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Public Health Interventions (public + health_intervention)
Selected AbstractsThe 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] Is the health of young unemployed Australians worse in times of low unemployment?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2009Justin Newton Scanlan Abstract Objective: To compare the health of young unemployed Australians during a period of low unemployment (April 2007: rate 4.4%) against published Australian norms for 18,24 year olds and unemployed people during a time of higher unemployment (February 1995 to January 1996: rate 8.1% to 8.9%). Methods: Two hundred and fifty-one unemployed 18,25 year olds residing in New South Wales completed the SF36 Health Survey version 2 (SF36v2) during a time of low unemployment. SF36v2 subscale and component summary scores were compared with published norms for 18,24 year olds and for unemployed persons during a time of higher unemployment. Results: Young unemployed people during a period of low unemployment reported poorer health in all areas when compared with age-matched norms and poorer psychological health when compared with the published norms for unemployed people from a time when unemployment rates were higher. Conclusions: The health of young unemployed individuals during a time of low unemployment was poor when compared to both the general population and to unemployed people during a time of higher unemployment. Implications: Public health interventions must focus on improving the health of young unemployed people to support their engagement with and contribution to Australian society. [source] Breastfeeding expectations versus reality: a clusterrandomised controlled trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2005Tina Lavender Objective To evaluate the affect of an antenatal educational breastfeeding intervention on women's breastfeeding duration. Design Cluster randomised controlled trial. Unit of randomisation: electoral ward. The primary outcome was the proportion that fulfilled their antenatal breastfeeding expectation. Secondary outcomes were the number of women breastfeeding on discharge and at four months. Data were collected using a series of questionnaires and diaries. Setting Teaching hospital in North West of England. Participants Women who expressed a desire to breastfeed at the start of their pregnancy. Methods Women were allocated to either routine antenatal education or an additional single educational group session supervised by a lactation specialist and attended by midwives from their locality. Main outcome measure The proportion of women who fulfilled their expectation of breastfeeding. Result One thousand three hundred and twelve women were randomised, with 1249 (95%) women available for analysis. There was no difference between the groups in the proportion of women who attained their expected duration of breastfeeding (OR 1.2; 95% CI 0.89,1.6; ,2= 1.4, df= 1, P= 0.2; mean cluster size 156, design effect 1.6). There were no differences between the groups in the uptake of breastfeeding on discharge (OR = 1.2; 95% CI 0.8,1.7; ,2= 1.1, df= 1, P= 0.3; mean cluster size 163, design effect = 2.0) or exclusively at four months (OR = 1.1; 95% CI 0.6,1.8; ,2= 0.07, df= 1, P= 0.8; mean cluster size 156, design effect 1.6). Conclusion The provision of a single educational group session supervised by a lactation specialist, and attended by midwives and women, failed to promote the uptake of breastfeeding. Public health interventions, which encourage positive attitudes to breastfeeding within the family and wider community, should be developed and evaluated. [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] 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] 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] 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 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] Evaluating complex public health interventions: theory, methods and scope of realist enquiryJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2007James B. Connelly MD MSc FFPH Abstract The standard models used in the study of complex public health interventions are inadequate. They adopt a simple empiricist theoretical foundation and attempt to graft onto an essentially open social system a contrived laboratory experimentation typically in the form of a randomized, controlled trial. By understanding the ontological and epistemological claims of critical realism, it is possible to transcend the methodological inadequacy of the standard model approach. Critical realism posits a substantive causal theory, an end to fact-value dualism, and a coherent and emancipatory model of social action; all of these features amount to a systematic and compelling account of public health practice and a coherent approach to evaluation of complex public health interventions. [source] Promoting Physical Activity Among Youth Through Community-Based Prevention MarketingJOURNAL OF SCHOOL HEALTH, Issue 5 2010Carol A. Bryant PhD BACKGROUND: Community-based prevention marketing (CBPM) is a program planning framework that blends community-organizing principles with a social marketing mind-set to design, implement, and evaluate public health interventions. A community coalition used CBPM to create a physical activity promotion program for tweens (youth 9,13 years of age) called VERBÔ Summer Scorecard. Based on the national VERBÔ media campaign, the program offered opportunities for tweens to try new types of physical activity during the summer months. METHODS: The VERBÔ Summer Scorecard was implemented and monitored between 2004 and 2007 using the 9-step CBPM framework. Program performance was assessed through in-depth interviews and a school-based survey of youth. RESULTS: The CBPM process and principles used by school and community personnel to promote physical activity among tweens are presented. Observed declines may become less steep if school officials adopt a marketing mind-set to encourage youth physical activity: deemphasizing health benefits but promoting activity as something fun that fosters spending time with friends while trying and mastering new skills. CONCLUSIONS: Community-based programs can augment and provide continuity to school-based prevention programs to increase physical activity among tweens. [source] Fetal origins of developmental plasticity: Are fetal cues reliable predictors of future nutritional environments?AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2005Christopher W. Kuzawa Evidence that fetal nutrition triggers permanent adjustments in a wide range of systems and health outcomes is stimulating interest in the evolutionary significance of these responses. This review evaluates the postnatal adaptive significance of fetal developmental plasticity from the perspective of life history theory and evolutionary models of energy partitioning. Birthweight is positively related to multiple metabolically costly postnatal functions, suggesting that the fetus has the capacity to distribute the burden of energy insufficiency when faced with a nutritionally challenging environment. Lowering total requirements may reduce the risk of negative energy balance, which disproportionately impacts functions that are not essential for survival but that are crucial for reproductive success. The long-term benefit of these metabolic adjustments is contingent upon the fetus having access to a cue that is predictive of its future nutritional environment, a problem complicated in a long-lived species by short-term ecologic fluctuations like seasonality. Evidence is reviewed suggesting that the flow of nutrients reaching the fetus provides an integrated signal of nutrition as experienced by recent matrilineal ancestors, which effectively limits the responsiveness to short-term ecologic fluctuations during any given pregnancy. This capacity for fetal nutrition to minimize the growth response to transient ecologic fluctuations is defined here as intergenerational "phenotypic inertia," and is hypothesized to allow the fetus to cut through the "noise" of seasonal or other stochastic influences to read the "signal" of longer-term ecologic trends. As a mode of adaptation, phenotypic inertia may help the organism cope with ecologic trends too gradual to be tracked by conventional developmental plasticity, but too rapid to be tracked by natural selection. From an applied perspective, if a trait like fetal growth is designed to minimize the effects of short-term fluctuations by integrating information across generations, public health interventions may be most effective if focused not on the individual but on the matriline. Am. J. Hum. Biol. 17:5,21, 2005. © 2004 Wiley-Liss, Inc. [source] A global perspective of migration and occupational healthAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2010Marc B. Schenker MD Abstract Background Global migration has dramatically increased over the past decade and is at an all-time high, approaching 200 million persons per year. Demographics and economic interdependence suggest that immigration will continue for the near future at record high levels. Methods A review of the few studies that have investigated occupational injury and illness rates among immigrant populations. Results Existing data indicate that higher rates of fatal and non-fatal injuries are common compared to native populations. This increase is in part due to immigrants working in higher risk occupations (e.g., agriculture, construction), but occupational morbidity and mortality is higher among immigrants than native-born workers within occupational categories. Conclusions Research is needed to identify the causes of increased risk among immigrants and to provide direction to effective public health interventions. Research methods must be adapted to different epidemiologic characteristics of immigrant populations, including lack of standard sampling frames, different language and culture from the dominant culture, and precarious work status. Am. J. Ind. Med. 53:329,337, 2010. © 2010 Wiley-Liss, Inc. [source] Upper extremity pain and computer use among engineering graduate students: A replication studyAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2009Cammie Chaumont Menéndez PhD Abstract Background Recent literature identified upper extremity musculoskeletal symptoms at a prevalence of >40% in college populations. The study objectives were to determine weekly computer use and the prevalence of upper extremity musculoskeletal symptoms in a graduate student population, and make comparisons with previous graduate and undergraduate cohorts. Methods One hundred sixty-six graduate students completed a survey on computing and musculoskeletal health. Associations between individual factors and symptom status, functional limitations, academic impact, medication use, and health services utilization were determined. Logistic regression analyses evaluated the association between symptom status and computing. Cross-study comparisons were made. Results More symptomatic participants experienced functional limitations than asymptomatic participants (74% vs. 32%, P,<,0.001) and reported medication use for computing pain (34% vs. 10%, P,<,0.01). More participants who experienced symptoms within an hour of computing used health services compared to those who experienced symptoms after an hour of computer use (60% vs. 12%, P,<,0.01). Years of computer use (OR,=,1.59, 95% CI 1.05,2.40) and number of years in school where weekly computer use was more than 10 hr (OR,=,1.56, 95% CI 1.04,2.35) were associated with pain within an hour of computing. Cross-study comparisons found college populations more similar than different. Conclusion The overall findings reinforced previous literature documenting the prevalence of upper extremity musculoskeletal symptoms in college populations, suggesting an important population for participating in public health interventions designed to support healthy computing practices and identify risk factors important to evaluate in future cohort studies. Am. J. Ind. Med. 52:113,123, 2009. © 2008 Wiley-Liss, Inc. [source] Latest news and product developmentsPRESCRIBER, Issue 8 2008Article first published online: 12 MAY 200 Glargine preferred to lispro as type 2 add-on Basal insulin glargine (Lantus) and insulin lispro (Humalog) at mealtimes improved glycaemic control equally well in patients with type 2 diabetes poorly controlled by oral agents, but patient satisfaction was greater with basal insulin (Lancet 2008;371:1073-84). The 44-week APOLLO trial, funded by Sanofi Aventis, was a nonblinded randomised comparison of basal and prandial insulin regimens added to oral treatment in 418 patients. It found similar reductions in HbA1C (,1.7 vs ,1.9 per cent respectively). Fasting and nocturnal glucose levels were lower with insulin glargine and postprandial levels were lower with insulin lispro. The basal regimen was associated with fewer hypoglycaemic events (5.2 vs 24 per patient per year), less weight gain (3.01 vs 3.54kg) and greater improvement in patient satisfaction scores. Treating hypertension cuts mortality in over-80s Treating hypertension in the over-80s reduces all-cause mortality by 21 per cent, the HYVET study has shown (N Engl J Med online: 31 March 2008; doi: 10.1056/NEJMoa 0801369). Compared with placebo, treatment with indapamide alone or with perindopril for an average of 1.8 years also reduced the incidence of fatal stroke by 39 per cent, cardiovascular death by 23 per cent and heart failure by 64 per cent. The incidence of stroke was reduced by 30 per cent but this was of borderline statistical significance. Fewer serious adverse events were reported with treatment than with placebo. New work for NICE The DoH has announced the 18th work programme for NICE. Seven public health interventions include preventing skin cancer, smoking by children and excess weight gain during pregnancy. Public health guidance will include the provision of contraceptive services for socially disadvantaged young people. Two new clinical guidelines are sedation in young people and management of fractured neck of femur. New technology appraisals may include eight therapies for cancer, two new monoclonal antibodies for psoriasis and rheumatoid arthritis, an oral retinoid for severe chronic hand eczema and methylnaltrexone for opioid-induced bowel dysfunction. Combinations no better against CV disease Taking ezetimibe and simvastatin (Inegy) does not appear to slow the progression of atherosclerosis more than high-dose simvastatin alone, say researchers from The Netherlands (N Engl J Med 2008;358: 1431-43). In patients with hypercholesterolaemia, there was no difference in regression or progression of atherosclerosis after two years' treatment with simvastatin 80mg per day alone or combined with ezetimibe 10mg per day. Adverse event rates were similar. In patients with vascular disease or high-risk diabetes, there was no difference between the ACE inhibitor ramipril 10mg per day or the ARB telmisartan (Micardis) 80mg per day as monotherapy, or their combination, in the risk of a composite outcome of cardiovascular death, MI, stroke and admission for heart failure (N Engl J Med 2008;358:1547-59). Combined treatment was associated with higher risks of hypotensive symptoms, syncope and renal dysfunction. Twice-daily celecoxib increases CV risk Taking celecoxib (Celebrex) twice daily carries a higher risk of cardiovascular events than the same total dose taken once daily, a metaanalysis suggests (Circulation 2008; doi: 10.1161/ CIRCULATIONAHA.108. 764530). The analysis of six placebo-controlled trials involving a total of 7950 patients taking celecoxib for indications other than rheumatoid arthritis found that the combined risk of cardiovascular death, myocardial infarction, stroke, heart failure or thromboembolic event increased with dose over the range 400-800mg per day. The risk was significantly greater with 200mg twice daily (HR 1.8) than 400mg once daily (HR 1.1). Patients at greatest baseline risk were at disproportionately increased risk from celecoxib. Long-term etanercept effective in AS An open-label study suggests that etanercept (Enbrel) remains effective in the treatment of ankylosing spondylitis in the long term (Ann Rheum Dis 2008;67:346-52). Of 257 patients who completed six months' treatment with etanercept and who entered the nonblinded extension study, 126 completed a total of 168-192 weeks' treatment. The commonest adverse events were injection-site reactions (22 per cent), headache (20 per cent) and diarrhoea (17.5 per cent). The annual rate of serious infections was 0.02 per person. Response and partial remission rates after 192 weeks were similar to those reported after 96 weeks. Metformin reduces risk Metformin reduces the risk of developing diabetes in individuals at increased risk, a meta-analysis suggests (Am J Med 2008;121:149-57.e2). The study included 31 mostly small, randomised, controlled trials involving a total of 4570 participants and lasting at least eight weeks (8267 patient-years of treatment). Metformin was associated with reductions in body mass (,5.3 per cent), fasting glucose (,4.5 per cent) and insulin resistance (,22.6 per cent); lipid profiles also improved. The odds of developing diabetes were reduced by 40 per cent,an absolute risk reduction of 6 per cent over 1.8 years. MHRA clarifies cough and colds advice Press reports mistakenly suggested that the MHRA had banned some cough and cold remedies when it issued new guidance on treating young children, the MHRA says. The Agency's advice followed a review of over-thecounter cough and cold medicines for children by the Commission on Human Medicines. Children under two are at increased risk of adverse reactions and should no longer be treated with products containing antihistamine (chlorphenamine, brompheniramine, diphenhydramine), antitussives (dextromethorphan, pholcodine), expectorants (guaifenesin, ipecacuanha) and decongestants (phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and xylometazoline). The MHRA said these products, which are classified as general sale medicines, should be removed from open shelves until available in new packaging that complies with the advice. They may still be supplied by a pharmacist for the treatment of older children. Coughs and colds should be treated with paracetamol or ibuprofen for fever, a simple glycerol, honey or lemon syrup for cough, and vapour rubs and inhalant decongestants for stuffy nose. Saline drops can be used to thin and clear nasal secretions in young babies. Parents are being urged not to use more than one product at a time to avoid inadvertently administering the same constituent drug twice. Perindopril brand switch Servier Laboratories is replacing its current formulations of perindopril (Coversyl, Coversyl Plus) with a new product that is not bioequivalent. The current Coversyl brand contains perindopril erbumine (also known as tert -butylamine). The new formulation contains perindopril arginine; it will be distinguished by new brand names (Coversyl Arginine, Coversyl Arginine Plus) and new packaging. Coversyl 2, 4 and 8mg tablets are equivalent to Coversyl Arginine 2.5, 5 and 10mg. Servier says the change is part of the simplification and harmonisation of global manufacturing; the arginine salt is already used in other countries and offers greater stability and a longer shelf-life. Both Coversyl and Coversyl Arginine will be in the supply chain for the next few weeks. Generic perindopril will continue to be the erbumine salt and prescriptions for generic perindopril are not affected. New from NICE Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Clinical Guidance No. 63, March 2008 This clinical guideline focuses on additional aspects of care for women with gestational diabetes (88 per cent of cases) or pre-existing diabetes (of which about 40 per cent is type 2 diabetes) and their babies. To date, insulin aspart (NovoRapid) is the only drug in the guideline specifically licensed for use in pregnancy and NICE advises obtaining informed consent to implement its recommendations for using other insulins and oral hypoglycaemic agents. As with other guidelines, NICE begins by stressing the importance of patient-centred care and involving women in decisions about their treatment. The guideline is divided into six sections, dealing with consecutive periods of pregnancy. Preconceptual planning should include empowering women to help them reduce risks, optimising glycaemic control (after retinal assessment) and increasing monitoring intensity, and providing information about the effects of pregnancy on diabetes. Metformin may be recommended as an adjunct or alternative to insulin, but other oral hypoglycaemic agents should be replaced with insulin, although glibenclamide is an option during pregnancy. Isophane insulin is the preferred long-acting insulin; lispro (Humalog) and aspart are considered safe to use. ACE inhibitors and angiotensin-II receptor blockers should be replaced with other antihypertensive agents and statins should be discontinued. Recommendations for screening and treatment of gestational diabetes build on previous guidance (CG62). Drug treatment will be needed by 10-20 per cent , this includes insulin (soluble, aspart or lispro) and/or metformin or glibenclamide, tailored to individual need. Antenatal care includes optimising glycaemic control. Insulin lispro or aspart should be considered in preference to soluble insulin. If glycaemic control cannot be achieved with insulin injections, an insulin pump may be indicated. The guideline includes a timetable for appointments and the care that should offered after each interval. Recommendations for intrapartum care, which supplement those in CG55, include frequent monitoring of blood glucose. Neonatal care includes recommendations for monitoring and screening the infant and the management of hypoglycaemia. Postnatal care (supplementing CG37) involves adjusting maternal treatment to avoid hypoglycaemia and recommendations for returning to community care. Metformin and glibenclamide are the only oral agents suitable for breastfeeding women. Women with gestational diabetes need advice about glycaemic control and planning for future pregnancies. Lifestyle advice and measurement of annual fasting plasma glucose should be offered. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. Technology Appraisal No. 138, March 2008 The latest technology appraisal of asthma treatments covers inhaled steroids for adults and children over 12 with chronic asthma. It makes only two recommendations. First, the cheapest appropriate option is recommended. Second, when a steroid and a long-acting beta2-agonist are indicated, the decision to prescribe a combined inhaler or separate devices should take into account therapeutic need and likely adherence. Combined inhalers are currently less expensive than separate devices, though they may not remain so. When a combined inhaler is chosen it should be the cheapest. NICE concludes that, at equivalent doses, there is little difference in the effectiveness or adverse event profile of the available steroids or the fixed-dose combinations. According to specialist advice, choosing the best device for an individual remains the overriding concern. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Technology Appraisal No. 139, March 2008 NICE recommends continuous positive airway pressure (CPAP) for adults with moderate or severe obstructive sleep apnoea, and for those with a milder disorder if quality of life and functioning are impaired and alternative strategies such as lifestyle change have failed. Diagnosis and treatment is the responsibility of a specialist team. A CPAP device costs £250-£550 and lasts for seven years. Copyright © 2008 Wiley Interface Ltd [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] Projections of US prevalence of arthritis and associated activity limitationsARTHRITIS & RHEUMATISM, Issue 1 2006Jennifer M. Hootman Objective To update the projected prevalence of self-reported, doctor-diagnosed arthritis and arthritis-attributable activity limitations among US adults ages 18 years and older from 2005 through 2030. Methods Baseline age- and sex-specific prevalence rates of arthritis and activity limitation, using the latest surveillance case definitions, were estimated from the 2003 National Health Interview Survey, which is an annual, cross-sectional, population-based health interview survey of ,31,000 adults. These estimates were used to calculate projected arthritis prevalence and activity limitations for 2005,2030 using future population projections obtained from the US Census Bureau. Results The prevalence of self-reported, doctor-diagnosed arthritis is projected to increase from 47.8 million in 2005 to nearly 67 million by 2030 (25% of the adult population). By 2030, 25 million (9.3% of the adult population) are projected to report arthritis-attributable activity limitations. In 2030, >50% of arthritis cases will be among adults older than age 65 years. However, working-age adults (45,64 years) will account for almost one-third of cases. Conclusion By 2030, the number of US adults with arthritis and its associated activity limitation is expected to increase substantially, resulting in a large impact on individuals, the health care system, and society in general. The growing epidemic of obesity may also significantly contribute to the future burden of arthritis. Improving access and availability of current clinical and public health interventions aimed at improving quality of life among persons with arthritis through lifestyle changes and disease self-management may help lessen the long-term impact. [source] Effect of an Integrated Public Health Curriculum in an Emergency Medicine ResidencyACADEMIC EMERGENCY MEDICINE, Issue 2009Marian Betz Background: Emergency departments (EDs) serve as a central point of interaction between the public and the medical system. Emergency physicians need education in public health in order to optimize their clinical care and their ability to evaluate potential public health interventions in the ED. Methods: As part of the Centers for Disease Control and Prevention (CDC) and the Association of American Medical College's (AAMC) national initiative for "Regional Medicine-Public Health Education Centers-Graduate Medical Education", we designed and implemented a new public health curriculum for the emergency medicine residents. Over four sessions during regular didactic time, we used a modular approach to link a basic public health principle, such as environmental hazard assessment, to a relevant clinical topic, such as violent patients and ED safety. Each session emphasized resident involvement, including small group work and role-plays. Journal clubs and quality assurance projects supplemented the curriculum. We sought resident feedback through focus groups and anonymous online pre- and post-tests for each session. Assessment: Both before and after the curriculum, 76% of responders felt it was important for physicians to receive training in public health. The program appeared to have a positive effect on residents' comfort level with various public health topics, and felt the residency program had taught them the skills necessary to implement public health principles in clinical practice (23.8%, versus 11.5% before; p<0.05). Conclusions: Integration of public health principles into existing clinical curricula in emergency medicine may increase resident interest and knowledge. Combining public health and emergency medicine topics in regular didactic conferences facilitates public health education for residents. [source] Sexual behaviour and diagnosis of people over the age of 50 attending a sexual health clinicAUSTRALASIAN JOURNAL ON AGEING, Issue 1 2009Chris Bourne Objectives:,To investigate the sexual health and behaviour of older Australians attending a sexual health clinic. Methods:,A retrospective patient record of people aged 50 years and over attending the clinic. Results:,2438 people aged 50 years and over attending. The main reasons for attending were assessment of genital symptoms (40%), testing for sexually transmitted infections (STIs) (23%), and HIV testing/care (13%); more than 50% of the clients had a previous sexual health problem and more than 50% had not been tested for HIV. Men reported more lifetime sexual partners than women and were significantly more likely to report using condoms (P < 0.05), although condom use was variable. Genital herpes (10% women, 6% men) and non-gonococcal urethritis (9% men) were the most commonly diagnosed STIs. Conclusions:,High levels of unsafe sex and many important sexual health problems were identified which provide direction for public health interventions for older sexually active Australians. [source] | ||||||||||||||||