Environmental health risk assessment of dioxin in foods and the sustainability of public health interventions at severe dioxin hot spots in Vietnam

This study assessed environmental health risk from dioxin in foods and sustainability of risk reduction programs at two heavily contaminated former military sites in Vietnam. The study involved 1000 household surveys, analysis of food samples and in-depth discussions with residents and officials. The findings indicate that more than 40 years after the war, local residents still experience high exposure to dioxin if they consume local high risk foods. Public health intervention programs were rated moderately to well sustained. Internal migration, and lack of clear, official guidance and sensitivity regarding dioxin issues were the main challenges for sustainability of prevention programs.

Dioxin risk reduction programme at the most severe dioxin hot spot in Vietnam: Residual knowledge, attitude and practices five years post intervention

Bien Hoa Airbase was one of the bulk storage and supply facilities for defoliants during the Vietnam War. Environmental and biological samples taken around the airbase have elevated levels of dioxin. In 2007, a pre-intervention knowledge, attitude and practice (KAP) survey of local residents living in Trung Dung and Tan Phong wards was undertaken regarding appropriate strategies to reduce dioxin exposure. A risk reduction programme was implemented in 2008 and post-intervention KAP surveys were undertaken in 2009 and 2013 to evaluate the longer term impacts. Quantitative assessment was undertaken via a KAP survey in 2013 among 600 local residents randomly selected from the two intervention wards and one control ward (Buu Long). Eight in-depth interviews and two focus group discussions were also undertaken for qualitative assessment. Most programme activities had ceased and dioxin risk communication activities had not been integrated into local routine health education programmes; however, main results generally remained and were better than that in Buu Long. In total, 48.2% of households undertook measures to prevent exposure, higher than those in pre- and post-intervention surveys (25.8% and 39.7%) and the control ward (7.7%). Migration and the sensitive nature of dioxin issues were the main challenges for the programme's sustainability

Environmental health risk assessment of dioxin exposure through foods in a Dioxin hot spot—Bien Hoa City, Vietnam

This study used the Australian Environmental Health Risk Assessment Framework to assess the human health risk of dioxin exposure through foods for local residents in two wards of Bien Hoa City, Vietnam. These wards are known hot-spots for dioxin and a range of stakeholders from central government to local levels were involved in this process. Publications on dioxin characteristics and toxicity were reviewed and dioxin concentrations in local soil, mud, foods, milk and blood samples were used as data for this risk assessment. A food frequency survey of 400 randomly selected households in these wards was conducted to provide data for exposure assessment. Results showed that local residents who had consumed locally cultivated foods, especially fresh water fish and bottom-feeding fish, free-ranging chicken, duck, and beef were at a very high risk, with their daily dioxin intake far exceeding the tolerable daily intake recommended by the WHO. Based on the results of this assessment, a multifaceted risk management program was developed and has been recognized as the first public health program ever to have been implemented in Vietnam to reduce the risks of dioxin exposure at dioxin hot-spots.

New strategy toward dioxin risk reduction for local residents surrounding severe dioxin hotspots in Vietnam

Background A public health intervention program with active involvement of local related stakeholders was piloted in the Bien Hoa dioxin hot spot (2007-2009), and then expanded to the Da Nang dioxin hot spot in Vietnam (2009-2011). It aimed to reduce the risk of dioxin exposure through foods for local residents. This article presents the results of the intervention in Da Nang. Methodology To assess the results of this intervention program, pre-intervention and post-intervention knowledge-attitude-practice (KAP) surveys were implemented in 400 households, randomly selected from four wards surrounding Da Nang Airbase in 2009 and 2011, respectively. Results After the intervention, the knowledge on the existence of dioxin in food, dioxin exposure pathways, potential high risk foods and preventive measures significantly increased (p < 0.05). 98% were willing to follow advice on preventing dioxin exposure. Practices to reduce the risk of dioxin exposure also statistical significantly improved (p<0.05). After intervention, 60.4% of households undertook exposure preventive measures, significantly higher than that of the pre-intervention survey (39.6%; χ2 =40.15 , P<0.001). High risk foods had quite low rates of daily consumption (from 0% to 2.5%) and were significantly reduced (p<0.05). Conclusions This is seen as an effective intervention strategy toward reducing the risk of human exposure to dioxin at dioxin hot spots. While greater efforts are needed for remediating dioxin polluted areas inside airbases, there is also evidence to suggest that, during the past four decades, pollution has been expanding to the surrounding areas. For this reason, this model should be quickly expanded to the remaining dioxin hot spots in Vietnam to further reduce the exposure risk in these areas.

Knowledge, attitudes and practices to reduce exposure among residents living near Danang dioxin hot spot : 2.5 years after a preventative intervention

Da Nang Airbase in Viet Nam served as a bulk storage and supply facility for Agent Orange and other herbicides during Operation Ranch Hand 1961-1971[1]. Studies have shown that environmental and biological samples taken around the airbase site have elevated levels of dioxin [1-3]. Residents living in the vicinity of the airbase are at risk of exposure to dioxin in soil, water and mud and particularly through the consumption of local contaminated food. In 2009, a pre-intervention cross sectional survey was undertaken. This survey examined the knowledge, attitudes and practices (KAP) of householders living near Da Nang Airbase, relevent to reducing dioxin exposure through contaminated food. The results showed that despite living near a severe dioxin hot spot, the residents had very limited knowledge of both exposure risk and measures to reduce exposure to dioxin[4]. In response, the Vietnam Public Health Association (VPHA) and Da Nang Public Health Association implemented a risk reduction program at four residential wards in the vicinities of the Da Nang Airbase in 2010. A post intervention KAP survey was under taken in 2011, and the results showed that knowledge of the existence of dioxin in food, dioxin exposure pathways, potential high risk foods, and preventive measures was significantly enhanced. This new study monitored KAP 2.5 years after the intervention through a 2013 survey of food handlers from 400 households that were randomly selected from the four intervention wards. The results show that most of the positive outcomes remained stable or had increased; some KAP indicators decreased compared to those in the post-intervention survey, but were still significantly higher than the pre-intervention levels. In 2014, these findings will be incorporated with qualitative assessments and the results of laboratory analysis of dioxin concentrations in foods in Da Nang and Bien Hoa dioxin hot spots to comprehensively assess the sustained effects of the intervention.

Sustainability of public health interventions to reduce the risk of dioxin exposure at severe dioxin hot spots in Vietnam

Severe dioxin contamination at Bien Hoa and Da Nang airbases, Vietnam is of international concern. Public Health risk reduction programs were implemented in Bien Hoa in 2007-2009 and in Da Nang in 2009-2011. In 2009 and 2011 we reported the encouraging results of these interventions in improving the knowledge, attitude and practices (KAP) of local residents in reducing the dioxin exposure risk through foods. In 2013 we revisited these dioxin hot spots, aimed to evaluate whether the results of the intervention were maintained and to identify factors affecting the sustainability of the programs. To assess this, 16 in-depth interviews, six focus group discussions, and pre and post intervention KAP surveys were undertaken. 800 respondents from six intervention wards and 200 respondents from Buu Long Ward (the control site) were randomly selected to participate in the surveys. The results showed that as of 2013, the programs were rated as "moderately sustained" with a score of 3.3 out of 5.0 (cut off points 2.5 to <3.5) for Bien Hoa, and "well sustained" with a score of 3.8 out of 5.0 (cut off points 3.5 to <4.5) for Da Nang. Most formal intervention program activities had ceased and dioxin risk communication activities were no longer integrated into local routine health education programs. However, the main outcomes were maintained and were better than that in the control ward. Migration, lack of official guidance from City People's Committees and local authorities as well as the politically sensitive nature of dioxin issues were the main challenges for the sustainability of the programs.

Environmental health risk assessment of dioxin in foods at the two most severe dioxin hot spots in Vietnam

Background Bien Hoa and Da Nang airbases were bulk storages for Agent Orange during the Vietnam War and currently are the two most severe dioxin hot spots. Objectives This study assesses the health risk of exposure to dioxin through foods for local residents living in seven wards surrounding these airbases. Methods This study follows the Australian Environmental Health Risk Assessment Framework to assess the health risk of exposure to dioxin in foods. Forty-six pooled samples of commonly consumed local foods were collected and analyzed for dioxin/furans. A food frequency and Knowledge–Attitude–Practice survey was also undertaken at 1000 local households, various stakeholders were involved and related publications were reviewed. Results Total dioxin/furan concentrations in samples of local “high-risk” foods (e.g. free range chicken meat and eggs, ducks, freshwater fish, snail and beef) ranged from 3.8 pg TEQ/g to 95 pg TEQ/g, while in “low-risk” foods (e.g. caged chicken meat and eggs, seafoods, pork, leafy vegetables, fruits, and rice) concentrations ranged from 0.03 pg TEQ/g to 6.1 pg TEQ/g. Estimated daily intake of dioxin if people who did not consume local high risk foods ranged from 3.2 pg TEQ/kg bw/day to 6.2 pg TEQ/kg bw/day (Bien Hoa) and from 1.2 pg TEQ/kg bw/day to 4.3 pg TEQ/kg bw/day (Da Nang). Consumption of local high risk foods resulted in extremely high dioxin daily intakes (60.4–102.8 pg TEQ/kg bw/day in Bien Hoa; 27.0–148.0 pg TEQ/kg bw/day in Da Nang). Conclusions Consumption of local “high-risk” foods increases dioxin daily intakes far above the WHO recommended TDI (1–4 pg TEQ/kg bw/day). Practicing appropriate preventive measures is necessary to significantly reduce exposure and health risk.

Apprendre à bien lire : une étude coût efficacité des Actions Lecture

How to Improve Pupils' Literacy? A Cost-Effectiveness Analysis of the Action Lecture This article presents a cost-effectiveness analysis of an innovative teaching method run in some nursery and primary schools in Paris. This project, named Action Lecture, is designed to improve pupils' abilities and taste on literacy. We report the results of an evaluation of this program. We describe the experimental protocol that was built to estimate the program's impact on several types of indicators (academic abilities, attitude toward reading, school life) by comparing the evolution of treatment schools and control schools. Data were processed following a Differences-in-Differences (DID) method. Then we use the estimation of the impact on academic achievement to conduct a cost-effectiveness analysis and take a reduction of the class size program as a benchmark. The results are positive for the Action Lecture program both in terms of impact's evaluation and in terms of cost-effectiveness ratio.

Evaluation of public hospital performance in Khanh Hoa Province : Vietnam in connection with patient and staff satisfaction surveys

This research aimed to develop a framework for performance evaluation of public hospitals in Vietnam that is culturally, socially, and politically appropriate. The research included both qualitative and quantitative methods and identified and validated novel instruments to measure patient satisfaction and job satisfaction of hospital staff and to determine a set of hospital indicators that reflect the quality of hospital performance. New models for understanding the determinants of patient and staff satisfaction were developed along with a new performance indicator framework for hospital performance. These instruments will now be applied to the evaluation of hospital services in Khanh Hoa Province, permitting longer term evaluation of their effectiveness in changing system wide performance and satisfaction.

El bien común como fundamento de la responsabilidad del estado

Resumen: Los doctrinarios, a la hora de fundamentar la responsabilidad del Estado, han esgrimido diversas teorías. En el presente trabajo nos proponemos plantear otra mirada al respecto, postulando el bien común como fundamento de la responsabilidad del Estado. Para ello, conceptualizamos el bien común para repasar las distintas respuestas que se han dado en torno al interrogante de por qué el Estado responde. Ello, a fin de demostrar que todas esas respuestas, en definitiva, se cimientan en el bien común. Finalmente, ahondamos en doctrina ius-administrativista, iusfilósofica y de orden jurisprudencial para sustentar nuestra opinión.

Incidencia de la constitución matrimonial en la consecución del bien común

Resumen: La consideración de un determinado modelo matrimonial como socialmente valioso, aquel estable y constituido entre un varón y una mujer, se fundamenta en su incidencia en la consecución del bien común. Los datos empíricos demuestran los efectos beneficiosos que este modelo tiene en adultos casados y, especialmente, en los niños criados por sus padres biológicos unidos en matrimonio armonioso, además de su insustituible importancia como garante y promotor de la renovación demográfica. La ley desempeña un rol pedagógico y ejemplar preponderante en la preservación y fomento de esta concepción matrimonial socialmente preferible. El debilitamiento de este modelo matrimonial es atribuido a algunos factores que han incidido en su desestructuración, destacando la impronta de las ideologías de la desvinculación y de género. La necesidad de promover políticas públicas que tiendan a la recuperación del matrimonio estable entre un varón y una mujer resulta imperiosa para el logro del bien común y la consecuente plenitud integral de los miembros de la sociedad.

Inconstitucionalidad de la ley argentina 26.618 de 2010 : su reforma. El matrimonio es un bien jurídico exclusivo del varón y la mujer, como tales. En consecuencia, es indisponible por el Estado.

Resumen: El presente artículo presenta las razones jurídicas que fundan la inconstitucionalidad de la ley argentina 26.618 de legalización de las uniones de personas del mismo sexo. Parte del reconocimiento de la igual dignidad esencial de todas las personas y analiza luego la reforma del matrimonio civil dispuesto por la ley 26.618 y la necesidad de reglamentación previa y específica del vínculo filiatorio y de parentesco por adopción y la improcedencia de la aplicación de las técnicas de procreación asistida en las uniones homosexuales o lésbicas. Señala cómo esta legislación afecta a terceros: al menor de edad en desamparo familiar, a la persona por nacer y, también, al matrimonio, a la familia y a la sociedad. El desarrollo presenta los argumentos por los cuales se sostiene que esta ley ha hecho una extensión irrazonable del nombre de matrimonio. También se cuestiona la “cláusula complementaria” prevista por la ley, que evidencia el abuso cometido y la imposibilidad de legislar sin lógica. Considera la actuación de los legisladores y la violación de lo anticipado en las respectivas plataformas electorales y señala que el matrimonio es una realidad anterior al derecho positivo. Finaliza con reflexiones sobre el límite objetivo que surge de la realidad y el riesgo caos social y jurídico-político y la necesidad de derogación de la ley 26.618.

Perseverancia y bien morir : el Baladro de Burgos visto desde su marco

Integran este número de la revista ponencias presentadas en Studia Hispanica Medievalia VIII: Actas de las IX Jornadas Internacionales de Literatura Española Medieval, 2008, y de Homenaje al Quinto Centenario de Amadis de Gaula

La contribución del matrimonio al bien común : perspectivas y desafíos

Resumen: Este artículo se propone estudiar la vinculación entre matrimonio y bien común, a partir del debate en la Argentina de la ley 26.618 de legalización de las uniones homosexuales como matrimonio y de los lineamientos propuestos por Benedicto XVI en Caritas in Veritate. Se advierte una claudicación en la búsqueda del bien común que obedece a diferentes factores, sobre todo el relativismo cultural. Se propone una noción de bien común que respeta la dignidad de la persona y su dimensión social y se consideran las contribuciones del matrimonio al bien común. Se advierte cómo la ley 26.618 concede a las uniones de personas del mismo sexo beneficios propios del matrimonio entre varón y mujer sin que se cumplan las funciones sociales de esa institución. También se proponen algunas condiciones de la vida social que favorecen al matrimonio para que así contribuya al bien común, con especial referencia al ámbito de la legislación, las políticas públicas, los medios de comunicación, la empresa y el mundo del trabajo y la ciencia y la tecnología. Finalmente, se consideran los obstáculos que surgieron en el reciente debate legislativo por la aparición de un laicismo militante y la contribución de las religiones al bien común desde una sana laicidad en esta materia.

San Agustín : la luz de la ley y el bien del hombre

Pensamos que el tema del orden natural es determinante de la antropología y la ética de San Agustín. La contemplación del orden real y la conquista de la restauración y reproducción del mismo en el seno del ser y el obrar del hombre, son imperativos ineludibles en el camino hacia la realización del destino humano. Nos guían en este estudio diversos intereses. En primer lugar pretendemos poner en evidencia la importancia del conocimiento del orden del ser para la antropología y la ética agustiniana, en la que es central el tema de la caridad entendida como ordo amoris. En segundo lugar prestaremos atención a las principales consecuencias del orden: la unidad y la paz que esta conlleva a distintos estratos señalados por la reflexión agustiniana. Finalmente proponemos iluminar a partir de estas ideas de San Agustín, ciertas tesis de la filosofía contemporánea que consideran, en su intento por procurar la paz, que la caridad sólo halla fundamento en el nihilismo de las ontologías débiles.