Health target programmes and health care services--any link?: a conceptual and comparative study (part 1)

Against the background of the separation between health policy being concerned mainly with cost-containment on the one hand and the commitment to 'Health for all' based on health target programmes on the other, we undertook a conceptual and comparative study of the policy documents of national and regional health target programmes in countries of the European Union, Australia, Canada, New Zealand and the USA to analyse (1) whether they define objectives for health care; and (2) whether they have a clear orientation towards health outcomes. With the exception of Australia, health target programmes focus on intervention areas outside health services which explains why they remain in the 'forgotten corner' of health policy. Therefore, there is a need to develop an integrated approach, combining health targets for all possible intervention areas including health services, to fully utilise the potential of health target programmes.     

Heterologous priming–boosting with DNA and vaccinia virus expressing kinetoplastid membrane protein-11 induces potent cellular immune response and confers protection against infection with antimony resistant and sensitive strains of Leishmania (Leishmania) donovani

Background

Emergence of resistance against commonly available drugs poses a major threat in the treatment of visceral leishmaniasis (VL), particularly in the Indian subcontinent. Absence of any licensed vaccine against VL emphasizes the urgent need to develop an effective alternative vaccination strategy.

Methodology

We developed a novel heterologous prime boost immunization strategy using kinetoplastid membrane protein-11 (KMP-11) DNA priming followed by boosting with recombinant vaccinia virus (rVV) expressing the same antigen. The efficacy of this vaccination regimen in a murine and hamster model of visceral leishmaniasis caused by both antimony resistant (Sb-R) and sensitive (Sb-S) Leishmania (L.) donovani is examined.

Result

Heterologous prime-boost (KMP-11 DNA/rVV) vaccination was able to protect mice and hamsters from experimental VL induced by both Sb-S and Sb-R-L. (L.) donovani isolates. Parasite burden is kept significantly low in the vaccinated groups even after 60 days post-infection in hamsters, which are extremely susceptible to VL. Protection in mice is correlated with strong cellular and humoral immune responses. Generation of polyfunctional CD8⁺ T cell was observed in vaccinated groups, which is one of the most important prerequisite for successful vaccination against VL. Protection was accompanied with generation of antigen specific CD4⁺ and CD8⁺ cells that produced effector cytokines such as IFN-γ, IL-2 and TNF-α. KMP-11-DNA/rVV vaccination also developed strong cytotoxic response and reversed T-cell impairment to induce antigen specific T cell proliferation.

Conclusion

KMP-11 is a unique antigen with high epitope density. Heterologous prime boost vaccination activates CD4⁺ and CD8⁺ T-cell mediated immunity to confer resistance to VL. This immunization method also produces high quality T-cells secreting multiple effector cytokines thus enhancing durability of the immune response. Thus the vaccination regime as described in the present study could provide a potent strategy for future anti-leishmanial vaccine development.     

The relationship between malignant mesothelioma and an asbestos cement plant environmental risk: a spatial case–control study in the city of Bari (Italy)

Objectives  To estimate the mesothelioma risk and environmental asbestos exposure (EAE) due to an asbestos-cement plant. Methods  A spatial case–control study including 48 malignant mesothelioma (MM) cases occurred in the period 1993–2003 selected from the regional mesothelioma register (RMR) and 273 controls. The disease risk was estimated by means of a logistic-regression model, in which the probability of disease-occurrence is expressed as a function of the classes of distances. A non-parametric method was applied to estimate the full relative risk surface. Results  Significant MM odds ratio of 5.29 (95 CI: 1.18–23.74) was found for people living within a range up to 500 m centered on the plant. The non-parametric estimation of relative risk surface unveiled a marked peak near the plant not paralleled by the spatial distribution of controls. Conclusion  Evidence of an association between mesothelioma risk and EAE is highlighted. The role played by the RMR in increasing the public health local authorities awareness is stressed.     

Site-specific effects of 17β-estradiol in hornyhead turbot (Pleuronichthys verticalis) collected from a wastewater outfall and reference location

Studies throughout the southern California bight have indicated persistent estrogenic activity in male hornyhead turbot (Pleuronichthys verticalis). Plasma 17β-estradiol (E2) concentrations correlated with gonadal DNA damage in fish collected near a wastewater treatment plant outfall, but not from fish collected at the reference location. When the same species was collected from the same reference location and treated with E2, no relationship between uptake and gonadal DNA damage was observed. To evaluate the site-specific effects of E2 in fish from a wastewater outfall and fish from a reference location, male hornyhead turbot from each location were exposed to 15 μg/L aqueous E2 in a time-course experiment, with fish sampled every 12 h for 48 h. Concentrations of E2 were measured in the aqueous exposure and in plasma from the fish. Vitellogenin (vtg) was also measured in the plasma, and 8-oxo-7,8-dihydro-2′-deoxyguanosine levels in male gonads were measured as an indicator of DNA damage. Untreated fish from the outfall had significantly lower E2 in the plasma relative to the untreated reference fish, and this trend was consistent at each time point in the E2-treated fish. Vtg was significantly induced after 36 h of exposure in fish from both sites and no significant differences were observed between the sites. A significant increase of oxidative DNA damage was observed in E2-treated fish from the outfall population and the damage was significantly correlated with plasma E2 concentrations only in fish from the outfall after 48 h. These results indicated that there were significant differences in E2 disposition and gonadal genotoxicity between the hornyhead turbot populations following exposure to E2, suggesting that fish at wastewater outfalls may be more sensitive to DNA damage, which may be temporally related to concentrations of E2 in plasma.     

What is 'normal' about women's (hetero)sexual desire and orgasm?: a report of an in-depth interview study

This paper challenges the rapidly re-emerging medicalised model of women's sexual problems, or female sexual dysfunction, particularly those concerned with problems of orgasm. It reports a qualitative in-depth interview study of 33 women between the ages of 19 and 60 years (mean age 28.6 years) where the data analysis particularly focused upon their subjective perceptions of what constituted 'normal' sexual satisfaction for themselves and other women. The data comprised taped interviews which were fully transcribed and analysed using an interpretive framework based on both symbolic interactionist and psychodynamic concepts. The results indicated that these women's desires and expectations differed appreciably from those reported in the typical clinical and sexological literature. Women interviewed here seemed less concerned with achieving orgasm through heterosexual intercourse for themselves than the literature suggested they might be. There was however, evidence of a strong desire to experience orgasm in this way for the sake of their male partners. Thus, it is suggested that there is probably a closer relationship between popular beliefs about what is 'normal' based upon the medical model with women placing themselves in a dysfunctional category, than there is between the everyday enjoyment of sex and women identifying themselves as being sexually healthy.     

Responsiveness of the EQ-5D and 8-item Parkinson’s Disease Questionnaire (PDQ-8) in a 4-year follow-up study

Objective  

The purpose of this study was to evaluate the responsiveness of the EQ-5D and the Parkinson’s Disease Questionnaire (PDQ-8) to deterioration in health-related quality of life (HRQoL) in patients with Parkinson’s disease (PD).     

Emerging social media ‘platform’ approaches to alcohol marketing: a comparative analysis of the activity of the top 20 Australian alcohol brands on Facebook (2012-2014)

Social media platforms are important actors in the development of alcohol marketing techniques. While public health research has documented the activities of brands and consumers related to alcohol promotion and consumption on social media, there remains the need to develop an account of the native, participatory and data-driven advertising model of these platforms. This article examines the relationship between alcohol brands, media platforms and their users by analysing the activity of the 20 most popular alcohol brands’ Australian Facebook pages in 2012 and 2014. We report that the number of fans of alcohol brands increased by 52% from 2012 to 2014. While the number of posts dropped 12% from 2012 and 2014, total interactions with posts by users increased by 9%. Overall, brand activity and engagement became more consistent between 2012 and 2014. We argue that the changing character of user engagement with alcohol brands on Facebook can be related to changes in the platform architecture. Facebook is orchestrating a shift from exposure to engagement as its key advertising metric, and thus departing substantially from established mass media advertising paradigms. Effective policy responses to alcohol marketing in the digital era depend on a more rigorous examination of the marketing infrastructure of social media platforms.     

Winter activity of questing ticks (Ixodes ricinus and Dermacentor reticulatus) in Germany − Evidence from quasi-natural tick plots,field studies and a tick submission study

Changing climatic conditions and other anthropogenic influences have altered tick distribution, abundance and seasonal activity over the last decades. In Germany, the two most important tick species are Ixodes ricinus and Dermacentor reticulatus, the latter of which has expanded its range across the country during the past three decades. While I. ricinus was rarely found during the colder months in the past, D. reticulatus is known to be active at lower temperatures. To quantify tick appearance during winter, specimens were monitored in quasi-natural tick plots three times a week. Additionally, the questing activities of these two tick species were observed throughout the year at nine field collection sites that were regularly sampled by the flagging method from April 2020 to April 2022. Furthermore, tick winter activity in terms of host infestation was analysed as part of a nationwide submission study from March 2020 to October 2021, in which veterinarians sent in ticks mainly collected from dogs and cats. All three study approaches showed a year-round activity of I. ricinus and D. reticulatus in Germany. During the winter months (December to February), on average 1.1% of the inserted I. ricinus specimens were observed at the tops of rods in the tick plots. The average questing activity of I. ricinus amounted to 2 ticks/100 m² (range: 1-17) in the flagging study, and 32.4% (211/651) of ticks found infesting dogs and cats during winter 2020/21 were I. ricinus. On average 14.7-20.0% of the inserted D. reticulatus specimens were observed at the tops of rods in the tick plots, while the average winter questing activity in the field study amounted to 23 specimens/100 m² (range: 0-62), and 49.8% (324/651) of all ticks collected from dogs and cats during winter 2020/21 were D. reticulatus. Additionally, the hedgehog tick Ixodes hexagonus was found to infest dogs and cats quite frequently during the winter months, accounting for 13.2% (86/651) of the collected ticks. A generalized linear mixed model identified significant correlations of D. reticulatus winter activity in quasi-natural plots with climatic variables. The combined study approaches confirmed a complementary main activity pattern of I. ricinus and D. reticulatus with climate change-driven winter activity of both species. Milder winters and a decrease of snowfall, and consequently high winter activity of D. reticulatus, among other factors, may have contributed to the rapid spread of this tick species throughout the country. Therefore, an effective year-round tick control is strongly recommended to not only efficiently protect dogs and cats with outdoor access from ticks and tick-borne pathogens (TBPs), but also to limit the further geographical spread of ticks and TBPs to so far non-endemic regions. Further measures, including information of the public, are necessary to protect both, humans and animals, in a One Health approach.     

Partners in care?: views and experiences of carers from a cohort study of the early implementation of the Mental Health (Care & Treatment) (Scotland) Act 2003

Carers are seen as legitimate stakeholders in wider policy processes and increasingly as ‘co‐producers’ and key providers of care. Mental health carers, however, especially those caring for relatives subject to compulsory care and treatment, often feel overlooked and marginalised, caring in complex circumstances with little or no professional support. The Mental Health (Care & Treatment) (Scotland) Act 2003 (MHCT Act) implemented in 2005 aspired to change this for the better. This article focuses specifically on findings from seven focus groups and 10 individual interviews with 33 carers from three Health Board areas and the State Hospital in Scotland. Interviews were conducted at two stages during 2007 and 2008 as part of a wider study. Participating carers were supporting relatives who were under different compulsory measures and so had experience of new procedures under the MHCT Act. The data were gathered as part of a cohort study exploring service users’, carers’ and professionals’ early experiences of the Act’s implementation. A topic guide was used to explore the impact of compulsion on carers; the ‘Named Person’ role; Mental Health Tribunals; the principles underpinning the MHCT Act; and suggestions for improving the law. The study found that new provisions, in particular the Named Person role and Mental Health Tribunals, had resulted in positive change. However, many carers still felt isolated and unsupported. They remained critical of the lack of consultation and involvement at both individual and collective levels. Few were aware of their right to a carer’s assessment and many were sceptical that this would make any difference. Acknowledging the study’s limitations, we discuss the implications for practice in light of broader policy agendas of personalisation, recovery, recognition for carers and promotion of more community‐based mental health services.     

Changes in knowledge, attitudes and behaviors of Italian university students regarding contraceptive methods and STDs (1998–2008): a cross-sectional study

Aim

The aim of the study is to evaluate changes in opinions and behaviors of university students about sexual attitudes, use and effectiveness of contraceptive methods and sexually transmitted diseases (STDs).

Subjects and methods

The study was carried out through three surveys in 1998, 2003 and 2008. A self-completion questionnaire, divided into three major sections, was administered. The groups were analyzed with the Chi-square test and the multiple logistic regression analysis; the significance level was set at p?<?0.05.

Results

Contraceptive methods were not used by 12.0, 12.5, and 16.2 % of the sample in 1998, in 2003 and 2008 respectively. The condom was the most common method used by responders, followed by the pill; both methods of birth control are also considered the most effective. In 2008, students demonstrated to have a good knowledge about STDs transmission through sexual intercourse and contraceptive use was higher among responders with multiple partners (p?=?0.028), lower in smokers (p=?0.003) and female gender (p?=?0.001).

Conclusion

The results highlight the necessity to activate programs on sex education, on the use of contraceptives and STD prevention. Peer education should also be considered.     

Synthesis, characterization, and study on HeLa cells activity of a dinuclear complex [Cu4(phen)4(H2O)2]·(pyri)·3H2O

The complex [Cu4(phen)4(H2O)2]·(pyri)·3H2O(where phen=1,10-phenanthroline and pyri=3,5-pyridine dicarboxylic acid)has been synthesized and characterized. IR spectra, elemental analysis and X-ray single-crystal diffraction were carried out to determine the composition and crystal structure of the complex. The binding of the complex with HC-DNA (HeLa cells DNA, which was extracted by ourselves) was investigated by fluorescence spectrum. Gel electrophoresis assay demonstrates the ability of the complex to cleave the extracted HC-DNA. Additionally, the complex exhibited a significant cytotoxic specificity and cancer cell inhibitory rate. The apoptotic tests indicate that the complex have an apoptotic effect on HeLa cells.     

Medically unexplained illness and the diagnosis of hysterical conversion reaction (HCR) in women’s medicine wards of Bangladeshi hospitals: a record review and qualitative study

Background

Breast cancer is the leading cause of cancer mortality among Jordanian women. Breast malignancies are detected at late stages as a result of deferred breast health-seeking behaviour. The aim of this study was to explore Jordanian women’s views and perceptions about breast cancer and breast health.

Methods

We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65?years) with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis.

Results

Three themes were constructed from the group discussions: a) Ambivalence in prioritizing own health; b) Feeling fear of breast cancer; and c) Feeling safe from breast cancer. The first theme was seen in women’s prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women’s perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband’s rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women’s perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations.

Conclusions

Women’s ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast health care.     

Residential exposure to overhead high-voltage lines and the risk of testicular cancer: results of a population-based case–control study in Hamburg (Germany)

Background: In a population-based case–control study we examined the association between residential exposure to overhead high-voltage lines and testicular cancer. Methods: We recorded the residential biography of cases with testicular cancer identified by the Hamburg Cancer Registry and of controls that were randomly selected from the mandatory registry of residents in Hamburg. The study included 145 incident cases between 15 and 69 years of age, diagnosed between 1995 and 1997, and 313 controls, matched for age in 5-year strata. In model A, exposure was defined by distance (ever vs never). Model B took into account residence time and the inverse distance from the nearest high-voltage line. It distinguished between low and high exposure, the never exposed persons serving as a reference group. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by unconditional logistic regression. For men below the age of 40 years and men aged 40 years and over separate analyses were carried out. Results: Within a corridor of 100 m the prevalence of exposure to high-voltage lines in Hamburg was 6.9% in cases and 5.8% in controls (OR=1.3; 95% CI=0.56–2.80). In the more complex model B we found an OR of 1.2 (95% CI=0.60–2.47) for low exposure and 1.7 (95% CI=0.91–3.32) for high exposure. Younger men show slightly increased risks in both models. Conclusions: In all, residential exposure to high-voltage lines did not seem to be a major risk factor for testicular cancer in our study. Yet, the fact that risks for men below the age of 40 years were slightly increased in both exposure models deserves further attention.     

A randomized trial of the impact of a specific care plan in 1120 Alzheimer’s patients (PLASA study) over a two-year period: Design and baseline data

Objectives: To describe the design and baseline patient characteristics of a multicomponent specific care and assistance plan (PLASA) study in Alzheimer’s Disease (AD). The study is designed to evaluate the effect of PLASA in AD primarily looking at change in functional capacity.Design: Two-years prospective cluster randomized controlled trial comparing PLASA and usual care. Setting: Forty-nine hospitals in France.Participants: 1120 community-dwelling AD.Intervention: Patients in the intervention group are evaluated bi-annually using a standardized comprehensive global assessment. In the case of decline in any one domain a standardized study protocol recommends specific physician directed intervention in addition to information and training for the caregiver.Measurements: Alzheimer Disease Cooperative Study-Activities of Daily Living scale, Resource Utilization in Dementia scale, Clinical Global Impression of Change.Results: At baseline, the two groups were similar regarding patient and caregiver characteristics. The mean patient age was 79.61 + 5.72 years and the mean MMSE 19.73 + 4.01 for the whole cohort. Time since dementia diagnosis was about 1.37 + 1.65 years in the whole cohort. Almost a third of the patients lived alone at baseline. Mean monthly time spent in caregiving in the whole cohort was 52.70 + 71.83 hours for instrumental activities and 17.73 + 51.38 hours for basic activities.Conclusion: Persons with dementia suffer different losses at different stages of the disease and therefore accurate assessment of abilities and losses is critical to assist the person in planning for their future and for care needs. The PLASA intervention study is ongoing with 2 year follow-up to be completed in 2007. This research was supported by French Ministry of Health Grant: PHRC 02-006-01. Trial registration: clinicaltrials.gov Identifier: NCT 00480220.     

An impact and feasibility evaluation of a six-week (nine hour) active play intervention on fathers’ engagement with their preschool children: a feasibility study

Research has demonstrated the benefits of father involvement with their children and a link between uninvolved fatherhood and societal problems. Children's Centres (n?=?15) received 6?×?90-minute active play sessions designed to foster 6 aspects of parental engagement. Fathers’ engagement and attitudes to child physical activity were measured pre- and post-intervention via questionnaire. Acceptability of the intervention was explored through participant and staff focus groups. Results showed no effect on overall time fathers spent with their child during the week (t (36)?=?0.178, p?=?0.860) and the weekend (t (36)?=?1.166, p?=?0.252). Qualitative results demonstrated the sessions provided opportunities for fathers to spend quality time with their children. Parenting self-efficacy increased across the subscale control, t (36)?=??2.97, p?=?0.04. Fathers increased awareness of their role in motivating their child to play (z?=??2.46, p?=?0.01). Further longitudinal research is recommended.