The Public Health of Cubans and Cuban Americans: A Symposium

This flyer promotes the event "The Public Health of Cubans and Cuban Americans: A Symposium" cosponsored by the FlU Herbert Wertheim College of Medicine, the Robert Stempel College of Public Health & Social Work, the Latin American and Caribbean Center, and the Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA). Part of the CRI/LACC Cuba and the Professions Lecture Series

Leptospirosis in northern Tanzania: exploring the role of rodents and ruminant livestock in a neglected public health problem

Leptospirosis is an important but neglected zoonotic disease that is often overlooked in Africa. Although comprehensive data on the incidence of human disease are lacking, robust evidence of infection has been demonstrated in people and animals from all regions of the continent. However, to date, there are few examples of direct epidemiological linkages between human disease and animal infection. In East Africa, awareness of the importance of human leptospirosis as a cause of non-malarial febrile illness is growing. In northern Tanzania, acute leptospirosis has been diagnosed in 9% of patients with severe febrile illness compared to only 2% with malaria. However, little is known about the relative importance of different potential animal hosts as sources of human infection in this area. This project was established to investigate the roles of rodents and ruminant livestock, important hosts of Leptospira in other settings, in the epidemiology of leptospirosis in northern Tanzania. A cross-sectional survey of rodents living in and around human settlements was performed alongside an abattoir survey of ruminant livestock. Unusual patterns of animal infection were detected by real-time PCR detection. Renal Leptospira infection was absent from rodents but was detected in cattle from several geographic areas. Infection was demonstrated for the first time in small ruminants sub-Saharan Africa. Two major Leptospira species and a novel Leptospira genotype were detected in livestock. L. borgpetersenii was seen only in cattle but L. kirschneri infection was detected in multiple livestock species (cattle, sheep and goats), suggesting that at least two distinct patterns of Leptospira infection occur in livestock in northern Tanzania. Analysis of samples from acute leptospirosis in febrile human patients could not detect Leptospira DNA by real-time PCR but identified social and behavioural factors that may limit the utility of acute-phase diagnostic tests in this community. Analysis of serological data revealed considerable overlap between serogroups detected in cattle and human leptospirosis cases. Human disease was most commonly attributed to the serogroups Mini and Australis, which were also predominant reactive serogroups in cattle. Collectively, the results of this study led to the hypothesis that livestock are an important reservoir of Leptospira infection for people in northern Tanzania. These results also challenge our understanding of the relationship between Leptospira and common invasive rodent species, which do not appear to maintain infection in this setting. Livestock Leptospira infection has substantial potential to affect the well-being of people in East Africa, through direct transmission of infection or through indirect effects on food production and economic security. Further research is needed to quantify the impact of livestock leptospirosis in Africa and to develop effective interventions for the control of human and animal disease.

Perception of HIV among pregnant women in the public health system in two municipalities of the state of São Paulo

Aim: To verify the knowledge of pregnant women on mother-to-child transmission (MTCT) of HIV, the availability of HIV tests in the public health system and counseling on the disease in two cities, Birigui and Piacatu, São Paulo State, Brazil. Methods: This is a descriptive and exploratory research using as samples, the files of 141 pregnant women attending the Basic Health Unit. Data were collected by survey, followed by a semi-structured questionnaire with open and closedend questions. Data were analyzed on Epi Info™ 7.1.4, by the Chi-square and Exact Fisher tests. Results: From all the 141 pregnant women, 119 were interviewed and 92.4% reported to have been informed about the need of taking the HIV test during prenatal exams. However, only 5.9% were counseled and 20.2% reported to be aware of how to prevent MTCT of HIV, usually mentioning lactation suppression and prescribed medication. The association between the knowledge about how to prevent MTCT of HIV and some social, demographic and economic variables like ethnics, educational level, home location, occupation, age and parenting was not verified. Conclusions: It is necessary to advise pregnant women on the importance of taking the HIV test regardless of the examination outcome, which was not observed in the cities where the research was conducted.

Prevalence of chronic diseases in private healthcare sector of South Africa: A threat to public health

Purpose: To evaluate the prevalence of patients suffering from registered chronic disease list (CDL) conditions in a section of the South African private health sector from 2008 - 2012. Methods: This study was a retrospective analysis of the medicine claims database of a nationally (South African) representative Pharmacy Benefit Management (PBM) company data between 2008 and 2012. Statistical analysis was used to analyse the data. Descriptive analysis was performed to calculate the prevalence of CDL conditions for the entire population, and stratified by age and gender. However, MIXED linear modelling was used to determine changes in the average number of CDL conditions per patient, adjusted for age and gender from 2008 - 2012. Results: An increase of 0.20 in chronic diseases was observed from 2008 - 2012 in patients having any CDL condition, with an average of 1.57 (1.57 - 1.58, 95 % CI) co-morbid CDL conditions in 2008 and 1.77 (1.77 - 1.78, 95 % CI) in 2012. This increase in average number of CDL conditions per patient between 2008 and 2012 was statistically significant (p < 0.05), but with no large practical significance (d < 0.8). Conclusion: Prevalence of patients with CDL conditions along with risk of co-morbidity has been increasing with time in the private health sector of South Africa. Risk of increased co-morbidity with age and among different genders was prevalent.

Public health implications of dietary fiber intake to reduce the cost of chronic diseases

Objective: To assess the epidemiological evidence on dietary fiber intake and chronic diseases and make public health recommendations for the population in Romania based on their consumption. Populations that consume more dietary fiber from cereals, fruits and vegetables have less chronic disease. Dietary Reference Intakes recommend consumption of 14 g dietary fiber per 1,000 kcal, or 25 g for adult women and 38 g for adult men, based on epidemiologic studies showing protection against cardiovascular disease, stroke, hypertension, diabetes, obesity, metabolic syndrome, gastrointestinal disorders, colorectal -, breast -, gastric -, endometrial -, ovarian - and prostate cancer. Furthermore, increased consumption of dietary fiber improves serum lipid concentrations, lowers blood pressure, blood glucose leads to low glycemic index, aids in weight loss, improve immune function, reduce inflammatory marker levels, reduce indicators of inflammation. Dietary fibers contain an unique blend of bioactive components including resistant starches, vitamins, minerals, phytochemicals and antioxidants. Dietary fiber components have important physiological effects on glucose, lipid, protein metabolism and mineral bioavailability needed to prevent chronic diseases. Materials and methods: Data regarding diet was collected based on questionnaires. We used mathematical formulas to calculate the mean dietary fiber intake of Romanian adult population and compared the results with international public health recommendations. Results: Based on the intakes of vegetables, fruits and whole cereals we calculated the Mean Dietary Fiber Intake/day/person (MDFI). Our research shows that the national average MDFI was 9.8 g fiber/day/person, meaning 38% of Dietary Requirements, and the rest of 62% representing a “fiber gap” that we have to take into account. This deficiency predisposes to chronic diseases. Conclusions and recommendations:The poor control of relationship between dietary fiber intake and chronic diseases is a major issue that can result in adverse clinical and economic outcomes. The population in Romania is at risk to develop such diseases due to the deficient fiber consumption. A model of chronic diseases costs is needed to aid attempts to reduce them while permitting optimal management of the chronic diseases. This paper presents a discussion of the burden of chronical disease and its socio-economic implications and proposes a model to predict the costs reduction by adequate intake of dietary fiber.

Alcohol consumption among university students: a typology of consumption to aid the tailoring of effective public health policy

Objective: Elevated levels of alcohol consumption among university students are well documented. Policymakers have attempted to combat this issue at a university, national and international level. Tailoring public health policy to effectively tackle alcohol use is crucial. Using Q-methodology, the current study aims to develop a typology of alcohol consumption in the Irish university student population. Setting: A large Irish university. Participants Hundreds of possible statements on types of consumption were generated from a systematic review and a set of one-on-one interviews. These were reduced to 36 statements, 6 statements which define each of the 6 previously defined consumption types. Participants were advised to scan through the 36 statements and fill the statements into a ‘forced choice, standardised distribution’. Following this, a 45–90 min interview was conducted with students to illuminate subjectivity surrounding alcohol consumption. Analysis was conducted using PQ Method and NVivo software. Principal component analysis, followed by varimax rotation, was conducted to uncover the final factor information. Results: In total, 43 students completed the Q-study: 19 men and 24 women. A typology describing 4 distinct groupings of alcohol consumer was uncovered: the guarded drinker, the calculated hedonist, the peer-influenced drinker and the inevitable binger. Factor loadings of each of the consumer groupings were noted for type description. Conclusions: This is the first study to propose ideal types of alcohol consumption among a university student population. Further research is required to investigate the degree to which each of these ideal types is subscribed. However, this typology, in addition to informing public policy and strategies, will be a valuable analytic tool in future research.

Robustness in health research : do differences in health measures, techniques, and time frame matter?

Survey-based health research is in a boom phase following an increased amount of health spending in OECD countries and the interest in ageing. A general characteristic of survey-based health research is its diversity. Different studies are based on different health questions in different datasets; they use different statistical techniques; they differ in whether they approach health from an ordinal or cardinal perspective; and they differ in whether they measure short-term or long-term effects. The question in this paper is simple: do these differences matter for the findings? We investigate the effects of life-style choices (drinking, smoking, exercise) and income on six measures of health in the US Health and Retirement Study (HRS) between 1992 and 2002: (1) self-assessed general health status, (2) problems with undertaking daily tasks and chores, (3) mental health indicators, (4) BMI, (5) the presence of serious long-term health conditions, and (6) mortality. We compare ordinal models with cardinal models; we compare models with fixed effects to models without fixed-effects; and we compare short-term effects to long-term effects. We find considerable variation in the impact of different determinants on our chosen health outcome measures; we find that it matters whether ordinality or cardinality is assumed; we find substantial differences between estimates that account for fixed effects versus those that do not; and we find that short-run and long-run effects differ greatly. All this implies that health is an even more complicated notion than hitherto thought, defying generalizations from one measure to the others or one methodology to another.

Community food security gaps in surveillance and monitoring

This paper describes the gaps in monitoring and surveillance identified while conducting Community Food Security assessments in three geographical areas located in south-east Queensland, Australia

Strategic directions report for the social determinants of health project

This report presents the outcomes of a project undertaken by the VACCHO Public Health Research Unit to explore ways to build capacity in Aboriginal and Torres Strait Islander social determinants research. The project was funded by the Cooperative Research Centre for Aboriginal Health.----- The project involved a series of four social determinants research workshops conducted in July and August 2009 and a collaborative forum conducted in September 2009. Invitations to participate were extended to the VACCHO membership and the nine universities in Victoria. Three workshops were held with ACCHOs (in Bendigo, Melbourne and Gippsland), and one workshop with universities (in Melbourne).----- The workshops aimed to build VACCHO’s social determinants research capacity and provide direction for VACCHO on ways to more effectively engage in Aboriginal health research. Through the workshops, VACCHO aimed to work with ACCHOs to identify research processes and issues that are equitable and sustainable, and which address the social determinants of health.----- At the workshops, participants explored questions around the priorities for the social determinants of Aboriginal health and considered the key partnerships that might be important to social determinants research.----- At the workshops with ACCHOs, participants identified key research priorities and questions in Aboriginal social determinants and health. This focus reflects the need for Aboriginal and Torres Strait Islander community representatives to identify the priorities in health and social determinants research. Identifying these priorities is important if researchers are to respond in a meaningful way and undertake relevant research in the most urgent areas of need. At the university workshop, participants focused on identifying research process and implementation issues in social determinants research.----- The final forum brought together ACCHOs, university representatives, invited presenters and participants from justice, education and housing departments, and representatives from non-government funding organisations. The forum aimed to provide an insight into how priorities and funding decisions are made, and how research can help to ensure they are influenced by the priorities of the community. The findings from the workshops were presented at the forum and used to develop pathways for future research.

Evidence-based practice

Introduction This chapter traces the history of evidence-based practice from its roots in evidence-based medicine to contemporary thinking about the usefulness of such an approach to practice. It defines evidence-based practice and differentiates it from terms such as evidence-based medicine, evidence-based policy and evidence-based healthcare. As evidence-based practice is concerned with identifying ‘good evidence’, this chapter will first describe the nature and production of knowledge, as it is important to understand the subjective nature of knowledge and the research process. The chapter considers the necessary skills for evidence-based practice, and discusses the processes of attaining the necessary evidence and its limitations. We examine the barriers and facilitators to identifying and implementing ‘best practice’ and when evidence-based practice is appropriate to use. The chapter concludes with a discussion about the limitations of evidence-based practice and the potential use of other sources of information to guide practice.

The impact of globalisation on health

After reading this chapter, you should be able to: • understand the concept of globalisation and appreciate its complexity • identify the significant impacts of globalisation on population health, particularly the incidence of communicable and non-communicable diseases • understand the distribution of the global burden of disease in high-, middle- and low-income countries • critically evaluate the factors contributing to the major causes of death in low-income countries • understand some of the achievements of the global public health community and appreciate the challenges it faces.

Health protection

Our understanding of how the environment can impact human health has evolved and expanded over the centuries, with concern and interest dating back to ancient times. For example, over 4000 years ago, a civilisation in northern India tried to protect the health of its citizens by constructing and positioning buildings according to strict building laws, by having bathrooms and drains, and by having paved streets with a sewerage system (Rosen 1993). In more recent times, the ‘industrial revolution’ played a dominant role in shaping the modern world, and with it the modern public health system. This era was signified by rapid progress in technology, the growth of transportation and the expansion of the market economy, which lead to the organisation of industry into a factory system. This meant that labour had to be brought to the factories and by the 1820s, poverty and social distress (including overcrowding and infrequent sewage and garbage disposal) was more widespread than ever. These circumstances, therefore, lead to the rise of the ‘sanitary revolution’ and the birth of modern public health (Rosen 1993). The sanitary revolution has also been described as constituting the beginning of the first wave of environmental concern, which continued until after World War 2 when major advances in engineering and chemistry substantially changed the face of industry, particularly the chemical sector. The second wave of environmental concern came in the mid to late 20th century and was dominated by the environmental or ecology movement. A landmark in this era was the 1962 publication of the book Silent Spring by Rachel Carson. This identified for the first time the dramatic effects on the ecosystem of the widespread use of the organochlorine pesticide, DDT. The third wave of environmental concern commenced in the 1980s and continues today. The accelerated rate of economic development, the substantial increase in the world population and the globalisation of trade have dramatically changed the production methods and demand for goods in both developed and developing countries. This has lead to the rise of ‘sustainable development’ as a key driver in environmental planning and economic development (Yassi et al 2001). The protection of health has, therefore, been a hallmark of human history and is the cornerstone of public health practice. This chapter introduces environmental health and how it is managed in Australia, including a discussion of the key generic management tools. A number of significant environmental health issues and how they are specifically managed are then discussed, and the chapter concludes by discussing sustainable development and its links with environmental health.

Researching with the Aboriginal Community, MPH2057- Aboriginal Health Course (Monash University), delivered by the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) & The Burnet Institute at The Burnet Institute, Melbourne, Victoria, 29 September 2010

A copy of the slide presentation titled 'Researching with the Aboriginal Community'. It was presented by Bronwyn Fredericks for the Master of Public Health Program (MPH2057- Aboriginal Health Course) at Monash University. The Monash University Aboriginal Health Course (MPH2057) is delivered in partnership by the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) & The Burnet Institute. The 2010 Aboriginal Health Course was run on Level 3 of The Burnet Institute, 89 Commercial Road, Prahan, Melbourne, Victoria, 29 September 2010.