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PubMed2006

National environmental health measures for minority and low-income populations: tracking social disparities in environmental health.

Healthy People 2010 [US Department of Health and Human Services, 2004. Healthy People 2010. Available: http://www.healthypeople.gov/Publications/ [accessed May 22, 2004]] has established as a top priority the elimination of health disparities. Current research suggests that characteristics of the social, physical and built environment contribute to these disparities. In order to track progress and to assess the potential contributions of the various components of the "environment," tools specific to environmental health disparities are required. In this paper, we discuss one potential tool, a set of candidate measures that may be used to track disparities in outcomes, as well as measures that may be used analytically to assess potential causal pathways. Several other reports on health and environmental measures have been produced, including the Environmental Protection Agency's (EPA) America's Children and the Environment. However, there has not been a comprehensive discussion about environmental measures that focus on racial, ethnic and socioeconomic disparities in health. Therefore, we focus on measures specific to historically disadvantaged populations. Based on a conceptual framework that views health disparities as partially driven by differential access to resources and exposures to hazards, we group the measures into four categories: social processes, environmental contaminants/exposures, bodyburdens of environmental contaminants, and health outcomes. We provide a few examples to illustrate each category, including residential segregation, PM(2.5) exposures, blood mercury concentrations, and asthma morbidity and mortality. These measures and categories are derived from a review of environmental health disparities from several disciplines. As a next step in a long-term effort to better understand the relationship between social disadvantage, environment, and health disparities, we hope that the proposed measures and literature review serve as a foundation for future monitoring of environmental health disparities. These efforts may aid community organizations, local agencies, scientists and policy makers in allocating resources and developing interventions.

Asthma↗
PubMed2004

HRT and gynaecologic cancer after WHI: old stuff or new doubts?

Previous studies had shown that there is little concern about endometrial cancer risk with hormone replacement therapy (HRT), whereas the risk of ovarian cancer is still debated. A new paper based on the women's health initiative (WHI) study devoted to gynaecologic cancers has been published in the October 2003 issue of JAMA, leading to the conclusion that also for endometrial and ovarian cancer risk, as the first WHI publication did for breast cancer risk, the previous large studies have been confirmed. About follow-up the authors conclude that, "The increased burden of endometrial biopsies required to assess vaginal bleeding further limits the acceptability of this regimen." These conclusions deserve a thorough analysis and must be read in the light of the burden of available epidemiological and clinical data and of recommended clinical practice. In the WHI trial the use of continuous combined HRT has resulted in a considerable increase of both imaging and invasive exams, to investigate women with bleeding or spotting, but the findings of these exams have been invariably negative. As far as, all published studies agree on the fact that continuous combined HRT either has no effect or significantly reduces the risk of both endometrial hyperplasia and cancer, there should be no reason to close-watching endometrium of women using this regimen with a different strategy from that employed on any healthy woman.

Biopsy↗
PubMed2006

The effectiveness of human impact assessment in the Finnish Healthy Cities Network.

OBJECTIVES: To develop a framework for analysing the effectiveness of prospective assessment and to apply the framework to human impact assessments (HuIA) carried out in the Finnish Healthy Cities Network. METHODS: The framework was formed by synthesizing and developing the themes that emerged from the published literature on effectiveness. The research material consists of interviews with people who participated in the assessment process in the municipalities (19 interviews). The research material also included assessment documents, proceedings of working meetings, municipal policy documents, background material and project reports produced in the municipalities studied. The research datasets were examined by content analysis. RESULTS: HuIA increased the decision-makers' awareness of effects and functioned as a tool for empowerment. The latter was apparent, for instance, in the social welfare and healthcare sector, finding a role for itself in decisively co-ordinating interdisciplinary work and actively seeking to alleviate identified negative effects. The assessment process also opened up the planning process, committed various actors to the decision, helped select the right alternative and promoted social learning. CONCLUSIONS: From the viewpoint of preparation and decision-making, the effectiveness of a HuIA increases when assessment becomes a recurring process and an integral part of an organization's activities. Integration of an assessment into permanent structures or activities, such as drawing up programmes or preparing strategies, helps the results of the assessment to be seen more clearly. From the viewpoint of decision-making, it is also important to strengthen the decision-makers' expertise in prospective assessment. When the effectiveness of HuIA is looked at in a new way (i.e. from the viewpoint of goal achievement, decision-making or learning), a more comprehensive interpretation can be given.

City Planning↗
PubMed2006

Fruit and vegetable intake: Few adolescent girls meet national guidelines.

OBJECTIVE: To examine longitudinal changes in daily fruit and vegetable consumption among black and white adolescent girls and calculate the percent of girls who met the Healthy People 2010 recommendations. METHODS: Girls (1186 black and 1126 white) who participated in the National Heart, Lung, and Blood Institute Growth Health Study (NGHS) were included if they had completed a 3-day food diary for at least one of six annual assessments visits, beginning at ages 11 or 12. Mixed models estimated the association of visit and race with (a) average daily consumption of fruits and vegetables and (b) the probability of meeting intake recommendations on one or more out of 3 days. RESULTS: For girls of both races, fruit and vegetable consumption increased with age; white girls showed a greater increase in fruit and nutrient-rich vegetable intake than black girls. Across visits, girls consumed considerably fewer than the recommended daily servings of fruits (1.0-1.5), vegetables (1.7-2.5), or nutrient-rich vegetables (0.25). Most girls (95%) failed to meet Healthy People 2010 recommendations. CONCLUSIONS: Public health efforts are needed to meet Healthy People 2010 objectives.

Adolescent↗
PubMed2003

Health literacy education and training: a student-professional collaboration.

A Healthy People 2010 objective is to improve the health literacy of persons with inadequate or marginal literacy skills. We designed a nutrition education module for dietetics students that allowed learning about health literacy while teaching this information to interested practitioners. Students designed a workshop for nutritionists by conducting a learning needs assessment and then developing learning objectives, content/methods, and process/outcome objectives. Students presented interactive sessions on using literacy assessment tools and developing low-literacy education materials. Handout packets included a list of relevant literacy Web sites. Evaluations unanimously rated the workshop as excellent or good. By helping teach others, students' learning experience was enhanced.

Adult↗
PubMed1995

Secular trends in diet and risk factors for cardiovascular disease: the Framingham Study.

OBJECTIVE: In this study we examined changes in dietary intake and risk factors for cardiovascular disease that occurred over three decades in a US-population-based sample. DESIGN: Secular trends in dietary profiles and risk factors were studied in cross-sectional samples of subjects from the Framingham Study in 1957-1960, 1966-1969, and 1984-1988. RESULTS: Dietary levels of cholesterol appeared to have declined considerably, whereas macronutrient and fatty acid intakes appeared to change only slightly. Men appeared to increase their saturated fat intakes from 16.4% in 1966-1969 to 17.0% in 1984-1988 (P < .01). In spite of relatively stable mean total fat intake levels, 35% to 60% of Framingham Study men and women reported decreased consumption of higher-fat animal products over the 10-year period between 1974-1978 and 1984-1988. Framingham subjects who reported modifying their diets by substituting lower-fat foods for high-fat items between 1974-1978 and 1984-1988 were more likely to achieve the guidelines of the National Cholesterol Education Program and Healthy People 2000 for dietary fat and cholesterol intake and for serum total cholesterol level. Levels of systolic and diastolic blood pressure, total and low-density lipoprotein cholesterol, and cigarette smoking were also lower in 1984-1988 than in earlier times. Compared with 1957-1960, mean body mass index and prevalence rates of overweight and hypertension were higher in 1984-1988, despite higher levels of reported physical activity. CONCLUSIONS: The observed secular trends in diet and risk factor levels for cardiovascular disease in the Framingham population are important to guide the development and implementation of population-based strategies for promoting cardiovascular health, including nutrition interventions.

Adult↗
PubMed2003

The FIGO Save the Mothers Initiative: the Ethiopia-Sweden collaboration.

The overall goal of the FIGO Save the Mothers Fund was to establish basic and comprehensive emergency obstetric care (EmOC) with the specific objectives of increasing the availability and utilization of quality obstetric care as measured by the UN indicators. As a result of this commitment by FIGO, the Ethiopian Society of Obstetricians and Gynecologists (ESOG) launched the Save the Mothers Project (SMP) in West Showa Zone (WSZ), Ethiopia in 1998 to implement and test a demonstration project and evaluate the feasibility and impact of the intervention. The overall objectives matched FIGO's-reducing maternal deaths by promoting the availability, access and utilization of EmOC services for women with complications of pregnancy and childbirth. The intervention package included capacity building as a major activity, and physicians and other service providers from Ambo Hospital, Shenen and Ijaji Health Centers were trained in EmOC. This was intended to combat the high staff turnover in the area. Equipment, materials and supplies were also provided to the demonstration sites to enable them provide basic and comprehensive EmOC services. The interventions, begun in 1999, led to improvements in availability, utilization and met need, which suggests that such an approach may eventually lead to the reduction of maternal deaths. The cesarean section rate for Ambo Hospital increased from 3.7% in 1998 to 17.3% in 2001--an almost six-fold increase. At Ambo Hospital both the total number of deliveries and cases admitted with obstetric complications have increased from baseline. Patients with obstructed labor comprise 39% of all obstetric patients making it the leading cause of hospitalization. Obstetric hemorrhage comes next with 24% of all admissions. The case fatality rate (CFR) (for direct maternal deaths) decreased from 7.2% at baseline, to 4.6% in 2001--showing a definite trend of improvement. Currently, there is 24-h EmOC service at Ambo Hospital where an obstetrician and general medical practitioners with EmOC training are responsible for the service. Shenen and Ijaji health Centers are upgraded in terms of training of staff members, provision of equipment and supplies, and regular supervision so that the community in these areas has access to basic EmOC services. To replicate similar activities, in a setting like ours, EmOC projects have to be low cost to attract decision-makers. The SMP used almost US dollars 100,000 over 3 years to ensure availability of EmOC services for women in WSZ. A favorable political climate such as maintenance of relative peace, and flexibility in adapting to local conditions also contributed to the success of the SMP.

Cesarean Section↗
PubMed2003

Safe motherhood: the FIGO initiative.

Over the last twenty years the international community-realizing that the tragedy of women dying during pregnancy and in childbirth could no longer be tolerated-launched a series of initiatives aimed at making safe motherhood a cornerstone of health services in all countries. Making pregnancy and delivery safe events is particularly complex, as it involves infrastructural and logistic, as well as technical, issues. Women die because they have no access to skilled personnel during pregnancy and at the time of delivery and because--if an emergency situation arises--they cannot reach a facility where emergency obstetric services are available. FIGO, the International Federation of Obstetrics and Gynecology-as the only global organization representing the Obstetricians of the world-decided some time ago that it could not limit its activities to proposing technical guidelines and debating scientific issues. It had to move into the field and, through its affiliated societies, help change the ability of the multitude of women in the developing world to obtain skilled attendance at birth. In 1997, plans were made to launch activities in five areas where maternal mortality was particularly high: Central America (Guatemala, Honduras, Nicaragua and El Salvador), Ethiopia, Mozambique, Pakistan, and Uganda. Five member societies from the developed world (the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Italian Society of Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists of the United Kingdom; and the Swedish Society of Obstetrics and Gynecology) agreed to provide support to their counterparts in these five selected areas. The project is now in its final stage. Results are, by and large, positive, demonstrating that, by motivating health professionals in the field and for a relatively modest financial outlay, more efficient use of existing services could be made in a sustainable fashion to save lives.

Adult↗
PubMed2003

FIGO and women's health 2000-2003.

The International Federation of Gynecology and Obstetrics--FIGO--has been striving hard to carefully attend to women's well-being, and respect and implement their rights, the status and their health, which is well beyond the basic obstetric and gynecological requirement. FIGO is deeply involved in acting as a catalyst for the all-round activities of national obstetric and gynecologic societies to mobilise their members to participate in and contribute to, all of their endeavours. FIGO's committees strengthen these objectives and FIGO's alliance with WHO provides a springboard. The task is gigantic, but FIGO, through national obstetric and gynecological societies and with the strength of obstetricians and gynecologists as its battalion, can offer to combat and meet the demands.

Female↗
PubMed2002

Antepartum care in the twenty-first century.

Major factors impacting on antepartum care in the twenty-first century were reviewed in this article, including the impact of managed care and collaborative health care teams, the malpractice crisis, antepartum visits and the quality of care, increased use of the Internet and computer technology, the increasing age of childbearing, advances in genetic and prenatal diagnosis, the importance of evidence-based medicine, the goals of Healthy People 2010 [11], the Safe Mother Initiative, and the use of complementary and alternative medicine. Recommendations for antepartum care in the twenty-first century include; the formation of integrated collaborative health care teams to deal with the effects of managed care; development of a more sensitive health care system to assist all parties involved with medical malpractice; increased expertise in the use of the Internet and computer technology; acknowledging and preparing for the increased population of older gravidas; becoming aware of advances in genetic and prenatal diagnosis; increasing the ability to critically evaluate research and incorporate well-founded study findings into clinical practice; incorporating the goals of Healthy People 2010 [11] when providing care to antepartum patients; contributing resources and manpower to the Safe Mother Initiative to decrease maternal mortality in developing countries; becoming knowledgeable, obtaining adequate training, and utilizing or performing evidence-based studies to validate the use of complementary and alternative medicine in antepartum practice; and finally to find a balance between the factors impacting on prenatal care and the ability to continue to provide safe, high-quality, continuous, sensitive, and humane antepartum care.

Complementary Therapies↗