Bovine Tb Eradication Project – Recognizing Hot Button Issues

The Michigan Departments of Agriculture, Community Health, and Natural Resources, US Department of Agriculture (USDA) and Michigan State University work cooperatively together as the bovine TB eradication project partners. The interagency group combines expertise in epidemiology, veterinary and human medicine, pathology, wildlife biology, animal husbandry, regulatory law and policy and risk communications. The stakeholders, those impacted by the disease, include agriculture and tourism industry representatives, “Mom-and-Pop” businesses, hunters, wildlife enthusiasts, farmers, Local Health Departments and legislators. The regulatory agencies are the above mentioned project partners, excluding MSU and USDA Wildlife Services, both of which offer services to agencies and stakeholders. Eradicating bovine TB would not be difficult if there were no social issues surrounding it. The economy, hunting traditions, animal management, tourism and human health are all impacted by regulatory response to the disease. Often the social issues play a large role in decision making, therefore it is important to understand your clientele and anticipate public reaction to policy changes and requirements.

HEALTH EDUCATION IN THE CARE TO CLIENTS OF THE BLOOD GLUCOSE SELF-MONITORING PROGRAM

This article reports, in a systemized and analytical way, the experience of an Outreach Program in the period between 2010 and 2011. The study focused on health education interventions as strategies to improve the adherence of individuals with insulin- dependent diabetes mellitus (IDDM), clients of a blood glucose self-Monitoring program. In addition, we intended to contribute to the reorganization of the program's working processes in the unit. Health education strategies were used in both educational groups and home visits, thus permitting the provision of care that was more individualized. Data regarding the clients were organized on a spreadsheet and in files for the Family Health teams, which made it easier to identify the patients, including those who were absent, helping to decentralize the care. By using health education strategies, we intended to contribute to a more comprehensive and emancipatory care of the clients, aimed at a continuous reflection of the workers regarding their practices.

The double task of preventing malnutrition and overweight: a quasi-experimental community-based trial

Background: The Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age. Methods: A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models. Results: 196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI −0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (−0.31, 95%CI −0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding. Conclusions: Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

Socioeconomic determinants of health related quality of life in childhood and adolescence: results from a European study

STUDY OBJECTIVE: The objective of this study was to investigate the impact of two different socioeconomic status (SES) measures on child and adolescent self reported health related quality of life (HRQoL). The European KIDSCREEN project aims at simultaneous developing, testing, and implementing a generic HRQoL instrument. DESIGN AND SETTING: The pilot version of the questionnaire was applied in school surveys to students from 8 to 18 years of age, as well as to their parents, together with such determinants of health status as two SES indicators, the parental educational status and the number of material goods in the family (FAS, family affluence scale). PARTICIPANTS: Students from seven European countries: 754 children (39.8%; mean: 9.8 years), and 1142 adolescents (60.2 %; mean: 14.1 years), as well as their respective parents. MAIN RESULTS: In children, a higher parental educational status was found to have a significant positive impact on the KIDSCREEN dimensions: physical wellbeing, psychological wellbeing, moods and emotions, bullying and perceived financial resources. Increased risk of low HRQoL was detected for adolescents in connection with their physical wellbeing. Family wealth plays a part for children's physical wellbeing, parent relations and home life, and perceived financial resources. For adolescents, family wealth furthermore predicts HRQoL on all KIDSCREEN dimensions. CONCLUSIONS: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRQoL in childhood, whereas reduced access to material (and thereby social) resources may lead to a lower HRQoL especially in adolescence.

Cultural capital and social inequality in health

Economic and social resources are known to contribute to the unequal distribution of health outcomes. Culture-related factors such as normative beliefs, knowledge and behaviours have also been shown to be associated with health status. The role and function of cultural resources in the unequal distribution of health is addressed. Drawing on the work of French Sociologist Pierre Bourdieu, the concept of cultural capital for its contribution to the current understanding of social inequalities in health is explored. It is suggested that class related cultural resources interact with economic and social capital in the social structuring of people's health chances and choices. It is concluded that cultural capital is a key element in the behavioural transformation of social inequality into health inequality. New directions for empirical research on the interplay between economic, social and cultural capital are outlined.

TANK SIZING AND OPTIMIZING LOOP PLACEMENT IN A BRANCHED WATER DISTRIBUTION SYSTEM

More than eighteen percent of the world’s population lives without reliable access to clean water, forced to walk long distances to get small amounts of contaminated surface water. Carrying heavy loads of water long distances and ingesting contaminated water can lead to long-term health problems and even death. These problems affect the most vulnerable populations, women, children, and the elderly, more than anyone else. Water access is one of the most pressing issues in development today. Boajibu, a small village in Sierra Leone, where the author served in Peace Corps for two years, lacks access to clean water. Construction of a water distribution system was halted when a civil war broke out in 1992 and has not been continued since. The community currently relies on hand-dug and borehole wells that can become dirty during the dry season, which forces people to drink contaminated water or to travel a far distance to collect clean water. This report is intended to provide a design the system as it was meant to be built. The water system design was completed based on the taps present, interviews with local community leaders, local surveying, and points taken with a GPS. The design is a gravity-fed branched water system, supplied by a natural spring on a hill adjacent to Boajibu. The system’s source is a natural spring on a hill above Boajibu, but the flow rate of the spring is unknown. There has to be enough flow from the spring over a 24-hour period to meet the demands of the users on a daily basis, or what is called providing continuous flow. If the spring has less than this amount of flow, the system must provide intermittent flow, flow that is restricted to a few hours a day. A minimum flow rate of 2.1 liters per second was found to be necessary to provide continuous flow to the users of Boajibu. If this flow is not met, intermittent flow can be provided to the users. In order to aid the construction of a distribution system in the absence of someone with formal engineering training, a table was created detailing water storage tank sizing based on possible source flow rates. A builder can interpolate using the source flow rate found to get the tank size from the table. However, any flow rate below 2.1 liters per second cannot be used in the table. In this case, the builder should size the tank such that it can take in the water that will be supplied overnight, as all the water will be drained during the day because the users will demand more than the spring can supply through the night. In the developing world, there is often a problem collecting enough money to fund large infrastructure projects, such as a water distribution system. Often there is only enough money to add only one or two loops to a water distribution system. It is helpful to know where these one or two loops can be most effectively placed in the system. Various possible loops were designated for the Boajibu water distribution system and the Adaptive Greedy Heuristic Loop Addition Selection Algorithm (AGHLASA) was used to rank the effectiveness of the possible loops to construct. Loop 1 which was furthest upstream was selected because it benefitted the most people for the least cost. While loops which were further downstream were found to be less effective because they would benefit fewer people. Further studies should be conducted on the water use habits of the people of Boajibu to more accurately predict the demands that will be placed on the system. Further population surveying should also be conducted to predict population change over time so that the appropriate capacity can be built into the system to accommodate future growth. The flow at the spring should be measured using a V-notch weir and the system adjusted accordingly. Future studies can be completed adjusting the loop ranking method so that two users who may be using the water system for different lengths of time are not counted the same and vulnerable users are weighted more heavily than more robust users.

Rick Henderson and Mike Pochin: A Right Result? Advocacy, justice and empowerment

As Henderson and Pochin point out in the introduction to their book, recent years have seen the concept of advocacy given increasing prominence in central and local government policy in the UK. It made an appearance in local community care and long-stay hospital closure plans. It features in reforms to the health service in England and Wales, in the form of the Patient Advocacy and Liaison Services (DoH 2000), while proposed changes to the mental health system also accord a key role to service users' advocates. In addition, Valuing People, central government's proposals on the future strategy for people with learning disabilities, promised the widespread development of advocacy services (DoH 2001). Advocacy, traditionally located on the margins of state activity in the UK, is experiencing something of an attempt to shift it into mainstream policy and service provision. This makes it a significant time to review the core values and practices that have distinguished advocacy from other forms of professional and voluntary intervention and to explore how these may be preserved and developed in the contemporary context.

Community Research as a Factor Building Inclusive Community in Lithuania

Social and political change in Europe, increasing labour mobility, development of the new European social policy and increasingly global nature of the social problems had a profound effect on the socio-cultural and socio-educational work in community and on its objectives. In order to keep these new communitarian standards of social policy, the first steps have to be made in fostering local community with the perspective it will reach the western European communitarian level. That is the reason why university in these changes started to turn more and more to the society and first of all has put a great emphasis on the community research. This initiative was induced by non-existence of civic tradition during the communist period, the gap in the development of civil society and its culture, the weakness and the poorness of the third sector. This paper is based on the analysis of the community and civil society research conducted during recent years by the researchers of Kaunas University of Technology, Faculty of Social Sciences. The paper involves a review of the research methodology, interpretation of the received data and summary of the results. It discusses both theoretical and empirical possibilities of building and developing inclusive community.

Water quality and health in a Sahelian semi-arid urban context: an integrated geographical approach in Nouakchott, Mauritania

Access to sufficient quantities of safe drinking water is a human right. Moreover, access to clean water is of public health relevance, particularly in semi-arid and Sahelian cities due to the risks of water contamination and transmission of water-borne diseases. We conducted a study in Nouakchott, the capital of Mauritania, to deepen the understanding of diarrhoeal incidence in space and time. We used an integrated geographical approach, combining socio-environmental, microbiological and epidemiological data from various sources, including spatially explicit surveys, laboratory analysis of water samples and reported diarrhoeal episodes. A geospatial technique was applied to determine the environmental and microbiological risk factors that govern diarrhoeal transmission. Statistical and cartographic analyses revealed concentration of unimproved sources of drinking water in the most densely populated areas of the city, coupled with a daily water allocation below the recommended standard of 20 l per person. Bacteriological analysis indicated that 93% of the non-piped water sources supplied at water points were contaminated with 10-80 coliform bacteria per 100 ml. Diarrhoea was the second most important disease reported at health centres, accounting for 12.8% of health care service consultations on average. Diarrhoeal episodes were concentrated in municipalities with the largest number of contaminated water sources. Environmental factors (e.g. lack of improved water sources) and bacteriological aspects (e.g. water contamination with coliform bacteria) are the main drivers explaining the spatio-temporal distribution of diarrhoea. We conclude that integrating environmental, microbiological and epidemiological variables with statistical regression models facilitates risk profiling of diarrhoeal diseases. Modes of water supply and water contamination were the main drivers of diarrhoea in this semi-arid urban context of Nouakchott, and hence require a strategy to improve water quality at the various levels of the supply chain.

The Swiss Schools have been Governed by Local Lay Authorities

After the introduction of the liberal-democratic constitutions in the Swiss cantons in the first half of the 1830ies the grid of existing schools has been systemized and broadly expanded. The school systems have ever since been characterized by one key element: a special local authority type called „Schulkommission“ or „Schulpflege“. They take the form of committees consisting of laymen that are appointed by democratic elections like all the other executive bodies on the different federal levels in Switzerland. When it comes to their obligations and activities these community level school committees conform very much to the school boards in the American and Canadian school systems. They are accountable for the selection and supervision of the teachers. They approve decisions about the school careers of pupils and about curricular matters like the choice of school books. Normally their members are elected by the local voters for four year terms of office (reelection remains possible) and with regard to pedagogics they normally are non-professionals. The board members are responsible for classes and teachers assigned to them and they have to go to see them periodically. These visitations and the board meetings each month together with the teachers enable the board members to attain a deep insight into what happens in their schools over the course of their term of office. But they are confronted as laymen with a professional teaching staff and with educational experts in the public administration. Nevertheless this form of executive power by non-professionals is constitutive for the state governance in the Swiss as well as in other national political environments. It corresponds to the principles of subsidiarity and militia and therefore allows for a strong accentuation of liberty and the right of self-determination, two axioms at the very base of democratic federalist ideology. This governance architecture with this strong accent on local anchorage features substantial advantages for the legitimacy and acceptability of political and administrative decisions. And this is relevant especially in the educational area because the rearing of the offspring is a project of hope and, besides, quite costly. In the public opinion such supervision bodies staffed by laymen seem to have certain credibility advances in comparison with the professional administration. They are given credit to be capable of impeding the waste of common financial resources and of warranting the protection and the fostering of the community’s children at once. Especially because of their non-professional character they are trusted to be reliably immune against organizational blindness and they seem to be able to defend the interests of the local community against the standardization and centralization aspirations originating from the administrational expertocracy. In the paper these common rationales will be underpinned by results of a comprehensive historical analysis of the Session protocols of three Bernese school commissions from 1835 to 2005.

Attitudes and Beliefs of Pig Farmers and Wild Boar Hunters Towards Reporting of African Swine Fever in Bulgaria, Germany and the Western Part of the Russian Federation

This study investigated the attitudes and beliefs of pig farmers and hunters in Germany, Bulgaria and the western part of the Russian Federation towards reporting suspected cases of African swine fever (ASF). Data were collected using a web-based questionnaire survey targeting pig farmers and hunters in these three study areas. Separate multivariable logistic regression models identified key variables associated with each of the three binary outcome variables whether or not farmers would immediately report suspected cases of ASF, whether or not hunters would submit samples from hunted wild boar for diagnostic testing and whether or not hunters would report wild boar carcasses. The results showed that farmers who would not immediately report suspected cases of ASF are more likely to believe that their reputation in the local community would be adversely affected if they were to report it, that they can control the outbreak themselves without the involvement of veterinary services and that laboratory confirmation would take too long. The modelling also indicated that hunters who did not usually submit samples of their harvested wild boar for ASF diagnosis, and hunters who did not report wild boar carcasses are more likely to justify their behaviour through a lack of awareness of the possibility of reporting. These findings emphasize the need to develop more effective communication strategies targeted at pig farmers and hunters about the disease, its epidemiology, consequences and control methods, to increase the likelihood of early reporting, especially in the Russian Federation where the virus circulates

Sex- and gender-related risk factor burden in patients with premature acute coronary syndrome

BACKGROUND Few contemporary data exist on traditional (TRF) and non-TRF (NTRF) burden in patients with premature acute coronary syndrome (ACS). METHODS Prevalence of TRFs and NTRFs were measured in 1015 young (55 years old or younger) ACS patients recruited from 26 centres in Canada, the United States, and Switzerland. Risk factors were compared across sex and family history categories, and against a sample of the general Canadian population based on the 2000-2001 Canadian Community Health Survey. The 10- and 30-year risks of cardiovascular disease (CVD) were estimated using Framingham Risk Scores. RESULTS Risk factors were more prevalent in premature ACS patients compared with the general population. Young women with a family history of coronary artery disease showed the greatest risk factor burden including TRFs of hypertension (67%), dyslipidemia (67%), obesity (53%), smoking (42%), and diabetes (33%), and NTRFs of anxiety (55%), low household income (44%), and depression (37%). The estimated median 10-year risk of CVD was 7% (interquartile range [IQR], 3%-9%) in women and 13% (IQR, 7%-17%) in men, whereas the 30-year risk of CVD was 36% (IQR, 22%-49%) in women and 44% (IQR, 31%-57%) in men. CONCLUSIONS Patients with premature ACS, especially women with a positive family history, are characterized by a very high risk factor burden that is poorly captured by 10-year risk estimates but better captured by 30-year estimates. Consideration of NTRFs and use of 30-year risk estimates might better estimate risk in young individuals and improve the prevention of premature ACS.

Amadir: Livelihood and Resource Management in an Eritrean Highland Community: A development baseline

This publication presents the results of a study conducted in 2003 in Amadir, a village in the Central Highlands of Eritrea. It gives an overview of the natural resource base, livelihoods, farm management, and institutions that are important to the local community. The report concludes with a chapter on options for development as discussed with the village community and local administration. This report supports Eritrea's efforts to promote rural development. It contains an extensive summary in Tigrinya, as well as a large-scale satellite image and a large-scale land use map of the study area. The appendix presents a summary of the methods used in the study.