Evaluation of a programme to train village health workers in El Salvador

The civil war in El Salvador has had devastating effects onthe country's health care system, especially in rural areas.The Catholic Archdiocese of San Salvador undertook a programmeto train village health promoters, in an effort to alleviatethe serious shortage of primary health care in some of the affectedareas. The objectives of the programme included not merely anattempt to take medical care to the most needy, but rather thepromotion of health education and community development. Thevolunteer promoters received a four-week training course. A private non-profit international organization, AesculapiusInternational Medicine, took over the follow-up and supervisionof a group of promoters in 1984. One part of the programme evaluationwas a survey designed to assess the work patterns and attitudesof the promoters. It was found that most of them spent a greatdeal of time treating illnesses and very little on communityhealth education. As a result, a one-week course devoted tocommunity education was added to the curriculum and emphasiswas placed on increasing teaching skills and confidence.     

Mass produced village health workers and the promise of primary health care

The most evident aspect of primary health care (PHC) development in many countries is the mass recruitment and training of village health workers (VHWs). These VHW schemes are often merely an extension of the organized government health services. This paper takes the view that over emphasis of VHWs is a fatal limitation and narrowing of the original idea of PHC. In the spirit of PHC, communities should be allowed to go through the process of identifying their problems, sorting out their priorities, means of solving identified problems through the material and human resources they have at their disposal. Before communities have been allowed to go through such a process, the selection of VHWs is at best, an imposition from above. PHC is thus robbed of its most fundamental components, of community participation, self-determination and self-reliance.     

Tobacco cessation in Vietnam: Exploring the role of village health workers

The purpose of this study was to explore current tobacco use treatment (TUT) practice patterns, and attitudes and beliefs among Village Health Workers (VHWs) about expanding their role to include delivering smoking cessation interventions and the perceived barriers. We conducted a survey of 449 VHWs from 26 communes in Thai Nguyen province, Vietnam. We assessed TUT practice patterns including asking about tobacco use, advising smokers to quit, offering assistance (3As) and attitudes, self-efficacy, and norms related to TUT. Seventy two per cent of VHWs reported asking patients if they use tobacco, 78.6% offered advice to quit, and 41.4% offered cessation assistance to few or more patients in the past month. Self-efficacy was low, with 53.2% agreeing that they did not have the skills to counsel patients about smoking cessation. The most commonly reported barriers to offering TUT were a lack of training and perceived lack of patient interest. Greater awareness of their commune health centre’s smoke-free policy and higher levels of self-efficacy were associated with screening and offering cessation assistance. VHWs support an expanded role in tobacco cessation, but require additional resources and training to increase their self-efficacy and skills to provide effective treatment.     

某企业工作场所中锰水平和工人职业健康检查结果分析

目的 通过对某涉锰企业工作场所中锰浓度检测和工人职业健康检查,了解锰接触对健康危害的关系,为控制职业病提供依据.方法 采用典型抽样法,在12个工人经常停留的工作场所进行空气中锰浓度检测;采用整群抽样法,确定企业的全部538人工人作为研究对象.对研究对象进行职业健康检查.结果 2011至2013年工作场所中平均锰浓度分别为0.179、0.122、0.082 5 mg/m3,经秩和检验,差异有统计学意义(P＜0.05).健康检查结果显示,538人中,检查指标异常165人,异常率为30.7％,自觉神经系统症状异常率为32.7％(176/538).工作场所中锰浓度与健康检查各项指标异常率无相关关系,与自述神经系统症状的发生率有正相关关系(r=0.718,P＜0.05).结论 工作场所中锰浓度与自述神经系统症状的发生率之间存在正相关关系,锰的低剂量早期作用可以引起神经系统功能改变,造成潜在伤害.     

Sustained protection against mortality and morbidity from malaria in rural Gambian children by chemoprophylaxis given by village health workers

Mortality and morbidity from malaria were measured in children for a one-year period in a rural area of The Gambia 3-4 years after the introduction of a primary health care programme into some villages in the study area. Among children resident in primary health care villages who received treatment for febrile illnesses from a village health worker resident in their village there was no reduction in overall mortality or in morbidity from malaria compared with levels found in villages without a primary health care worker. However, among children aged 3-59 months who received malaria chemoprophylaxis from a village health worker in addition to treatment there was a 49% reduction in mortality and a 73% reduction in attacks of clinical malaria. The level of protection against malaria achieved by chemoprophylaxis given by village health workers 3-4 years after the chemoprophylaxis programme was started was as high as that obtained shortly after the introduction of the primary health care programme.     

Evaluation of a village health worker programme: the use of village health worker retained records

A village health worker (VHW) programme in a rural area in South Africa is evaluated, a year after the introduction of VHW-retained child record cards. The programme's success in promoting immunization and breastfeeding and the coverage of and contact with the community by the VHWs was investigated. A population survey on children under one year was matched to VHW records, showing that VHWs were reaching 70.8% of the target population. VHWs were more likely to visit a child with a Road to Health Card (RTHC) and who was born in the village. VHWs generally visit mothers once a month and make contact with most children in their first month of life. Children born before the start of the new VHW programme were compared with those born after, using survival analysis techniques and data from the RTHC on the first year of life of all children under two. An increase in polio immunization coverage was detected but there was a drop in measles immunization coverage. We conclude that a VHW-retained child record for the first year of life plays a valuable role in ongoing health care evaluation.     

某企业二甲基甲酰胺作业工人职业健康检查分析

目的探索二甲基甲酰胺(DMF)作业的职业健康检查项目和周期。方法对464名DMF作业工人作职业健康检查,统计分析其结果。结果DMF作业工人在上岗早期(3个月内)内即有肝功能受损,在岗期间作业工人的血小板计数下降有显著性(P=0.000),心电图、尿常规检查无实际临床意义。结论应注重DMF作业工人职业健康检查的针对性,必检项目建议检查肝功能,上岗3个月内动态检测肝功能;在岗期间是否必检尿常规和心电图有待斟酌。     

子宫颈癌醋酸染色检查及筛查方案的卫生经济学评价进展

子宫颈癌是全球女性第二大恶性肿瘤,2002年有近50万新发病例和27万死亡病例,其中约83%发生在发展中国家[1].人乳头状瘤病毒(HPV)预防性疫苗已研制成功,但引入我国人群尚需时日,筛查仍是未来几十年内我国控制子宫颈癌的重要手段.传统巴氏涂片筛查因实施要求较高,在卫生资源匮乏地区不宜大范围开展.目前推荐较多的三种筛查技术分别是液基细胞学检测、HPV DNA检测及宫颈染色后观察法,其中液基细胞学和HPVDNA检测的灵敏度和特异度更高,但费用与实施条件也更高.子宫颈染色后观察以醋酸染色检查(VIA)最多用,该法因价廉、易培训,经严格质量控制和培训可克服一定漏诊及误诊率,在经济欠发达地区应用前景较大[2].     

Respiratory exposure of grain inspection workers to carbon tetrachloride fumigant

Carbon tetrachloride (often mixed with carbon disulfide or ethylene dichloride) is a common constituent of liquid grain fumigants. Applied as liquids, these mixtures volatilize and achieve vapor concentrations sufficient to control insect infestations in stored grains. Absorbed grain desorbs fumigant components after the fumigation period, and it then becomes a source of exposure to workers who handle fumigated grain. Carbon tetrachloride meets the EPA's risk criteria for hepatotoxicity, nephrotoxicity and oncogenicity, and it has been under regulatory review since 15 October 1980. Present OSHA standards for CCl4 are a time-weighted average (TWA) of 10 ppm and an acceptable ceiling of 25 ppm. ACGIH and NIOSH have recommended lowering the OSHA standard. The point at which peak exposure occurs during the grain inspection process has been identified as the off odor test in which the inspector smells the grain sample for rancidity, sourness, etc. Ambient concentrations of CCl4 in 7750 grain samples submitted for inspection were determined by colorimetric tube, and these concentrations were an estimate of peak grain inspector exposure to CCl4. The average ambient concentration of CCl4 per grain sample was 1.69 ppm +/- 8.35. Approximately 380 TWA CCl4 exposures for grain inspection workers were determined by using passive dosimeters. All TWA exposures were less than 2 ppm. Variables are examined, such as location of work, grain type, time of year and grain transportation vehicle--all of which are known to the sampler or inspector before performing their job functions and which affect potential exposure.     

染色体型畸变率指标在射线工作者健康监护中应用的探讨

目的探讨染色体型畸变率增加在射线工作者健康监护中应用的意义。方法采用微量全血培养法,按WHO建议的标准对射线工作者(医用诊断X射线组、工业探伤组和海关货检组共772名及9名超剂量组)和40名正常人组进行染色体型畸变分析;职业外照射剂量用热释光剂量计测得。结果①各射线组的体型畸变率均比正常人增加了1～2倍,但两类人员的畸变类型均以无着丝粒畸变为主,占体型畸变率约95%,“双 环”等畸变极少;②体型畸变率的分布:95%的正常人畸变率<1%、其余为1%,各射线组的畸变率均分布在0%至≥3%的4个区段,其中2%和≥3%的2个区段合计为8.2%;③年剂量与体型畸变率分布:体型畸变率为2%和≥3%的2个区段中,年剂量当量<1mSv组仅占11.6%、3～19mSv组占66.6%、而>50mSv组(超剂量组)为100%;④各工龄组间体型畸变率的分布变化不大。结论在健康监护工作中,选择体型畸变率≥2%作为“预警值”较为合适;“双 环”或“稳定性畸变”的增加有较大的诊断价值;“预警值”应结合分析细胞量和其他指标综合判断才能得出客观的结论。     

Accidental exposure to HIV infection by health care workers

The health care worker's exposure to HIV presents a cascade of real and potential problems. Medical, psychological, employment, and legal problems present ongoing challenges, often in uncharted territory. The references listed below provide additional information to help in both individual cases and in prospectively setting up programs and action plans for hospitals and offices.     

广州地区村级妇幼保健员人力资源现状调查与思考

目的：通过问卷调查了解村级妇幼保健员的人口学特征、从业情况和收入状况,以期全面了解广州地区村级妇幼保健员队伍现状及存在的问题,为完善政策提供依据。方法2010年12月至2011年2月,采用自行设计的调查表对全市村级妇幼保健员进行普查。结果全市共7个区有村级妇幼保健员合计1279名,平均年龄44岁;具备医学专业人员仅370人,占29.2%;有38.1%村级妇幼保健员对月收入不满意。有53.0%的村级妇幼保健员兼任村妇女主任。结论村级妇幼保健员职能分配欠明确,人员素质待提高,需有合理措施维持队伍稳定,以改善服务质量。     

加强母婴保健监督全面实施卫生监督综合执法

卫生监督体制改革工作已在全国范围内全面展开 ,黑龙江省卫生监督所自建所起 ,紧紧围绕全面实施卫生监督综合执法这一卫生监督体制改革的主题 ,对旧有的卫生监督体制革故鼎新 ,将母婴保健监督纳入卫生监督综合执法实践中 ,在难点、重点、关键点上进行了大胆突破 ,取得了一些经验和成绩。作者将就卫生监督综合执法中 ,母婴保健监督工作的一些做法、体会 ,与同行探讨。     

Allergic reactions caused by latex: warning to health workers

In this study, a bibliographic survey is made of all articles, published during the last few years, dealing with allergic reactions to latex. The first article on allergic reactions associated with latex was published in Britain, in 1979. Since then, the number of cases reported have increased (Barton, 1993). Type I allergic reaction (immediate reaction) and Type IV (delayed reaction) are part of the latex allergic process (Steelman, 1995). Contact allergy is due to inadequate washing during manufacture, which results in the retention of water-soluble proteins that cause allergic reactions in susceptible people. A wide variety of allergic reactions that vary from contact dermatitis to anaphylatic shock are described in literature. These finding show that a health team must know the probable implications of latex allergy.     

Migration of health workers in the pacific islands: a bottleneck to health development

Human resources for health (HRH) are a crucial component of a well-functioning health system. Problems in the global HRH supply and distribution are an obstacle to achieving the health-related Millennium Development Goals and other health outcomes. The Pacific Island region, covering 20 000 to 30 000 islands in the South Pacific Ocean, is suffering a serious HRH crisis. Yet updated evidence and data are not available for the 22 Pacific Island Countries and Territories. The objective of this study was thus to explore the current HRH situation in the Pacific Island region, focusing particularly on the issue of health workforce migration. HRH trends and gaps differ by country, with some showing increases in HRH density over the past 20 years whereas others have made negligible progress. Currently, three Pacific Island countries are facing critical HRH shortages, a worsening of the situation from 2006, when HRH issues were first brought to widespread global attention. In this region, skilled personnel migration is a major issue contributing to the limited availability of HRH. Political commitment from source and destination countries to strengthen HRH would be a key factor toward increasing efforts to train new health personnel and to implement effective retention strategies.