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Health Interventions (health + intervention)
Kinds of Health Interventions Selected AbstractsHealth Interventions and Health Equity: The Example of Measles Vaccination in BangladeshPOPULATION AND DEVELOPMENT REVIEW, Issue 2 2001Michael A. Koenig Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention,measles vaccination,on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children,from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity. [source] Mental Health Interventions and Services for Vulnerable Children and Young PeopleCHILD AND ADOLESCENT MENTAL HEALTH, Issue 2 2009Anula Nikapota No abstract is available for this article. [source] Health interventions and satisfaction with services: a comparative study of urinary incontinence sufferers living in two health authorities in EnglandJOURNAL OF CLINICAL NURSING, Issue 5 2000Brenda Roe PhD, FRSH ,,This comparative study found that significantly more people with severe incontinence had contacted a health professional than had those with slight to moderate incontinence (P=0.00008). There was a significant linear trend towards people with severe incontinence seeing a health professional (P=0.00007). ,,The majority of people who were incontinent had not been asked to complete a bladder chart, which is an essential requirement for assessment and diagnosis of the type of incontinence and the subsequent health interventions that are offered. ,,Significantly more people in the health authority with an established continence advisory service had completed a bladder chart, had received physiotherapy and currently undertook pelvic floor muscle exercises than did those in the health authority without a continence service. ,,The majority of sufferers did not use any aids or appliances. Of those who did use incontinence aids, a majority bought their own. There was a significant linear trend for increased pad usage with increasing severity of incontinence (P=0.0003). ,,Significantly more people in the health authority with the continence service were satisfied with their healthcare and services, while more of those in the health authority without a service were unsatisfied (P=0.005). Significantly more people in the health authority without a service felt that healthcare and services could be improved (P=0.00001). ,,Significantly more people with severe incontinence were dissatisfied with services than were those with slight to moderate incontinence (P=0.01). [source] Harm reduction programmes in the Asia,Pacific RegionDRUG AND ALCOHOL REVIEW, Issue 1 2008GARY REID MPH Abstract Introduction and Aims. This paper reports on the public health intervention of harm reduction to address drug use issues in the Asia , Pacific region. Design and Methods. It is based on the report ,Situational analysis of illicit drug issues and responses in Asia and the Pacific', commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. A comprehensive desk-based review based on published and unpublished literature and key informant data. Results. Drug use in the Asia , Pacific region is widespread, resulting in serious adverse health consequences. Needle and syringe programmes are found in some parts of Asia, but not in the six Pacific Island countries reviewed. Outreach and peer education programmes are implemented, but overall appear minor in size and scope. Substitution therapy programmes appear to be entering a new era of acceptance in some parts of Asia. Primary health care specifically for drug users overall is limited. Discussion and Conclusions. Harm reduction programmes in the Asia , Pacific region are either small in scale or do not exist. Most programmes lack the technical capacity, human resources and a limited scope of operations to respond effectively to the needs of drug users. Governments in this region should be encouraged to endorse evidence-based harm reduction programmes. [source] Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providersJOURNAL OF ADVANCED NURSING, Issue 7 2010Karen L. Pielak pielak k.l., mcintyre c.c., tu a.w., remple v.p., halperin b. & buxton j.a. (2010) Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers. Journal of Advanced Nursing,66(7), 1602,1611. Abstract Title.,Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers. Aim., This paper is a report of a study conducted to examine the attitudes, beliefs, behavioural intentions and self-reported behaviour of nurses and physicians relating to key immunization behaviours and compare the findings for nurses and physicians. Background., Immunization is an important and effective public health intervention. Understanding immunization providers' attitudes and beliefs toward immunization has the potential to improve educational efforts and lead to behavioural change. Method., A postal survey was conducted with all immunization providers in British Columbia, Canada, in 2005. The survey elicited data on demographics, practice characteristics, attitudes, perceived social norms and perceived behavioural control related to key immunization behaviours. Results., Responses were received from 344 nurses and 349 physicians. The response rate was 67% for nurses and 22% for physicians. More nurses than physicians thought that administering all recommended vaccines at one visit was important (89·2% vs. 63·2%P < 0·001); nurses felt more pressure from parents to administer all recommended vaccines (82·4% vs. 48·7%P < 0·001), and nurses were also more likely to intend to give all recommended vaccines at one visit (98·8% vs. 73·8%P < 0·001). Both nurses and physicians thought that their own receipt of influenza vaccine each year was important (88·9%, 87·1% respectively P = 0·65). Conclusion., The foundational work done to develop the survey tool can be used to modify it so that survey findings can be validated according to the Theory of Planned Behaviour. The results could inform the development of behavioural change interventions targeting the identified determinants of immunization provider behaviour. [source] External cause-specific summaries of occupational fatal injuries.AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2003Part II: An analysis of years of potential life lost Abstract Background Fatal injury surveillance data provide an opportunity to assess the impact of occupational injuries and may indicate which industries or occupations are appreciably more hazardous than others, and thus should be given priority in public health intervention. Methods Fatalities from the National Traumatic Occupational Fatality surveillance system served as the basis for examining external cause (E-code) specific impact summaries. Years of potential life lost (YPLL) were calculated for fatal injuries in the years 1983,1994. Industries and occupations were compared with respect to frequency of fatal injuries. In addition, injuries in categories of external causes are examined across all industries and occupations. Results Machinery, electric current, homicide, falls, and transportation-related are the external cause groups highlighted by high frequency/rate of occurrence. Electric current event groups are also characterized by high average YPLL. Poisoning, conflagration, and lightning were also identified in several occupations as having high associated average YPLL. Conclusions The external-cause-specific analysis of average YPLL identified industries and occupations where, on average, younger workers were dying in fatal injuries. Noteworthy in this assessment were homicides and falls. The YPLL measure coupled with more commonly employed indices (e.g., rates) may provide a fuller description of the impact of occupational fatal injuries. Am. J. Ind. Med. 43:251,261, 2003. Published 2003 Wiley-Liss, Inc. [source] Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in TaiwanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 4 2006CHIH-HUNG KO md Abstract, During the 2003 outbreak, severe acute respiratory syndrome (SARS) spread to more than 30 countries. Not only did it cause severe health problems but it also imposed a great psychological impact on the public. SARS emerged in Taiwan during April 2003. This study investigates the psychosocial impact and the associated factors of depression of the SARS epidemic in Taiwan when the epidemic had just been controlled. A total of 1552 respondents were recruited in the study by random selection from the telephone book. Demographic data, SARS experience, self-perceived health state, neighborhood relationships, and depression were surveyed by telephone interviewing. Respondents were grouped as ,impacted group' and ,non-impacted group' according to whether they or their friends and family had been quarantined, or suspected of being infected. The psychosocial impact and associated factors were compared between the two groups. The ,impacted group' had higher depressive levels, poorer neighborhood relationships, poorer self-perceived health, and a higher economic impact than the ,non-impacted group'. The poorer self-perceived health and economic impact factors were associated with depression. The neighborhood relationship factor was negatively associated with depression for the ,impacted group', but not for the ,non-impacted group'. The ,impacted group' had experienced greater psychosocial impact possibly due to the SARS impact, the economic downturn, poor self-perceived health conditions, and decreased social support systems. An appropriate mental health intervention to improve the self-perceived health condition, to provide instrumental and psychological support for the ,impacted group', and to decrease the stigmatization and discrimination from the public could have buffered the psychological impact from this epidemic disaster. [source] Annotation: The role of prefrontal deficits, low autonomic arousal, and early health factors in the development of antisocial and aggressive behavior in childrenTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 4 2002Adrian Raine Background: This article selectively reviews the biological bases of antisocial and aggressive behavior in children with a focus on low autonomic functioning, prefrontal deficits, and early health factors. Results: Low resting heart rate is thought to be the best-replicated biological correlate of antisocial and aggressive behavior in child and adolescent populations and may reflect reduced noradrenergic functioning and a fearless, stimulation-seeking temperament. Evidence from neuropsychological, neurological, and brain imaging studies converges on the conclusion that prefrontal structural and functional deficits are related to antisocial, aggressive behavior throughout the lifespan. A prefrontal dysfunction theory of antisocial behavior is advanced. This argues that social and executive function demands of late adolescence overload the late developing prefrontal cortex, giving rise to prefrontal dysfunction and a lack of inhibitory control over antisocial, violent behavior that peaks at this age. Birth complications and minor physical anomalies are selectively associated with later violent behavior, especially when combined with adverse psychosocial risk factors for violence. Cigarette smoking during pregnancy may increase the risk for antisocial and violent behavior in later life by disrupting noradrenergic functioning and enhancement of cholinergic receptors that inhibit cardiac functioning. Malnutrition during pregnancy is associated with later antisocial behavior and may be mediated by protein deficiency. Conclusions: It is argued that early health intervention and prevention studies may provide the most effective way of reversing biological deficits that predispose to antisocial and aggressive behavior in children and adults. [source] Public Health in the Emergency Department: Overcoming Barriers to Implementation and DisseminationACADEMIC EMERGENCY MEDICINE, Issue 11 2009Mary Pat McKay MD Abstract This article is the outcome of a consensus building workshop entitled, "Overcoming Barriers to Implementation and Dissemination" convened at the 2009 Academic Emergency Medicine Consensus Conference, ,,Public Health in the ED: Surveillance, Screening, and Intervention." The participants were asked to address potential methods for overcoming barriers to the dissemination and implementation in the emergency department (ED) of evidenced-based practices to improve public health. The panel discussed three broad areas of interest including methods for disseminating evidence-based practices, barriers encountered during the process of implementation, and the importance of involvement in activities outside the ED including engagement in policy development and improvement. Four recommendations were discussed in detail and consensus was reached. The recommendations included 1) researchers and advocates should disseminate findings through multiple forums beyond peer-reviewed publications when an ED-based public health intervention has enough evidence to support integration into the routine practice of emergency care; 2) local barriers to implementation of public health interventions should be recognized and well understood from multiple perspectives prior to implementation; 3) innovation must be put into place and adapted based on local institutional context and culture as barriers and the best methods for overcoming them will vary across institutions; and 4) use of legislation, regulation, and incentives outside of the ED should support and strengthen ED-based interventions. For each area of interest, research dimensions to extend the current understanding of methods for effectively and efficiently implementing evidence-based public health interventions in the ED were discussed and consensus was achieved. [source] Measuring Fatness, Governing Bodies: The Spatialities of the Body Mass Index (BMI) in Anti-Obesity PoliticsANTIPODE, Issue 5 2009Bethan Evans Abstract:, The Body Mass Index (BMI) is the dominant means of defining and diagnosing obesity in national and international public health policy. This paper draws on geographical engagements with Foucault's work on biopower and governmentality to question the power afforded the BMI in obesity policy. With reference to a UK public health intervention involving the measurement of children's bodies within schools, the paper questions the multiple materialities and spatialities of the BMI with reference to both its role in the construction of geographies of obesity and its (in)ability to capture the fleshy, material, and experiential bodies of those individuals involved in the process of measurement. The paper contributes to poststructuralist health geographies through writing fleshy, active bodies into a Foucauldian reading of health and illness, thus questioning the justifications and implications of an obesity politics focussed on the BMI. [source] Using school management plans to track engagement in a public health interventionAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2002Lisa Barnett No abstract is available for this article. [source] Estimated Risk for Undiagnosed Diabetes in the Emergency Department: A Multicenter SurveyACADEMIC EMERGENCY MEDICINE, Issue 5 2007Adit A. Ginde MD BackgroundOne third of the 21 million Americans with diabetes remain undiagnosed. The emergency department (ED) is a novel setting for diabetes screening. ObjectivesTo estimate risk factors for undiagnosed diabetes in the ED. MethodsThis was a cross sectional survey in five Boston EDs. The authors enrolled consecutive adults without known diabetes over two 24-hour periods at each site. The focus was on diabetes risk factors and estimated risk for diabetes on the basis of American Diabetes Association (ADA) criteria. The authors also examined prior diabetes testing and willingness to participate in ED-based diabetes screening. ResultsSix hundred four patients (70% of eligible) were enrolled. On the basis of ADA risk score, 33% (95% confidence interval [CI] = 29% to 37%) were high risk for undiagnosed diabetes, and an additional 42% (95% CI = 38% to 46%) had elevated risk. For example, 58% (95% CI = 54% to 62%) of participants were overweight or obese (body mass index of ,25). Among these at-risk participants without prior diabetes testing, 73% (95% CI = 66% to 80%) reported amenability to having additional blood drawn for ED diabetes screening, and 98% (95% CI = 96% to 100%) indicated that they would follow up for confirmation of abnormal screening. ConclusionsMany ED patients in the study had risk factors for undiagnosed diabetes. Patient attitudes toward ED-based diabetes screening support further exploration of this important and currently underutilized opportunity for public health intervention. [source] Childhood cancer,mainly curable so where next?ACTA PAEDIATRICA, Issue 4 2000AW Craft More than 70% of childhood cancer is now curable with best modern therapy. The treatment is expensive but in terms of cost per life year saved, USD 1750, compares very favourably with other major health interventions. The rate of improvement in survival is slowing down. New, "designer", treatments are needed and, better still, prevention. The causes of childhood cancer are beginning to emerge. The origin for many is probably in utero and may be initiated by dietary and other environmental exposures perhaps in susceptible individuals. However, one of the great challenges for the future must be to extend the benefits of modern treatment to the 80% of the world's children who currently have little or no access to it in economically disadvantaged and emerging nations. The International Paediatric Oncology Society (SIOP) is leading the way in bringing hope for children with cancer worldwide. In India, with the support of the WHO, there is a "train the trainers" programme. In Africa, pilot studies of cost-effective treatments for Burkitt's lymphoma are producing gratifying results in Malawi and there are several examples of twinning programmes between major centres in developed and less well-developed countries. Conclusions: The future for children with cancer is bright. Most are curable and prevention may be just over the horizon. [source] The Conservation Relevance of Epidemiological Research into Carnivore Viral Diseases in the SerengetiCONSERVATION BIOLOGY, Issue 3 2007SARAH CLEAVELAND conservación de carnívoros; investigación epidemiológica; moquillo; rabia; Serengeti Abstract:,Recent outbreaks of rabies and canine distemper in wildlife populations of the Serengeti show that infectious disease constitutes a significant cause of mortality that can result in regional extirpation of endangered species even within large, well-protected areas. Nevertheless, effective management of an infectious disease depends critically on understanding the epidemiological dynamics of the causative pathogen. Pathogens with short infection cycles cannot persist in small populations in the absence of a more permanent reservoir of infection. Development of appropriate interventions requires detailed data on transmission pathways between reservoirs and wildlife populations of conservation concern. Relevant data can be derived from long-term population monitoring, epidemic and case-surveillance patterns, genetic analyses of rapidly evolving pathogens, serological surveys, and intervention studies. We examined studies of carnivore diseases in the Serengeti. Epidemiological research contributes to wildlife conservation policy in terms of management of endangered populations and the integration of wildlife conservation with public health interventions. Long-term, integrative, cross-species research is essential for formulation of effective policy for disease control and optimization of ecosystem health. Resumen:,Brotes recientes de rabia y moquillo en poblaciones silvestres del Serengeti muestran que las enfermedades infecciosas constituyen una causa significativa de mortandad que puede resultar en la extirpación regional de especies en peligro, aun en áreas extensas bien protegidas. Sin embargo, el manejo efectivo de una enfermedad infecciosa depende críticamente del entendimiento de la dinámica epidemiológica del patógeno. Los patógenos con ciclo infeccioso corto no pueden persistir en poblaciones pequeñas en ausencia de un reservorio de la infección más permanente. El desarrollo de intervenciones adecuadas requiere de datos detallados de las vías de transmisión entre reservorios y poblaciones de vida silvestre de preocupación para la conservación. Se pueden derivar datos importantes del monitoreo de poblaciones a largo plazo, de patrones de epidemias y de estudios de caso, del análisis genético de patógenos que evolucionan rápidamente, de muestreos sexológicos y de estudios de intervención. Examinamos estudios de enfermedades de carnívoros en el Serengeti. La investigación epidemiológica contribuye a las políticas de conservación de vida silvestre en términos de la gestión de poblaciones en peligro y de la integración de la conservación con intervenciones de salud pública. La investigación a largo plazo e integradora es esencial para la formulación de políticas efectivas para el control de enfermedades y la optimización de la salud del ecosistema. [source] Safety and efficacy of vaccinesDERMATOLOGIC THERAPY, Issue 2 2009Brenda L. Bartlett ABSTRACT For the past two centuries, vaccines have provided a safe and effective means of preventing a number of infectious diseases. Although the safety of some vaccines has been questioned in recent years, the currently available vaccines are more than a millionfold safer than the diseases they are designed to prevent. Vaccines, however, should always be used in conjunction with other public health interventions. One important intervention is education because the general public can be led to believe that vaccines are unsafe and not needed by misinformation readily available electronically and in print. Not only are some vaccines available via injection but other vaccines are also given orally or intranasally. New vaccines are being studied for topical and intravaginal use. In addition, new systems are being developed for more efficient production of vaccines, especially for influenza. Vaccines are currently available for only a limited number of viral and bacterial diseases. In the future, it is anticipated that safe and effective vaccines will be developed against a number of other viral and bacterial infections as well as fungal and protozoan diseases. [source] The Health Sector Gap in the Southern Africa Crisis in 2002/2003DISASTERS, Issue 4 2004Andre Griekspoor The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humanitarian community. The authors argue that the over-emphasis on food aid delivery occurred at the expense of other public health interventions, particularly preventative and curative health services. Health service needs were not sufficiently addressed despite the early recognition that ill-health related to HIV/AIDS was a major vulnerability factor. This neglect occurred because analytical frameworks were too narrowly focused on food security, and large-scale support to health service delivery was seen as a long-term developmental issue that could not easily be dealt with by short-term humanitarian action. Furthermore, there were insufficient countrywide data on acute malnutrition, mortality rates and performance of the public health system to make better-balanced evidence-based decisions. In this crisis, humanitarian organisations providing health services could not assume their traditional roles of short-term assistance in a limited geographical area until the governing authorities resume their responsibilities. However, relegating health service delivery as a long-term developmental issue is not acceptable. Improved multisectoral analytical frameworks that include a multidisciplinary team are needed to ensure all aspects of public health are dealt with in similar future emergencies. Humanitarian organisations must advocate for improved delivery and access to health services in this region. They can target limited geographical areas with high mortality and acute malnutrition rates to deliver their services. Finally, to address the underlying problem of the health sector gap, a long-term strategy to ensure improved and sustainable health sector performance can only be accomplished with truly adequate resources. This will require renewed efforts on part of governments, donors and the international community. Public health interventions, complementing those addressing food insecurity, were and are still needed to reduce the impact of the crisis, and to allow people to re-establish their livelihoods. These will increase the population's resilience to prevent or mitigate future disasters. [source] Injury and alcohol: a hospital emergency department studyDRUG AND ALCOHOL REVIEW, Issue 2 2001ANN M. ROCHE Abstract A pilot survey was undertaken of injury presentations to a public hospital emergency department to determine patterns of alcohol use in this population. Of the 402 injury presentations in the study period, a total of 236 injury cases were interviewed, of whom 45% (n = 107) and 29% (n = 69) had consumed alcohol 24 and 6 hours prior to injury. Mean age for all injury presentations was 35.1 years, and 32.6 years for alcohol injury cases. For both injury groups, males were significantly younger than females. Recent alcohol ingestion was three times more common among male than female injury presentations, but with females drinking at significantly lower levels. Of males who had consumed alcohol 6 hours prior to injury, nearly 70% were drinking at NHMRC harmful levels and 61% had drunk more than eight standard drinks. Overall, alcohol-involved injury cases commonly occurred among low-income, single males around 30 years of age who were regular heavy drinkers who were drinking heavily in licensed premises prior to their injury, and who sustained injury through intentional harm. In addition, one in five of the alcohol-involved injury cases were aged 15,18 years, i.e. below the legal age of purchase. The high proportion of hazardous and harmful drinkers among those who had consumed alcohol within the last 6 hours, and the injury sample overall, highlights the need for further research to explore the relationship between the occurrence of injury and the drinking patterns and environments associated with injury. Further research is also required to assess the efficacy of early and brief interventions for alcohol and drug use within the emergency ward setting. This information would enable appropriate public health interventions to be initiated. [source] Health outcomes associated with methamphetamine use among young people: a systematic reviewADDICTION, Issue 6 2010Brandon D. L. Marshall ABSTRACT Objectives Methamphetamine (MA) use among young people is of significant social, economic and public health concern to affected communities and policy makers. While responses have focused upon various perceived severe harms of MA use, effective public health interventions require a strong scientific evidence base. Methods We conducted a systematic review to identify scientific studies investigating health outcomes associated with MA use among young people aged 10,24 years. The International Classification of Diseases (ICD-10) was used to categorize outcomes and determine the level of evidence for each series of harms. Results We identified 47 eligible studies for review. Consistent associations were observed between MA use and several mental health outcomes, including depression, suicidal ideation and psychosis. Suicide and overdose appear to be significant sources of morbidity and mortality among young MA users. Evidence for a strong association between MA use and increased risk of human immunodeficiency virus (HIV) and other sexually transmitted infections is equivocal. Finally, we identified only weak evidence of an association between MA use and dental diseases among young people. Conclusions Available evidence indicates a consistent relationship between MA use and mental health outcomes (e.g. depression, psychosis) and an increased risk of mortality due to suicide and overdose. We found insufficient evidence of an association between MA use and other previously cited harms, including infectious diseases and dental outcomes. As such, future research of higher methodological quality is required to further investigate possible associations. Current interventions should focus attention upon MA-related health outcomes for which sound scientific evidence is available. [source] Substance use and misuse in the aftermath of terrorism.ADDICTION, Issue 6 2009A Bayesian meta-analysis ABSTRACT Aim To conduct a comprehensive analysis of the conflicting evidence on substance use and misuse following mass traumas such as terrorist incidents. Methods We reviewed and synthesized evidence from 31 population-based studies using Bayesian meta-analysis and meta-regression. Results The majority of the studied were conducted in the aftermath of the terrorist attacks of 11 September 2001. Controlling for exposure, type of incident and time since the event occurred, 7.3% [95% credible interval (CrI) 1.1,32.5%] of a population can be expected to report increased alcohol consumption in the first 2 years following a terrorist event. There is, however, a 20% probability that the prevalence will be as high as 14%. The unadjusted prevalence of increased cigarette smoking following a terrorist event is 6.8% (95% Cr I 2.6,16.5%). Unadjusted reports of mixed drug use (including narcotics and prescription medications) was 16.3% (95% Cr I 1.3,72.5%). Conclusions These results underscore the potentially pervasive behavioral health effects of mass terrorism, and suggest that public health interventions may usefully consider substance use as an area of focus after such events. [source] Standards for reporting non-randomized evaluations of behavioral and public health interventions: the TREND statementADDICTION, Issue 9 2004RAUL CAETANO First page of article [source] REJOINDER TO GARDNER'S "COMMENTARY ON KELLY AND JOHNSTON'S ,THE ALIENATED CHILD: A REFORMULATION OF PARENTAL ALIENATION SYNDROME'"FAMILY COURT REVIEW, Issue 4 2004Janet R. Johnston In this reply to Richard Gardner, we outline our points of disagreement with his formulation of parental alienation syndrome (PAS), showing that his focus on the alienating parent as the primary cause of children's negative attitudes and rejecting behavior toward the other parent is overly simplistic and not supported by findings from recent empirical research. It follows that we strongly object to Gardner's recommendations for legal and mental health interventions with alienated children as well as the use of the term PAS when referring to this problem. [source] Rural professionals' perceptions of interprofessional continuing education in mental healthHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2010Elizabeth A. Church PhD Abstract We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10-session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty-five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals' confidence (n = 49) with mental health interventions, issues and populations was measured pre- and post-programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter-agency linkages and collaborations had increased. Conditions that appeared to underpin the programme's success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co-ordinators as liaisons. Participants' dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health. [source] Medical technology adoption, uncertainty, and irreversibilities: is a bird in the hand really worth more than in the bush?HEALTH ECONOMICS, Issue 2 2010Joshua Graff Zivin Abstract The influence of current medical technology adoption decisions on the use of future potential interventions is often overlooked. Some health interventions, once exercised, restrict future potential interventions for both related and unrelated medical conditions. For example, treatment of a patient with an antibiotic may lead to resistance in that patient that precludes future treatment with the same or related compounds. This irreversibility raises the value of treatment modalities that preserve future treatment options. Surprisingly, partial reversibility with or without learning can either increase or decrease this value, depending on the distribution of patient types within the treated population. Evaluations that ignore these option values miss an important part of the welfare equation that is becoming increasingly important as individuals live longer and the stock of medical treatments increases. Copyright © 2009 John Wiley & Sons, Ltd. [source] Estimating production costs in the economic evaluation of health-care programsHEALTH ECONOMICS, Issue 1 2009Carmen Herrero Abstract We propose a method for calculating the production costs of an intervention in a manner that accounts for differences in productive ,effort.' This method could be used within a cost-effectiveness analysis framework in the evaluation of new medical technologies, pharmaceuticals, treatment programs, or public health interventions. We apply it to show evidence in favor of implementing a newborn screening program to detect congenital hearing impairment. Copyright © 2008 John Wiley & Sons, Ltd. [source] Infant mortality and child nutrition in BangladeshHEALTH ECONOMICS, Issue 9 2008Diane Dancer Abstract The excess female infant mortality observed in South Asia has typically been attributed to gender discrimination in the intra-household allocation of food and medical care. However, studies on child nutrition find no evidence of gender differences. A natural explanation could be that in environments of high infant mortality of females, the surviving children are healthier, so that child nutrition cannot be studied independently of mortality. In this paper, we use data from the 2004 Bangladesh Demographic Health Survey to investigate if there are any gender differences in survival probabilities and whether this leads to differences in child nutrition. We argue the importance of establishing whether or not there exists a dependence relationship between the two random variables , infant mortality and child nutrition , and in order to detect this we employ a copula approach to model specification. The results suggest, for example, that while male children have a significantly lower likelihood of surviving their first year relative to female children, should they survive they have significantly better height-for-age Z -scores. From a policy perspective, household wealth and public health interventions such as vaccinations are found to be important predictors of better nutritional outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source] The Making of ,African Sexuality': Early Sources, Current DebatesHISTORY COMPASS (ELECTRONIC), Issue 8 2010Marc Epprecht The notion that Africans share a common sexual culture distinct from people elsewhere in the world has for many years been a staple of popular culture, health, academic, and political discourse in the West as well as in Africa. Sometimes overtly racist (Black Peril) but sometimes intended to combat patronizing or colonialist stereotypes, the idea of a singular African sexuality remains an obstacle to the development of sexual rights and effective sexual health interventions. Where did the idea come from, and how has it become so embedded in our imaginations right across the political spectrum? This article traces the idea back in time to its earliest articulations by explorers, ethnographers, and psychiatrists, as well as to contestations of the idea in scholarship, fiction, and film influenced by Africa's emerging gay rights movement. It asks, what can we learn about the making of ,African sexuality' as an idea in the past that may suggest ways to challenge its enduring, harmful impacts in the present? [source] Understanding the "ghosts in the nursery" of pregnant women experiencing domestic violence: Prenatal maternal representations and histories of childhood maltreatment,INFANT MENTAL HEALTH JOURNAL, Issue 4 2010Johanna C. Malone Selma Fraiberg and colleagues (1975) conceptualized the "ghosts in the nursery" as experiences from a mother's past that influenced her ability to form a warm and attuned relationship with her child. Contemporary infant mental health interventions often ask the mother to reflect on her own history of attachment relationships to gain insight into as well as to strengthen her developing relationship with her child. This study investigated the association between a mother's history of childhood maltreatment (CM) and her subsequent prenatal maternal representation during the third trimester of pregnancy. Controlling for domestic violence (DV), distorted prenatal representations were associated with higher rates of self-reported childhood physical neglect. In addition, DV moderated the relationship between representations and CM, such that women who were exposed to DV during pregnancy and had distorted prenatal representations were least likely to report childhood physical and sexual abuse. Implications are discussed in relation to infant mental health interventions which rely on a parent's ability to psychologically access and reflect on childhood histories to more sensitively parent her own child. Selma Fraiberg y colegas (1975) definió el concepto de "fantasmas en el cuarto de los niños" como experiencias del pasado de las madres que ejercen influencia en la habilidad de ella para formarse una cálida y afinada relación con su infante. A menudo, las intervenciones contemporáneas de la salud mental infantil les piden a las madres que reflexionen sobre su propia historia de relaciones afectivas con el fin de lograr un mejor conocimiento y al mismo tiempo hacer más fuerte la relación que están desarrollando con sus hijos. Este estudio investigó la asociación entre la historia de una madre que tuvo una niñez llena de maltratos (CM) y su subsiguiente representación maternal prenatal durante el tercer trimestre del embarazo. Considerando por medio del experimento de control la variable de la violencia doméstica, (DV), las representaciones prenatales distorsionadas se asociaron con puntajes más altos de la auto-reportada negligencia física en la niñez. Es más, la violencia doméstica (DV) sirvió para moderar la relación entre las representaciones y el maltrato en la niñez (CM), a tal punto de que las mujeres que habían estado expuestas a la violencia doméstica (DV) durante el embarazo y tenían representaciones prenatales distorsionadas fueron las menos propensas a reportar el abuso físico y sexual en la niñez. Se discuten las implicaciones en relación con las intervenciones de la salud mental infantil que dependen de la habilidad de la madre de acceder a y reflexionar sobre sus historias de la niñez, sicológicamente, con el fin de criar a su propio infante con una mayor sensibilidad. Selma Fraiberg et collègues (1975) conceptualisa les "fantômes dans la crèche" en tant qu'expériences d'un passé de la mère qui ont influencé sa capacité à former une relation chaleureuse et sensible avec son enfant. Les interventions contemporaines de santé mentale du nourrisson demandent souvent à la mère de faire un effort de réflexion sur sa propre histoire de relations d'attachement afin d'arriver à mieux connaître sa relation qui se développe avec son enfant, et aussi de la renforcer. Cette étude s'est penchée sur l'association entre l'histoire de maltraitance durant l'enfance de la mère (abrégé CM en anglais) et sa représentation maternelle prénatale ultérieure durant le troisième trimestre de la grossesse. Avec un contrôle pour la violence conjugale (abrégée DV en anglais), les représentations prénatales déformées étaient liées à des taux plus élevés de négligence physique durant l'enfance auto-rapportées. De plus, la violence conjugale (DV) modérait la relation entre les représentations et la maltraitance durant l'enfance (CM), d'une telle manière que les femmes qui ont été exposées à la violence conjugale (DV) durant la grossesse et qui faisaient preuve de représentations prénatales déformées étaient les moins à même de signaler une maltraitance physique et des abus sexuels. Les implications sont discutées en relation aux interventions de santé mentale du nourrisson qui reposent que la capacité d'un parent à accéder psychologiquement aux histoires de son enfance et à y réfléchir de fa,on à élever son propre enfant de plus sensiblement. Selma Fraiberg und Kollegen (1975) konzeptualisiert die "Gespenster im Kinderzimmer", als Erfahrungen aus der Vergangenheit der Mutter, die ihre Fähigkeit, eine warme und angemessene Beziehung zu ihrem Kind aufzubauen. Zeitgemäße Interventionen der seelische Gesundheit von Kleinkindern fragen Mütter oft nach ihrer eigenen Geschichte von Bindungsbeziehungen, um einen Einblick zu bekommen, damit die sich entwickelnde Beziehung zu ihrem Kind gestärkt werden kann. Die vorliegende Studie untersuchte den Zusammenhang zwischen mütterlichen Misshandlungserfahrungen (CM) und deren späteren Schilderungen im dritten Trimenon ihrer eigenen Schwangerschaft. Maßgeblich für häusliche Gewalt (DV) war eine verzerrte Darstellung, die mit einer höheren Rate von selbst berichteter körperlicher Verwahrlosung assoziiert war. Darüber hinaus beeinflusste DV die Beziehung zwischen den Vorstellungen und den CM, so dass Frauen, die während der Schwangerschaft DV ausgesetzt waren, und verzerrten Darstellungen hatten mit großer Wahrscheinlichkeit von körperlichen und sexuellen Missbrauch berichteten. Die Auswirkungen werden in Bezug auf Interventionen der psychischen Gesundheit von Kindern diskutiert, die die elterliche Fähigkeit, psychologische Zusammenhänge zu verstehen und darüber hinaus zu Reflexion über die eigenen Kindheitsgeschichten anregen, damit die Eltern sensibler auf ihr eigenes Kind reagieren können. [source] Impact of organizational change on the delivery of reproductive services: a review of the literatureINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2005Tim Ensor Abstract In order to understand the impact of specific maternal health interventions, it is necessary to understand the likely effect of the health system structure. An important aspect of this structure is the organizational culture. Many systems in low-income countries have been based on a centrally planned and financed system. In recent years a series of organizational changes have been introduced into many systems and these substantially alter the way in which the system operates and impacts on reproductive health care provision. The main changes reviewed in this paper are: (i) decentralization, (ii) privatization and (iii) integration and sector wide approaches. Each of these changes is seen to have important implications for reproductive health. In each case it is clear that the nature of the impact depends crucially on the way it is implemented. Quantifying the impact of these changes remains extremely difficult given the many different ways they can be introduced and the many confounding factors that affect the overall impact. The literature does, however, point to a number of key issues that impinge on the way in which change is likely to affect reproductive health initiatives. Copyright © 2005 John Wiley & Sons, Ltd. [source] Cochrane Reviews of non-medication-based psychotherapeutic and other interventions for schizophrenia, psychosis, and bipolar disorder: A systematic literature reviewINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2009Xenia Tricia Jung ABSTRACT Mental health-care professionals are striving to keep up to date with health interventions that are effective and beneficial to patients. The Cochrane Reviews make available a systematic and up-to-date review of a comprehensive range of health interventions. We identified a total of 28 interventions from a systematic search and review of the Cochrane Reviews for either schizophrenia, psychosis, schizoaffective, or bipolar disorder. These interventions have been graded into tables of: strong support that merits application, moderate support that warrants consideration of application, not supported, and data that is deemed inconclusive. The tables provide a comprehensive summary and classification of evidence-based practices. This information is presented in a way to enable nurses and other health-care professionals to analyze their own practices to improve mental health services and outcomes for patients. Of the 28 interventions identified in this review, four had strong support and five had moderate support meriting application. Limitations of this review are discussed. [source] The Medical Assessment of Migrants: Current Limitations and Future PotentialINTERNATIONAL MIGRATION, Issue 2 2001V.P. Keane Attempts to control the importation of infectious diseases through the medical screening and evaluation of immigrants and refugees represent the modern application of some of the earliest recorded public health interventions. States with long-standing immigration programmes continue to require the medical examination and screening of migrants for certain diseases. In some instances, the public health effectiveness of these immigration medical assessments is of questionable value when considered from a population health basis. This article reviews current practices and describes recent studies where more modern and epidemiologically based immigration medical interventions have been undertaken. A more effective immigration medical assessment process is proposed through the use of results of this more empirical approach to immigration medical screening. [source] | ||||||||||||||||||||||||||||||||||