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Showing papers in "Journal of Public Health Research in 2016"


Journal ArticleDOI
TL;DR: It is argued that climate change should be integrated into medical education for three reasons: first, to prepare students for clinical practice in a climate-changing world; secondly, to promote public health and eco-health literacy; and finally, to deepen existing learning and strengthen graduate attributes.
Abstract: Climate change threatens many of the gains in development and health over the last century. However, it could also be a catalyst for a necessary societal transformation to a sustainable and healthy future. Doctors have a crucial role in climate change mitigation and health system adaptation to prepare for emergent health threats and a carbon-constrained future. This paper argues that climate change should be integrated into medical education for three reasons: first, to prepare students for clinical practice in a climate-changing world; secondly, to promote public health and eco-health literacy; and finally, to deepen existing learning and strengthen graduate attributes. This paper builds on existing literature and the authors' experience to outline potential learning objectives, teaching methods and assessment tasks. In the wake of recent progress at the United Nations climate change conference, COP-21, it is hoped that this paper will assist universities to integrate teaching about climate change into medical education. Significance for public healthThere is a strong case for teaching about climate change in medical education. Anthropogenic climate change is accepted by scientists, governments and health authorities internationally. Given the dire implications for human health, climate change is of fundamental relevance to future doctors. Integrating climate change into medical education offers an opportunity for future doctors to develop skills and insights essential for clinical practice and a public health role in a climate-changing world. This echoes a broader call for improved public health literacy among medical graduates. This paper provides medical schools with a rationale and an outline for teaching on climate change.

117 citations


Journal ArticleDOI
TL;DR: Systematic analysis of published reports and regional comparisons suggest that an etiologic role of diabetes in MERS-CoV may exist distinctive from that in H1N1, and introduction of effective public health vaccination intervention strategies against severe acute respiratory infections should be developed.
Abstract: Over the past two decades a number of severe acute respiratory infection outbreaks such as the 2009 influenza A (H1N1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) have emerged and presented a considerable global public health threat. Epidemiologic evidence suggests that diabetic subjects are more susceptible to these conditions. However, the prevalence of diabetes in H1N1 and MERS-CoV has not been systematically described. The aim of this study is to conduct a systematic review and meta-analysis of published reports documenting the prevalence of diabetes in H1N1 and MERS-CoV and compare its frequency in the two viral conditions. Meta-analysis for the proportions of subjects with diabetes was carried out in 29 studies for H1N1 (n=92,948) and 9 for MERS-CoV (n=308). Average age of H1N1 patients (36.2±6.0 years) was significantly younger than that of subjects with MERS-CoV (54.3±7.4 years, P<0.05). Compared to MERS-CoV patients, subjects with H1N1 exhibited 3-fold lower frequency of cardiovascular diseases and 2- and 4-fold higher prevalence of obesity and immunosuppression, respectively. The overall prevalence of diabetes in H1N1 was 14.6% (95% CI: 12.3- 17.0%; P<0.001), a 3.6-fold lower than in MERS-CoV (54.4%; 95% CI: 29.4-79.5; P<0.001). The prevalence of diabetes among H1N1 cases from Asia and North America was ~two-fold higher than those from South America and Europe. The prevalence of diabetes in MERS-CoV cases is higher than in H1N1. Regional comparisons suggest that an etiologic role of diabetes in MERS-CoV may exist distinctive from that in H1N1.

75 citations


Journal ArticleDOI
TL;DR: The present study quantitatively examines the patient-related factors of medication non-adherence to antihypertensive drugs, distinguishing between the determinants of deliberate versus non-deliberate non-Adherence.
Abstract: Background : Medication non-adherence is a major public health issue, creating obstacles to effective treatment of hypertension. Examining the underlying factors of deliberate and non-deliberate non-adherence is crucial to address this problem. Thus, the goal of the present study is to assess the socio-demographic, clinical and psychological determinants of intentional and unintentional non-adherence. Design and methods: A cross-sectional survey was conducted between March, 2015 and April, 2016. The sample consisted of hypertension patients holding at least one medical prescription (N=109). Measurements assessed patients’ medication adherence, health literacy, empowerment, self-efficacy, medication beliefs, and patients’ acceptance of their doctor’s advice, socio-demographic and clinical characteristics. Results : Patients who occasionally engaged in either intentional or unintentional non-adherence reported to have lower adherence selfefficacy, higher medication concern beliefs, lower meaningfulness scores and were less likely to accept the doctor’s treatment recommendations. Patients who occasionally engaged in unintentional nonadherence were younger and had experienced more side effects compared to completely adherent patients. Adherence self-efficacy was a mediator of the effect of health literacy on patients’ medication adherence and acceptance of the doctor’s advice was a covariate. Conclusions : Regarding the research implications, health literacy and adherence self-efficacy should be assessed simultaneously when investigating the factors of non-adherence. Regarding the practical implications, adherence could be increased if physicians i) doublecheck whether their patients accept the treatment advice given and ii) if they address patients’ concerns about medications. These steps could be especially important for patients characterized with lower self-efficacy, as they are more likely to engage in occasional nonadherence.

50 citations


Journal ArticleDOI
TL;DR: The study proposed highlights how, despite the reported nutritional information is often clear and comprehensive, consumers do not necessarily take the healthiest choice, but decisionmaking process is also influenced by the ability to decode the label and its graphical representation.
Abstract: Chronic diseases related to unbalanced and unhealthy eating habits have definitely become one of the major issues of modern age, not only in western countries but also in those ones where rapid economic growth has increased global prosperity levels. In order to avoid medical systems to collapse under excessive costs, International and Public Organizations strongly support health policies that aim to make people shift towards wholesome dietary patterns, also encouraging the use of food-labels to choose healthier products. To evaluate the consumers' knowledge and perception about food-labels a brief questionnaire was developed and shared on Facebook between January-March 2016. Most of the participants were young adults with higher education. They declared to do their shopping at least once a week, reading the food-labels quite often. Despite owing limited knowledge in basic nutrition principles and food-labelling they were generally able to recognize healthier products looking over their nutritional fact tables. Anyway, on average, what they care the most about the products they purchase is the global quality level rather than the nutritional values. In order to induce the whole population to use food label as an effective self-protection tool, more efforts should be done to improve their knowledge on nutrition fundamentals and basics about food labelling, because that would make them able to take safer and more conscious choices as regards their own health.

38 citations


Journal ArticleDOI
TL;DR: Tests with different genetic end-points complement each other with regard to sensitivity toward environmental genotoxins and are useful in detecting low genotoxicity levels which are expected in drinking water samples and could help health officers and drinking water managers to reduce genotoxic hazards and distribute high quality drinking water.
Abstract: Many studies have shown the presence of numerous organic genotoxins and carcinogens in drinking water. These toxic substances derive not only from pollution, but also from the disinfection treatments, particularly when water is obtained from surface sources and then chlorinated. Most of the chlorinated compounds in drinking water are nonvolatile and are difficult to characterize. Thus, it has been proposed to study such complex mixtures using short-term genotoxicity tests predictive of carcinogenic activity. Mutagenicity of water before and after disinfection has mainly been studied by the Salmonella/microsome (Ames test); in vitro genotoxicity tests have also been performed in yeasts and mammalian cells; in situ monitoring of genotoxins has also been performed using complete organisms such as aquatic animals or plants (in vivo). The combination of bioassay data together with results of chemical analyses would give us a more firm basis for the assessment of human health risks related to the consumption of drinking water. Tests with different genetic end-points complement each other with regard to sensitivity toward environmental genotoxins and are useful in detecting low genotoxicity levels which are expected in drinking water samples.

22 citations


Journal ArticleDOI
TL;DR: New knowledge is contributed of how PAR can be used to ensure that participants engaged in the field are involved in the entire process; consequently, this will ensure that the changes are feasible and sustainable.
Abstract: Background : In neonatal intensive care units (NICUs) health care professionals typically give most of their attention to the infants and the mothers while many fathers feel uncertain and have an unmet need for support and guidance. This paper describes and discusses participatory action research (PAR) as a method to improve NICUs’ service for fathers. Our goal is to develop a father-friendly NICU where both the needs of fathers and mothers are met using an approach based on PAR that involves fathers, mothers, interdisciplinary healthcare professionals, and managers. Design and methods: This PAR process was carried out from August 2011 to July 2013 and included participant observations, semi-structured interviews, multi sequential interviews, workshops, focus groups, group discussion, and a seminar. The theoretical framework of validity described by Herr and Anderson’s three criteria; process-, democratic-, and catalytic validity were used to discuss this PAR. Results : Twelve fathers, 11 mothers, 48 health professionals and managers participated in the PAR process. The collaboration ensured the engagement for viable and constructive local changes to be used in designing the concept of the father friendly NICU. Conclusions : This paper contributed new knowledge of how PAR can be used to ensure that participants engaged in the field are involved in the entire process; consequently, this will ensure that the changes are feasible and sustainable.

20 citations


Journal ArticleDOI
TL;DR: This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings, and has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training.
Abstract: Background. Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity – defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire – of the streamed simulations. Design and Methods. In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. Results. Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST. Conclusions. Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals’ learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training.

16 citations


Journal ArticleDOI
TL;DR: The author’s perspective on the leadership skills required for public health is presented and a five-day intensive course designed to enable participants to develop these skills over time is described, aimed at the practice of public health leadership.
Abstract: As public health practitioners and as clinicians we are taught to care for our patients, and for our community members. But how much do we teach and learn about how to lead, manage and care for our colleagues, our team members and ourselves? This paper emphasizes the need for leadership learning and teaching to become an essential element of the practice of public health. The paper presents the author's perspective on the leadership skills required for public health and describes a five-day intensive course designed to enable participants to develop these skills over time. The paper briefly covers leadership definitions, styles and types and key leadership skills. It mainly focuses on the design and ethos of the course, skills self-assessment, group interaction and methods for developing and refining leadership skills. The course uses a collaborative learning approach where the power differential between teachers, facilitators, guests and participants is minimized. It is based on creating an environment where any participant can reveal his or her stories, successes, failures, preferences and dislikes in a safe manner. It encourages continual, constructive individual reflection, self-assessment and group interaction. The course is aimed at the practice of public health leadership, with a particular emphasis on the leadership of self, of knowing oneself, and of knowing and understanding colleagues retrospectively as well as prospectively. The most important outcome is the design and implementation of participants' own plans for developing and nurturing their leadership skills. Significance for public healthThe nature of public health is changing rapidly and increasing in complexity. These changes include major shifts in the burden of disease and the insatiable demands of clinical medicine swamping those of public health. Public health practitioners have failed over many years to systematically ensure that leadership and management skills are essential parts of public health training (as they are in MBAs for example). This paper describes an approach and an intensive five-day course to assist practitioners to develop the key leadership skills needed to improve public health, whether it be locally, nationally or globally.

15 citations


Journal ArticleDOI
TL;DR: How the search conference can be used as a method for planning health promotion actions in local communities is described and discussed, showing how central elements in the planning of health promotionactions, as participation and involvements as well as evidence was a fundamental thinking in how the conference were accomplished.
Abstract: Aims: The aim of this article is to describe and discuss how the search conference can be used as a method for planning health promotion actions in local communities. Design and methods: The article draws on experiences with using the method for an innovative project in health promotion in three Norwegian municipalities. The method is described both in general and how it was specifically adopted for the project. Results and conclusions: The search conference as a method was used to develop evidence-based health promotion action plans. With its use of both bottom-up and top-down approaches, this method is a relevant strategy for involving a community in the planning stages of health promotion actions in line with political expectations of participation, ownership, and evidence-based initiatives.

13 citations


Journal ArticleDOI
TL;DR: The aim of the Ageing, Chronic Disease and Injury study is to compile data from various sources to better describe the patterns of chronic disease and injury across western Victoria to establish a profiling model that can be replicated in other geographical regions, and will be particularly useful in non-metropolitan settings.
Abstract: Background: An increasing burden of chronic disease and associated health service delivery is expected due to the ageing Australian population. Injuries also affect health and wellbeing and have a long-term impact on health service utilisation. There is a lack of comprehensive data on disease and injury in rural and regional areas of Australia. The aim of the Ageing, Chronic Disease and Injury study is to compile data from various sources to better describe the patterns of chronic disease and injury across western Victoria. Design: Ecological study. Methods: Information on demographics, socioeconomic indicators and lifestyle factors are obtained from health surveys and government departments. Data concerning chronic diseases and injuries will be sourced from various registers, health and emergency services, local community health centres and administrative databases and compiled to generate profiles for the study region and for sub-populations within the region. Expected impact for public health: This information is vital to establish current and projected population needs to inform policy and improve targeted health services delivery, care transition needs and infrastructure development. This study provides a model that can be replicated in other geographical settings.

12 citations


Journal ArticleDOI
TL;DR: There were considerable cultural, linguistic, and resourcing barriers hindering the participation of older Italian-Australians in medical research, and in this study setting there were few enabling strategies in place to address these barriers despite the national ethics guidelines for equitable participation in research.
Abstract: Background . Low-participation of culturally and linguistically diverse (CALD) patients in medical research remains a problem in migrant and refugee destination countries such as Australia. The aims of this study were to explore i) CALD persons’ perceptions and experiences of the medical system and medical research, in this case, older Italian Australians; and ii) the views of research professionals on CALD patient participation in medical research. Design and Methods. A qualitative study was conducted in Melbourne, Australia, in 2015 utilising in-depth interviews and focus groups with four stakeholder groups: older Italian Australians (n=21); adult children of older Italian Australians (n=10); hospital Human Research Ethics Committee administrators (n=4); and clinical researchers (n=4). The data were analysed for content and thematic analysis. Results . Themes for the CALD and family group were getting by in medical interactions; receptivity to medical research: testing the waters; and, receptivity to technology for support: passive versus active. Themes for the researcher and HREC groups about CALD patient participation in research were: exclusion; cultural factors; and e-consent. Conclusions . Our findings from four stakeholder perspectives and experiences confirm that there were considerable cultural, linguistic, and resourcing barriers hindering the participation of older Italian-Australians in medical research. Furthermore, our findings showed that in this study setting there were few enabling strategies in place to address these barriers despite the national ethics guidelines for equitable participation in research. The findings informed the creation of a multimedia tool whose purpose is to address and improve representation of CALD groups in clinical research.

Journal ArticleDOI
TL;DR: A reliable estimation of the phenomenon in all the main healthcare settings is a necessary prerequisite to set tailored policies for facing polypharmacy within a RHS; the results showed the necessity to put a special attention on LTCFs.
Abstract: Background . Polypharmacy is a main issue of patient safety in all healthcare settings ( i.e. increase adverse drug reactions and incidence of drug-drug interactions, etc.). The main object of the study was to evaluate the prevalence of polypharmacy and the appropriateness of drugs prescriptions in the regional health system (RHS) of Friuli Venezia-Giulia Region, Italy. Design and methods . We carried out a point prevalence study in May 2014; 1582 patients ≥65 years were included from: 14 acute hospitals, 46 Long Term Care Facilities (LTCFs) and 42 general practitioners’ (GPs) clinics. Data analysis included the evaluation of potentially inappropriate prescriptions (PIPs) taking Beers criteria as a reference. Results . Patients in therapy with 10 drugs or more were 13.5%: 15.2% in hospitals, 9.7% in GPs’ clinics and 15.6% in LTCFs. According to Beers criteria we identified 1152 PIPs that involved globally almost half of patients (46.0%): 41.9% in hospitals, 59.6% in LTCFs and 37.0% in GP’s clinics. The 53.9% of patients received at least one mainly kidney excreted drug; for these patients the evaluation of serum creatinine was overall present in the 87.7% (747/852): 96.4% in hospital ones, 87.5% in GPs’ clinics and 77.8% in LTCFs. LTCFs residents were significantly (P<0.05) more exposed to PIPs and less monitored for the renal function. Conclusions . A reliable estimation of the phenomenon in all the main healthcare settings is a necessary prerequisite to set tailored policies for facing polypharmacy within a RHS; the results showed the necessity to put a special attention on LTCFs.

Journal ArticleDOI
TL;DR: Dual perspectives of stigma are evaluated, that is, reports of stigma experienced by families affected by a heritable neglected tropical disease with reports of enacted stigma among neighbouring families unaffected by the disease, and it is found that unaffected neighbours reported enacting less stigma than affected respondents reported experiencing.
Abstract: Background: Disease-related stigma is a public health concern steadily gaining global attention. Evidence consistently shows that an individual’s attribution of disease cause can prompt or justify interpersonal stigma. However, few studies have explored causal beliefs about inherited disease and their influence on stigmatising behaviours in low and middle income countries. Design and methods: The study was conducted in 2013, in six communities in Wolaita zone, Southern Ethiopia. A total of 1800 respondents took part in the study, 600 were affected by an inherited disease and 1200 were unaffected neighbours. Two versions of the interviewer- administered survey were created, with measures assessed in parallel on experienced stigma for the affected and enacted stigma for unaffected respondents. Results: Mean levels of enacted stigma reported by unaffected respondents were slightly lower (2.0, SD=0.7) than experienced stigma reported by affected respondents [2.2 (standard deviation=1.1)]. Beliefs that podoconiosis was hereditary were significantly and positively associated with levels of enacted stigma reported by unaffected respondents and experienced stigma reported by affected respondents (PConclusions: If stigma reduction interventions are to be successful, culturally tailored, gender inclusive and innovative health education programs are required, directed at the general community as well as individuals affected by inherited diseases

Journal ArticleDOI
TL;DR: It is found that differences between student and non-student groups can be largely accounted for by smoking status, however, students may be more vulnerable to electronic cigarette use due to higher related-information exposure and the integration of vaping into hookah culture.
Abstract: We examine differences between college students and non-students with respect to orientation toward e-cigarettes. Participants were U.S. adults 18-24 (465 students, 409 non-students). Data collection employed an online survey by GfK Custom Research. Smoking, vaping, and use of alternate tobacco were assessed, as were variables from the Theory of Reasoned Action and Diffusion of Innovations. This study showed that smoking status largely explains use and orientation toward electronic cigarettes among both students and non-students, with differences attributable to higher smoking rates among non-students. Results also showed that among student smokers there was a greater level of information exposure concerning electronic cigarettes, and more prevalence in the use of alternate tobacco. Hookah use in that group was significantly greater than for non-student smokers. Together these findings suggest that students may be more vulnerable to electronic cigarette use due to higher related information exposure and the integration of vaping into hookah culture.

Journal ArticleDOI
TL;DR: Platform technologies represent an emerging large-scale, highly integrated informatics approach to public health, combining the technologies of Internet, the web, the cloud, social technologies, remote sensing and/or mobile apps into an online infrastructure that can allow more synergies in work within and across these systems.
Abstract: Health informatics has a major role to play in optimising the management and use of data, information and knowledge in health systems. As health systems undergo digital transformation, it is important to consider informatics approaches not only to curriculum content but also to the design of learning environments and learning activities for health professional learning and development. An example of such an informatics approach is the use of large-scale, integrated public health platforms on the Internet as part of health professional learning and development. This article describes selected examples of such platforms, with a focus on how they may influence the direction of health professional learning and development. Significance for public healthThe landscape of healthcare systems, public health systems, health research systems and professional education systems is fragmented, with many gaps and silos. More sophistication in the management of health data, information, and knowledge, based on public health informatics expertise, is needed to tackle key issues of prevention, promotion and policy-making. Platform technologies represent an emerging large-scale, highly integrated informatics approach to public health, combining the technologies of Internet, the web, the cloud, social technologies, remote sensing and/or mobile apps into an online infrastructure that can allow more synergies in work within and across these systems. Health professional curricula need updating so that the health workforce has a deep and critical understanding of the way that platform technologies are becoming the foundation of the health sector.

Journal ArticleDOI
TL;DR: A case study of an Indigenous dental clinical outplacement for dental students in Australia reports how an educational institution can successfully engage with an Indigenous oral health service to provide learning experiences to the students as well as deliver much needed services to the community.
Abstract: Background . Indigenous people worldwide suffer from poor oral health as compared to non-Indigenous citizens. One of the approaches to bring about improvement in Indigenous oral health is to enhance the service provision by implementing oral health outplacement programmes. A case study of such a programme for dental students in Australia reports how an educational institution can successfully engage with an Indigenous oral health service to provide learning experiences to the students as well as deliver much needed services to the community. Design and Methods. The assessment of this ongoing outplacement programme over the period of 2008-14, based on students’ feedback, highlights some of the key beneficial outcomes. Students agreed that the Indigenous outplacement programme improved their understanding of Indigenous issues (mean ± SD: 4.10±0.8; 5 refers to strongly agree on 5-point scale) and increased the possibility that they will practise in Indigenous health (3.66±1.0). They were pleased with the assistance received by clinical supervisors and clinic staff at the Indigenous dental clinic (4.28±0.8). Conclusions . This programme has demonstrated that structured student outplacements are valuable in building relations across cultures especially with Indigenous communities. It has also shown that university engagement with the public health sector can be beneficial to both institutions.

Journal ArticleDOI
TL;DR: Key learnings are presented from a combination of evaluation data from six population health short courses using a transformative learning framework from a 2010 independent international commission for health professionals that was designed to support the goals of transformative and interdependent health professionals.
Abstract: Background. With the recognition that professional education has not kept pace with the challenges facing the health and human service system, there has been a move to transformative education and learning professional development designed to expand the number of enlightened and empowered change agents with the competence to implement changes at an individual, organisation and systems level. Design and Methods. Since 2010, the Department of Health and Human Services in Victoria, Australia, in collaboration with The University of Melbourne’s School of Population and Global Health, has delivered seven population health short courses aimed to catalyse participants’ transformation into population health change agents. This paper presents key learnings from a combination of evaluation data from six population health short courses using a transformative learning framework from a 2010 independent international commission for health professionals that was designed to support the goals of transformative and interdependent health professionals. Participatory realist evaluation approaches and qualitative methods were used. Results. Evaluation findings reveal that there were mixed outcomes in facilitating participants’ implementation of population health approaches, and their transformation into population health agents upon their return to their workplaces. Core enablers, barriers and requirements, at individual, organisational and system levels influence the capability of participants to implement population health approaches. The iterative and systemic evolution of the population health short courses, from a one off event to a program of inter-dependent modules, demonstrates sustained commitment by the short course developers and organisers to the promotion of transformative population health learning outcomes. Conclusions: To leverage this commitment, recognising that professional development is not an event but part of an ongoing transformative process, suggestions to further align recognition of population health professional development programs are presented.

Journal ArticleDOI
TL;DR: The burden of fire-related injuries in terms of payment transfers and lost productivity due to periods of disability as indirect costs is high; in a population of 5.4 million, the annual loss exceeded EUR 5.7 million, which could be used in planning preventive measures and therefore yield savings.
Abstract: Background : The aim of this study was to assess the economic burden of fire-related injury from two perspectives: post-injury social security compensations and also productivity losses due to the lost productive time from a societal perspective induced by the injury. Design and methods : A cohort of 1503 inpatients who sustained firerelated injury during the period 2001–2005 was retrospectively followed up for 5-10 years until the end of 2010, using linkages between several administrative registers. The study process was started in 2015 and finalized on March 2016. Results : Annual productivity loss was on average EUR 5.72 million, giving a total for the five-year study period of EUR 28.6 million, with a mean value of EUR 19,070 per person. Mean/median disability time for those who received benefits was 572/63 days, ranging from 3 days to 36.5 years. Total average cost of benefits to the injured annually during the study period was EUR 1.03 million. This equates to EUR 3430 per patient for the whole cohort or EUR 14,860 for those who received benefits. Conclusions : The burden of fire-related injuries in terms of payment transfers and lost productivity due to periods of disability as indirect costs is high; in a population of 5.4 million, the annual loss exceeded EUR 5.7 million. The results could be used in planning preventive measures and therefore yield savings

Journal ArticleDOI
TL;DR: The GLP model proposes a project around the fundamental concept of engagement and sharing between students and academics across universities and cultural contexts to build capacity through education, while capitalising on strengths of existing global health placements.
Abstract: Objective . To design and implement an international and interprofessional Global Learning Partnership Model, which involves shared learning between academics and students from Universitas 21 network with other universities with United Nations Millennium Development Goal needs. Design . Two literature reviews were conducted to inform ethical aspects and curriculum design of the GLP model. Feedback from conference presentations and consultation with experts in education and public health has been incorporated to inform the current iteration of the GLP model. Intervention . The pilot group of 25 students from U21 universities and Kathmandu University, representing six health disciplines will meet in Nepal in April 2016 for a shared learning experience, including a one week university based workshop and three week community based experience. Outcome measures. A multi-phase, mixed method design was selected for the evaluation of the GLP model, utilising a combination of focus groups and questionnaires to evaluate the efficacy of the placement through student experience and learning outcomes in cultural competency, UN SDG knowledge, community engagement and health promotion skills. Results . The literature review demonstrated that cultural awareness and cultural knowledge were improved through participation in cultural immersion programs that incorporated preparatory workshops and clinical experiences. Data will be gathered in April 2006 and the results of the evaluation will be published in the future. Conclusions . The GLP model proposes a project around the fundamental concept of engagement and sharing between students and academics across universities and cultural contexts to build capacity through education, while capitalising on strengths of existing global health placements. Further the inclusion of host-country students and academics in this learning exchange will promote the establishment of an international and interprofessional network for ongoing health promotion.

Journal ArticleDOI
TL;DR: The health economic cost of death review system in Bangladesh is described for future public health research in low income countries to give an idea on how much cost will be required to run aDeath review system for a low income country settings using government health system.
Abstract: Introduction: Maternal and neonatal death review (MNDR) introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and s ...

Journal ArticleDOI
TL;DR: The Kenyan Village Medical Education Program is a student-led global health initiative that seeks to improve health outcomes in rural Kenya through culturally appropriate health education and represents an avenue through which global health leadership can be fostered amongst student volunteers.
Abstract: The Kenyan Village Medical Education Program is a student-led global health initiative that seeks to improve health outcomes in rural Kenya through culturally appropriate health education. The month-long program, which is organised by the Melbourne University Health Initiative (Australia), is conducted each January in southern rural Kenya. Significance for public healthThe Kenyan Village Medical Education (KVME) Program is a student-led global health initiative that involves exploring well-established strategies for the prevention of disease through workshops that are conducted in southern rural Kenya. These workshops are tailored to the unique needs and circumstances of rural Kenyan communities, and are delivered to community leaders, as well as to adults and children within the wider community. Aside from the KVME Program's emphasis on reducing the burden of preventable disease through health education, the positive impact of the KVME Program on the Program's student volunteers also deserves consideration. Throughout the month-long KVME Program, student volunteers are presented with opportunities to develop their understanding of cultural competency, the social and economic determinants of health, as well as the unique challenges associated with working in resource-poor communities. Importantly, the KVME Program also represents an avenue through which global health leadership can be fostered amongst student volunteers.

Journal ArticleDOI
TL;DR: An innovative approach to integrating the IPH competencies in core MPH subjects was developed and five online modules that corresponded with the learning outcomes of the core public health subjects were developed, implemented and evaluated in 2015.
Abstract: The Master of Public Health (MPH) is an internationally recognised post-graduate qualification for building the public health workforce. In Australia, MPH graduate attributes include six Indigenous public health (IPH) competencies. The University of Melbourne MPH program includes five core subjects and ten specialisation streams, of which one is Indigenous health. Unless students complete this specialisation or electives in Indigenous health, it is possible for students to graduate without attaining the IPH competencies. To address this issue in a crowded and competitive curriculum an innovative approach to integrating the IPH competencies in core MPH subjects was developed. Five online modules that corresponded with the learning outcomes of the core public health subjects were developed, implemented and evaluated in 2015. This brief report outlines the conceptualisation, development, and description of the curriculum content; it also provides preliminary student evaluation and staff feedback on the integration project. Significance for public healthThis approach to a comprehensive, online, integrated Indigenous public health (IPH) curriculum is significant, as it ensures that all University of Melbourne Master of Public Health (MPH) graduates will have the competencies to positively contribute to Indigenous health status. A workforce that is attuned not only to the challenges of IPH, but also to the principles of self-determination, Indigenous agency and collaboration is better equipped to be comprised of ethical and judgment-safe practitioners. Additionally, the outlined approach of utilizing IPH content and examples into core MPH subjects ensures both the Australian relevance for an Australian-based health professional course and international appeal through the modules inclusion of International Indigenous case-studies and content. Furthermore, approaches learned in a challenging Indigenous Australian context are transferable and applicable to other IPH challenges in a local, national and global context.

Journal ArticleDOI
TL;DR: It is concluded that the subjects not receiving NHS assitance have, at least in part, different health patterns and requirements, which should be considered when planning tailored interventions.
Abstract: We analysed drug dispensation by charitable organisations in a year time. Drugs were grouped according to the Anatomic Therapeutic Chemical classification and the amount dispensed was calculated with the system of the Daily Defined Dose (DDD) and expressed as DDD/1000 subjects/day. A number of 87,550 subjects were studied (13,308 Italians; 74,242 Immigrants). Though we noticed a great sesonal variability, the drugs most frequently dispensed were those for the respiratory, cardiovascular and gastrointestinal system and antibiotics, which is different from the rest of the Italian population and the immigrant population assisted by our National Health Service (NHS). We also found that chronic diseases are increasing in these subjects. We conclude that the subjects not receiving NHS assitance have, at least in part, different health patterns and requirements. This should be considered when planning tailored interventions.

Journal ArticleDOI
TL;DR: In Italy some vaccinations are mandatory and some others are recommended, but always more frequently there are parents who, when asked their children participate to the vaccination campaign, answer with: Sorry, I have decided not to vaccinate my child, the authors have the right to choose.
Abstract: As is known, in Italy some vaccinations are mandatory and some others are recommended. But always more frequently there are parents who, when asked their children participate to the vaccination campaign, answer with: Sorry, we have decided not to vaccinate our child, we have the right to choose.

Journal ArticleDOI
TL;DR: Pattern of inequity in health status, health care provision, and health risks are demonstrable in Ecuadorian maternal deaths, but at levels below of those three decades ago.
Abstract: Background : Maternal mortality ratio in Ecuador is the only millennium goal on which national agencies are still making strong efforts to reach 2015 target. The purpose of the study was to process national maternal death databases to identify a specific association pattern of variable included in the death certificate. Design and methods: The study processed mortality databases published yearly by the National Census and Statistics Institute (INEC). Data analysed were exclusively maternal deaths. Data corresponds to the 2003-2013 period, accessible through INEC’s website. Comparisons are based on number of deaths and use an ecological approach for geographical coincidences. Results : The study identified variable association into the maternal mortality national databases showing that to die at home or in a different place than a hospital is closely related to women’s socioeconomic characteristics; there was an association with the absence of a public health facility. Also, to die in a different place than the usual residence could mean that women and families are searching for or were referred to a higher level of attention when they face complications. Conclusions : Ecuadorian maternal deaths showed Patterns of inequity in health status, health care provision and health risks . A predominant factor seems unclear to explain the variable association found processing national databases; perhaps every pattern of health systems development played a role in maternal mortality or factors different from those registered by the statistics system may remain hidden. Some random influences might not be even considered in an explanatory model yet.

Journal ArticleDOI
TL;DR: Health professional education and training should provide understandings of environmental and social determinants of health and disease still contributing to systemic health inequalities; it should help health professionals appreciate the health and wellbeing needs of indigenous peoples and the social and historical contexts of these health needs.
Abstract: Health professional education curricula are notoriously contested and constrained. Diverse epistemological and pedagogical objectives compete for space amid complex schedules of clinical placements, rotations, laboratory work, lectures, and other core curriculum activities. Health professional educators must navigate these constraints as well as address course accreditation standards and the expectations and needs of their communities. Accreditation standards for health professional courses are designed to ensure that graduates are competent to practise safely and effectively; they are also designed to ensure graduates can address health issues in the broader community and populations. Health professional education and training should therefore provide understandings of environmental and social determinants of health and disease still contributing to systemic health inequalities; it should help health professionals appreciate the health and wellbeing needs of indigenous peoples and the social and historical contexts of these health needs. [...]


Journal Article
TL;DR: In this article, a representative random sample of Medicaid-eligible seniors was selected proportionately by geographic density (i.e., zip code) in Miami-Dade and Broward Counties.
Abstract: Background: Falls among the elderly are expensive and debilitating. Falls among elders are now the leading cause of injury ED visits, the leading cause of injury hospitalizations, a leading cause of hospitalization readmissions, the leading cause of hospitalizations from nursing homes, and a major cause of nursing home admissions. But, they are preventable. Design and Methods:A representative random sample of Medicaid-eligible seniors was selected proportionately by geographic density (i.e., zip code) in Miami-Dade and Broward Counties. Subjects participated in informational workshops; non-invasive somatic fall risk factor analysis; HIPPA-compliant sharing of risk reports with their physicians; in-home environmental fall risk analysis; pre- and post-fall counseling; periodic telephone calls to the elders’ support network (including physicians) and periodic safetygrams for an average of 28 months. Using 1.3 billion claims from the Florida Medicaid Data Warehouse, the participant groups were compared with several control groups on 1.) hospitalizations for injurious falls; 2.) nursing home stays for fall-caused injuries and 3.) Medicaid savings as a proportion of program costs. The study was carried out in 2015. Results: The treatment groups had statistically significantly lower healthcare utilization due to injurious falls than did various control groups: hospitalizations were lower; nursing home stays were lower; independent audits showed a savings of $2.40 for every $1.00 invested. Conclusions: Multi-disciplinary, socio-medical fall prevention programs for community-resident elders can significantly reduce healthcare utilization due to injurious falls among dual eligible elders.