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Health Programmes (health + programme)
Kinds of Health Programmes Selected AbstractsKey issues relating to decentralization at the provincial level of health management in CambodiaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2005Bunnan Men Abstract The following study was conducted as part of a review of management systems at a Provincial Health Department (Kampong Cham Province) and a National Health Programme (National Immunization Program) in 2002,2003 in Cambodia. The aim of this paper is to identify, analyse and recommend those management system factors that are critical to the success of health management performance, with a particular focus on provincial management. The review has identified critical success factors associated with health management performance at the sub-national level that include a stronger role for effective human resource management in health sector reform, elevation of the status of planning in senior level management, and the development of a more comprehensive and transparent finance system. These success factors will position the provincial level of health management to respond more effectively to the reform challenges of administrative de-concentration and political decentralization that are currently underway across a range of government sectors in Cambodia. Copyright © 2005 John Wiley & Sons, Ltd. [source] Accessing rural populations: role of the community pharmacist in a breast and cervical cancer screening programmeJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Timothy R. McGuire Pharm.D. FCCP Abstract Rationale, Community pharmacists are one of the most frequently visited health care providers in the USA. The article describes a demonstration project which used community pharmacists to educate and enrol low to moderate income and medically under-served women into a statewide breast and cervical cancer screening programme. Methods, The Nebraska Department of Health programme entitled, ,Every Woman Matters', funded through the Centers of Disease Control and Prevention, provided no cost or low cost mammography and pap smears to eligible women. Patient enrolment packets were distributed to 91 pharmacies expressing an initial interest in participating. These were reduced to 28 pharmacies based on their commitment level during the initial 3 months of the study. Results, One hundred and fourteen patient referrals were generated from the 28 network pharmacies; two from pharmacies in urban areas, and 112 referrals from rural sites. All referrals were from the 22 independently owned pharmacies in the study. Conclusions, Results suggest that the use of independent community pharmacies in the rural setting can be an effective method of recruiting women into public health programmes. [source] Poisoning deaths among Finnish children from 1969 to 2003ACTA PAEDIATRICA, Issue 10 2009Juho E Kivistö Abstract Aim:, Trends in paediatric deaths due to poisoning are little studied. The aim of this study was to investigate the cause and secular trend of poisoning deaths among Finnish children. Methods:, Death certificates of all Finnish children aged 0,15 who died due to poisoning between 1969 and 2003 were obtained from the Statistics of Finland and analysed. Results:, During the study period, altogether 121 children aged 0,15 years died from poisoning in Finland. Among 0- to 4-year olds, the incidence of poisoning deaths declined to practically zero by the beginning of 1980s. Most of these deaths were unintentional poisonings. Among 5- to 15-year olds, the incidence of poisoning deaths varied during the study period. In this age group, up to 53% of the deaths were suicides among girls compared with 20% among boys (p = 0.017). The corresponding figures for substance abuse were 54% among boys and 9% among girls (p < 0.001). Conclusion:, Despite the declining secular trend seen in paediatric poisoning deaths in Finland from 1969 to 2003, the risk of death from both intentional and unintentional poisoning persists in children. Health programmes should be continued especially to promote well-being in families and to prevent teenage suicides and substance abuse. [source] Outcome of an oral health outreach programme for preschool children in a low socioeconomic multicultural areaINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2 2008INGER WENNHALL Background., Despite a significant reduction in the prevalence of dental caries, childhood tooth decay is still a public health problem in both developed and developing countries. Objective., The aim of this study was to evaluate the caries preventive effect of an oral health programme for preschool children living in a low socioeconomic multicultural area in the city of Malmö, Sweden. Methods., Eight hundred and four 2-year-old children were enrolled and recalled every third month between ages 2 and 3 and semi-annually between ages 3 and 5 years. From an outreach facility, parents were instructed on oral health with a focus on toothbrushing and diet, and provided fluoride tablets free of charge. Participants completed a clinical examination and a structured interview at age of 5 years, at which point 651 children (81%) remained in the programme. The results of the intervention group were compared with a non-intervention reference group consisting of 201 5-year-old children from the same district. Results., In the intervention group, 96% attended four or more of their scheduled appointments, and mean caries prevalence was significantly lower than in the reference group (5.4 deft vs. 6.9 deft; P < 0.001). The prevented defs fraction was 27%. Parents' daily assistance with toothbrushing and administering fluoride tablets was significantly better in the intervention group than in the reference group (P < 0.05). Conclusion., This study demonstrated that the early start of oral health programme had a significant beneficial effect on caries prevalence after 3 years. [source] Relationship between area deprivation and the anticaries benefit of an oral health programme providing free fluoride toothpaste to young childrenCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 3 2004R. P. Ellwood Abstract , Objective:,To determine the effectiveness of providing free toothpaste containing either 1450 or 440 ppm F on caries experience in 5-year-old children living in areas with different levels of material deprivation. Design:, Five-year, examiner-blind, randomized, controlled, parallel-group, clinical trial. Children were randomly assigned to three groups. Setting:, Health Districts in the north-west of England with high levels of dental caries. Clinical examinations were performed in schools during the period October 1999 to April 2000 when the children were 5,6 years old. Participants:, Children from 3-month birth cohorts resident in nine, nonfluoridated health districts. Interventions:, Toothpaste containing either 440 or 1450 ppm F and dental health literature posted at 3-month intervals and toothbrush provided annually from the age of 1,5 years. Comparison group received no intervention. Main outcome measures:, Mean dmft and proportion of participants with dmft > 0, dmft , 4, upper primary incisor caries and extraction of one or more primary teeth. Outcomes tabulated for quartiles of participants based on the distribution of the Townsend index of material deprivation. Results:, A total of 3467 children were included in the final data analysis. The Townsend index was found to be useful in identifying groups of children with increased caries risk. Overall, participants in the programme using the high-fluoride toothpaste had significantly (P < 0.002) less caries than the comparison group with similar absolute reductions in mean dmft for the most- and least-deprived groups. Relative to the comparison group the association between deprivation and dental caries was changed so that in the most-deprived quartile those using the low-fluoride toothpaste tended to have less dental caries than the comparison group whereas in the least deprived they tended to have more. This difference in the association (slope) was statistically significant (P < 0.05). Provision of both low- and high-fluoride toothpaste appeared to reduce the risk of extractions for participants in the most-deprived quartile (P < 0.05). Conclusion:, The relative benefits of the programmes supplying the two toothpastes considered in this study are different depending on the deprivation status of the participants. For the most-deprived groups postal provision of either a low- or high-fluoride toothpaste provides similar levels of benefit. In the less deprived groups only provision of the high-fluoride toothpaste provided a benefit. The absolute caries reduction seen for provision of the high-fluoride toothpaste was not related to the deprivation status and hence the programme did not reduce deprivation-related health inequalities. Targeting the programme using the methods employed in this study is unlikely to improve the effectiveness of the programme. [source] Effectiveness of an oral health education programme in primary schools in Zimbabwe after 3.5 yearsCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 4 2001Jo E. Frencken Abstract , Many medical and dental professionals in African nations believe that school teachers, through attendance of a short workshop, can be trained to provide oral health education. This increases the number of professionals available and is regarded as an important way forward in improving oral health. Objectives: The current study assesses the effectiveness of an oral health education programme administered by schoolteachers in a district in Zimbabwe over a period of 3.5 years. Methods: The experimental group consisted of schools that had sent representatives to a regional workshop on oral health held in 1992. The control group was selected at random from schools not having attended the workshop. A total number of 439 boys and 526 girls were examined in 1992. Follow-up evaluations were carried out in 1993, 1994 and 1996. The dependent variables were plaque accumulation and caries increment in grade 2 and grade 4 children of experimental and control schools. Results: ANOVA test with year of evaluation (1992,94), experiment/control school, age and gender as independent variables showed no statistically significant difference in mean plaque scores in longitudinally examined original grade 2 (P>0.20) and grade 4 children (P=0.06) from experimental and control schools. The mean caries increment score in the experimental and control schools was 0.04 and 0.19, respectively. ANOVA test with fluoride levels and gender as independent variables on caries increment in experimental and control schools did not show a statistically significant difference (P=0.06). Conclusion: The one-time training of teachers in aspects of oral health was ineffective in lowering plaque levels over a period of 3.5 years. Considering the low caries increment observed over the study period, the effect of the oral health programme on caries levels in the study group was inconclusive. [source] The Mental Health of Expatriate and Kosovar Albanian Humanitarian Aid WorkersDISASTERS, Issue 2 2005Barbara Lopes Cardozo The mental health consequences of exposure to traumatic events and the risk factors for psychological morbidity among expatriate and Kosovar Albanian humanitarian aid workers have not been well studied. In June 2000, we used standardised screening tools to survey 285 (69.5%) of 410 expatriate aid workers and 325 (75.8%) of 429 Kosovar Albanian aid workers from 22 humanitarian organizations that were implementing health programmes in Kosovo. The mean number of trauma events experienced by expatriates was 2.8 (standard deviation: 2.7) and by Kosovar staff 3.2 (standard deviation: 2.8). Although only 1.1% of expatriate and 6.2% of Kosovar aid workers reported symptoms consistent with the diagnosis for post-traumatic stress disorder, 17.2% and 16.9%, respectively, reported symptoms satisfying the definition of depression. Regression analysis demonstrated that the number of trauma events experienced was significantly associated with depression for the two sets of workers. Organisational support services may be an important mediating factor and should be targeted at both groups. [source] Original article: Prevalence of oral and dental disorders in institutionalised elderly people in Rasht, IranGERODONTOLOGY, Issue 3 2010Maryam Rabiei doi:10.1111/j.1741-2358.2009.00313.x Prevalence of oral and dental disorders in institutionalised elderly people in Rasht, Iran Objective:, The aim of this study was to determine the prevalence of dental and oral mucosal lesions in institutionalised elderly people in Rasht. Background:, Oral health in the elderly people is important to tailor the health programmes for this increasing age group within the population. Methods:, A total of 216 elderly people residing in a geriatric nursing home were included in the study. Subjects were interviewed and examined clinically and registered in a data collection form and analysed using spss version 11 program (SPSS Inc, Chicago, Illinois, USA). Results:, The prevalence of dental and oral disorders was 44.9% and 86.1% respectively. The most frequent oral disorders were dry mouth (42.1%), fissure tongue (25.9%), atrophic of tongue (25%), sublingual varicosity (22.7%), burning sensation (16.7%) and varix (15.3%). The prevalence of edentulousness was 56% (95%CI: 49,63%). The mean level of retained teeth was 3.22. The odds of an oral mucosal disorder in females were significantly more than in males (OR = 2.79, 95%CI: 1.25,6.23). Discussion:, The findings revealed a high prevalence of dental and oral disorders in institutionalised elderly people in Rasht in comparison to similar studies. The mean of retained teeth was also much lower than in other reports. Therefore, the necessity for regular oral examination of these rapidly expanding age groups of people is essential. [source] Equality of what in health?HEALTH ECONOMICS, Issue 2 2009Distinguishing between outcome egalitarianism, gain egalitarianism Abstract When deciding how to weigh benefits to different groups, standard economic models assume that people focus on the final distribution of utility, health or whatever. Thus, an egalitarian is assumed to be an egalitarian in the outcome space. But what about egalitarianism in the gains space, such that people focus instead on how equally benefits are distributed? This paper reports on a study in which members of the public were asked to rank a number of health programmes that differed in the distribution of benefits and final outcomes in ways that enabled us to distinguish between different types of egalitarianism. The results suggest that outcome egalitarianism dominates, particularly for differences in health by social class, but a sizeable minority of respondents appear to be gain egalitarians, especially when the health differences are by sex. These results have important implications for how we think about outcome-based social welfare functions in economics. Copyright © 2008 John Wiley & Sons, Ltd. [source] Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, ChinaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Qingyue Meng Abstract Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended. Copyright © 2004 John Wiley & Sons, Ltd. [source] District health systems in a neoliberal world: a review of five key policy areas,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2003Malcolm Segall Abstract District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a ,second generation' reform,to be superseded by third generation reforms with a market orientation,flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass compaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor. Copyright © 2003 John Wiley & Sons, Ltd. [source] Accessing rural populations: role of the community pharmacist in a breast and cervical cancer screening programmeJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Timothy R. McGuire Pharm.D. FCCP Abstract Rationale, Community pharmacists are one of the most frequently visited health care providers in the USA. The article describes a demonstration project which used community pharmacists to educate and enrol low to moderate income and medically under-served women into a statewide breast and cervical cancer screening programme. Methods, The Nebraska Department of Health programme entitled, ,Every Woman Matters', funded through the Centers of Disease Control and Prevention, provided no cost or low cost mammography and pap smears to eligible women. Patient enrolment packets were distributed to 91 pharmacies expressing an initial interest in participating. These were reduced to 28 pharmacies based on their commitment level during the initial 3 months of the study. Results, One hundred and fourteen patient referrals were generated from the 28 network pharmacies; two from pharmacies in urban areas, and 112 referrals from rural sites. All referrals were from the 22 independently owned pharmacies in the study. Conclusions, Results suggest that the use of independent community pharmacies in the rural setting can be an effective method of recruiting women into public health programmes. [source] The rationale of value-laden medicineJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2002Michael H. Kottow MA(Soc) MD Abstract Medicine is becoming increasingly confident that scientific advances, especially in the area of genetics, will allow a major improvement in the control and eradication of disease. This development seems to go hand in hand with health-enhancement strategies, erasing the distinction between the states of health and disease, and blurring the specific goals of medical services. Medicine tends to become an increasingly technocentric practice that relies heavily on expert knowledge and on epidemiological evidence, neglecting the lived-body experience of being ill, and tending to transform costly medical services into commodities only affordable by the affluent. This paper argues that disease is not merely a functional description, but rather a definitely value-laden organismic state that is experienced by the patient, needs to be explored and treated by medical practitioners, and requires the assessment and participation of social institutions concerned with the delivery and support of medical services. Each of these perspectives introduces its own set of values, both in the clinical encounter and in public health programmes. Bioethics seems to be the appropriate discipline to discuss all these values involved, and help assign them properly in order to rescue the caring concern of medicine for the sick, as well as uphold a principle of fairness in publicly funded medical services. [source] Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural GhanaPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2008Karen M. Edmond Summary This study evaluated the diagnostic accuracy of a verbal autopsy (VA) tool in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana and was nested within a community-based maternal vitamin A supplementation trial (ObaapaVitA trial). All stillbirths and neonatal deaths between 1 January 2003 and 30 June 2004 were prospectively included. Community VAs were carried out within 6 months of death and were classified with a primary cause of death by three experienced paediatricans. The reference standard diagnosis was obtained by the study paediatrician in 4 district hospitals in the study area. There were 20 317 deliveries, 661 stillbirths and 590 neonatal deaths with a VA diagnosis in the study population. A total of 311 stillbirths and 191 neonatal deaths had both a VA and a hospital reference standard diagnosis. The VA performed poorly for stillbirth diagnoses such as congenital abnormalities and maternal haemorrhage. Accuracy was higher for intrapartum obstetric complications and antepartum maternal disease. For neonatal deaths, sensitivity was >60% for all major causes; specificity was 76% for birth asphyxia but >85% for prematurity and infection. Overall, VA diagnostic accuracy was higher than expected in this rural African setting. Our classification system was based on the expected public health importance of the individual causes of death, differing implications for intervention and the ability to distinguish between the individual causes in low-resource settings. We believe this system was easier to use than traditional approaches and resulted in high precision and accuracy. However, further simplifications are needed to allow use of the World Health Organisation VA in routine child health programmes. The diagnostic accuracy of the VA tool should also be assessed in other regions and in multicentre studies. [source] Adverse perinatal conditions in hearing-impaired children in a developing countryPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2006Bolajoko O. Olusanya Summary Prevailing adverse perinatal conditions in developing countries have been associated with substantial mortality, but little evidence exists on their impact on permanent childhood disabilities and morbidity due to limitations in clinical investigations and medical records. This study aims to identify the possible association between parent-reported adverse perinatal conditions and permanent hearing loss, in order to establish service needs within current maternal and child health programmes. Structured questionnaires were administered to 363 parents of deaf children and 309 parents of normal-hearing children in an inner city area of Lagos, Nigeria. The parents were from all social classes. After a multivariable logistic regression analysis, birth asphyxia [OR 20.45; 95% CI 6.26, 66.85], difficult delivery [OR 8.09; 95% CI 2.76, 23.68], neonatal jaundice [OR 2.45; 95% CI 1.25, 4.79] and neonatal seizures [OR 2.30; 95% CI 1.09, 4.85] were associated with permanent hearing loss. Consanguineous marriages [OR 6.69; 95% CI 2.72, 16.46] and family history of deafness [OR 6.27; 95% CI 2.07, 18.97] also emerged as additional risk factors for permanent hearing loss. In addition, parents of children in state-owned schools for the deaf were significantly more likely to belong to higher social classes compared with normal-hearing children in mainstream state-owned schools. There is a need to incorporate services for the early detection of permanent hearing loss into current maternal and child healthcare programmes in developing countries. [source] MASS-VACCINATION PROGRAMMES AND THE VALUE OF RESPECT FOR AUTONOMYBIOETHICS, Issue 5 2008LOTTE ASVELD ABSTRACT Respect for autonomy is problematic in relation to public health programmes such as vaccination, as the success of such programmes depends on widespread compliance. European countries have different policies for dealing with objectors to vaccination programmes. In some countries compliance is compulsory, while in others objectors are exempted or allowed to enter the programme under specific conditions. In this paper I argue that the objectors should not be treated as a homogenous group as is done in the above-mentioned policies. Objectors have different arguments for not participating in vaccination programmes. Considering the value of respect for autonomy, some but not all of these arguments need to be accommodated by authorities. The concept of ,narrative autonomy' provides criteria to distinguish between tenable and untenable claims to the right to refuse vaccination. Narrative autonomy understands autonomy as essentially linked to identity, as this provides the moral framework with which we assess our first-order preferences. The above-mentioned concept of autonomy is derived from the concept of narrative identity as described by Marya Schechtman. She suggests that the application of the Articulation Constraint and the Reality Constraint enables us to establish the validity of personal narratives. Additionally, form and content features of identity, as proposed by Anthony Laden, will be used as criteria to establish the compatibility of the defectors' arguments with shared scientific and political values. Such compatibility is essential to accommodate respect for autonomy in the context of public health. [source] Welfarism Versus ,Free Enterprise': Considerations Of Power And Justice In The Philippine Healthcare SystemBIOETHICS, Issue 5-6 2003Peter A. Sy ABSTRACT The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and ,free enterprise.' Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of ,power' proposed here as ,access to and control of resources.' [source] PERINATAL AND CHILDHOOD PRECURSORS OF ADULT CARDIOVASCULAR DISEASECLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 2007Lawrence Beilin SUMMARY 1Longitudinal studies from the US, Australia and Europe have demonstrated tracking of childhood risk factors for cardiovascular disease from adolescence into adult life. These factors include obesity, blood cholesterol levels, blood pressure and measures of insulin resistance. Worldwide increases in childhood obesity and overweight are already resulting in increases in adolescent diabetes and are likely to translate into earlier onset hypertension and cardiovascular disease in adults. 2Low birth weight has also been associated with increased risk of adult cardiovascular disease, diabetes and high blood pressure, but there is considerable debate as to the relative importance of pre- and postnatal influences. 3These issues are discussed in the context of results of a longitudinal cohort study of cardiovascular and metabolic risk factors in Western Australia, the ,Raine' childhood cohort, which showed that in a well-nourished Australian population at age 8 there was a U-shaped relationship between birth weight and a cluster of factors predisposing to adult cardiovascular disease, with postnatal weight gain being the dominant factor. 4Future public health programmes should focus on both pre- and early postnatal factors predisposing to obesity, hypertension and diabetes. 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