.
The burden on health-related issues due to unplanned urban policies is higher despite the present knowledge of interventions and availability of current technologies. This burden could increase substantially, given the rapid growth in urban populations and the application of partial or misguided solutions to urban transport problems. Part of the reason is the failure to consider holistically the health, social and environment consequences and the related costs of individual travel choices and government policies in the ﬁeld of trafﬁc and mobility. Urban transport-related issues and its impact on health, environment, costs and beneﬁts are discussed in this paper.
Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal
Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.
Gadelha, Carlos Augusto Grabois; Costa, Laís Silveira
The structural sustainability of the Brazilian health system refers to the country's pattern of development according to how this pattern is expressed and reproduced in the Brazilian population. This derives not only from its social dimension, but also from the economic one, as it accounts for a significant part of the gross domestic product and of job creation, and produces a great impact on the generation of innovation and national competitiveness. The federal government has institutionalized the role of health in the national development agenda due to its strategic aspect. Despite this, the fragility of its productive base continues to be a major vulnerability for the National Health System and for Brazil's competitiveness in a global environment. This signals that the virtuous establishment of the relation between health and development involves the rupture of cognitive and political paradigms that separate, in an impermeable way, the economic from the social order.
Patz, Jonathan A; Frumkin, Howard; Holloway, Tracey; Vimont, Daniel J; Haines, Andrew
Health is inextricably linked to climate change. It is important for clinicians to understand this relationship in order to discuss associated health risks with their patients and to inform public policy. To provide new US-based temperature projections from downscaled climate modeling and to review recent studies on health risks related to climate change and the cobenefits of efforts to mitigate greenhouse gas emissions. We searched PubMed and Google Scholar from 2009 to 2014 for articles related to climate change and health, focused on governmental reports, predictive models, and empirical epidemiological studies. Of the more than 250 abstracts reviewed, 56 articles were selected. In addition, we analyzed climate data averaged over 13 climate models and based future projections on downscaled probability distributions of the daily maximum temperature for 2046-2065. We also compared maximum daily 8-hour average ozone with air temperature data taken from the National Oceanic and Atmospheric Administration, National Climate Data Center. By 2050, many US cities may experience more frequent extreme heat days. For example, New York and Milwaukee may have 3 times their current average number of days hotter than 32°C (90°F). High temperatures are also strongly associated with ozone exceedance days, for example, in Chicago, Illinois. The adverse health aspects related to climate change may include heat-related disorders, such as heat stress and economic consequences of reduced work capacity; respiratory disorders, including those exacerbated by air pollution and aeroallergens, such as asthma; infectious diseases, including vectorborne diseases and waterborne diseases, such as childhood gastrointestinal diseases; food insecurity, including reduced crop yields and an increase in plant diseases; and mental health disorders, such as posttraumatic stress disorder and depression, that are associated with natural disasters. Substantial health and economic cobenefits could be
Jaworowska, Agnieszka; Blackham, Toni; Davies, Ian G; Stevenson, Leonard
Consumption of takeaway and fast food continues to increase in Western societies and is particularly widespread among adolescents. Since food is known to play an important role in both the development and prevention of many diseases, there is no doubt that the observed changes in dietary patterns affect the quality of the diet as well as public health. The present review examines the nutritional characteristics of takeaway and fast food items, including their energy density, total fat, and saturated and trans fatty acid content. It also reports on the association between the consumption of such foods and health outcomes. While the available evidence suggests the nutrient profiles of takeaway and fast foods may contribute to a variety of negative health outcomes, findings on the specific effects of their consumption on health are currently limited and, in recent years, changes have been taking place that are designed to improve them. Therefore, more studies should be directed at gaining a firmer understanding of the nutrition and health consequences of eating takeaway and fast foods and determining the best strategy to reduce any negative impact their consumption may have on public health.
Jansà, Josep M
Foreign migration in Spain is at present a priority in the social and demographic context the country. At a worldwide level, trends in the evolution of population and social, political and economical indicators, appear to maintain for the coming years, the present trends on migrations from poor countries to the rich ones. In the health area, considering migration as a relatively recent phenomena in Spain, and considering that is mainly constituted by young and healthy population, there are not still data available on the main health needs of migrants related to aging. Data from other countries with a longer migrant tradition, shows mental health disorders and social and cultural barriers for adaptation, as basic health determinants for older migrants. Related to the effects in the health system, the inclusion of the aging factor in general population and migrant needs, offer an optimistic panorama for future planning. Migrant aging in Spain, despite of its middle and long term perspective, do require a progressive adaptation of knowledge and resources to cover future needs. Considering this coming future, health professionals do need to be trained in intercultural skills and knowledge.
India and the EU are currently negotiating a Trade and Investment Agreement which also covers services. This paper examines the opportunities for and constraints to India-EU relations in health services in the context of this agreement, focusing on the EU as a market for India's health services exports and collaboration. The paper provides an overview of key features of health services in the EU and India and their bearing on bilateral relations in this sector. Twenty six semi-structured, in-person, and telephonic interviews were conducted in 2007-2008 in four Indian cities. The respondents included management and practitioners in a variety of healthcare establishments, health sector representatives in Indian industry associations, health sector officials in the Indian government, and official representatives of selected EU countries and the European Commission based in New Delhi. Secondary sources were used to supplement and corroborate these findings. The interviews revealed that India-EU relations in health services are currently very limited. However, several opportunity segments exist, namely: (i) Telemedicine; (ii) Clinical trials and research in India for EU-based pharmaceutical companies; (iii) Medical transcriptions and back office support; (iv) Medical value travel; and (v) Collaborative ventures in medical education, research, training, staff deployment, and product development. However, various factors constrain India's exports to the EU. These include data protection regulations; recognition requirements; insurance portability restrictions; discriminatory conditions; and cultural, social, and perception-related barriers. The interviews also revealed several constraints in the Indian health care sector, including disparity in domestic standards and training, absence of clear guidelines and procedures, and inadequate infrastructure. The paper concludes that although there are several promising areas for India-EU relations in health services, it will be
Full Text Available Abstract Background India and the EU are currently negotiating a Trade and Investment Agreement which also covers services. This paper examines the opportunities for and constraints to India-EU relations in health services in the context of this agreement, focusing on the EU as a market for India's health services exports and collaboration. The paper provides an overview of key features of health services in the EU and India and their bearing on bilateral relations in this sector. Methods Twenty six semi-structured, in-person, and telephonic interviews were conducted in 2007-2008 in four Indian cities. The respondents included management and practitioners in a variety of healthcare establishments, health sector representatives in Indian industry associations, health sector officials in the Indian government, and official representatives of selected EU countries and the European Commission based in New Delhi. Secondary sources were used to supplement and corroborate these findings. Results The interviews revealed that India-EU relations in health services are currently very limited. However, several opportunity segments exist, namely: (i Telemedicine; (ii Clinical trials and research in India for EU-based pharmaceutical companies; (iii Medical transcriptions and back office support; (iv Medical value travel; and (v Collaborative ventures in medical education, research, training, staff deployment, and product development. However, various factors constrain India's exports to the EU. These include data protection regulations; recognition requirements; insurance portability restrictions; discriminatory conditions; and cultural, social, and perception-related barriers. The interviews also revealed several constraints in the Indian health care sector, including disparity in domestic standards and training, absence of clear guidelines and procedures, and inadequate infrastructure. Conclusions The paper concludes that although there are several
Nordentoft, Helle Merete; Kappel, Nanna
. The guidelines appear to be instrumental and over-simplistic representations of the often ‘messy’ realities surrounding the research process that is often guided by relational and local negotiations of ethical solutions. Vulnerable participants, for instance, challenge both professional and research ethics......, leaving both professionals and researchers in ethical and moral dilemmas. In this article, we specifically focus on the methodological challenges of obtaining informed consent from drug users and terminally ill cancer patients in our PhD research. The question is how to illuminate the needs and problems......Ethical guidelines for conducting research are embedded in the Helsinki Declaration of 1964. We contend that these abstract and intentionally universal guidelines need to be appropriated for social and healthcare research, in which purpose and methods often deviate from medical research...
Nordentoft, Helle Merete; Kappel, Nanna
, leaving both professionals and researchers in ethical and moral dilemmas. In this article, we specifically focus on the methodological challenges of obtaining informed consent from drug users and terminally ill cancer patients in our PhD research. The question is how to illuminate the needs and problems......Ethical guidelines for conducting research are embedded in the Helsinki Declaration of 1964. We contend that these abstract and intentionally universal guidelines need to be appropriated for social and healthcare research, in which purpose and methods often deviate from medical research....... The guidelines appear to be instrumental and over-simplistic representations of the often ‘messy’ realities surrounding the research process that is often guided by relational and local negotiations of ethical solutions. Vulnerable participants, for instance, challenge both professional and research ethics...
Full Text Available Abstract Background The aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population. Methods The World Health Organization Assessment Instrument for Mental Health Systems (WHO AIMS was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a mental health services; and b human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a the Executive Bureau of the Department of Health (Datasus; and b the National Register of Health Institutions (CNS. Results There are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS. At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents. The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days. In June 2006, there were 848 Community Psychosocial Centers (CAPS registered in Brazil, a ratio of 0.9 CAPS per 200,000 inhabitants, unequally distributed in the different geographical areas: the Northeast and the North regions having lower figures than the South and Southeast regions. Conclusion The country has opted for innovative services and programs, such as the expansion of Psychosocial Community Centers and the Return Home program to deinstitutionalize
The healthcare burden is increasing in both the developed and the developing world and there is widespread acceptance that the historical pharmaceutical business model is not sustainable. In order to meet the healthcare challenge, companies and academia need to develop new business models to increase the probability of success and decrease the cost of failure. New partnerships have already emerged in the area of neglected diseases and other models for diseases of the developed world are emerging.
In 2016 the National Institute for Health and Care Excellence (NICE) published a guideline on oral health for adults in care homes in England. The author was a co-opted member of the NICE oral health for adults in care homes public health advisory committee. This article reviews the NICE guideline as it applies to care homes, and relates it to the results of a survey of oral care practice undertaken in a large care home organisation and the available research literature from the past 20 years. The literature and survey results suggest that, if translated into practice, the NICE guideline could do much to improve oral health for adults in care homes. The survey highlighted that 85% of residents required support from carers to undertake mouth care. It also found that care homes experienced significant difficulties in accessing dental services for residents. The author concludes that providers need to equip staff with the necessary knowledge and skills to undertake mouth care and to give this area of personal care greater priority. Finally, the author suggests that the Care Quality Commission could ensure that the NICE guideline is translated into practice in care homes.
Full Text Available The United Arab Emirates (UAE has experienced tremendous economic and industrial growth in the petroleum, airline, maritime and construction sectors, especially since the discovery of oil reserves. Mass recruitment of low skilled or unskilled laborers from less-developed countries has been utilized to satisfy the manpower demands of these fast paced industrial developments. Such workforce recruitment has created an unusual populace demographic, with the total UAE population estimated at 8.3 million, composed of 950,000 Emiratis, with the remainder being multinational expatriate workers, with varying educational qualifications, work experience, religious beliefs, cultural practices, and native languages. These unique characteristics pose a challenge for health and safety professionals tasked with ensuring the UAE workforce adheres to specific occupational health and safety procedures. The paper discusses two case studies that employ a novel multimedia approach to raising health and safety awareness among a multinational workforce.
Loney, Tom; Cooling, Robert Fletcher; Aw, Tar-Ching
The United Arab Emirates (UAE) has experienced tremendous economic and industrial growth in the petroleum, airline, maritime and construction sectors, especially since the discovery of oil reserves. Mass recruitment of low skilled or unskilled laborers from less-developed countries has been utilized to satisfy the manpower demands of these fast paced industrial developments. Such workforce recruitment has created an unusual populace demographic, with the total UAE population estimated at 8.3 million, composed of 950,000 Emiratis, with the remainder being multinational expatriate workers, with varying educational qualifications, work experience, religious beliefs, cultural practices, and native languages. These unique characteristics pose a challenge for health and safety professionals tasked with ensuring the UAE workforce adheres to specific occupational health and safety procedures. The paper discusses two case studies that employ a novel multimedia approach to raising health and safety awareness among a multinational workforce.
Full Text Available Abstract Background Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. Methods A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT, the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. Results Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. Conclusion Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains
Full Text Available Over the years, epidemiology has played a key role in improving our understanding about the determinants of health and disease. In the 19th century epidemiological observations led to the discovery of the modes of communication of cholera much before the discovery of the causative organism responsible for it. Similarly, in the 20th century, it led to the discovery of the risks of tobacco smoking, and the modes of transmission of AIDS. In the 21st century, advancement in the computation, visualization, communication, and mhealth technologies are likely to expand the landscape of epidemiology which has now acquired the status of a core discipline of health sciences.
Bosch-Capblanch, Xavier; Lavis, John N; Lewin, Simon; Atun, Rifat; Røttingen, John-Arne; Dröschel, Daniel; Beck, Lise; Abalos, Edgardo; El-Jardali, Fadi; Gilson, Lucy; Oliver, Sandy; Wyss, Kaspar; Tugwell, Peter; Kulier, Regina; Pang, Tikki; Haines, Andy
In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.
Intervention research in rural health disparities communities presents challenges for study design, implementation, and evaluation, thus threatening scientific rigor, reducing response rates, and confounding study results. A multisite nutrition intervention was conducted in the rural Lower Mississip...
van der Feltz-Cornelis CM
Full Text Available Christina M van der Feltz-Cornelis,1–3 Jim van Os,4,6 Susanne Knappe,5 Gunter Schumann,6 Eduard Vieta,7 Hans-Ulrich Wittchen,5 Shôn W Lewis,8 Iman Elfeddali,2,9 Kristian Wahlbeck,10,11 Donald Linszen,4 Carla Obradors-Tarragó,12,13 Josep Maria Haro12–141Trimbos Instituut, Utrecht, 2Tilburg University, Tranzo Department, Tilburg, 3GGz Breburg, Tilburg, 4Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Center, Maastricht, the Netherlands; 5Institute of Clinical Psychology and Psychotherapy and Center for Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; 6Institute of Psychiatry, King’s College London, London, UK; 7Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; 8School of Community-Based Medicine, University of Manchester, Manchester, UK; 9Department of Health Promotion/School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; 10The Nordic School of Public Health, Gothenburg, Sweden; 11National Institute for Health and Welfare, Helsinki, Finland; 12Centro de Investigación Biomédica en Red de Salud Mental, Madrid, 13Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, 14Universitat de Barcelona, Barcelona, SpainBackground: The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders.Methods: The research was conducted as an
Cruz, Evelyn; Guhleman, Patricia; Onheiber, Patrice Mocny
For at least 20 years, the probability that an infant born in Wisconsin would die during the first year of life has been approximately three times greater for infants born to African American women than for those born to White women. Over the same period of time, other states have made improvements in African American infant mortality, whereas Wisconsin's ranking has fallen to last place. Various state and local efforts have been made to address the issue; however, it is only in the last 2 to 3 years that Wisconsin's high rate of African American infant mortality has become an agreed-upon health priority. This article discusses the factors that have converged to bring African American infant mortality to the forefront of Wisconsin public health policy and programs. Particular attention is given to the role of Wisconsin's Minority Health Program in relation to public health leadership and coalition building. Key actions currently underway to implement effective, evidence-based solutions are also described.
Mirin, Steven; Summergrad, Paul
Objective: Regardless of the outcome of current efforts at healthcare reform, the resources that academic health centers need--to provide care for increasingly complex patient populations, support clinical innovation, grow the clinical enterprise, and carry out their research and teaching missions--are in jeopardy. This article examines the value…
Burns, L R
Integrated health systems are confronted with numerous dilemmas that must be managed. Many of these dilemmas are an inherent part of the system's structure, given that multiple competing hospitals, medical groups, and (sometimes) health plans are often under one organizational roof. This article presents an analysis of these dilemmas--referred to in the management literature as polarities--as they are found in six integrated health systems in Illinois. The nine polarities that must be managed include (1) hospital systems that want to be organizations of physicians; (2) system expansion by growing the physician component; (3) system centralization and physician decentralization; (4) centripetal and centrifugal forces involving physicians; (5) system objectives and physician interests; (6) system centralization and hospital decentralization; (7) primary care physicians and specialists; (8) physician autonomy via collectivization; and (9) vertical and virtual integration. The article identifies some of the solutions to the polarities that have been enacted by systems. In general, executives and physicians in integrated health systems must attend to the processes of integration as much as or more than the structures of integration.
era influenced much by the economic reforms and globalization. .... electronic databases. ... conducted using 'primary health care', 'economic development', .... America. 38 [30-48]. 0.5 [0.4-0.6]. 2.1 [1.8-2.6]. 18 [14-22]. South-east Asia.
Nitschke, I; Reiber, T
The dental services of the public health service (OGD) should not confine themselves to dental screening in kindergartens and schools but also turn their attention to the advancement of oral health in the special risk groups of the senior citizens. Although government resources are limited, new capacities could be gained by restructuring. Is it really prudent, in a lifetime perspective, for the OGD to solely focus on the oral health of youths while oral neglect in long-term care carries on unabated? A stronger support by the OGD of gerodontology should be instituted on its boards, publicised in health reports, and implemented in supervisory bodies for quality management of the long-term care facilities. An endorsement of the structures of long-term care insurance and training facilities would be desirable. The OGD could assist the fitter seniors through specific education to participate in dental prevention programmes and motivate physicians to inspect the oral cavity. Furthermore, recommendations regarding the structuring of geriatric dental care by the OGD would be helpful. The OGD is a vital partner to gerodontology. Therefore, further projects should be conducted in cooperation with dental organisations.
Weist, Mark D.; Mellin, Elizabeth A.; Chambers, Kerri L.; Lever, Nancy A.; Haber, Deborah; Blaber, Christine
Background: This article reviews challenges to collaboration in school mental health (SMH) and presents practical strategies for overcoming them. Methods: The importance of collaboration to the success of SMH programs is reviewed, with a particular focus on collaboration between school- and community-employed professionals. Challenges to effective…
Reid, R S
The UNICEF message to the pediatricians and child health experts attending the Regional Pediatric Congress of the Union of National Pediatric Societies of Turkish Republics is that the way children are conceptualized in the development process has a major impact on poverty. UNICEF argues that human resource development is the safest way out of population pressure, vanishing forests, and despoiled rivers. Thailand, South Korea, Taiwan, and Singapore are examples of countries that "sacrificed, deferred consumer gratification of the elites, and disciplined themselves" in order to provide better care for their children in terms of good nutrition, good health care, and rigorous primary and secondary education for all children. Family planning was available to all parents. The emphasis was on hygiene, immunization, clean water supplies, and sanitation. Lower infant and child mortality created confidence in child survival and parental willingness to have fewer children. The working population is healthier due to the state nutrition programs and a better skilled labor force due to education and training. These countries are no longer underdeveloped because of the priority on children for over a generation and a half. Robert Heilbroner has described this strategy for development as based on social development, human development, and protection of children aged under 5 years. The Alma Ata conference in 1976 was instrumental in focusing on the health of the child by setting a standard of health for all by the year 2000. Many countries are moving in the direction proposed in these agendas. The result has been a 33% reduction in child mortality within 10 years and greater immunization in some developing countries than in Europe and North America. Immunization rates in Ankara, Turkey; Calcutta, India; Lagos, Nigeria; and Mexico City are higher than in Washington, D.C. or New York City. The 1990 World Summit for Children found that the following rules are applicable to
Sharma, Anjali; Zodpey, Sanjay P
A competent and motivated health workforce is indispensable to achieve the best health outcomes possible through given available resources and circumstances. However, apart from the shortages and unequal distribution, the workforce has fallen short of responding to the public health challenges of 21 st century also because of primarily the traditional training of health professionals. Although, health professionals have made enormous contributions to health and development over the past century, the 20 th century educational strategies are unfit to tackle 21 st century challenges. One of the key recommendations of the Lancet Commission on Education of Health Professionals is to improve health through reforms of professional education by establishing networks and partnerships which takes advantage of information and communication linkages. The primary goal of this manuscript is to highlight the potential of networks and partnerships in advancing the agenda of educational reforms to revitalize public health education in India. It outlines the current status and expanding scope of public health education in India, existing networks of public health professionals and public health education institutions in the country, and opportunities, advantages and challenges for such networks. Although, we have networks of individuals and institutions in the country, there potential to bring about change has still not being utilized fully and effectively. Immediate collaborative efforts could be directed towards designing and adaptation of competency driven curriculum frameworks suitable of addressing public health challenges of 21 st century, shifting the current focus of curriculum to multidisciplinary public health outlook, developing accreditation mechanisms for both the programs and institutions, engaging in creating job opportunities and designing career pathways for public health professionals in public and private sector. These efforts could certainly be facilitated
GE Xinliang; YANG Jie; LI Feng; WANG Huahua
A robust face pose estimation approach is proposed by using face shape statistical model approach and pose parameters are represented by trigonometric functions. The face shape statistical model is firstly built by analyzing the face shapes from different people under varying poses. The shape alignment is vital in the process of building the statistical model. Then, six trigonometric functions are employed to represent the face pose parameters. Lastly, the mapping function is constructed between face image and face pose by linearly relating different parameters. The proposed approach is able to estimate different face poses using a few face training samples. Experimental results are provided to demonstrate its efficiency and accuracy.
The themes of citizen participation and citizenship have assumed great relevance in public policy in most countries of the world. In this article, after briefly summarizing the main stages of development of the concept of citizenship, the prominence of social participation as a practice of citizenship will be depicted. Next, the potential and limits of deliberative approaches established to promote new strategies of citizens' participation in health will be analyzed. The paper will then focus on critical aspects that contribute to reducing or hindering the exercise of citizenship rights, including: the issue of representation underpinning the citizen participation methods; the issue of the influence of participatory devices in decision-making processes; and the limited experience and interest in assessing the effectiveness of citizen participation in the health sector.
Pellegrini, V D
Escalating economic pressures on the clinical enterprise threaten the missions of education and research in many of the most prestigious academic health centers. Following the model of industry, mergers of the healthcare delivery systems of teaching hospitals and clinics held promise for economies of scale and an improved operating margin. Failure to follow business principles in constructing the merged entity, differences in organizational governance and culture, and inability of physician leadership to prioritize, downsize, and consolidate clinical programs to optimize operational efficiencies all compromise the success of such mergers in academic medicine. Academic institutions and their respective governing boards need to exercise greater discipline in financial analysis and a willingness to make difficult decisions that show favor to one parent institution over another if mergers are to be effective in this setting. To date, an example of a vibrant and successful merger of academic health centers remains to be found.
During the next decades, manned space missions are expected to be aiming at the Lagrange points, near Earth asteroids, and Mars flyby and/or landing. The question is therefore: Are we ready to go? To answer this with a yes, we are currently using the International Space Station to develop an integrated human physiological countermeasure suite. The integrated countermeasure suite will most likely encounter: 1) Exercise devices for aerobic, dynamic and resistive exercise training; 2) sensory-motor computer training programs and anti-motion sickness medication for preparing EVAs and G-transitions; 3) lower limb bracelets for preventing and/or treating the VIIP (vision impairment and intracranial pressure) syndrome; 4) nutritional components for maintenance of bone, muscle, the cardiovascular system and preventing oxidative stress and damage and immune deficiencies (e. g. omega-3 fatty acids, PRO/K, anti-oxidants and less salt and iron); 5) bisphosphonates for preventing bone degradation.; 6) lower body compression garment and oral salt and fluid loading for landing on a planetary surface to combat orthostatic intolerance; 7) laboratory analysis equipment for individualized monitoring of biomarkers in blood, urine and saliva for estimation of health status in; 8) advanced ultrasound techniques for monitoring bone and cardiovascular health; and 9) computer modeling programs for individual health status assessments of efficiency and subsequent adjustments of countermeasures. In particular for future missions into deep space, we are concerned with the synergistic effects of weightlessness, radiation, operational constraints and other spaceflight environmental factors. Therefore, increased collaboration between physiological, behavioral, radiation and space vehicle design disciplines are strongly warranted. Another venue we are exploring in NASA's Human Research Program is the usefulness of artificial gravity for mitigating the health risks of long duration weightlessness.
Anna Paldy; Janos Bobvos
In Hungary detailed research work has been carried out since several years to help the process of getting prepared and adapted to the impacts of climate change. The research activities concerned mainly the health impacts of heat waves (excess mortality). Based on the results of the time series statistical analysis of weather variables and daily mortality of Budapest, it was found that a 5º C increase of the daily mean temperature increases of the risk of all cause mort...
The growth of the Internet, mobile phones, social media and other digital technologies has changed our world in many ways. It has provided individuals with information that was previously only available to a select few. An example of the reach of technology is data that as of October 2012, there are over 6 billion phones worldwide (BBC, 2012). The availability of data in real time has presented hopes of intervening more efficiently and managing health problems by leveraging limited human reso...
Sun, Jing; Guo, Yutao; Wang, Xiaoning; Zeng, Qiang
The aging population with chronic and age-related diseases has become a global issue and exerted heavy burdens on the healthcare system and society. Neurological diseases are the leading chronic diseases in the geriatric population, and stroke is the leading cause of death in China. However, the uneven distribution of caregivers and critical healthcare workforce shortages are major obstacles to improving disease outcome. With the advancement of wearable health devices, cloud computing, mobile...
Aziz, Hafsa; Zia, Aadarash; Anwer, Amania; Aziz, Muneeba; Fatima, Shazia; Faheem, Muhammad
ZIKV has emerged as grave global health issue in the past few years. ZIKV was firstly isolated in 1947 from a rhesus sentinel monkey in the Zika forest in Uganda. It is usually transmitted by the bite of infected mosquitoes and infects skin fibroblasts, skin keratinocytes, etc. ZIKV until now was under reported because of its clinical similarity with the dengue and chikungunya. It is usually spread through the course of the sylvatic cycle. In this cycle, the virus or pathogen lifespan is spent between the wild animal and vectors. The intrinsic incubation period is not yet fully known but it is observed that the very first symptoms of ZIKV infection can appear or develop within 3-12 days of time period and usually subside within 7 days of time. There is a strong relationship between prenatal Zika virus infection and microcephaly; other serious brain anomalies to the infant or newborn are Guillain-Barré syndrome. To date no vaccines are available for ZIKV prevention hence only symptomatic treatment is recommended in infected patients. Usually ZIKV is detected by serologic (IgM ELISA), plaque reduction neutralization test (PRNT) along with in-house" molecular techniques (RT-PCR). ZIKV infection being imminent global health issue warrants strong protective measures to prevent it from becoming an epidemic. Early detection and prevention is the key to tackle this grave potential health hazard. J. Med. Virol. 89:943-951, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.
Connor, Jason P; Gullo, Matthew J; White, Angela; Kelly, Adrian B
Polysubstance use is common, particularly amongst some age groups and subcultures. It is also associated with elevated risk of psychiatric and physical health problems. We review the recent research findings, comment on changes to polysubstance diagnoses, report on contemporary clinical and epidemiological polysubstance trends, and examine the efficacy of preventive and treatment approaches. Approaches to describing polysubstance use profiles are becoming more sophisticated. Models over the last 18 months that employ latent class analysis typically report a no use or limited-range cluster (alcohol, tobacco and marijuana), a moderate-range cluster (limited range and amphetamine derivatives), and an extended-range cluster (moderate range, and nonmedical use of prescription drugs and other illicit drugs). Prevalence rates vary as a function of the population surveyed. Wide-ranging polysubstance users carry higher risk of comorbid psychopathology, health problems, and deficits in cognitive functioning. Wide-ranging polysubstance use is more prevalent in subcultures such as 'ravers' (dance club attendees) and those already dependent on substances. Health risks are elevated in these groups. Research into the prevention and treatment of polysubstance use is underdeveloped. There may be benefit in targeting specific polysubstance use and risk profiles in prevention and clinical research.
Okello, D O; Lubanga, R; Guwatudde, D; Sebina-Zziwa, A
This paper presents the results of a health facility survey conducted in Uganda between June 1992 and December 1993. The survey covered both government and non-government organisation (NGO) facilities from 10 districts in the five regions of the country. The main objective of the survey was to assess resource use, costs and financing of health facilities. The survey found differences between resource levels of NGOs and government facilities. Government facilities were inadequately maintained, and mostly in a state of disrepair. The user fee scheme that had been recently introduced in some government units to meet running costs was not only inadequate, but was not being used to meet the needs of consumers. In addition, most available resources, including human resources, were concentrated in hospitals. As a result, there was heavy demand for hospital services and less use of services in the lower level facilities. And furthermore, staff in government facilities were paid much less than staff working for NGOs, who not only got better pay but also in-kind forms of rewards, which made them better motivated to work. The number of qualified staff, particularly for primary health care, was grossly inadequate, and most of the work in local facilities was being done by unqualified employees, such as ward maids and dressers. In order to alleviate some of the problems identified, particularly in government facilities, there is a need to explore ways in which more can be done with the available resources to improve the efficiency of health services. The user charge system could be effective in improving the resource base of the health facilities, but it must result in visible improvement in the quality of services for consumers to be willing to pay. Collection methods should be standardised, and expenditures supervised. As part of the government's decentralisation programme, districts should be given the power to recruit and fire personnel. Once this authority is in place, the
Full Text Available Three-dimensional (3D face models can intrinsically handle large pose face recognition problem. In this paper, we propose a novel pose-invariant face recognition method via RGB-D images. By employing depth, our method is able to handle self-occlusion and deformation, both of which are challenging problems in two-dimensional (2D face recognition. Texture images in the gallery can be rendered to the same view as the probe via depth. Meanwhile, depth is also used for similarity measure via frontalization and symmetric filling. Finally, both texture and depth contribute to the final identity estimation. Experiments on Bosphorus, CurtinFaces, Eurecom, and Kiwi databases demonstrate that the additional depth information has improved the performance of face recognition with large pose variations and under even more challenging conditions.
Hu, Yuanan; Cheng, Hefa; Tao, Shu
Driven by the growing demand for food products of animal origin, industrial livestock and poultry production has become increasingly popular and is on the track of becoming an important source of environmental pollution in China. Although concentrated animal feeding operations (CAFOs) have higher production efficiency and profitability with less resource consumption compared to the traditional family-based and "free range" farming, they bring significant environmental pollution concerns and pose public health risks. Gaseous pollutants and bioaerosols are emitted directly from CAFOs, which have health implications on animal producers and neighboring communities. A range of pollutants are excreted with the animal waste, including nutrients, pathogens, natural and synthetic hormones, veterinary antimicrobials, and heavy metals, which can enter local farmland soils, surface water, and groundwater, during the storage and disposal of animal waste, and pose direct and indirect human health risks. The extensive use of antimicrobials in CAFOs also contributes to the global public health concern of antimicrobial resistance (AMR). Efforts on treating the large volumes of manure generated in CAFOs should be enhanced (e.g., by biogas digesters and integrated farm systems) to minimize their impacts on the environment and human health. Furthermore, the use of veterinary drugs and feed additives in industrial livestock and poultry farming should be controlled, which will not only make the animal food products much safer to the consumers, but also render the manure more benign for treatment and disposal on farmlands. While improving the sustainability of animal farming, China also needs to promote healthy food consumption, which not only improves public health from avoiding high-meat diets, but also slows down the expansion of industrial animal farming, and thus reduces the associated environmental and public health risks. Copyright © 2017 Elsevier Ltd. All rights reserved.
Day Michael J
Full Text Available Abstract 'One Health' proposes the unification of medical and veterinary sciences with the establishment of collaborative ventures in clinical care, surveillance and control of cross-species disease, education, and research into disease pathogenesis, diagnosis, therapy and vaccination. The concept encompasses the human population, domestic animals and wildlife, and the impact that environmental changes ('environmental health' such as global warming will have on these populations. Visceral leishmaniasis is a perfect example of a small companion animal disease for which prevention and control might abolish or decrease the suffering of canine and human patients, and which aligns well with the One Health approach. In this review we discuss how surveillance for leishmaniases is undertaken globally through the control of anthroponootic visceral leishmaniasis (AVL and zoonotic visceral leishmaniasis (ZVL. The ZVL epidemic has been managed to date by the culling of infected dogs, treatment of human cases and control of the sandfly vector by insecticidal treatment of human homes and the canine reservoir. Recently, preventive vaccination of dogs in Brazil has led to reduction in the incidence of the canine and human disease. Vaccination permits greater dog owner compliance with control measures than a culling programme. Another advance in disease control in Africa is provided by a surveillance programme that combines remote satellite sensing, ecological modelling, vector surveillance and geo-spatial mapping of the distribution of vectors and of the animal-to-animal or animal-to-human pathogen transmission. This coordinated programme generates advisory notices and alerts on emerging infectious disease outbreaks that may impede or avoid the spreading of visceral leishmaniasis to new areas of the planet as a consequence of global warming.
Nagaraja, Sharath Burugina; Menezes, Ritesh G; Zachariah, Rony; Wilson, Nevin
There is increasing impetus, interest and opportunity for people working in public health programmes in India to carry out operational research (OR) around relevant programme issues and then publish that in peer-reviewed publications. These published researches are valuable in analysing, documenting and advocating for locally generated evidence to inform policy and practice. Ethics review and approval is an essential step in the process of OR but is often viewed as a barrier rather than a prerequisite of good practice in OR. Journals and peer reviewers are also increasingly requiring approvals from local institutional ethics committees (IECs).
DeMairo, Pauline; Dischell, Jackie; Jouthe, Sorahya A.; Horner, Andrea
The Teen Outreach Reproductive CHallenge (TORCH) is a peer education program that provides information on various topics relevant to adolescent sexual health to a diverse audience, ranging from teens to health care providers. This information is disseminated through various projects by a group of New York City high-school students who are…
Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard
Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level). PMID:25215910
Full Text Available Background: Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective: This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design: A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results: The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions: One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level.
de Jong, J.T.V.M.
This article addresses four major challenges for efforts to create synergy between the global mental health movement and cultural psychiatry. First, although they appear to share domains of mutual interest, the worlds of global mental health and cultural psychiatry have distinct lineages. Expanding
Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard
Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).
DeMairo, Pauline; Dischell, Jackie; Jouthe, Sorahya A.; Horner, Andrea
The Teen Outreach Reproductive CHallenge (TORCH) is a peer education program that provides information on various topics relevant to adolescent sexual health to a diverse audience, ranging from teens to health care providers. This information is disseminated through various projects by a group of New York City high-school students who are…
Grammens, Tine; Maes, Virginie; Hutse, Veronik; Laisnez, Valeska; Schirvel, Carole; Trémérie, Jean Marie; Sabbe, Martine
During the first half of 2016, several outbreaks of measles were reported in the three regions of Belgium. Main challenges for public health were severe complications occurring in adults, nosocomial transmission and infection in healthcare workers. Here, we describe those outbreaks and lessons learnt for public health.
Babiski, Laura; And Others
The Boarding Home Support Program for adults with mental health problems uses health promotion mechanisms of self-care, mutual aid, and healthy environments. The program is challenged by increased numbers of persons served, substandard homes, and conflicts between tenant and operator needs and between individual and group tenant needs. (SK)
Stimpson, Jim P; Li, Tao; Shiyanbola, Oyewale O; Jacobson, Janelle J
Academic health centers (AHCs) play a vital role in the health care system. The training of health care personnel and delivery of health care services, especially to the most complex and financially challenged patients, has been a responsibility increasingly shouldered by AHCs over the years. Additionally, AHCs play a significant role in researching and developing new treatment protocols, including discovering and validating new health technologies. However, AHCs face unique financial challenges in fulfilling their social mission in the health care system. Reforms being implemented under the Affordable Care Act and shifting economic patterns are threatening the financial sustainability of AHCs.The authors review challenges facing AHCs, including training new health care professionals with fewer funding resources, disproportionate clinical care of complex and costly patients, charity care to uninsured and underinsured, and reduced research funding opportunities. Then, they provide a review of some potential solutions to these challenges, including new reimbursement methods, improvements in operational efficiency, price regulation, subsidization of education, improved decision making and communication, utilization of industrial management tools, and increasing internal and external cooperation. Devising solutions to the evolving problems of AHCs is crucial to improving health care delivery in the United States. Most likely, a combination of market, government, and system reforms will be needed to improve the viability of AHCs and assist them in fulfilling their social and organizational missions.
Full Text Available BACKGROUND: Many former Soviet Union (fSU countries face a high burden of disease and a much lower life expectancy compared to western countries. Many of the underlying causes are amenable to public health interventions, but the prevailing Soviet approach to prevention has largely failed to address the new and more complex public health issues these countries face. This study looks at public health challenges in Ukraine, in particular at those related to public health education. METHODS: The research is based on a small-scale, qualitative analysis of information collected through i review of literature related to public health and public health education in the former Soviet Union and Ukraine, as well as curricula and training material for epidemiology students in Ukrainian medical schools, ii observations during workshops for epidemiology students and teachers from Ukrainian medical schools and iii semi-structured interviews with epidemiology students and teachers from Ukrainian medical schools. The collected data was interpreted using the method of thematic discourse analysis, which allowed identifying major areas challenging public health education in the country. RESULTS: The main challenges identified were seen in the outdated conceptual understanding of public health, particularly in epidemiology. These challenges underlie further problems including limited hours and narrow content of epidemiology training, lack of training in research skills, inadequate training material and conservative attitudes among teachers and students towards prevailing ideas and development. DISCUSSION AND CONCLUSION: There is urgent need for a wider definition of public health, moving towards the “New Public Health” approach and subsequently a series of changes to education curricula and materials. Curricula reform should provide additional hours for covering non-communicable diseases, non-medical topics such as health policy and health promotion and ensure
Udonwa, N E
The issue of human capital flight has been discussed at different forums with a consensus opinion that it has its merits and demerits to equitable health system. Most often one nation becomes a substantial net exporter of talent, leaving the provider nation at risk of depleting its natural supply of talent. This paper looks into the historical perspective of human capital flight or "brain drain", and its burden. It attempts to elucidate the various causes and suggested solutions. The paper's objective is to educate colleagues on the conceptual and contextual imperatives of the issue. Using a convenient sample of key informants who were medical colleagues in Nigeria relevant information was sourced from these colleagues, documents from the postgraduate medical college of Nigeria and the internet on maters relating to human capital flight and brain drain. Every year, thousands of qualified doctors, and other professionals leave Nigeria tempted by significantly higher wages, brighter prospects for employment and education, stability, food security. It appears that the potential exposure to different working conditions, resources and professional environments can be of advantage to the country, should Nigeria be able to recall these professionals. It also appears that necessary economic reforms that make staying at home rewarding, that is--good leadership, and policy planning that seriously looks into rural development, among other issues, are keys ingredients to reversing the trend in order to ensure a more equitable health system.
Castellano, José M; Narula, Jagat; Castillo, Javier; Fuster, Valentín
Cardiovascular disease is the leading cause of death in the world, affecting not only industrialized but, above all, low- and middle-income countries, where it has overtaken infectious diseases as the first cause of death and its impact threatens social and economic development. The increased prevalence of cardiovascular disease in recent years together with projected mortality for the coming decades constitute an irrefutable argument for the urgent implementation of well-planned interventions to control the pandemic of cardiovascular diseases, especially in the more economically deprived countries. The combination of behavioral, social, environmental, and biological factors, and others related to health care systems, that contribute to the development of cardiovascular diseases requires a multi-sector strategy that promotes a healthy lifestyle, reduces cardiovascular risk factors, and cuts mortality and morbidity through quality health care services. These proposals should be guided by leaders in the scientific community, government, civil society, private sector, and local communities. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.
Pagani, Victoria; Kivits, Joëlle; Minary, Laetitia; Cambon, Linda; Claudot, Frédérique; Alla, François
Introduction: Since 2000, the notion of “complex interventions” has been emerging in the health research field. “Complex interventions” and “complexity” are commonly used terms, but they are generally not defined. Conceptual ambiguities persist concerning the notion of complexity. The objective of this exploratory review is to characterize the notion of complexity: What is complexity? Where does this notion come from and what does it cover? What are the consequences of complexity in the health field?Methods: To clarify the concept of complexity, a narrative review was conducted in the fields of humanities and social science, managerial economics, psychology and healthcare.Results: The concept of complexity, that can be attributed to Edgar Morin, has been the subject of appropriations, adaptations, and operations in multiple areas. Complexity consists of understanding the factors influencing individual decisions. In the field of healthcare, the concept of complexity is used more pragmatically and is defined by objective characteristics of interventions (defined as complex) or their contexts for the practical purposes of evaluation.Discussion: The notions of complexity and complex interventions have implications for researchers and users of the results of research. In particular, the notion of complexity is designed to provide a better understanding of the mechanism of effectiveness of interventions, support transferability and use by actors and decision-makers.
Fihl, Preben; Cosar, Serhan
people is a very challenging problem for methods based on pictorials structure as for any other monocular pose estimation method. In this report we present work on a multi-view approach based on pictorial structures that integrate low level information from multiple calibrated cameras to improve the 2D...
Full Text Available In addition to the researchers, referees have important roles for publishing a valuable scholarly paper. A scientific work is evaluated in different phases from the beginning till it is published. In each of these phases, unpleasant experiences may happen for researchers and referees. Researchers as the producers of scientific papers experience research anxiety, library anxiety, information seeking anxiety, and referee anxiety. On the other hand, referees experience referees’ anxiety. So it is very important to recognize the effective factors causing anxiety and try to eliminate these problems. As the research area is very broad, all these mentioned concepts are parts of the research process. But one of the most critical stages of research is the review of scientific works particularly in the field of health. “The selection of the referee is the most important decision that the editors make about a scientific work” (1. Referee selection is very important in the area of health because the results of these researches have direct or indirect effects on public health (2. If the facilities are not properly provided for referees, many problems may occur including anxiety referee. Findings of Von Glinow and Novelli showed that there was an unpleasant sense for referees when they feel particular biases from the editor (3. Weller also states that there is an unpleasant sensation if the authors identify their referees (4. Other factors that cause anxiety during the referee process are: receiving several papers to review (5, selecting an inappropriate referee for a paper by the editor (6, lack of clear guidelines and standards of review (4, young and inexperienced referees and inappropriate behavior of journal staff and research centers, lack of scientific knowledge of the referee, and lack of enough ability for the referee to reject the article, all causing unpleasant feelings. In a simple definition, referee anxiety includes any discomfort of
Mezencev, R; Klement, C
Human foodborne botulism is an intoxication caused by ingestion of botulinum neurotoxins (BoNT) of serotypes A, B, E, and rarely also serotype F, produced in contaminated food by anaerobic bacteria Clostridium botulinum group I, group II, or by toxigenic strains of C. butyricum and C. baratii. BoNT-producing Clostridia are ubiquitously distributed in the environment and, under suitable conditions, they can enter the food chain, proliferate and produce BoNT in a variety of foods. In the past, the risk of foodborne botulism was primarily associated with homemade canned foods; however, the epidemiological importance of commercial and restaurant food is increasing nowadays. In this article, we review the public health aspects of foodborne botulism, including its clinical, epidemiological and laboratory diagnosis and discuss potential risks associated with minimally heated, vacuum or modified atmosphere-packed, ready-to-eat foods of extended durability.
Pop Cristiana Lucretia
Full Text Available Purpose: This essay aims to signal up the detrimental effects of sedentary behaviours determined by extensive use of technology. Material: The paper is a survey of the most relevant data related to physical inactivity consequences with a specific reference to the Eastern Europe countries. Results . There is no doubt that children and young people will prefer the technology and its commodities, but they need to be encouraged to practice exercise, to control their posture and weight. Physical activity favorably influences on mental health and reduces the incidence and severity of diseases and pathological conditions, such as cardiovascular disease, type II diabetes, osteoarthritis, osteoporosis and obesity. Conclusions . Promoting physical activity as a healthy life style component in schools and in universities targets the enhancement of vigour, resilience, employement and social outcomes for graduates and comunities.
Kerr, Michael S; Mustard, Cam
There is significant personal injury risk associated with the provision of high-quality healthcare. The magnitude of this risk, combined with the possibility that it can often go underappreciated by caregivers and the organizations they work for, might help explain why the health sector has largely missed out on the benefits of an overall declining trend in injury rates. Despite covering two very different topics in their lead papers, Shamian and El-Jardali and Clements, Dault and Priest present a surprising degree of overlap in relation to what might help enable effective workplace change. Leadership, role clarity, trust, respect, values and workplace culture are all viewed as key enablers of effective teamwork by Clements, Dault and Priest. They could also be considered required ingredients of successful workplace health initiatives, as discussed by Shamian and El-Jardali. A lot of background and positional work regarding teamwork and healthy workplaces exists, but this has not necessarily translated into front-line change. These authors have done an excellent job of pointing out the potential benefits of workplace changes. What is needed now is for someone to take the lead in developing, implementing and evaluating these changes. The adult human form is an awkward burden to lift or carry. Weighing up to 200 pounds or more, it has no handles, it is not rigid, and it is susceptible to severe damage if mishandled or dropped. When lying in bed, a patient is placed inconveniently for lifting and the weight and placement of such a load would be tolerated by few industrial workers.
Full Text Available OBJECTIVE: To critically discuss, describe and analyze the data on infant mortality provided by public health services of Cabinda, Angola. METHOD: The deaths of children aged less than one year old in 2007 and 2008 were analyzed in the Cabinda province. Provincial hospital records and those of the WHO office were used due to the limited quality and availability of official information. RESULTS: In 2007, 11,734 children were born, and 366 of them died in their first year of life: 113 on the first day, 87 by the 28th day and 166 in the remaining 337 days. In 2008, 13,441 children were born and 275 died; 109 died on the first day and 69 by the 28th day. Malaria was the main cause of death (one out of three. Pneumonia was the second cause in 2007 and the third in 2008, presenting consistent reduction, from 65 to 40 deaths. Cases of diarrhea from 2007 (9.83% decreased to 3.27% in 2008. Tetanus accounted for about 5% of all deaths. Perinatal causes increased in proportion, particularly neonatal asphyxia (17.75% in 2007 and 26.90% in 2008 and prematurity (13.38% in 2007 and 17.45% in 2008. CONCLUSIONS: Improvements in the quality of prenatal care, attendance during delivery and to new born risk, would reduce infant mortality. The lack of sanitation, inadequate water supply and poor access to health services played an important role as determinants of infant mortality observed in Cabinda. This study highlights the need to reorganize the civil registration system.
Full Text Available In Hungary detailed research work has been carried out since several years to help the process of getting prepared and adapted to the impacts of climate change. The research activities concerned mainly the health impacts of heat waves (excess mortality. Based on the results of the time series statistical analysis of weather variables and daily mortality of Budapest, it was found that a 5º C increase of the daily mean temperature increases of the risk of all cause mortality by 10%; and the risk of death due to cardio-vascular diseases by 12%. The frequency of heat waves has been increasing since the nineties. The most extreme heat wave hit the country in 2007 with an excess mortality around 1100 cases. A three level heat health warning system was launched in 2005 as an action to support adaptation. A significant association was found between global radiation and the increase of melanoma cases. The incidence of melanoma morbidity increased between 2003– 2008, the number of new cases changed from 1854 to 2610. The data of the previous years support that there is an increasing risk of vector borne diseases, as the continuous increase of the incidence of Lyme diseases (15% per year showed it. Although tick-borne encephalitis is present in the country, the incidence of the disease does not show a strong correlation with climate variability. Diseases like West Nile virus and Hanta virus infection appeared and showed an increasing tendency. The vector of Leishmaniasis also appeared in Hungary. Another consequence of climate change is the temporal and spatial change of allergenic plant species. New, invasive plants will appear, the length of pollination has been increasing.
Simiyu, Ken; Masum, Hassan; Chakma, Justin; Singer, Peter A
A traditional pathway for developing new health products begins with public research institutes generating new knowledge, and ends with the private sector translating this knowledge into new ventures. But while public research institutes are key drivers of basic research in sub-Saharan Africa, the private sector is inadequately prepared to commercialize ideas that emerge from these institutes, resulting in these institutes taking on the role of product development themselves to alleviate the local disease burden. In this article, the case study method is used to analyze the experience of one such public research institute: the Kenya Medical Research Institute (KEMRI). Our analysis indicates that KEMRI's product development efforts began modestly, and a manufacturing facility was constructed with a strategy for the facility's product output which was not very successful. The intended products, HIV and Hepatitis B diagnostic kits, had a short product life cycle, and an abrupt change in regulatory requirements left KEMRI with an inactive facility. These problems were the result of poor innovation management capacity, variability in domestic markets, lack of capital to scale up technologies, and an institutional culture that lacked innovation as a priority.However, KEMRI appears to have adapted by diversifying its product line to mitigate risk and ensure continued use of its manufacturing facility. It adopted an open innovation business model which linked it with investors, research partnerships, licensing opportunities, and revenue from contract manufacturing. Other activities that KEMRI has put in place over several years to enhance product development include the establishment of a marketing division, development of an institutional IP policy, and training of its scientists on innovation management. KEMRI faced many challenges in its attempt at health product development, including shifting markets, lack of infrastructure, inadequate financing, and weak human
Full Text Available Abstract Background A traditional pathway for developing new health products begins with public research institutes generating new knowledge, and ends with the private sector translating this knowledge into new ventures. But while public research institutes are key drivers of basic research in sub-Saharan Africa, the private sector is inadequately prepared to commercialize ideas that emerge from these institutes, resulting in these institutes taking on the role of product development themselves to alleviate the local disease burden. In this article, the case study method is used to analyze the experience of one such public research institute: the Kenya Medical Research Institute (KEMRI. Discussion Our analysis indicates that KEMRI’s product development efforts began modestly, and a manufacturing facility was constructed with a strategy for the facility’s product output which was not very successful. The intended products, HIV and Hepatitis B diagnostic kits, had a short product life cycle, and an abrupt change in regulatory requirements left KEMRI with an inactive facility. These problems were the result of poor innovation management capacity, variability in domestic markets, lack of capital to scale up technologies, and an institutional culture that lacked innovation as a priority. However, KEMRI appears to have adapted by diversifying its product line to mitigate risk and ensure continued use of its manufacturing facility. It adopted an open innovation business model which linked it with investors, research partnerships, licensing opportunities, and revenue from contract manufacturing. Other activities that KEMRI has put in place over several years to enhance product development include the establishment of a marketing division, development of an institutional IP policy, and training of its scientists on innovation management. Summary KEMRI faced many challenges in its attempt at health product development, including shifting markets, lack
Palazuelos, Daniel; Dhillon, Ranu
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.
Shidhaye, Rahul; Raja, Anusha; Shrivastava, Sanjay; Murhar, Vaibhav; Ramaswamy, Rohit; Patel, Vikram
The proportion of individuals with mental disorders receiving evidence based treatments in India is very small. In order to address this huge treatment gap, programme for improving mental health care is being implemented in Sehore district of Madhya Pradesh, India. The aim of this study was to complete the situational analysis consisting of two parts; document review of Sehore district mental health programme followed by a qualitative study. The findings suggest that there are major health system challenges in developing and implementing the mental health care plan to be delivered through primary health care system in Sehore district.
The way that an economist and an animal health professional use economics differs and creates frustrations. The economist is in search of optimizing resource allocation in the management of animal health and disease problems with metrics associated with the productivity of key societal resources of labour and capital. The animal health professional have a strong belief that productivity can be improved with the removal of pathogens. These differences restrict how well economics is used in animal health, and the question posed is whether this matters. The paper explores the question by looking at the changing role of animals in society and the associated change of the animal health professional's activities. It then questions if the current allocation of scarce resources for animal health are adequately allocated for societies and whether currently available data are sufficient for good allocation. A rapid review of the data on disease impacts - production losses and costs of human reaction - indicate that the data are sparse collected in different times and geographical regions. This limits what can be understood on the productivity of the economic resources used for animal health and this needs to be addressed with more systematic collection of data on disease losses and costs of animal health systems. Ideally such a process should learn lessons from the way that human health has made estimates of the burden of diseases and their capture of data on the costs of human health systems. Once available data on the global burden of animal diseases and the costs of animal health systems would allow assessments of individual disease management processes and the productivity of wider productivity change. This utopia should be aimed at if animal health is to continue to attract and maintain adequate resources. Copyright © 2016 Elsevier B.V. All rights reserved.
In recent decades, both public health professionals and the populations targeted by prevention and health promotion programs have shown an increasing interest in ethical issues since some interventions have been seen as impinging on fundamental rights and values. Insofar as bioethics is not adapted to population interventions and community health issues, a specific expertise in public health ethics is now required. However, ethical expertise in this area faces many challenges. The purpose of this paper is to examine four of these challenges. The first three challenges concern professional or specialist expertise. The paper suggests that expertise in public health ethics should go beyond the search for greater sophistication in defining ethical principles. Experts in public health ethics also need to identify appropriate strategies to include public health professionals in ethical analysis and to adopt a critical and reflexive approach to the status of moral experts and moral expertise. However, the main challenge is to identify appropriate ways of reconciling lay and specialist ethical expertise. The paper argues that secular morality and common morality represent two key sources of lay ethics expertise and that the fundamental values that inform discourse ethics should be derived from both forms of expertise.
Wang, Chao; Song, Xubo
Head poses can be automatically estimated using manifold learning algorithms, with the assumption that with the pose being the only variable, the face images should lie in a smooth and low-dimensional manifold. However, this estimation approach is challenging due to other appearance variations related to identity, head location in image, background clutter, facial expression, and illumination. To address the problem, we propose to incorporate supervised information (pose angles of training samples) into the process of manifold learning. The process has three stages: neighborhood construction, graph weight computation and projection learning. For the first two stages, we redefine inter-point distance for neighborhood construction as well as graph weight by constraining them with the pose angle information. For Stage 3, we present a supervised neighborhood-based linear feature transformation algorithm to keep the data points with similar pose angles close together but the data points with dissimilar pose angles far apart. The experimental results show that our method has higher estimation accuracy than the other state-of-art algorithms and is robust to identity and illumination variations.
Fakhir, M. M.; Woo, W. L.; Chambers, J. A.; Dlay, S. S.
Variance pose is an important research topic in face recognition. The alteration of distance parameters across variance pose face features is a challenging. We provide a solution for this problem using perspective projection for variance pose face recognition. Our method infers intrinsic camera parameters of the image which enable the projection of the image plane into 3D. After this, face box tracking and centre of eyes detection can be identified using our novel technique to verify the virtual face feature measurements. The coordinate system of the perspective projection for face tracking allows the holistic dimensions for the face to be fixed in different orientations. The training of frontal images and the rest of the poses on FERET database determine the distance from the centre of eyes to the corner of box face. The recognition system compares the gallery of images against different poses. The system initially utilises information on position of both eyes then focuses principally on closest eye in order to gather data with greater reliability. Differentiation between the distances and position of the right and left eyes is a unique feature of our work with our algorithm outperforming other state of the art algorithms thus enabling stable measurement in variance pose for each individual.
Fagerström, Lisbeth; Salmela, Susanne
The aim of the present study was to describe personnel's attitudes to change processes between a regional hospital and the primary health care centre as well as investigate these results with regards to theories pertaining to change and leading change. Leadership has three crucial dimensions: focusing on personnel, results/key processes and the ethical base of activities. A survey was conducted in 2003 using a comprehensive questionnaire. The total sample consisted of the personnel (n = 899) at the two organizations (answering rate was 68.8%). The data were analysed descriptively. Approximately two-thirds of the respondents understood why the merger was occurring. Only one-third expressed that they had received sufficient information regarding the merger. In total 67% felt that the merger would create conflict while approximately one-fourth expressed uncertainty. Despite such negative responses, approximately two-thirds felt there were advantages to the merger. Significant differences were seen between the groups. In times of change personnel expect leaders to focus on dialogue with their personnel and to anchor the vision of the change process amongst the personnel. By identifying the 'prison of thought' and creating an atmosphere where reflection and discussion are valued the nurse leader can help prevent resistance to change.
Young, M F; Martorell, R
Recent recognition of the early onset and high prevalence of wasting (30%) and stunting (20%) among infants 0-5 months in India draws attention to the need to understand the causes and develop prevention strategies. Such growth failure has dire consequences in the short (increased mortality) and long-term (loss of human capital and increased risk of chronic diseases). Food interventions before 6 months will increase morbidity/mortality through contamination in settings of poor sanitation and hygiene. Waiting to improve nutrition only after the initiation of complementary feeding at 6 months is a missed opportunity and may permanently alter life trajectory and potential. This underscores the importance of maternal nutrition. Iron and folic acid and protein energy supplementation during pregnancy are interventions that can improve maternal nutrition and birth outcomes. Maternal supplementation during lactation should be considered as a means to improve maternal and child outcomes, although the evidence needs strengthening. Support and counseling are also required to improve maternal diets and promote exclusive breastfeeding. Programs focused on improving maternal nutrition across the continuum of preconception, pregnancy and lactation are likely to have the greatest impact as mothers are central gatekeepers to the health and future of their children.
Recognition for the growing role of extra-academic demands and players in the dynamics of human resource training for the market and, in particular, for research is discussed. Their synergies with the movement towards maturation of the sectoral system of healthcare innovation and with the priorities of the Sistema Único de Saúde (Brazilian National Health System) are discussed. The methodological adequacy of the process for evaluating these trends used by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination Office for Advancement of University-level Personnel) is analyzed. In a general manner, these trends mean adding new indicators for technological and social productivity to the predominantly academic criteria that already exist. The continuation and deepening of ongoing initiatives aimed at bringing in new formats for postgraduate programs and courses and new courses customized for the demands of the extra-academic market, among other markets, either of a social or technological-business nature, are discussed. In addition, the deepening of initiatives for stimulating postdoctoral training work, which is scarce in Brazil, is discussed.
Full Text Available Abstract Background The implementation of the 58th World Health Assembly resolution on e-health will pose a major challenge for the Member States of the World Health Organization (WHO African Region due to lack of information and communications technology (ICT and mass Internet connectivity, compounded by a paucity of ICT-related knowledge and skills. The key objectives of this article are to: (i explore the key determinants of personal computers (PCs, telephone mainline and cellular and Internet penetration/connectivity in the African Region; and (ii to propose actions needed to create an enabling environment for e-health services growth and utilization in the Region. Methods The effects of school enrolment, per capita income and governance variables on the number of PCs, telephone mainlines, cellular phone subscribers and Internet users were estimated using a double-log regression model and cross-sectional data on various Member States in the African Region. The analysis was based on 45 of the 46 countries that comprise the Region. The data were obtained from the United Nations Development Programme (UNDP, the World Bank and the International Telecommunications Union (ITU sources. Results There were a number of main findings: (i the adult literacy and total number of Internet users had a statistically significant (at 5% level in a t-distribution test positive effect on the number of PCs in a country; (ii the combined school enrolment rate and per capita income had a statistically significant direct effect on the number of telephone mainlines and cellular telephone subscribers; (iii the regulatory quality had statistically significant negative effect on the number of telephone mainlines; (iv similarly, the combined school enrolment ratio and the number of telephone mainlines had a statistically significant positive relationship with Internet usage; and (v there were major inequalities in ICT connectivity between upper-middle, lower-middle and
Caroli, S. [Istituto Superiore di Sanita' , Rome (Italy). Lab. di Tossicologia Applicata; Menditto, A. [Istituto Superiore di Sanita' , Rome (Italy). Lab. di Biochimica Clinica
In the frame of the bilateral governmental programme for scientific and technical cooperation existing between Italy and Hungary a successful series of biennial Symposia were undertaken since the early 1980s. These were designed to provide scientists of both countries with a permanent forum for the evaluation of ongoing joint projects, the exchange of views on future priorities dealt with by these Symposia always made the participation of prominent scientists from other countries a necessary complement substantially enhancing the international characteristics of such events. Each Symposium features a specific theme of primary importance within the general context of human health and environmental protection. In this respect, the ninth edition of this series of Symposia focuses on the major concerns raised by chemical pollution on all aspects of urban life. More than one half of the world population lives today in big cities, with all the attendant problems as regards air, water and soil quality, safe disposal of urban waste, occupational exposure, in one word, the physical, mental and cultural welfare of citizens at large. All facets concurring to protect and maintain urban health will be thus taken into consideration and highlighted in about forty invited lectures, while posters will be displayed in a permanent session throughout the conference duration. [Italian] Nel quadro degli accordi bilaterali di collaborazione tecnica e scientifica vigenti tra Italia ed Ungheria e' stata intrapresa con successo sin dall'inizio degli anni '80 una serie di simposi a cadenza biennale. Tali manifestazioni hanno lo scopo di fornire agli studiosi di entrambi i paesi un forum permanente per la valutazione dell'andamento dei progetti comuni di ricerca, lo scambio di idee sulle priorita' future e la proposta di nuove iniziative. D'altro canto, la natura sovranazionale dei problemi oggetto di questi simposi ha reso anche necessaria la presenza di
Mustafa, Mybera; Berisha, Merita; Lenjani, Basri
Before its collapse, Kosovo's healthcare system was an integrated part of the Former Yugoslav Republics System (known as relatively well advanced for its time). Standstill had begun in the last decade of the twentieth century as the result of political disintegration of the former state. The enthusiasm of the healthcare professionals and the people of Kosovo that at the end of the conflict healthcare services will consolidate did not prove just right. Although we can claim that reorganization of Kosovo healthcare was a serious push (especially in the first years after the conflict), the intensity of development begun to fall at the latter stages. Although the basic legislation for the operation of the Healthcare System today in Kosovo does exist, the largest cause for the reform stagnation is where the law is not implemented properly and measures are not set as to a meaningful system of accountability. Twelve years have passed by since the 1999 war-conflict and, although, Kosovo has made progress in many other spheres, it has not yet reached to consolidate a health system comparable to those of other European countries. Intending to get out of difficult situation, several healthcare strategic plans have been developed in the past decade in Kosovo, but attempts in this direction have not been particularly fruitful. This script describes the actual Healthcare complexity of a situation in Kosovo 12 years after the end of the 1999 war-conflict. Interconnection and historical background is also looked upon and is described in the flow of events. Finally, the description of transfer competencies from international administrators to the local authorities as well as the flow of strategic planning that took place since 1999 has also been analyzed.
Renee Yuen-Jan Hsia
Full Text Available Globally, 90% of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden, with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala, Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. This data was collected when patients were seen initially and included patient condition, demographics, clinical variables, cause, severity, as measured by the Kampala trauma score, and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005, 872 injury visits for children <18 years old were recorded. The mean age was 11 years (95% CI 10.9–11.6; 68% (95% CI 65–72% were males; 64% were treated in casualty and discharged; 35% were admitted. The most common causes were traffic crashes (34%, falls (18% and violence (15%. Most children (87% were mildly injured; 1% severely injured. By two weeks, 6% of the patients admitted for injuries had died and, of these morbidities, 16% had severe injuries, 63% had moderate injuries and 21% had mild injuries. We concluded that, in Kampala, children bear a large burden of injury from preventable causes. Deaths in low severity patients highlight the need for improvements in facility-based care. Further studies are necessary to capture overall child injury mortality and to measure chronic morbidity owing to sequelae of injuries.
Full Text Available
In recent years, the results of the Human Genome Project have lead to huge expectations relating to the rapid implementation of its results in the field of prevention.The possibility to provide early detection for those individuals more susceptible to complex diseases, because of their genetic make-up, might theoretically result in individualized primary (e.g., chemoprevention and secondary prevention (e.g., assiduous monitoring programs.
The issue of an individuals inherited susceptibility to develop complex diseases, however, is much more complicated than it first appears, because of the delicate links between scientific developments, technical applications and ethical considerations. Consequently, besides the framework required for the critical evaluation of genetic testing (analytical validity, clinical validity and clinical utility of the test,we must also consider these three fundamental aspects:
• From pooled and meta-analyses of genetic association studies, it appears that most of the commonly identified genetic variants (polymorphisms confers a low risk of disease (on average ORs of 1.5, if not lower, which only increases with the interaction of well-known environmental risk factors
• From preliminary studies, the result from a ‘positive’ genetic testing does not seem to motivate behavioural changes;
• There is a need for an evidence-based approach to genetic testing that integrates the cost-utility evaluation of each available genetic test [Health Technology Assessment (HTA framework] while considering the weight of the relevant ethical issues.
In the remote village of Martadi, in Bajura district of western Nepal, the total fertility rate is 7. 20% of newborns die before they reach age 1. Temporary migration, mainly to India, is common due to the inability of the rugged and rocky terrain to supply enough food. The existence of temporary migration and a high frequency of remarriage suggest a high rate of sexually transmitted diseases. The relatively new hospital is very much under used (e.g., only 35 patients in 1995). The office in Kolti that supplies vaccines to Martadi has gone at least six months without receiving any new child immunization drugs, despite the presence of an air service. During and after delivery, no one, not even family members or traditional birth attendants, can touch a woman, who is confined to a cow-shed to deliver and care for her child and herself alone. Yet sick animals receive care. A new mother also is required to bathe herself, often requiring a walk of many hours. Women often identify access to water as their top priority. Pregnant or postpartum women are forbidden from eating green vegetables because of the belief that they cause diarrhea. Sanitation is better now in Martadi than in the past. Diarrhea and vomiting were once very prevalent. The international organization, CARE, along with the Ministry of Local Development operate the Remote Area Basic Needs Project, which revolves around community organization, agroforestry, rural infrastructure, and primary health care. The project has helped villagers construct low-cost toilets. It provides training in basic hygiene. Households have kitchen-gardens. Many families are now eating green vegetables regularly. Fruit trees are being introduced. Villagers recognize the value of child immunization. Some small-scale drinking water systems are operating. Villagers are trained in repair and management of these systems. About 33% of women aged 15-49 want no more children. A first-ever outreach program for female sterilization services
Bansal, Dipika; Purohit, Vilok K
Essential Medicine Concept, a major breakthrough in health care, started in 1977 when World Health Organization (WHO) published its first list. Appropriate use of essential medicines is one of the most cost-effective components of modern health care. The selection process has evolved from expert evaluation to evidence-based selection. The first Indian list was published in 1996 and the recent revision with 348 medicines was published in 2011 after 8 years. Health expenditure is less in India as compared to developed countries. India faces a major challenge in providing access to medicines for its 1.2 billion people by focusing on providing essential medicines. In the future, countries will face challenges in selecting high-cost medicines for oncology, orphan diseases and other conditions. There is a need to develop strategies to improve affordable access to essential medicines under the current health care reform.
Smith, Timothy W; Orleans, C Tracy; Jenkins, C David
Daily habits (e.g., smoking, diet, and exercise) and their immediate consequences (e.g., obesity) confer risk for most of the major health problems in industrialized nations. Hence, determinants of these behaviors and their modifications have been central topics in health psychology. Considerable scientific and applied progress has been made, but the field faces important challenges and opportunities in the future. These challenges and opportunities include changes in demographics and patterns of health, the need for a more comprehensive model of the domain of health behavior and prevention, the need to integrate behavioral and psychosocial risk and resilience, the incorporation of new technologies, and addressing a variety of professional and economic barriers to the implementation of prevention in health care.
Fihl, Preben; Moeslund, Thomas B.
Pose estimation of people have had great progress in recent years but so far research has dealt with single persons. In this paper we address some of the challenges that arise when doing pose estimation of interacting people. We build on the pictorial structures framework and make important...... contributions by combining color-based appearance and edge information using a measure of the local quality of the appearance feature. In this way we not only combine the two types of features but dynamically find the optimal weighting of them. We further enable the method to handle occlusions by searching...
Zhang, Xinzhi; Pérez-Stable, Eliseo J; Bourne, Philip E; Peprah, Emmanuel; Duru, O Kenrik; Breen, Nancy; Berrigan, David; Wood, Fred; Jackson, James S; Wong, David W S; Denny, Joshua
Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.
Presents a model curriculum on health promotion and disease prevention for allied health students. Suggested program elements include (1) promoting personal health patterns, (2) fitting health promotion into daily routines, (3) using persuasion, (4) working with support groups and individuals, and (5) serving as a clearinghouse. (CH)
Health communication in health management process contributes to the overall efficiency of the health-care delivery systems. For this the individual health worker should be able to co-ordinate, integrate and adopt his functions. This is basically required which is minutely discussed in this paper by the author PMID:22557543
Smith, Scott R; Kushalnagar, Poorna; Hauser, Peter C
Deaf individuals have more cardiovascular risks than the general population that are believed to be related to their cardiovascular health knowledge disparities. This phenomenological study describes where 20 deaf sign language-using adolescents from Rochester, New York, many who possess many positive characteristics to support their health literacy, learn cardiovascular health information and their lived experiences accessing health information. The goal is to ultimately use this information to improve the delivery of cardiovascular health education to this population and other deaf adolescents at a higher risk for weak health literacy. Deaf bilingual researchers interviewed deaf adolescents, transcribed and coded the data, and described the findings. Five major sources of cardiovascular health information were identified including family, health education teachers, healthcare providers, printed materials, and informal sources. Despite possessing advantageous characteristics contributing to stronger health literacy, study participants described significant challenges with accessing health information from each source. They also demonstrated inconsistencies in their cardiovascular health knowledge, especially regarding heart attack, stroke, and cholesterol. These findings suggest a great need for additional public funding to research deaf adolescents' informal health-related learning, develop accessible and culturally appropriate health surveys and health education programming, improve interpreter education, and disseminate information through social media.
The purpose of this comprehensive literature review it to explore cross-cultural issues in occupational rehabilitation and work disability prevention. A literature review on cross-cultural issues was performed in medicine, health sciences, and social sciences databases (PubMed, Ingenta, Canadian Centre for Occupational Health and Safety, Ergonomics Abstract, Google Scholar, OSH Update and the Quebec Workers' Compensation Board data base). A total of 27 documents published until 2010 in English or French were selected and analyzed. Cross-cultural issues in occupational rehabilitation show that representations of pain, communication and therapist-patient relationship and intercultural competence could be presented as the major topics covered in the selected literature. As for the general topic of immigrant workers and OSH, barriers were identified revealing personal, relational, contextual and structural levels that put immigrant and minority workers in situation of vulnerability (ex. linguistic and cultural barriers, lack of knowledge of the system, precarious work or exposition to higher risk hazards, etc.). Cultural issues in occupational rehabilitation put less attention to work-related contextual factors but emphasized on attitude and pain behaviours, perceptions of illness and appropriate treatment, therapist-patient relationship and cultural competences among OT professionals. The growth of immigration in countries such as Canada poses a real challenge to the delivery of health care and rehabilitation services. Despite growing concerns in providing culturally appropriate heath cares, intervention models, tools and training tools are still lacking in occupational rehabilitation and disability management. Nevertheless, cultural competence seems to be a promising concept to be implemented in work rehabilitation and disability management.
The purpose of this paper is to explore challenges to the performance and sustainability of mutual health organisations (MHOs) and health institutions towards enhancing access to quality health care (HC) in Ghana. Data were gathered through interviews and documentary review. Problems with late release of reimbursement funds for discharging with claims by the central government has impacted heavily on the financial and strategic management and decision-making processes of the MHOs and health institutions. The lack of in-depth analysis of the financial viability of the MHOs; and the limited number of schemes selected. Recommends the need to ensure prompt release of reimbursement funds by government to enable the MHOs to reimburse claims to health institutions. There is a perceived tension between the MHOs and HC institutions due to late release of reimbursement funds by the government. Contributes to understanding of how the NHI Act influences the operations of MHOs and health institutions towards increasing access to quality HC and financing.
Rahim, Anika; Knights Née Jones, Felicity; Fyfe, Molly; Alagarajah, Janagan; Baraitser, Paula
International health electives pose specific ethical challenges for students travelling from to low and middle income countries. We undertook a systematic review of the literature on interventions to prepare students to identify ethical issues addressed, educational approaches and to collate evidence on the effectiveness of different strategies. We searched nine electronic databases of peer-reviewed literature and identified grey literature through key word searches; supplemented through citation mapping and expert consultation. Articles that described ethical training conducted by universities or professional bodies were included for review. We reviewed forty-four full text articles. Ten sources of published literature and seven sources of grey literature met our inclusion criteria. We identified thirteen ethical situations that students should be prepared to manage and eight generic skills to support this process. Most interventions were delivered before the elective, used case studies or guidelines. Some suggested ethical principles or a framework for analysis of ethical issues. Only two papers evaluated the intervention described. Our paper collates a small but growing body of work on education to prepare students to manage ethical issues. Ethical training should have elements that are delivered before, during and after the elective. Interventions should include case studies covering thirteen ethical issues identified here, linked to ethical principles and a process for responding to ethical issues. We suggest that evaluations of interventions are an important area for future research.
Choi, Young B; Capitan, Kathleen E; Krause, Joshua S; Streeper, Meredith M
This paper discusses the challenges associated with privacy in health care in the electronic information age based on the Health Insurance Portability and Accountability Act (HIPAA) and the Security Rules. We examine the storing and transmission of sensitive patient data in the modem health care system and discuss current security practices that health care providers institute to comply with HIPAA Security Rule regulations. Based on our research results, we address current outstanding issues that act as impediments to the successful implementation of security measures and conclude the discussion and offer possible avenues of future research.
Gao, Sheng; Mioc, Darka; Boley, Harold;
applications using a Web-based GIS. Recent progress on the database storage and geospatial Web Services has advanced the use of Web-based GIS for health applications, with various proprietary software, open source software, and Application Programming Interfaces (APIs) available. Current challenges in applying...... Web-based GIS for health, such as data heterogeneity, data privacy and confidentiality, powerful processing abilities, and appropriate data representation to users are also discussed. The continuous development of Web-based GIS for health applications will further enhance disease surveillance, health......Web-based GIS is increasingly used in health applications. It has the potential to provide critical information in a timely manner, support health care policy development, and educate decision makers and the general public. This paper describes the trends and recent development of health...
Lindsay P. Galway
Full Text Available The shortcomings of public health research informed by reductionist and fragmented biomedical approaches and the emergence of wicked problems are fueling a renewed interest in ecological approaches in public health. Despite the central role of interdisciplinarity in the context of ecological approaches in public health research, inadequate attention has been given to the specific challenge of doing interdisciplinary research in practice. As a result, important knowledge gaps exist with regards to the practice of interdisciplinary research. We argue that explicit attention towards the challenge of doing interdisciplinary research is critical in order to effectively apply ecological approaches to public health issues. This paper draws on our experiences developing and conducting an interdisciplinary research project exploring the links among climate change, water, and health to highlight five specific insights which we see as relevant to building capacity for interdisciplinary research specifically, and which have particular relevance to addressing the integrative challenges demanded by ecological approaches to address public health issues. These lessons include: (i the need for frameworks that facilitate integration; (ii emphasize learning-by-doing; (iii the benefits of examining issues at multiple scales; (iv make the implicit, explicit; and (v the need for reflective practice. By synthesizing and sharing experiences gained by engaging in interdisciplinary inquiries using an ecological approach, this paper responds to a growing need to build interdisciplinary research capacity as a means for advancing the ecological public health agenda more broadly.
Hussain, Mohammad Akhtar; Sharma, Kavya; Zodpey, Sanjay
Public health engineering can play an important and significant role in solving environmental health issues. In order to confront public health challenges emerging out of environmental problems we need adequately trained public health engineers / environmental engineers. Considering the current burden of disease attributable to environmental factors and expansion in scope of applications of public health / environmental engineering science, it is essential to understand the present scenario of teaching, training and capacity building programs in these areas. Against this background the present research was carried out to know the current teaching and training programs in public health engineering and related disciplines in India and to understand the potential opportunities and challenges available. A systematic, predefined approach was used to collect and assemble the data related to various teaching and training programs in public health engineering / environmental engineering in India. Public health engineering / environmental engineering education and training in the country is mainly offered through engineering institutions, as pre-service and in-service training. Pre-service programs include diploma, degree (graduate) and post-graduate courses affiliated to various state technical boards, institutes and universities, whereas in-service training is mainly provided by Government of India recognized engineering and public health training institutes. Though trainees of these programs acquire skills related to engineering sciences, they significantly lack in public health skills. The teaching and training of public health engineering / environmental engineering is limited as a part of public health programs (MD Community Medicine, MPH, DPH) in India. There is need for developing teaching and training of public health engineering or environmental engineering as an interdisciplinary subject. Public health institutes can play an important and significant role in this
Mohammad Akhtar Hussain
Full Text Available Public health engineering can play an important and significant role in solving environmental health issues. In order to confront public health challenges emerging out of environmental problems we need adequately trained public health engineers / environmental engineers. Considering the current burden of disease attributable to environmental factors and expansion in scope of applications of public health / environmental engineering science, it is essential to understand the present scenario of teaching, training and capacity building programs in these areas. Against this background the present research was carried out to know the current teaching and training programs in public health engineering and related disciplines in India and to understand the potential opportunities and challenges availables. A systematic, predefined approach was used to collect and assemble the data related to various teaching and training programs in public health engineering / environmental engineering in India. Public health engineering / environmental engineering education and training in the country is mainly offered through engineering institutions, as pre-service and in-service training. Pre-service programs include diploma, degree (graduate and post-graduate courses affiliated to various state technical boards, institutes and universities, whereas in-service training is mainly provided by Government of India recognized engineering and public health training institutes. Though trainees of these programs acquire skills related to engineering sciences, they significantly lack in public health skills. The teaching and training of public health engineering / environmental engineering is limited as a part of public health programs (MD Community Medicine, MPH, DPH in India. There is need for developing teaching and training of public health engineering or environmental engineering as an interdisciplinary subject. Public health institutes can play an important and
Oden, Maria; Mirabal, Yvette; Epstein, Marc; Richards-Kortum, Rebecca
Recent reports have highlighted the need for educational programs to prepare students for careers developing and disseminating new interventions that improve global public health. Because of its multi-disciplinary, design-centered nature, the field of Biomedical Engineering can play an important role in meeting this challenge. This article describes a new program at Rice University to give undergraduate students from all disciplines a broad background in bioengineering and global health and provides an initial assessment of program impact. Working in partnership with health care providers in developing countries, students in the Beyond Traditional Borders (BTB) initiative learn about health challenges of the poor and put this knowledge to work immediately, using the engineering design process as a framework to formulate solutions to complex global health challenges. Beginning with a freshman design project and continuing through a capstone senior design course, the BTB curriculum uses challenges provided by partners in the developing world to teach students to integrate perspectives from multiple disciplines, and to develop leadership, communication, and teamwork skills. Exceptional students implement their designs under the guidance of clinicians through summer international internships. Since 2006, 333 students have designed more than 40 technologies and educational programs; 28 have been implemented in sub-Saharan Africa, Latin America, the Caribbean, southeast Asia, and the United States. More than 18,000 people have benefited from these designs. 95% of alumni who completed an international internship reported that participation in the program changed or strengthened their career plans to include a focus on global health medicine, research, and/or policy. Empowering students to use bioengineering design to address real problems is an effective way to teach the new generation of leaders needed to solve global health challenges.
Lavrentiev, M M
This monograph deals with the problems of mathematical physics which are improperly posed in the sense of Hadamard. The first part covers various approaches to the formulation of improperly posed problems. These approaches are illustrated by the example of the classical improperly posed Cauchy problem for the Laplace equation. The second part deals with a number of problems of analytic continuations of analytic and harmonic functions. The third part is concerned with the investigation of the so-called inverse problems for differential equations in which it is required to determine a dif ferential equation from a certain family of its solutions. Novosibirsk June, 1967 M. M. LAVRENTIEV Table of Contents Chapter I Formu1ation of some Improperly Posed Problems of Mathematic:al Physics § 1 Improperly Posed Problems in Metric Spaces. . . . . . . . . § 2 A Probability Approach to Improperly Posed Problems. . . 8 Chapter II Analytic Continuation § 1 Analytic Continuation of a Function of One Complex Variable fro...
Full Text Available Head pose estimation from single 2D images has been considered as an important and challenging research task in computer vision. This paper presents a novel head pose estimation method which utilizes the shape model of the Basel face model and five fiducial points in faces. It adjusts shape deformation according to Laplace distribution to afford the shape variation across different persons. A new matching method based on PSO (particle swarm optimization algorithm is applied both to reduce the time cost of shape reconstruction and to achieve higher accuracy than traditional optimization methods. In order to objectively evaluate accuracy, we proposed a new way to compute the pose estimation errors. Experiments on the BFM-synthetic database, the BU-3DFE database, the CUbiC FacePix database, the CMU PIE face database, and the CAS-PEAL-R1 database show that the proposed method is robust, accurate, and computationally efficient.
Kate L. Bassil
Full Text Available Many government, academic and research institutions collect environmental data that are relevant to understanding the relationship between environmental exposures and human health. Integrating these data with health outcome data presents new challenges that are important to consider to improve our effective use of environmental health information. Our objective was to identify the common themes related to the integration of environmental and health data, and suggest ways to address the challenges and make progress toward more effective use of data already collected, to further our understanding of environmental health associations in the Great Lakes region. Environmental and human health databases were identified and reviewed using literature searches and a series of one-on-one and group expert consultations. Databases identified were predominantly environmental stressors databases, with fewer found for health outcomes and human exposure. Nine themes or factors that impact integration were identified: data availability, accessibility, harmonization, stakeholder collaboration, policy and strategic alignment, resource adequacy, environmental health indicators, and data exchange networks. The use and cost effectiveness of data currently collected could be improved by strategic changes to data collection and access systems to provide better opportunities to identify and study environmental exposures that may impact human health.
Valente, Thomas W; Pitts, Stephanie R
The use of social network theory and analysis methods as applied to public health has expanded greatly in the past decade, yielding a significant academic literature that spans almost every conceivable health issue. This review identifies several important theoretical challenges that confront the field but also provides opportunities for new research. These challenges include (a) measuring network influences, (b) identifying appropriate influence mechanisms, (c) the impact of social media and computerized communications, (d) the role of networks in evaluating public health interventions, and (e) ethics. Next steps for the field are outlined and the need for funding is emphasized. Recently developed network analysis techniques, technological innovations in communication, and changes in theoretical perspectives to include a focus on social and environmental behavioral influences have created opportunities for new theory and ever broader application of social networks to public health topics.
David M. Park
Full Text Available Contemporary ancestor worship is currently practiced around the world in several different forms. However, the essence and practice of ancestor worship varies throughout Asia, Africa, Oceania and Latin America. The context of countries under the influence of Confucianism is very different from that of other countries. Confucianism teaches that ancestor worship is the most prized display of filial piety toward one’s dead ancestors. Amongst Asian countries under the influence of Confucianism – specifically China, Japan, Malaysia, Taiwan, Vietnam and Korea – ancestor worship has not only been accepted and propagated as a culture, but it is also considered to be filial piety. Especially the Korean people think that ancestor worship is a very important expression of filial piety, and it is a ritual which they practice regularly during their festive days. What does Confucianism teach about filial piety, and how is ancestor worship practiced? What does the Bible teach about filial piety? Are practical applications of biblical filial piety present in Korean society? Rather than allowing Confucian ancestor worship to take root in Korean society as a traditional Korean heritage, the conclusion is that Korean Christians must make an effort to teach and facilitate biblical filial piety.
Synthetic biology is a relatively new science with tremendous potential to change how we view and know the life sciences, but like many developing technologies, it has provoked ethical concerns from the scientific community and the public and confronts demands for new regulatory measures. The concerns raised involve the danger of "dual use," in which results for improving human well-being and the environment may be misappropriated for bioterror. To counteract these dangers, many governments, but the United States and Israel in particular, have introduced new laws and redoubled measures for biosafety and biosecurity. In the United States, the recent H5N1 results achieved by two groups of NIH-funded investigators highlighted the dilemma of balancing the risk of dual-use research and the freedom of science. In Israel, concern for unconventional terrorism is long-standing, and the country is constantly engaged in improving biosecurity and biodefense measures. In 2008, the Israeli parliament passed the Regulation of Research into Biological Disease Agents Law, a legislative framework for safeguarding research into biological disease agents. This article summarizes and analyzes the current state of affairs in the United States and Israel, ethical attitudes, and regulatory responses to synthetic biology.
Amirault, Ray J.
Today's technologies come and go at an alarming rate, and the length of time any one technology, either software or hardware, exists before being supplanted by a newer technology is growing ever shorter. For anyone working within the field of instructional technology, this rapid replacement rate of technologies can hold immense implications for…
This paper examines the problems faced by students using ICT facilities to satisfy their ... assignments, for final year research works or to kill boredom amongst others .... of the research are presented in tables showing the frequency and the.
Julia D. Foutz
Full Text Available Background: From 1970 to 2010, the Alaskan population increased from 302,583 to 698,473. During that time, the growth rate of Alaskan seniors (65+ was 4 times higher than their national counterparts. Ageing in Alaska requires confronting unique environmental, sociodemographic and infrastructural challenges, including an extreme climate, geographical isolation and less developed health care infrastructure compared to the continental US. Objective: The objective of this analysis is to compare the health needs of Alaskan seniors to those in the continental US. Design: We abstracted 315,161 records of individuals age 65+ from the 2013 and 2014 Behavioral Risk Factor Surveillance System, of which 1,852 were residents of Alaska. To compare residents of Alaska to residents of the 48 contiguous states we used generalized linear models which allowed us to adjust for demographic differences and survey weighting procedures. We examined 3 primary outcomes – general health status, health care coverage status and length of time since last routine check-up. Results: Alaskan seniors were 59% less likely to have had a routine check-up in the past year and 12% less likely to report excellent health status than comparable seniors in the contiguous US. Conclusions: Given the growth rate of Alaskan seniors and inherent health care challenges this vulnerable population faces, future research should examine the specific pathways through which these disparities occur and inform policies to ensure that all US seniors, regardless of geographical location, have access to high-quality health services.
Background: Despite decades of disagreement among mental health practitioners and researchers in the Western world pertaining to the causation, classification and treatment of mental disorders there is an ongoing push to implement western mental health models in developing countries. Little information exists on the adaptability of western mental health models in developing countries. Method: This paper presents a review of the attempt to implement a western-oriented mental health system ...
Michael Pascal Hengartner
Experts in personality psychology and personality disorders have long emphasised the pervasive and persistent detrimental impact of maladaptive personality traits on mental health and functioning. However, in routine psychiatric practice maladaptive personality is readily ignored and personality traits are seldom incorporated into clinical guidelines. The aim of this narrative review is to outline how pervasively personality influences public mental health and how personality thereby challeng...
Gholizadeh, Masumeh; Delgoshaei, Bahram; Gorji, Hasan Abulghasem; Torani, Sogand; Janati, Ali
One of the main factors relating to quality of hospitals is effective discharge planning. Discharge planning promotes the quality of inpatient care and reduces unplanned hospital readmission. The current study investigated the challenges of discharge planning observed in the health system of Iran. This qualitative research was conducted using a thematic and framework analyses to identify the challenges under each themes defined by the World Health Organization (WHO), to understand barriers in developing an effective discharge planning system in Iran health system. The data was collected from detailed semi-structured interviews and sessions of focus group discussions. This study involved 51 participants including health policy makers, hospital and health managers, faculty members, nurses, practitioners, community medicine specialists and other professionals of the Ministry of Health and Medical Education (MOHME). To reduce the bias and to increase the credibility of the study, evaluation criteria from Lincoln and Guba were used. All interviews and FGDs were recorded and transcribed, then analyzed by the software MAXQDA-11 and also manually. According to the WHO health systems framework, challenges of effective hospital discharge planning were divided into six areas, leadership/governance, service delivery, information, financing, health workforce, and medical production(themes), in which there were 5,3,2,2,3,1 subthemes respectively. It is evident from the findings of this study that changes in the perspective of policy makers, health staff and managers, strengthening of systematic approach, and establishment of required infrastructures are essential for successful implementation of effective discharge planning in health systems in Iran.
health information in video, audio and text simultaneously, and marketing health information 4. Management. Including: accreditation of companies, institutions and individuals in the health field, access to senior managers, improving internal relationship, expanding health services marketing (4 and participating in social development, such as building hospitals. 5. Social Communication. Including: contributing to mass movements or services, such as earthquakes, floods, etc., establishing online communities (8, forming a group of fans interested in a special fields such as health tourism and AIDS, motivating the users and members of the health different fields (11, monitoring health products and services, and enhancing patient interaction with other patients as well as patients with other people. In spite of all these potentialities and capabilities provided by social media for the general public, especially health professionals, there are important questions posed by the users, active organizations in the field of media, policy makers and the health authorities. These questions are related to issues such as protection of user information, validation of information and information value (7, intellectual property, convincing the members about the usability and usefulness of the media, the lack of appropriate foundation, anxiety of users about controlling the media by other people’s fear and misconceptions about the media (12, and the quantity and quality of impact on family members, mental health, identity and education systems. It seems that paying particular attention to health researchers and providing the perfect infrastructure to provide this information in various media, including health journals, can make different aspects of this issue clear so that health administrators can easily use social media in writing strategies and plans in different fields of health.
Kuo, Alex Mu-Hsing
Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed.
Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed. PMID:21937354
Dias, Maria Angelica de Salles; Friche, Amélia Augusta de Lima; Oliveira, Veneza Berenice de; Caiaffa, Waleska Teixeira
The Belo Horizonte Observatory for Urban Health (OSUBH), housed in an academic setting, was founded in 2002 as part of a broader agenda to strengthen local and national health systems. Its mission is to build the capacity of the workforce in research on population health and to conduct studies on urban issues that can guide the planning of activities aimed at improving the health of populations, especially in heavily urbanized areas, associated with intra-urban inequalities. It focuses on the acquisition of advanced knowledge on urban health (metric) through scientific research, to contribute to public policies that may interfere with health, both at individual and community levels. During its lifetime, many partnerships and studies have been developed, but many challenges still exist in order for it to consolidate its position as a legitimate space and as a tool to generate systematic information for governments and populations.
Arantes, Luciano José; Shimizu, Helena Eri; Merchán-Hamann, Edgar
The aim of this study was to analyze what contributions the Family Health Strategy has made towards the development of primary healthcare in Brazil, and what challenges it faces. A literature review was conducted and articles were analyzed from three dimensions: political/institutional, organizational, and technical/healthcare. In the first dimension, the Family Health Strategy was found to have helped expand primary healthcare, the institutionalization of evaluations, and the promotion of equity. The main challenges identified were funding, the training, education, and management of personnel, and cross-sectoral action. In terms of organization, the benefits include a broader supply of services, access to health services through organized initiatives for specific diseases or age groups, and more comprehensive healthcare. The challenges involve access, the entry point, integration with the healthcare network, planning, and social participation. As for technical/healthcare considerations, the main benefits identified were the fostering of multidisciplinary working practices, family focus, reception, rapport, humanization, community orientation, production of care, and performance. The challenges for its improvement are associated with complex factors and require greater political/institutional effort.
Drehobl, Patricia; Stover, Beth H; Koo, Denise
The public health workforce is vital to protecting the health and safety of the public, yet for years, state and local governmental public health agencies have reported substantial workforce losses and other challenges to the workforce that threaten the public's health. These challenges are complex, often involve multiple influencing or related causal factors, and demand comprehensive solutions. However, proposed solutions often focus on selected factors and might be fragmented rather than comprehensive. This paper describes approaches to characterizing the situation more comprehensively and includes two visual tools: (1) a fishbone, or Ishikawa, diagram that depicts multiple factors affecting the public health workforce; and (2) a roadmap that displays key elements-goals and strategies-to strengthen the public health workforce, thus moving from the problems depicted in the fishbone toward solutions. The visual tools aid thinking about ways to strengthen the public health workforce through collective solutions and to help leverage resources and build on each other's work. The strategic roadmap is intended to serve as a dynamic tool for partnership, prioritization, and gap assessment. These tools reflect and support CDC's commitment to working with partners on the highest priorities for strengthening the workforce to improve the public's health. Published by Elsevier Inc.
Merican, M I; Rohaizat, Y; Haniza, S
The Malaysian health care system is a success story among countries of equivalent socio-economic status. However there are numerous challenges faced by the nation, which create the need for changes and reform. There is rising consumer demands and expectations for high technology and high cost medical care due to improved standards of living, changing disease patterns and demographic changes, inadequate integration of health services, maldistribution of resources and the threats as well as opportunities of globalisation and liberalisation. The changes in health policy, priorities and planning for the country are guided by the country's development policies, objectives and the challenges of Vision 2020, Vision for Health and the goals of the health system in ensuring universal access, improving equity and efficiency and the quality of life of the population. The essential services in the health system of the future are information and education of individuals to empower support for the wellness paradigm. There is also a need to restructure the national health care financing and the health care delivery system. The present roles and responsibilities of MOH also need to be reviewed.
Wallington, Sherrie Flynt; Blake, Kelly D; Taylor-Clark, Kalahn; Viswanath, K
News coverage of health topics influences knowledge, attitudes, and behaviors at the individual level, and agendas and actions at the institutional and policy levels. Because disparities in health often are the result of social inequalities that require community-level or policy-level solutions, news stories employing a health disparities news frame may contribute to agenda-setting among opinion leaders and policymakers and lead to policy efforts aimed at reducing health disparities. This study objective was to conduct an exploratory analysis to qualitatively describe barriers that health journalists face when covering health disparities in local media. Between June and October 2007, 18 journalists from television, print, and radio in Boston, Lawrence, and Worcester, Massachusetts, were recruited using a purposive sampling technique. In-depth, semi-structured interviews were conducted by telephone, and the crystallization/immersion method was used to conduct a qualitative analysis of interview transcripts. Our results revealed that journalists said that they consider several angles when developing health stories, including public impact and personal behavior change. Challenges to employing a health disparities frame included inability to translate how research findings may impact different socioeconomic groups, and difficulty understanding how findings may translate across racial/ethnic groups. Several journalists reported that disparities-focused stories are "less palatable" for some audiences. This exploratory study offers insights into the challenges that local news media face in using health disparities news frames in their routine coverage of health news. Public health practitioners may use these findings to inform communication efforts with local media in order to advance the public dialogue about health disparities.
Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra
The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.
Ana, Godson R. E. E.; Shendell, Derek G.
The United Nations (UN) mandate of achieving healthful living for all by the year 2015 through the Millennium Development Goals (MDGs) is facing several challenges. In the school environment, and particularly in less developed countries (LDCs), the situation is further strained by both relatively weak infrastructure and competing governmental…
Via a consultation process, the PEROSH members identified what occupational safety and health topics the European institutes specialised in, and what they see as the major trends and future challenges in the world of work and their impact on OSH. A second part of the consultation analysed future
Nichols, Barbara L
The following four articles are based on presentations delivered at Building Global Alliances V: The Challenges of Migration for Health Professional Women, held in Philadelphia on December 7-8, 2008 and hosted by CGFNS International (formerly the Commission on Graduates of Foreign Nursing Schools).
Pinciroli, Francesco; Bonacina, Stefano; Marceglia, Sara; Ferrante, Simona; Mazzola, Luca
Curricular recommendations coming from highly respectable associations are highly useful. Nevertheless, they show fatigue in keeping the pace of any fast evolution, as in the ICT happens. So we do the attempt to disclose the emerging challenges affecting e-Health curricular education.
Ornelas, India J.; Perreira, Krista M.; Beeber, Linda; Maxwell, Lauren
Mexican immigrant mothers face many challenges that put them at increased risk for poor mental health. To understand the factors that lead to the development of depressive symptoms among Mexican immigrant mothers, we analyzed data from 20 qualitative, semistructured interviews. Participants included low-income, Mexican-born mothers of young…
Bosi, Maria Lucia Magalhaes
This paper discusses the challenges to the qualitative health research approach, under the regime of productivity that rules current academic evaluation in many countries. The analysis considers aspects common to several contexts, illustrating the discussion with the Brazilian context and, more specifically, within the dynamics of the collective…
Via a consultation process, the PEROSH members identified what occupational safety and health topics the European institutes specialised in, and what they see as the major trends and future challenges in the world of work and their impact on OSH. A second part of the consultation analysed future res
Barnes, Seraphine Pitt; Torrens, Anna; George, Valerie; Brown, Kelli McCormack
Background: Coordinated school health programs (CSHP) frequently struggle with how to adequately evaluate implementation. The CSHP framework provides flexibility in how it is implemented; however, this flexibility makes it a challenge to effectively evaluate. Portfolios have been used as a technique for evaluating progress and achievement. This…
K.R. Short (Kirsty); M. Richard (Mathilde); J.H. Verhagen (Josanne); D.A.J. van Riel (Debby); E.J.A. Schrauwen (Eefje); J.M.A. van den Brand (Judith); B. Mänz (Benjamin); R. Bodewes (Rogier); S. Herfst (Sander)
textabstractInfluenza A viruses are amongst the most challenging viruses that threaten both human and animal health. Influenza A viruses are unique in many ways. Firstly, they are unique in the diversity of host species that they infect. This includes waterfowl (the original reservoir), terrestrial
Short, Kirsty R; Richard, Mathilde; Verhagen, Josanne H; van Riel, Debby; Schrauwen, Eefje J A; van den Brand, Judith M A; Mänz, Benjamin; Bodewes, Rogier; Herfst, Sander
Influenza A viruses are amongst the most challenging viruses that threaten both human and animal health. Influenza A viruses are unique in many ways. Firstly, they are unique in the diversity of host species that they infect. This includes waterfowl (the original reservoir), terrestrial and aquatic
Full Text Available In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.
Full Text Available The promises of ICT have been poorly redeemed in health care; many projects have failed. This article conceptualizes the co-construction of services and technologies in order to help future practitioners in the field to understand and find solutions to the challenges in ICT-enhanced service change. The conceptualization is created by structuring the findings of a case study with the help of theoretical concepts. The conceptualization then is implemented in another case to study its potential for finding challenges and suggesting solutions. Both cases demonstrate challenges for codevelopment that contributed to poor project outcomes. Participants in eHealth projects need a better understanding of development as the parallel shaping of multiple objects. They need better skills in managing the change process and a better understanding of methods for collaboration throughout the development. The projects would benefit from networking with actors who have adequate understanding of the process as a whole and of methods of codevelopment.
Bonnefoi, Marc S; Belanger, Scott E; Devlin, Dennis J; Doerrer, Nancy G; Embry, Michelle R; Fukushima, Shoji; Harpur, Ernest S; Hines, Ronald N; Holsapple, Michael P; Kim, James H; MacDonald, James S; O'Lone, Raegan; Pettit, Syril D; Stevens, James L; Takei, Ayako S; Tinkle, Sally S; van der Laan, Jan Willem
The public health and environmental communities will face many challenges during the next decade. To identify significant issues that might be addressed as part of the International Life Sciences Institute (ILSI) Health and Environmental Sciences Institute (HESI) scientific portfolio, an expert group of key government, academic, and industry scientists from around the world were assembled in 2009 to map the current and future landscape of scientific and regulatory challenges. The value of the scientific mapping exercise was the development of a tool which HESI, individual companies, research institutions, government agencies, and regulatory authorities can use to anticipate key challenges, place them into context, and thus strategically refine and expand scientific project portfolios into the future.
Cynthia M. LeRouge
Full Text Available “Baby Boomers” (adults born between the years of 1946 and 1964 make up the largest segment of the population in many countries, including the United States (about 78 million Americans . As Baby Boomers reach retirement age and beyond, many will have increasing medical needs and thus demand more health care resources that will challenge the healthcare system. Baby Boomers will likely accelerate the movement toward patient self-management and prevention efforts. Consumer Health Information Technologies (CHIT hold promise for empowering health consumers to take an active role in health maintenance and disease management, and thus, have the potential to address Baby Boomers' health needs. Such innovations require changes in health care practice and processes that take into account Baby Boomers' personal health needs, preferences, health culture, and abilities to use these technologies. Without foundational knowledge of barriers and opportunities, Baby Boomers may not realize the potential of these innovations for improving self-management of health and health outcomes. However, research to date has not adequately explored the degree to which Baby Boomers are ready to embrace consumer health information technology and how their unique subcultures affect adoption and diffusion. This position paper describes an ecological conceptual framework for understanding and studying CHIT aimed at satisfying the personal health needs of Baby Boomers. We explore existing literature to provide a detailed depiction of our proposed conceptual framework, which focuses characteristics influencing Baby Boomers and their Personal Health Information Management (PHIM and potential information problems. Using our ecological framework as a backdrop, we provide insight and implications for future research based on literature and underlying theories represented in our model.
Full Text Available Orientation: In South Africa, workplace programmes in the automotive industry focus predominantly on occupational health and safety and HIV and AIDS. The implementation of focused workplace interventions might be hampered when companies are not convinced that the condition (i.e. HIV and AIDS is the main negative health influencing factor responsible for increased production costs.Research purpose: The study investigated the health influencing conditions perceived to negatively impact company production costs and related interventions.Motivation for the study: Apart from HIV and AIDS, little information is available about the health challenges in the South African workplace and focused HIV and AIDS programmes might only partly respond to the key health challenges of workplaces. The inter-relatedness of various risky lifestyle factors linked to health conditions necessitates a comprehensive health promotion approach.Research approach, design and method: A cross-sectional survey was conducted amongst 74 companies selected through stratified random sampling. Non-parametric tests were conducted to investigate the health influencing factors perceived to impact production costs, the monitoring thereof, extent of containment and the implementation of interventions in terms of company size and ownership.Main findings: The health factors perceived to have a moderate to large impact were HIV and AIDS, smoking, alcohol use, stress, back and neck ache and tuberculosis, also reported to be better monitored and managed by medium and large organisations. Small organisations reported a smaller impact, fewer efforts and less success. HIV and AIDS programmes were more evident in large companies and those with wellness programmes (52%. Workplace programmes enabled better monitoring and managing of impacting health conditions. Smaller organisations were not convinced of the benefits of interventions in addressing health challenges.Practical/managerial implications
camera and joint estimation software of the Kinect for Xbox 360. A threat determination is made based on the pose identified by the network. Ac- curacy...mapping produced by the Kinect sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.5. Test subject and generated model. The subject is...16 3.2. Joint position estimates extracted from Kinect . Example of col- lecting orthogonal poses
Weinreb, L F; Bassuk, E L
The number of homeless families in the United States is growing at an alarming rate. Homeless families are at an increased risk for numerous medical conditions and have complex health and psychosocial needs. In response to the growing crisis, policymakers have generally focused on families' immediate needs rather than developing a comprehensive long-term response. Health programs have been challenged to develop effective methods of providing outreach and comprehensive, continuous, coordinated services. Family medicine is uniquely qualified to meet the health care needs of homeless families and can play an important role in providing clinical service, designing medical education, developing research, and defining a national advocacy agenda.
Elmuti, Dean; Khoury, Grace; Omran, Omar; Abou-Zaid, Ahmed S
This article explores current supply chain management challenges and initiatives and identifies problems that affect supply chain management success in the U.S. health-care industry. In addition, it investigates the impact of health care supply chain management (SCM) initiatives on the overall organizational effectiveness. The attitudinal results, as well as the performance results presented in this study support the claim of health care proponents that the SCM allows organizations to reduce cost, improve quality, and reduce cycle time, and leads to high performance.
Full Text Available Abstract Exposure to high levels of air pollution can cause a variety of adverse health outcomes. Air quality in developed countries has been generally improved over the last three decades. However, many recent epidemiological studies have consistently shown positive associations between low-level exposure to air pollution and health outcomes. Thus, adverse health effects of air pollution, even at relatively low levels, remain a public concern. This paper aims to provide an overview of recent research development and contemporary methodological challenges in this field and to identify future research directions for air pollution epidemiological studies.