The physician's role in suicide prevention: lessons learned from a public awareness campaign

The suicide rate in Minnesota has increased every year since 2000, making suicide a serious public health problem. In the spring and summer of 2009, the nonprofit organization Suicide Awareness Voices of Education (SAVE) launched a public awareness campaign targeting four populations at high risk of suicidal behavior and suicide: adult men, seniors, teens, and American Indians. The goals of the campaign were to increase awareness about suicide in general and to let people know how they could help someone who may be at risk. In their evaluation of the campaign, researchers found a need to provide physicians and other health care professionals with appropriate information about suicide and resources that are available for those who may need help.They also learned the importance of engaging physicians in planning future campaigns.     

A longitudinal assessment of inter-sectoral participation in a community-based diabetes prevention programme

To understand the development of inter-sectoral participation in the three intervention municipalities of Stockholm Diabetes Prevention Programme (SDPP) case studies with a longitudinal assessment were conducted using the spidergram method, document analysis and group discussions. At three time points, the members of the local steering committees assessed the extent of participation from narrow to wide inter-sectoral participation in five key areas: planning, resources, leadership, network and implementation. Wide participation of various interest groups was recognised in planning and implementing activities whereas local resources, the representation of the leadership and the extent of the network were perceived as more restricted. Expert involvement varied during the programme period but was not regarded as exerting control over the local programmes. Participation within the local steering committees decreased, with a stronger focus on the project co-ordinator and other local partners in latter years. The extent of partner engagement increased due to focusing on activities approaching multi-sector collaboration and institutionalisation. Overall, communication and shared responsibility appeared critical in influencing both the development and perception of participation. In conclusion, to understand the dynamic process of participation at different times, areas and levels, the development and use of evaluation designs combining different methods and information sources throughout the lifespan of a project are recommended.     

Representativity of a postal public health questionnaire survey in Sweden, with special reference to ethnic differences in participation

AIM: Non-participation in health surveys is a common phenomenon. When differences between participants and non-participants are considerable, the external validity of the sample survey may decrease and false conclusions might be drawn about the health status of the population. For this reason, the authors aimed to investigate the representativity of a postal questionnaire survey performed in the county of Scania, Sweden, in 1999-2000. The survey, which was based on an 18- to 80-year-old population sample, had a 58% response rate (n = 13 604). METHODS: For some variables, the information obtained using the questionnaire was compared with information obtained from a population register that covers all the population in the county (for the 18- to 80-year-old group, n = 850 476). The population register includes, among other data, information on age, gender, educational level, country of birth, and healthcare expenditure. RESULTS: Men, individuals with a low level of education, and immigrants were under-represented in the survey. However, except for immigrants, the under-representation was not large. Among immigrants, particularly those born in former Yugoslavia, the Arabic-speaking countries, and Poland were very significantly under-represented in the study. By contrast, immigrants born in other Nordic countries had responded to almost the same extent as respondents born in Sweden. The survey sample had about the same healthcare utilization costs as did the general population. CONCLUSIONS: In summary, the "Health Survey for Scania, 2000" seems largely representative of the total Scanian population. A major concern, however, is the under-representation of the immigrant population.     

Cost effectiveness and equity of a community based cardiovascular disease prevention programme in Norsj?, Sweden.

STUDY OBJECTIVE: To evaluate the cost effectiveness and equity of a community based cardiovascular disease prevention programme. DESIGN: A prospective cross sectional design. SETTING: A community based intervention to reduce cardiovascular disease in the district of Norsjö (n = 5500), Sweden. The intervention was aimed at both the general population and at individuals thought to be at special risk, the emphasis being on changing dietary habits and reducing cholesterol concentrations. PARTICIPANTS: The participants were men and women aged 30-60 years. MAIN RESULTS: The mean serum cholesterol concentration in the Norsjö population was reduced by nearly 20% during the first six years of intervention. It was estimated that the programme's overall total societal costs were 363,000 pounds and estimates of the cost per year of life saved ranged from 14,900 pounds to net savings, according to different assumptions. Taking only health care costs and savings into account, the cost per year of life saved ranged from 1100 pounds to 4050 pounds. The results varied between different sex and age groups, but not between social classes. Even if a causal relationship exists between low cholesterol concentrations and excess mortality, the estimated side effects of lowering cholesterol values in Norsjö were negligible in comparison with the expected benefits. CONCLUSIONS: The community based intervention in Norsjö seems to be cost effective even under conservative assumptions. The approach used seems to have benefited all social classes. Cost effectiveness analyses that take consequences for equity into account are valuable tools in decision making.     

突发公共卫生事件对构建现代医防结合机制的启示

文章讨论了由突发公共卫生事件引发的对构建现代医防结合机制的反思及其对策措施。透过SARS危机,暴露出我国现行公共卫生管理体制上存在的医防分离的严重性,提示我们应改革现行医院等级评审标准,增加医疗机构疾病预防控制工作分值比例;改革医学教育模式,促进多学科、跨专业的合作;加强医疗机构预防保健科建设,规范做好院内感染控制工作;统一规范建设卫生信息网络;以构建现代疾病预防控制临床沟通系统。     

Control of pertussis—Lessons learnt from a 10-year surveillance programme in Sweden

Sweden was the only country in the world without any general pertussis vaccination when acellular pertussis (aP) vaccines were introduced. Since 1996 aP vaccines are given at the ages of 3, 5 and 12 months, with a 99% coverage, and until 2007 without a later booster. The long-term effects of aP vaccines, monitored within an enhanced surveillance project, were discussed at an international workshop in Stockholm in November 2008. The unique Swedish experience demonstrates that aP vaccines are capable of achieving the primary goal of a national vaccination programme, i.e., to significantly reduce the burden of pertussis in pre-school children. Throughout the 10-year surveillance period the highest age-specific incidence was reported in unvaccinated infants or those who had received only one dose, with most hospitalisations in this age group and eight deaths among unvaccinated infants. Complementary strategies are needed to achieve further reduction in morbidity from circulation of Bordetella pertussis.     

Pattern of participation in a cohort aged 50-60 years at first invitation to the service-screening programme with mammography in Stockholm county, Sweden

BACKGROUND: Mammography screening can only be effective if a high proportion of the invited women attend. The aim of the present study was to search for patterns of participation in women who were invited to five consecutive rounds in a large screening programme. METHOD: Stockholm service-screening programme started 1989 and invites women between 50 and 69 years of age to mammography with 2 years interval. 64,852 women were eligible for an invitation to all five rounds during a 10-year period and were included in the study. RESULTS: More than 50% attended at all five rounds, and more than 70% at least four rounds. Only 8.5% were permanent non-participants. Women who attended at the first invitation round were more likely to attend also at subsequent rounds. CONCLUSIONS: It is possible to reach a high participation also in a large urban screening programme, but it seems that the invitation and examination at first round are most important in order to get a high compliance. Women who come at first round are more likely to come back for routine screening at a majority of subsequent rounds.     

Relationships between volunteerism and social-physical health and QOL with community-dwelling elderly participating in a long-term care prevention programme

OBJECTIVE: The aim of this study was to clarify the influence of volunteerism as part of a long-term care prevention program on social and physical health indicators and QOL, as compared with non-participation among elderly people. METHODS: The baseline survey was conducted in 2003 among elderly people (age, 70-84 years) living in a rural community in Miyagi Prefecture. We recruited elderly volunteer leaders for long-term care prevention from among the 1,503 elderly people participating in the baseline survey. Of these, 77 individuals were registered as volunteer leaders. One year later, we conducted a follow-up survey to clarify the influence of volunteerism. Finally, we analyzed data for 69 volunteer leaders and 1,207 non-leaders, focusing on influences of volunteerism on social and physical health and QOL using a logistic regression model. State of volunteer activity was treated as a dependent variable, and social and physical health indicators and QOL indices as independent variables. RESULTS: Non-participating individuals had significant declines in Intellectual Activity (OR: 4.51, 95% CI: 1.60-12.74), Social Role (OR: 2.85, 95%CI: 1.11-7.21), Self-efficacy for ADL (OR: 4.58, 95%CI: 1.11-18.88), Satisfaction with Economic State (OR: 2.83, 95%CI: 1.11-7.21), and Contact with Neighbors (OR: 3.62, 95%CI: 1.29-10.16), as compared with volunteers. CONCLUSION: These results suggest that volunteerism prevents lowering of higher-level functional capacity and social networking among community-dwelling elderly individuals.     

Men's perspectives on fall risk and fall prevention following participation in a group‐based programme conducted at Men's Sheds,Australia

Research on older men's views regarding fall prevention is limited. The purpose of this qualitative study was to explore the experiences and perspectives of older men regarding fall risk and prevention so that fall prevention programmes can better engage older men. Eleven men who had taken part in a group‐based fall prevention programme called Stepping On conducted at Men's Sheds in Sydney, Australia, participated in semi‐structured interviews during June and July 2015 which were audio‐recorded and transcribed. Data were coded and analysed using constant comparative methods. Over‐arching theoretical categories were developed into a conceptual framework linking programme context and content with effects of programme participation on men. Men's Sheds facilitated participation in the programme by being inclusive, male‐friendly places, where Stepping On was programmed into regular activities and was conducted in an enjoyable, supportive atmosphere. Programme content challenged participants to think differently about themselves and their personal fall risk, and provided practical options to address fall risk. Two major themes were identified: adjusting the mindset where men adopted a more cautious mindset paying greater attention to potential fall risks, being careful, concentrating and slowing down; and changing the ways where men acted purposefully on environmental hazards at home and incorporated fall prevention exercises into their routine schedules. Practitioners can engage and support older men to address falls by better understanding men's perspectives on personal fall risk and motivations for action.     

Understanding community participation: a health programme in the Philippines

The principle of community participation is so well recognizedin international health circles that no declaration about primaryhealth care is made without it.1 Yet in actually planning andimplementing programmes it is very difficult to find clear waysof following this principle. This paper analyses the concreteaspects of community participation in the Munoz-community basedhealth programme, a small nongovernment health programme fundedby Missionary Medical Actions (MEMISA - the Netherlands) andestablished in Munoz, Nueva Ecija, the Philippines. The programme started as a parish based charity clinic witha policy of free consultations and medicines but underwent agradual evolution towards a mother and child health (MCH) programme,with a growing emphasis on the participation of the (pregnant)mothers and community health workers (CHWs) in the villages.The sponsoring agency, staff members and CHWs agreed to strivefor financial independence by the year 1990-91. This would requirea better cooperation with the Rural Health Unit (the governmentpublic health sector) at the programme level, and a higher degreeof community participation at the level of the community ifthe MCH-programme was to be maintained after the discontinuationof external financial support. An intensive debate among staff members and CHWs revealed alack of clear understanding of the concept of community participation.Specifically, the absence of an instrument to assess the processof community participation resulted in a vague and unsatisfactoryanalysis of the situation. Recently, an analytical frameworkfor such an analysis has been developed2 which focuses on participationas a process, enabling an assessment of participation to gobeyond the limits of a merely quantitative analysis. It appearsto be a useful instrument for analysing community participation,describing what has been achieved and identifying some of theelements that influenced this process. We have applied thisframework retrospectively to our programme as described here.     

Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda

BACKGROUND: To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda. METHODS: Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach. RESULTS: The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families. CONCLUSION: Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the 'opt-out' approach to HIV testing required further evaluation.     

Fieldwork challenges: lessons learned from a north-south public health research partnership

The value of collaborative international research in addressing global public health challenges is increasingly recognized. However, little has been written about lessons learned regarding fieldwork to help guide future collaborative efforts. Through a research partnership between two Northern universities, one Southern university, and a Southern faith-based organization, we evaluated a school-based HIV prevention intervention with South African adolescents. In this article, we highlight the seven key fieldwork-related challenges experienced and identify the lessons learned. The underlying theme is that of reconciling a structured and reasoned "desk" planning process with the more fluid and unpredictable reality of conducting fieldwork. This concern is particularly significant in resource-deprived environments and/or contexts that are less familiar to Northern partners. Fieldwork is unpredictable, but obstacles can be minimized through meaningful participation in both planning and field research. Sharing practical lessons from the field can prove a useful resource for both researchers and practitioners.     

Co-operation as a strategy for provision of welfare services--a study of a rehabilitation project in Sweden

BACKGROUND: During the past 15 years, there have been many initiatives to improve the integration between different welfare agencies. This study is describing and analysing the co-operation between agencies involved in a rehabilitation project in Sweden, and discussing such inter-agency co-operation as a strategy for provision of complex welfare services. METHODS: The study is based on a process evaluation, where the co-operation between the agencies was followed and documented during the time of the project. Different kinds of data were collected through interviews, focus groups and diaries. The contents of these data were analysed in order to evaluate the process of co-operation. In addition, there was also an evaluation of the effects of the co-operation, based on official documents, statistics, etc. RESULTS: The evaluation shows that it was possible to co-operate across the organizational boundaries of the different agencies, but there were obstacles related to organizational and cultural differences of the agencies, divided loyalties of the officials and limited resources available to deal with the complex needs of the clients. At the same time, the commitment and the relations between the officials were facilitating the co-operation. DISCUSSION: Based on the evaluation of this project, it seems that co-operation could be an effective strategy to deal with clients who need services from different welfare agencies. At the same time, however, it is clear that inter-agency co-operation requires a lot of time and energy and should therefore be used with caution.