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PubMed2004

Prevention and control of mental illnesses and mental health: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan.

As part of the National Action Plan for Non-communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD), mental illnesses have been grouped alongside non-communicable diseases (NCD) within a combined strategic framework in order to synchronize public health actions. The systematic approach for mental illnesses is centred on safeguarding the rights of the mentally ill, reducing stigma and discrimination, and de-institutionalisation and rehabilitation of the mentally ill in the community outlining roles of healthcare providers, the community, legislators and policy makers. The approach has implications for support functions in a number of areas including policy building, manpower and material development and research. Priority action areas for mental health as part of NAP-NCD include the integration of surveillance of mental illnesses in a comprehensive population-based NCD surveillance system; creating awareness about mental health as part of an integrated NCD behavioural change communication strategy; integration of mental health with primary healthcare; the development of sustainable public health infrastructure to support community mental health initiatives; building capacity of the health system in support of prevention and control activities; effective implementation of existing legislation and harmonizing working relationships with law enforcing agencies. NAP-NCD also stresses on the need to integrate mental health into health services as part of a sustainable and integrated medical education programme for all categories of healthcare providers and the availability of essential psychotropic drugs at all healthcare levels. It lays emphasis on protecting the interests of special groups such as prisoners, refugees and displaced persons, women, children and individuals with disabilities. Furthermore, it promotes need-based research for contemporary mental health issues.

Communicable Disease Control↗

PubMedDate not supplied

Cancer of the oral cavity - trends in Karachi South (1995-2002).

The objective was to study the time trends in site-specific oral cancer incidence and to determine the age-and socio-economic profile over time in Karachi South. Oral cancer ranks second in this population, in both genders. The incidence is the highest reported worldwide. Incident oral cancer cases received at the Karachi Cancer Registry during 1(st) January 1995 to 30(th) June 2004 were reviewed. To ensure maximally complete data, cases registered between 1(st) January 1995 and 31(st) December 2002 were considered for the present study. Cases of lymphoma, leukemia and melanoma were not included. Trends were studied by grouping cases into two periods, 1995-1997 and 1998-2002. A total of 2253 cases of oral cancer were registered in Karachi South for the 8 year study period accounting for 8.8% of all cancer cases. Overall, the most common site was the mucosa cheek (55.9%), followed by the tongue (28.4%), palate (6.8%), gum (4.4%), lip (3.1%) and floor of the mouth (1.4%). About 30% of cases occurred in patients 40 years and younger and 23% occurred in patients 65 years and older. Sub-categories of oral cancer showed variation in trends, but an earlier onset of disease in period two was evident for all categories. The incidence of lip cancer in men decreased, the rates remained level in females. An increased incidence was observed for tongue, but a more dramatic increase in the cheek was evident in both sexes, despite no improvement during the past decade in detection of early, localized lesions. A strong socio-economic factor with a poorer, low literacy profile of oral cancer was apparent in the entire study period. The evidence that the largest increase in incidence has occurred in this population may unfavorably affect the mortality rates. Oral cancer trends are an interplay of prevalent risk factors, the level of prevalence, preventive education and intervention. Cost effective and efficient cancer control focused around the target populations would be beneficial for Pakistan. Educational campaigns should include information on oral hygiene, awareness of risk factors and symptoms and the importance of seeking early professional help when any of these are recognized. Audio-visual media involvement is imperative in view of the literacy status of the target population. Capacity building is required by the Government to increase the availability and accessibility of professionals. Population screening would reduce the incidence of oral cancer, but requires careful planning, and extensive financial resources. Mobilization of general practitioners, health visitors, volunteer organizations and medical students for early detection of oral cancer is the essential need of today.

Adult↗

PubMed2003

A perspective on nutrition communication in developing countries: from theory to practice.

Though nutrition communities are still far from understanding how to bring science to bear in formulating effective policies and programs, the contributions of nutrition science have provided recommendations leading to ways and means to improve nutrition in developing countries. To transfer these recommendations into successful implementation, effective nutrition communication has played an important role in the development. Nevertheless, its success has been limited due to several factors including the fact that there is likely only a small proportion of professionals who consistently aim to use theory as a tool to guide action. This paper highlights the importance of using theoretical frameworks to guide the design and implementation. Based on Thailand's experience, social cognitive theory and social marketing are suggested for further applications in developing country context. It is proposed that the role of researchers/practitioners should be formed to facilitate nutrition implementation. Issues relating to the creation of supportive structures and environments i.e. quality personnel, capacity building, proper status and reasonable budgets, are also identified.

Developing Countries↗

PubMed2003

The importance of high-level training for nutrition scientists in Sub-Saharan Africa.

Can the African people investigate and critically analyse nutrition needs in their context, identify national or community nutrition problems, plan and evaluate nutrition programs, educate, and communicate scientific knowledge in nutrition without high-level trained staffs with a strong scientific base in human nutrition? Will they be able to tackle their nutrition problems without a sustainable organisation for long-term training and research? In this paper, an attempt is made to analyse factors that will contribute to improving human nutrition in Sub-Saharan Africa. The paper also highlights an experience of institutional capacity building in Senegal, West Africa.

Africa South of the Sahara↗

PubMed2005

Autism -- experiences in a tertiary care hospital.

UNLABELLED: Pervasive developmental disorders (PDD) or Autistic Spectrum Disorders (ASD) include Autistic Disorder (commonest), Asperger's syndrome, Childhood Disintegrative Disorders, Rett's syndrome and PDD-NOS (not otherwise specified). OBJECTIVE: Autism is an important cause of social disability and reported more often from the developed world than from the developing countries. The present study was aimed to establish the diagnosis of autism amongst children with derangements of language, communication and behavior; ascertain and treat the co-morbidities; identify underlying cause and create a sensitivity and awareness among various health care professionals. METHODS: Sixty-two of the seventy-five referred patients fulfilled the DSM-IV (Diagnostic and Statistical Manual of Mental Disorder) criteria for autism. Evaluation included a detailed history, clinical examination, IQ assessment, Connor's scoring for hyperactivity and Fragile-X screening. Management of co-morbidities was done. A follow up of these patients was done. Parents' assessment of the child was also done. A registry for autistic children was established at the Department of Pediatrics with other major institutions of Delhi. RESULTS: The male:female ratio was 8:1 and missed diagnosis was common. Professional awareness is merited. Behavioral modification by early intervention and stimulation improved the core symptoms of autism. Important co-morbidities included mental retardation (95%), hyperactivity (53%) and seizures (10%) cases. Control of co-morbidities in these children facilitated child's periodic assessment and implementation of intervention programmes. In the registry initiated 62 patients were enrolled at AIIMS and 6 were identified from other hospitals. CONCLUSION: Autism does occur in Indian children too. Diagnosis is often missed. Capacity building among health professionals by a more structured teaching of developmental disabilities in the medical curriculum is required. The need to attend to co-morbidities and associated symptoms was clear. The initiation of the registry and beginning of networking was important.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

Health and sustainability of rural communities.

The challenges associated with rural and remote health have been widely acknowledged by rural communities and the health care community for some time now. However, it is only recently that any concerted effort has begun to address these difficulties. The aim of this paper was to examine the issue of rural health and sustainability internationally with a particular emphasis on the Canadian context. This paper used a framework to: articulate the nature of rural health and sustainability; examine the historical, socio-cultural, ethical, legal, economic and political aspects of rural health and sustainability; delineate the importance and significance of rural health and sustainability to Canadian citizens, and analyze progress made in relation to rural health and sustainability. This paper concludes by cautioning that rural health and sustainability can only be enhanced by innovative strategies that employ both capacity building partnerships with rural people that are supported overall, by adequate funding allocation.

Journal Article↗

PubMed2004

Investigating the health of rural communities: toward framework development.

How healthy are the residents of rural Canada? How healthy are Canada's rural communities? Members of an interdisciplinary research team at the Brandon University Rural Development Institute, Manitoba, Canada, formed a partnership with rural stakeholders in an attempt to strengthen and build capacity in rural communities. One component of this research was the development of a framework to assist residents of rural communities to assess the health and sustainability of their community. Through dialogue with partners and review of the literature, a preliminary framework can be generated. This article formed the first step in the creation of such a framework. The article begins with common term and concept development, extends to a critical analysis of framework literature and culminates with consideration of steps to be taken next in the establishment of a framework and indicators that are both meaningful and useful for rural residents and their communities.

Journal Article↗

PubMed2005

[How to cope with the global tuberculosis burden--experiences and perspectives for Japan's international cooperation].

Tuberculosis is a global burden disease, most possibly ranking high among diseases over the coming several decades, with 2 million deaths and over 8 million new cases annually. How can TB be controlled and eradicated quickly in the world? A major answer will be the wider application of the most effective control programme, i.e. DOTS recommended by WHO. But it has been developed in the long try and error efforts, including the ones by Dr. K. Styblo of IUATLD in African countries. The key components of successful TB programme are summarised as follows, which Dr. Kochi of WHO adopted as a global policy package. They are; 1) political commitment, 2) case finding by sputum microscopy, 3) use of short course chemotherapy under supervision, 4) a secured supply of anti-TB drugs, and 5) a standardised recording, reporting and monitoring system. The targets by 2005 are set 85% cure rate and 70% detection rate. By 2002, however, only half the targets have been achieved, and global expansion of DOTS with other strategies need to be strengthened. Emerging threats are HIV epidemic, MDR-TB increase and health sector reform taking place in the world. Stop TB partnership with its office in WHO has been formed to strengthen a global capacity, mobilizing various technical and financial partners. Japan's contribution to the global TB problem started in early 1960s. In the last 40 years, technical cooperation in national TB programme (NTP) has been made through JICA in over 15 countries, including United Arab Emirates. Thailand, Nepal, Afghanistan, Tanzania, Indonesia, Solomon Islands, Yemen, Philippines, Cambodia, Myanmar, Pakistan, Zambia, and China (TB project is on-going in underlined countries). In these projects, capacity strengthening of NTP has been given priority, including construction of national TB center, a model area development, nationwide DOTS expansion in collaboration with WHO or others, supply of anti-TB drugs, TB laboratory network with QA, collaborative operational research. An operational research for community based DOTS and ART is newly started in Zambia under JICA project. Besides, over 1800 doctors and technologists from 90 countries have been trained at Research Institute of Tuberculosis (RIT) through its international training courses in the last 40 years. These courses are organised collaboratively with WHO or other agencies, inviting globally renowned lecturers and ex-participants, and have been reputed widely. We aim not only to teach skills and knowledge but also to motivate them to do something new. This becomes possible only through human relationship in the course. I may need to mention about my personal commitment: First, I have worked to develop a community based TB programme model utilising village health volunteers in Bangladesh in 1980s. This system has now covered over 70% of the total patients in the country through BRAC, local NGO. Secondly, the application of participatory action research (PAR) method in introducing or expanding DOTS in Bangladesh and other countries. Staff members of NTP and local/ peripheral workers participate in the trials and discuss actively in the workshops periodically. This PAR approach empowers both NTP managers and peripheral staff. Through the international cooperation, we aim ultimately at 1) support for self-reliance, 2) empowerment (capacity building for problem finding and solution) of the people concerned, and 3) promotion of global peace without arms.

Delivery of Health Care↗

PubMed2005

The Cartagena Protocol on Biosafety: interaction between the Convention on Biological Diversity and the World Organisation for Animal Health.

The Cartagena Protocol on Biosafety is an international agreement (adopted on 29 January 2000 as a supplementary agreement to the Convention on Biological Diversity) that addresses the potential adverse effects of living modified organisms. It focuses primarily on transboundary movements and is therefore relevant to international trade. It includes provisions on import decision-making, risk assessment and management, information-sharing, documentation, capacity-building, compliance, liability and redress, public awareness and participation, and socio-economic considerations. Given the scope of the Protocol, there may be cases where trade in living modified organisms also falls under the mandate of existing international bodies such as the OIE (World Organisation for Animal Health) and other standard-setting bodies. There could therefore be benefits from collaboration between the Secretariat of the Convention on Biological Diversity and the World Organisation for Animal Health on issues such as risk assessment and management, information-sharing, documentation requirements, and procedures related to unintentional transboundary movements. This paper reviews the key provisions of the Protocol and attempts to highlight areas of the agreement which are also of interest to various international bodies, particularly the OIE.

Animal Welfare↗

PubMed2005

Counties selecting public health priorities--a "bottom-up" approach (Croatian experience).

The subject of this paper is how to incorporate a multi-disciplinary and inter-sectored approach into development of public health policy and plans at the local (county) level in Croatia by educational program. Method used was the public health capacity building program "Health--Plan for it", which was developed with the aim to assist the counties to overcome recognized weaknesses and introduce more effective and efficient local public health practices. Two main instruments were used: Local Public Health Practice Performance Measures Instrument, and Basic Priority Rating System. This program has helped counties to asses population health needs in a participatory manner, to plan for health and, ultimately, assure provision of the right kind and quality of services (better tailored to population health needs). This program's benefits are going beyond and above the county level. It provides support for the Healthy Cities project locally, and facilitates changes in national policymaking body's mindset that a "one-size-fits-all" approach is sufficient.

Croatia↗

PubMed2005

Assessment of capacity for cardiovascular disease control and prevention in Thailand: a qualitative study.

The present study explored community members' knowledge and perceptions about cardiovascular disease (CVD), risk factors and prevention, and identified the current capacity of primary care providers to manage and control CVD at the provincial level. A qualitative study, including in-depth interviews and focus group discussions, was conducted in Suphan Buri Province, Thailand. Participants included community members, CVD patients and healthcare providers in health centers and hospitals. The results showed that community members had little knowledge about the symptoms and signs of heart attack or stroke. They perceived that existing health centers and community hospitals were not sufficiently equipped to treat CVD patients. Primary healthcare workers reported that they lacked skills to manage heart disease, particularly emergency care. Physicians said that they had too little time to educate patients and felt that medical schools should update their curricula, including practical training on CVD management in a low-resource setting. Nurses reported that they had inadequate training in health education for the prevention of CVD. There was a problem of inadequate feedback mechanisms in the existing referral system for continuing improvement. All of the health professionals agreed that more community participation and the involvement of non-health sectors and non-government organizations were needed in the national CVD control program. In conclusion, capacity building for strengthening CVD prevention and control at the primary care level should be implemented. The existing training and education systems have to be revised with an orientation towards health promotion and disease prevention. Publicity of CVD burden and preventive measures, and local programs, should be implemented with community participation.

Adult↗

PubMed2005

Management of district hospitals--exploring success.

INTRODUCTION AIM: The aim of the study was to explore and document what assists a rural district hospital to function well. The lessons learned may be applicable to similar hospitals all over the world. METHOD: A cross-sectional exploratory study was carried out using in-depth interviews with 21 managers of well-functioning district hospitals in two districts in South Africa. RESULTS: Thirteen themes were identified, integrated into three clusters, namely 'Teams working together for a purpose', 'Foundational framework and values' and 'Health Service and the community'. Teamwork and teams was a dominant theme. Teams working together are held together by the cement of good relationships and are enhanced by purposeful meetings. Unity is grown through solving difficult problems together and commitment to serving the community guides commitment towards each other, and towards patients and staff. Open communication and sharing lots of information between people and teams is the way in which these things happen. The structure and systems that have developed over years form the basis for teamwork. The different management structures and processes are developed with a view to supporting service and teamwork. A long history of committed people who hand over the baton when they leave creates a stable context. The health service and community theme cluster describes how integration in the community and community services is important for these managers. There is also a focus on involving community representatives in the hospital development and governance. Capacity building for staff is seen in the same spirit of serving people and thus serving staff, all aimed at reaching out to people in need in the community. The three clusters and thirteen themes and the relationships between them are described in detail through diagrams and narrative in the article. CONCLUSION: Much can be learned from the experience of these managers. The key issue is the development of a team in the hospital, a team with a unified vision of giving patients priority, respecting each other as well as patients, and working in and with the community to achieve optimal health care in the district hospital.

Attitude of Health Personnel↗

PubMed2005

A comparison of two systems for chlorinating water in rural Honduras.

This study investigated a small subset of the two community water-disinfection systems--hypochlorinators and tablet feeders-in rural Honduras. Levels of residual chlorine were assessed at three locations within the distribution system: the tank, the proximal house, and the distal house. The levels of residual chlorine were compared with the standard guidelines set by the Pan American Health Organization and the International Rural Water Association for potable water that require a minimum of 1.0 (tank), 0.5 (proximal house), and 0.2 (distal house) ppm for each location. The levels of residual chlorine were also compared across systems, e.g. hypochlorinators to tablet feeders. At the tank and proximal house, tablet feeders had significantly higher mean values for levels of residual chlorine (measured in ppm) than hypochlorinators (tank: 1.20 vs 0.67; proximal house: 0.44 vs 0.32, p < 0.001 for both) with no significant difference at the distal house (0.16 vs 0.16). At the tank and proximal house, tablet feeders were more likely to meet recommended standards than hypochlorinators (90.3% vs 13.3%, p < 0.0001 and 41.3% vs 23.7%, p < 0.0001) with a smaller difference seen at the distal house (30.6% vs 27.1%, p = 0.24). The apparent dichotomy in chlorine levels of tablet feeders (e.g. between tank/proximal house and distal house) is discussed. The results suggest that tablet feeders may be more effective than hypochlorinators in supplying clean water in rural, resource-poor settings and possibly serve as an alternative technology for water disinfection. Further research on techniques for empowering and building capacity within community water boards will help organize and introduce sustainable water systems in developing countries.

Chlorine↗

PubMedDate not supplied

Neologisms in medical practice: their potential to be 'useful', 'useless' or 'misleading'.

BACKGROUND: The advances in human endeavours have led to changes in technology. New words, neologisms, have been creeping up and are coined with astounding speed. While these terms are fascinating etymologically, their impact needs to be appreciated from a realistic perspective to keep one aware of the collateral changes we are importing into common language, particularly in medical practice. The aim of this paper is to identify some of such neologisms, outline their current use and then discuss their potential to be 'useful' 'useless' or 'misleading'. METHODS: Terminologies in medical practice and information technology have been selected by the authors and their meanings have been analysed. RESULTS: The terminologies of our present interest include: Computer literacy; Surfing the web; Networking; Information technology; Medical informatics; Telemedicine; Capacity building; Problem-based learning; Mentoring; Learning curve; Evidence-based medicine; Impression; Comorbid conditions; Family medicine; Andropause; Surgical site infection; Confidence interval. CONCLUSION: Neologisms are inescapable in the face of rapid advances in knowledge, equipment and information dissemination to and through diverse cultures and languages. In their assimilation, we should be considerate in discarding familiar terms that have served time.

Humans↗

PubMed2005

The eHealth agenda for developing countries.

Delivering eHealth in developing countries faces different health and socio-economic challenges to the developed one. But, if a global health infrastructure is to evolve, then developing countries need to play their part. So, whilst the context may differ, the localization-globalization of content issues needs to be jointly addressed. In providing robust and affordable connectivity, particularly to rural areas, developing countries can fully exploit the potential of handheld computers and wireless connectivity. Over such an infrastructure new ways of building capacity, both locally and globally, can be supported. Finally, an eHealth infrastructure can support the delivery of healthcare in communities, thereby supporting individuals and community development.

Developing Countries↗

PubMed2005

[Ecological misunderstanding, integrative approach, and potential industries in circular economy transition].

Based on the Social-Economic-Natural Complex Ecosystem theory, this paper questioned 8 kinds of misunderstandings in current planning, incubation, development, and management of circular economy, which had led to either ultra-right or ultra-left actions in ecological and economic development. Rather than concentrated only on the 3-r micro-principles of "reduce-reuse-recycle", thise paper suggested 3-R macro-principles of "Rethinking-Reform-Refunction" for circular economy development. Nine kinds of eco-integrative strategies in industrial transition were put forward, i.e., food web-based horizontal/parallel coupling, life cycle-oriented vertical/serial coupling, functional service rather than products-oriented production, flexible and adaptive structure, ecosystem-based regional coupling, social integrity, comprehensive capacity building, employment enhancement, and respecting human dignity. Ten promising potential eco-industries in China's near-future circular economy development were proposed, such as the transition of traditional chemical fertilizer and pesticide industry to a new kind of industrial complex for agro-ecosystem management.

China↗

PubMed2005

Enabling medical professionals to respond effectively and with sensitivity to the needs of adolescents.

Adolescence is a period when important changes occur in an individual's life. It is a period of both risk to health and well-being, and of opportunity to set the stage for healthy adulthood. Most adolescents are healthy, but a small (and in some places not so small) proportion of them face health (including both physical and psychological) problems as well as social problems. Many individuals and institutions have important contributions to make in ensuring the health of adolescents. Medical professionals have crucial contributions to make--both as service providers and as community-change agents. Studies from many places show that adolescents value medical professionals as credible sources of help, and reach out to them for health information and services, albeit in small numbers. However, studies from many parts of the world suggest that medical professionals are unable and/or unwilling to respond to the needs of adolescents effectively and with sensitivity. There is growing recognition of the public-health benefits of strengthening the technical as well as the inter-personal competencies of medical professionals, and of helping them clarify their attitudes so that they could deal with adolescents with understanding and respect. Initiatives in this area are under way in many countries. WHO strongly supports these capacity-building initiatives, and urges that orientation and training programmes be followed up with ongoing support to enable medical professionals to perform to the best of their abilities. WHO also stresses the importance of informing and engaging families and communities to support the provision of health information and services to young people.

Adolescent↗

PubMed2006

Evolution of HIV/AIDS prevention programs--United States, 1981-2006.

When the first cases of what would become known as acquired immunodeficiency syndrome (AIDS) were reported in 1981, the magnitude of the epidemic and the numbers of deaths were unimaginable. During the next 25 years, an unprecedented mobilization of individual, community, and government resources was directed at stopping the epidemic. CDC currently supports a wide range of human immunodeficiency virus (HIV) prevention activities in the United States, including 1) collection of behavioral and HIV/AIDS case surveillance data that document trends in the epidemic and risk behaviors; 2) programs conducted by state, territorial, and local health departments, community-based and national organizations, and education agencies; 3) capacity building to improve HIV-prevention programs; 4) program evaluation to monitor the delivery and outcomes of prevention services; and 5) research leading to new strategies for preventing transmission of HIV/AIDS. Since 1994, local and state health departments have allocated resources to specific programs and populations through local community planning processes that involve health department staff, prevention providers, and members of affected communities. A three-pronged approach has been developed, consisting of 1) prevention activities directed at persons at high risk for contracting HIV; 2) HIV counseling, testing, and referral services; and 3) prevention activities directed at improving the health of persons living with HIV and preventing further transmission.

Communicable Disease Control↗