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PubMed2003

Conservation of biodiversity of the coastal resources of Sundarbans, Northeast India: an integrated approach through environmental education.

The Indian Sundarbans, a diversified coastal wetland on the southern fringe of the State of West Bengal, harbors a luxuriant biodiversity and acts as a potential refuge of living marine resources. Girdled with thick mangrove foliage, this estuarine delta system offers an excellent nursery ground for most of the brackishwater finfish and shellfish. Since supply of hatchery-produced tiger prawn seed (Penaeus monodon) is highly inadequate in West Bengal, the aquaculture farms of this region largely depend on the supply from natural resources. Being motivated by a regular cash income, the majority of coastal people from Sundarbans have adopted prawn seed collection as their profession almost throughout the year as an important source of earning. The users are neither trained nor guided at any stage from collection to marketing and are fully dependent on traditional methods. They first sort out the tiger prawn seeds (mainly the postlarval stage PL 20) accounting only 0.25-0.27% of the total catch and thereafter the major portion of the haul are thrown away on the beach flats or the tidal mudflats. This wasted by-catch contains the juveniles of economic and uneconomic varieties of finfish and shellfish along with a bulk of holoplankters and meroplankters (non-target species). This practice causes several ecological and occupational consequences, namely, (i) the huge destruction of the pelagic biota that can lead to severe stock depletion as well as hamper the energy transference through the marine ecosystem food webs; (ii) constant dragging of nets along the coast and tidal creeks paves the way for soil erosion, uprooting the mangrove seedlings and saltmarsh vegetation; (iii) the water quality is deteriorating in the catchment areas due to mud erosion and (iv) due to constant contact with the seawater, the collectors are affected with waterborne diseases, skin infections, reproductive tract disease in women and many other contagious diseases. This paper, in addition to identifying the challenge to environmental quality and resource abundance, emphasizes the need for grass-root public education so that local people come to understand, support and implement sustainable resource conservation and environmental protection activities now and in the future. As a follow-up course of action, the authors have initiated a general awareness program for developing consciousness among the coastal people regarding proper use of natural resources. Initiatives are taken for educating coastal people by holding workshops and seminars with the use of educational resource materials. Exclusive awareness camps and grass root level training for coastal people are also being proposed as a future course of action by means of exhibitions, audiovisuals etc. It is proposed that local government bodies come forward to mitigate this problem with scientific and rational approaches and to take proper actions towards conservation.

Animals↗

PubMed2000

Genetic and environmental contributions to obesity.

Groups that are already concerned about obesity can be linked together. This can generate plans of action and may lead to small-scale interventions. At the same time, awareness needs to be raised among other potential partners, especially federal, state, and local government agencies. As a partnership is built, funding opportunities, from public and private entities, should increase. The ultimate need is a public health campaign to combat an important public health problem.

Energy Metabolism↗

PubMed1992

A review of data on measles cases from sentinel surveillance sites in north-western Nigeria.

This review was carried out to evaluate the impact of the revised Expanded Programme on Immunisation (EPI) against measles in the six north-western states of Nigeria through the sentinel surveillance system. The revised EPI was launched in all states by 1985, with a strategy of phased acceleration to reach all local government areas by 1987, and to achieve 80% vaccine coverage of children under two years, with 50% reduction in EPI disease morbidity by 1990. Results of the review showed a dramatic decrease in measles cases in each state: 70% overall from 1985 to 1988. Of 918 cases with known measles vaccination status, 90.6% were unvaccinated and 9.4% had documented immunisation. One concern is that 19% of cases occur in unimmunised infants under nine months. Although a suitable vaccine for children under nine months is available, it is not yet in use in Nigeria and these cases are therefore not preventable. At present, our best strategy is to increase coverage through a vigorous EPI campaign, concentrating on underserviced and hard-to-reach areas, and to strengthen surveillance so that measles outbreaks are identified early and action taken.

Child, Preschool↗

PubMed1993

Preventing unintended teenage pregnancies.

A review of the literature on unplanned and teenage pregnancies was undertaken for four District Health Authorities. This work was carried out within a national context of increasing conception rates for teenage women aged 16 and under and in the knowledge that pregnant teenagers and their children tend to have poor life chances. The Health of the Nation White Paper has now focused attention on this by the inclusion of a target to reduce pregnancies to under 16-year-old women by half. To achieve this, health authorities need some understanding of the types of services which might be effective. Whilst there is limited evaluative work on the effectiveness of services for young people in this country, international comparisons suggest that some methods for reducing unintended teenage pregnancies may be more effective than others. The specific service issues identified are the need for advice and support pre-conceptually, during pregnancy and after abortion/birth; the need for easier access to contraception; the need for improved information on risky behaviour--particularly relating to pregnancy, sexually transmitted diseases, HIV/AIDS and substance abuse, and the need for improved medical and social care for pregnant teenage women. The most effective approaches for preventing unintended teenage pregnancy would appear to be the development of comprehensive advisory and family planning services, including sex education and the commitment by central and local government to tackle the adverse socio-economic factors which are associated with teenage pregnancy.

Adolescent↗

PubMedDate not supplied

A severe epidemic of meningococcal meningitis in Nigeria, 1996.

A particularly severe epidemic of meningococcal meningitis (cerebrospinal meningitis, CSM) occurred in Nigeria between January and June 1996. There were 109,580 recorded cases and 11,717 deaths, giving a case fatality rate of 10.7% overall. This is the most serious epidemic of CSM ever recorded in Nigeria, and may be the largest in Africa this century. It took over 3 months and the combined efforts of a National Task Force set up by the Federal Ministry of Health, the WHO, UNICEF, UNDP, Médecins Sans Frontières, the International Red Cross and several other non-governmental organizations to bring the epidemic under control. The main control measures centred on active treatment of infected persons, mass vaccination and health education. The exact number of persons treated cannot be ascertained, but there were treatment centres in almost every Local Government Area in the affected States. A study of 1577 patients admitted at the Infectious Diseases Hospital, Kano, showed that 84% of those infected were aged < or = 20 years and that, for the first time, infants aged < or = 2 months were affected. Despite intervention, the case fatality rate of 9.1% among this group of patients was similar to the nationwide figure of 10.7%. Long-acting oily chloramphenicol proved highly effective in the treatment of patients, and its routine use in epidemic CSM is recommended. Over 13 million persons were vaccinated in the course of the epidemic. For the first time, cases of CSM were reported from States south of the 'African meningitis belt', suggesting an extension of the belt. The severity of this epidemic yet again underscores the need for a clear policy regarding control measures aimed at forestalling future epidemics. The availability of the recently developed polysaccharide-protein conjugate vaccine should facilitate a decision on mass vaccination for the prevention of epidemic CSM in Africa.

Adolescent↗

PubMedDate not supplied

Compliance to correct dose of chloroquine in uncomplicated malaria correlates with improvement in the condition of rural Nigerian children.

Non-compliance to correct dosing is thought to be one of the main causes of treatment failure of chloroquine in the home management of childhood malaria. There are few studies of compliance to drugs used for tropical diseases. In order to study compliance in the rural setting, chloroquine syrup was packaged with a novel pictorial insert for compliance to correct dosing. Compliance was assessed in a field trial in September 1996-December 1997, involving 632 children with uncomplicated malaria in Udi local government area in Nigeria. Written informed consent was obtained from mothers/guardians before children were enrolled in the study. There were 3 arms to the trial: control villages (group I) received chloroquine syrup without further intervention, group II received a pictorial insert with chloroquine syrup, and group III received chloroquine syrup, the pictorial insert and verbal instructions. Each group was made up of 3 health centres. Compliance was assessed by volumetric measurement of the chloroquine syrup left in 30-mL bottles and by questionnaires administered to mothers/helpers of the children. Control villages recorded full compliance for 36.5 +/- 4.4% of the children, group II for 51.9 +/- 7.9% and group III for 73.3 +/- 4.2%. There was a significant correlation (P < 0.0001) between full compliance, improvement and time for improvement of the condition. This study is deemed important because it focuses on children, who bear the greatest burden of malaria. It is unique for introducing a pictorial insert that illiterate villagers, who may not understand the use of age or weight in drug dispensing, may utilize as a substitute.

Antimalarials↗

PubMed2001

Compilation and evaluation of a Paso del Norte emission inventory.

Emission inventories of ozone precursors are routinely used as input to comprehensive photochemical air quality models. Photochemical model performance and the development of effective control strategies rely on the accuracy and representativeness of an underlying emission inventory. This paper describes the tasks undertaken to compile and evaluate an ozone precursor emission inventory for the El Paso/Ciudad Juárez/Southern Doña Ana region. Point, area and mobile source emission data were obtained from local government agencies and were spatially and temporally allocated to a gridded domain using region-specific demographic and land-cover information. The inventory was then processed using the US Environmental Protection Agency (EPA) recommended Emissions Preprocessor System 2.0 (UAM-EPS 2.0) which generates emissions files compatible with the Urban Airshed Model (UAM). A top down evaluation of the emission inventory was performed to examine how well the inventory represented ambient pollutant compositions. The top-down evaluation methodology employed in this study compares emission inventory ratios of non-methane hydrocarbon (NMHC)/nitrogen oxide (NOx) and carbon monoxide (CO)/NOx ratios to corresponding ambient ratios. Detailed NMHC species comparisons were made in order to investigate the relative composition of individual hydrocarbon species in the emission inventory and in the ambient data. The emission inventory compiled during this effort has since been used to model ozone in the Paso del Norte airshed (Emery et al., CAMx modeling of ozone and carbon monoxide in the Paso del Norte airshed. In: Proc of Ninety-Third Annual Meeting of Air & Waste Management Association, 18-22 June 2000, Air & Waste Management Association, Pittsburgh, PA, 2000).

Databases, Factual↗

PubMed2003

Air quality data from large cities.

This paper presents an assessment of the air quality for the principal cities in developed and developing countries. Part of the vast and widely dispersed information on air quality that is available at this time on the Internet was compiled, thus making possible a comprehensive evaluation of the tendencies that emerged at the end of the 20th century. Likewise, these values are compared to the air quality thresholds recommended by two international organizations: guideline levels of the World Health Organization (WHO) and limit values of the European Union (EU), in order to determine air quality concentration levels in large cities around the world. The current situation of air quality worldwide indicates that SO(2) maintains a downward tendency throughout the world, with the exception of some Central American and Asian cities. NO(2) maintains levels very close to the WHO guideline value around the world. For particulate matter, it is a major problem in almost all of Asia, exceeding 300 microg/m(3) in many cities. Ozone shows average values that exceed the selected guideline values in all of the analyses demonstrating that it is a global problem. In general, the worldwide trend is to a reduction in the concentrations of pollutants because of the increasingly strong restrictions which local governments and international organizations impose. However, in poor countries and those with low average incomes, concentrations of air pollutants remain high and the trend will be the elevation of their ground levels as they develop, making the problem even worse.

Air Pollutants↗

PubMed1999

Urban anglers' perception of risk from contaminated fish.

The Newark Bay Complex includes the Newark Bay, tidal portions of the Hackensack River, Passaic River, Arthur Kill, and Kill van Kull. It is a highly industrialized urban area including five counties and more than 20 local governments with a large racially-mixed population of more than 3 million people. In 1982, research conducted by the New Jersey Department of Environmental Protection (NJDEP) showed elevated levels of chemical contaminants in five species of fish and one type of crab in the Newark Bay Complex. Subsequently, the State of New Jersey adopted advisories to guide citizens on safe consumption practices for fish and crabs. Since then, fish consumption advisories have been issued primarily through the Fish and Game Digest, a publication distributed by the state to licensed anglers. However, anglers in the Complex are not required to have a fishing license because the waters are marine. Therefore, most anglers in this area do not receive advisory information. To gain greater insight into the information sources and risk perceptions of urban anglers, a survey was conducted of 300 anglers at 26 fishing and crabbing locations in the Newark Bay Complex during the summer and early fall of 1995. The objectives of the study were to learn anglers': (1) knowledge of fish consumption advisories; (2) belief in the advisories; (3) perception of how safe fish are to eat; (4) sources for information about fish and fishing; and (5) sources for information on fish consumption advisories. The study concluded that while 60% had heard about advisories, they either did not believe or were unconcerned about health effects from eating contaminated species. In addition, the most used source for information about fish and fishing was other fishermen, while newspapers were selected as a source for information about community news, health, and food safety.

Animals↗

PubMed2006

Control of Chagas disease.

The Southern Cone Initiative (Iniciativa de Salud del Cono Sur, INCOSUR) to control domestic transmission of Trypanosoma cruzi is a substantial achievement based on the enthusiasm of the scientific community, effective strategies, leadership, and cost-effectiveness. INCOSUR triggered the launch of other regional initiatives in Central America and in the Andean and Amazon regions, which have all made progress. The Central American Initiative targeted the elimination of an imported triatomine bug (Rhodnius prolixus) and the control of a widespread native species (Triatoma dimidiata), and faced constraints such as a small scientific community, the difficulty in controlling a native species, and a vector control programme that had fragmented under a decentralized health system. International organizations such as the Japan International Cooperation Agency (JICA) have played an important role in bridging the gaps between fragmented organizational resources. Guatemala achieved virtual elimination of R. prolixus and ;reduction of Tri. Dimidiata and El Salvador and Honduras revitalized their national programmes. The programme also revealed new challenges. Tri. dimidiata control needs to cover a large geographic area efficiently with stratification, quality control, community mobilization, and information management. Stakeholders such as the National Chagas Program, the local health system and their communities, as well as local government must share responsibilities to continue comprehensive vector control.

Animals↗

PubMed1997

Effect of organisational downsizing on health of employees.

BACKGROUND: Reduction of personnel by businesses and other organisations (organisational downsizing) is common in Europe, but little is known about its effects on the health of employees. METHODS: We used employers' records to investigate the relation between downsizing and subsequent absenteeism because of ill health in 981 local-government workers who remained in employment in Raisio, south-western Finland, during a period of economic decline (1991-95). Data were separated into three time periods: 1991, before downsizing; 1993, major downsizing in some workplaces and occupations; and 1993-95, after downsizing. We obtained data on sick leave from records kept by the occupational health-care unit in Raisio. We also investigated whether the effects of downsizing were dependent on ten other predictors of sick leave. FINDINGS: There was a significant association between downsizing and medically certified sick leave. The rate of absenteeism was 2.3 times greater (95% CI 2.0-2.7) after major downsizing, classified by occupation, than after minor downsizing. The corresponding rate ratios for musculoskeletal disorders and trauma were 5.7 (4.1-8.0) and 2.7 (1.7-4.2), respectively. The effects of downsizing by workplace depended on the age distribution of the staff. When the proportion of employees who were older than 50 years was high, downsizing increased the individual risk of absence because of ill health by 3.2-14.0 times, depending on diagnostic category. When the proportion of employees over 50 years was low, downsizing had only slight effects on health. Other risk factors that increased rates of sick leave after downsizing were age over 44 years, a large workplace, poor health before downsizing, and high income. INTERPRETATION: Downsizing is a risk to the health of employees. But this risk varies according to individual factors, such as age, socioeconomic status, and health, as well as factors related to place of work, for example, size and age structure of the staff.

Absenteeism↗

PubMed2000

Techniques for analysis of disease clustering in space and in time in veterinary epidemiology.

Techniques to describe and investigate clustering of disease in space - the nearest-neighbour test, autocorrelation, Cuzick-and-Edwards' test and the spatial scan statistic - and in time - the Ederer-Myers-Mantel test and the temporal scan statistic - are reviewed. The application of these techniques in veterinary epidemiology is demonstrated by the analysis of a data set describing the occurrence of blowfly strike - both body strike and breech strike - between August 1998 and May 1999 in 33 commercial sheep flocks located within two local government areas of southeastern Queensland, Australia. By applying a combination of these methods, the occurrence of blowfly strike in the study area is well-characterised in both space and time. Guidelines for investigating disease clusters in veterinary epidemiology are discussed.

Animals↗

PubMed2001

Blowfly strike in sheep flocks as an example of the use of a time-space scan statistic to control confounding.

The use of a time-space scan statistic--defined by a cylindrical window with a circular geographic base and height corresponding to time--was investigated as a method of detecting clustering in veterinary epidemiology whilst controlling confounding. The example data set consisted of farmer-recorded occurrence of body strike and breech strike between August 1998 and May 1999 in 26 sheep flocks located in two local government areas of southeastern Queensland, Australia. This information was derived from a questionnaire survey mailed to farmers. Potentially confounding factors included in the investigation were flock size (< or = median, > median), flock structure (proportion of lambs, wethers, ewes and rams), pesticide application for flystrike control (yes, no) and rainfall (< or = median, > median). The total sheep population within selected flocks was 92,660; 1012 (1.09%) and 518 (0.56%) cases of body strike and breech strike were reported in 16 and 10 flocks, respectively.Clustering analyses of body strike and breech strike were undertaken separately, because different predisposing factors are associated with these diseases. Significant clustering of body strike (28.76 degrees S, 151.82 degrees E) during March 1999 and breech strike (28.73 degrees S, 151.16 degrees E) between February and May 1999 was detected. Adjusting for flock structure, flock size, pesticide use and rainfall did not alter the most likely cluster of body strike identified--although the relative risk changed (> 10%) after adjusting for flock structure. Adjustment for flock structure and rainfall resulted in different clusters of breech strike being identified.

Animals↗

PubMed2002

Castration, other management practices and socio-economic implications for dog keepers in Nsukka area, Enugu state, Nigeria.

Structured interviews were used to obtain information from 258 respondents from among 625 people who were selected by stratified random sampling from villages in five of seven local government areas of Nsukka area. Information included gender and literacy status of the respondents, whether the respondents had (between 1990 and 1995) presented any of their dogs for castration, the comparative market value of the dogs, and dog use and owner preference for castrates in performance of such duties. Information on bathing, vaccinations, confinements, use of veterinarians and cultural and religious uses of dogs also were sought. Also, 208 (80%) of the respondents had their dogs castrated. Of the respondents, 23% were literate, 37% semiliterate and 40% illiterate. Of the 367 non-respondents, 63% were not available during the time of contact and 37% resented dog keeping and therefore refused to talk. About 958 dogs were owned by respondents, of these dogs, 56%, 27% and 17% were females, intact males and castrates, respectively. There was no association between the respondent's literacy status and dog-sex preference in performance of such uses as security, hunting, and "economic reasons". The three most-important reasons for dog keeping were security, pet and hunting. However, the use of castrates for security was favoured by most keepers irrespective of literacy status. Most of the respondents agreed that dogs are used as gifts and 72% of the respondents agree that dog meat is a protein source. Castration should be encouraged because of its market value. Usage was low of veterinary services, confinement, and bathing of dogs.

Animal Husbandry↗

PubMed2000

Decentralising the health sector: issues in Brazil.

The health sector in Brazil has undergone important changes, particularly with the development of the Unified Health System (SUS). Decentralisation is an important principle of SUS and advances have been made in transferring responsibilities and resources to the local government units, known as municipios. This article describes the changes introduced, focusing on the system of municipio classification and the funding mechanisms introduced through the basic operating rule (BOR) of 1996. The paper then moves on to analysing three key issues of decentralisation in Brazil that are related to the policy process, the system of decentralisation and the output of decentralisation. Firstly, the formal process by which decisions on health sector reform are made is discussed with particular attention being paid to the negotiated and relatively open policy space. Secondly, the role of the states is discussed within the decentralised system. Thirdly, the impact of decentralisation on equity is discussed with particular reference to the resourcing of the Municipal Health Funds. The article concludes by emphasising the political nature of health sector decentralisation and the need to develop the conditions for effectiveness in decentralisation programmes.

Brazil↗

PubMed2002

The Danish health care system from a British perspective.

The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weakness, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a one-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. The dominance of tax financing helps to achieve control over the level of health care expenditure, as well as securing equity in financing the services. The reliance on local government for financing and running health care has both advantages and disadvantages, and the split between county and municipal responsibility leads to problems of co-ordination. The remuneration of general practitioners by a mix of capitation payment and fee for services has the advantage of capping expenditure whilst leaving the GPs with an incentive to compete for patients by providing them with good services. The GP service is remarkably economical. The hospital sector displays much strength, but there seem to be problems with respect to: (i) perceived lack of resources and waiting lists; (ii) impersonal care, lack of continuity of care and failures in communication between patients and staff; (iii) management problems and sometimes demotivated staff. The relationship between patients and providers is facilitated by free access to GPs and absence of any charges for hospital treatment. The biggest threat is continuation of avoidable illness caused by poor health habits in the population. The biggest opportunity is to strengthen public health measures to tackle these poor health habits.

Delivery of Health Care↗

PubMed2003

Service production and contract choice in primary physician services.

Since payment systems for physicians may affect the efficiency of health care service provision, the design of compensation schemes is a major policy concern. According to standard labour economics and agency theory, fee-for-service contracts are likely to induce higher service production than salary contracts and (pure) capitation contracts. Payment systems may also influence service quality and the overall cost control. Despite the obvious policy significance of these issues, the available empirical research is very limited. This paper is an attempt to remedy this situation by addressing the impact of alternative contracts and payment systems on primary care physicians' service supply. The Norwegian primary physician service is an ideal setting for exploring the impact of payment systems. It is a centralised scheme where health services are mostly publicly financed. Until the June 1st 2001, there were two main types of primary care physicians: local government employees remunerated by a fixed salary, and contract physicians mostly financed by fee-for-service payments. We find that physicians with a fee-for-service contract produce a higher number of consultations and other patient contacts than physicians with a fixed salary. This difference is mostly due to longer working hours, but time efficiency is greater as well. Moreover, a part of the difference is due to a selection effect: salaried physicians prefer shorter working hours and prefer to work less intensively. When these and other effects are taken into account, we find that a change from a salary contract to a fee-for-service contract will increase service production by 20-40%.

Capitation Fee↗

PubMed2003

The economics of public health: financing drug abuse treatment services.

Drug abuse treatment financing exhibits a heterogeneous set of sources from federal, state, and local governments, as well as private sources from insurance, patient out-of-pocket, and charity. A public health model of drug abuse treatment is presented for a market that can be characterized by excess demand in many communities and an implied policy of rationing. According to best estimates, as many as 6.7 million individuals may need treatment, but only an estimated 1.5 million individuals actually participated in treatment episodes. Since, as demonstrated empirically, drug abuse treatment has a robust and positive social net benefit to society, it is perplexing that treatment financing stops with a rationing outcome that inhibits social welfare. The justification for public financing is centered on the external costs of drug addiction, but subsidization is grounded in the reality that a large number of addicted individuals do not have sufficient resources to pay for treatment out-of-pocket, nor do they have private insurance coverage. Social welfare losses are generated by financial arrangements that are inconsistent with rational budgeting theory and as such would lead to non-optimal organization and management of the drug abuse treatment system.

Budgets↗