Making abortions safe: a matter of good public health policy and practice

Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally.     

Can public health performance standards improve the quality of public health practice?

Recent developments suggest that a national public health performance standards program could succeed in improving the quality of public health practice. Public health standards also may be useful for enhancing accountability and strengthening the science base of public health practice. For national public health performance standards to have a substantial influence on the quality of public health practice, several important issues must be addressed. These include agreement as to the ultimate purpose and appropriate unit of measurement, delineation of the specific qualities to be measured, and expansion of strategies to promote widespread use of public health practice standards.     

Thailand: Current public health perspectives

Thailand's public health system is in transition, reflecting the economic status of the country. The decentralized system has made great strides in improving the health of its people. But paradoxes exist. While some urban areas have an oversupply of CT Scanners, rural villages still cope with hygiene-related illnesses. Malaria and Yellow Fever no longer dominate health resources. Now AIDs, heart disease and accidents top the problem list. Like other countries, Thailand also struggles with health financing to address the unmet needs.     

Distance learning in the public health workplace

The Master of Applied Epidemiology (MAE) Program implemented in Canberra to produce public health practitioners with specified competencies in the control of communicable diseases. Twenty one of the 24 months of training is distance learning defined as, 'where the learner is physically remote from the training institution'. During this time the trainees are in supervised employment in Public Health centres across the country. Here they learn directly from first hand experiences in the work place. They return to Canberra for short, intensive periods of interactive sessions with their peers and supervisors. Lessons learnt from conducting this program are discussed in this article. They include: all trainees are not suited to this form of training; the quality of support from the field supervisors is highly variable and their role in modelling crucial to the trainees performance; demands on the academic staff is high; and the frequency of contact between trainee and academic supervisor varies considerably. To date this program has made major contributions by enhancing communicable disease surveillance and control but it demands intensive resources to sustain, quality training, and support. This model of distance learning can be adapted in the Pacific both for graduate degree courses and also for continuing education for all levels of health professionals.     

Cross-border health activities in the Euregios: good practice for better health

BACKGROUND: Health-related cooperation between neighbouring countries has a long tradition in the European Union, especially in the transfrontier structures well-known under the label of Euregio or Euroregion. OBJECTIVE: Overview and analysis of cross-border health-related activities in the Euregios. METHODS: The EU-funded project "EUREGIO" carried out a systematic inventory analysis of cross-border health projects. It is based on written surveys among 53 Interreg IIIA secretariats, 67 Euregios and 328 project bodies. The responses of 122 health projects were considered. RESULTS: 37 Euregios or similar cross-border structures established health-relevant working groups, working circles, forums or projects. The cross-border health projects cover a wide spectrum of issues, e.g., education and training, patient care, prevention, and disaster control. Target groups were in most cases medical personnel, patients or decision-making bodies. Four official criteria for cooperation (joint project development, implementation, staffing and financing) are met by the great majority of projects. However, the survey shows a lack of information, publication and evaluation. CONCLUSIONS: Cross-border cooperation in health is underrepresented in many regions. The project results point to great potentials which should be further developed both in terms of quantitative and qualitative aspects. Recommendations are given for project actors and stakeholders.     

Nutrigenomics in public health nutrition: short-term perspectives

Knowledge of the human genome is helping us better understand nutrition. The nutrition-health relationship depends on the adaptive capacity of genes and their functioning with the diet consumed. The greater the efficiency of the system, the lower the metabolic wear suffered. Several epidemiological studies have reported that early-life metabolic imprinting occurs in Man. Both in the uterus and during the first years of life, under and overfed mother-child units imprint gene changes that lead to chronic metabolic problems in later life. Many other mechanisms can modify gene performance, such as gene silencing, gene compensation by a vitamin or a bioactive phytochemical, or simply DNA multiplication during cell reproduction and polyploidisation. The new area of science related to the lateral transfer of recombinant genes is opening new horizons to the nutritional sciences changing the nutritional value or the organoleptic characteristics of food, or even changing genes in persons at risk of chronic disease. Many recent studies provide details about the kinds of diet, nutrients and other compounds that are the best for Man; biotechnology is becoming an instrument enabling food to be offered in the best of conditions.     

农村公共卫生体系绩效评价指标的初步构建

目的:初步构建我国农村公共卫生体系绩效评价指标。方法:德尔菲法。结果:两轮咨询专家的应答率分别为65.00%和84.44%,专家协调系数分别为0.24和0.41。从投入、产出、评价3个方面初步构建了38项评价指标。结论:评价指标综合考虑了农村公共卫生体系的各个方面,对快速评价农村公共卫生体系的绩效具有一定的实际应用价值。     

Health indicators and public health planning

Health indicators are considered to be fundamental to the public health planning process. To a large extent, programs and services relevancy depends on indicators used for planning. Based upon a review of the literature, criteria for judging the acceptability of available indicators are presented and described. The principal health indicators developed for planning health programmes and services are then analysed in terms of these criteria. The dimensions of health measured by the various indicators are noted together with the relevancy and limits of each group of indicators analysed.     

Potential risk of HIV transmission in barbering practice in Ethiopia: from public health and microbiological perspectives

ABSTRACT: BACKGROUND: HIV and other blood borne infections can be transmitted through the use of improperly sterilized and disinfected sharp equipments. METHODS: A cross sectional study was conducted from January to June, 2010 to assess the potential risk of HIV transmission in barbering practice in Ethiopia from public health and microbiological perspectives. Barbers in barbershop were interviewed using pre-designed questionnaires and check lists were used to evaluate barbering practice. Microbiological data from tips of the sharpener before and after the barbering was collected and processed as per the standard procedure. RESULTS: One hundred and twenty three barbering sessions and barbers were observed in which 106 (86.2%) were males. Ninety six (78%) of the respondents knew that HIV could be transmitted by sharing non-sterile sharp instruments. Among the total participants 59 (48%) had the correct knowledge of what sterilization mean and 111 (94.1%) of them believed its importance in their work place. Barbers had a mean knowledge score of 6 [PLUS-MINUS SIGN] 1.5 out of a score of 10 regarding sterilization and disinfection as well as in the transmission of HIV in their work place. Three (2.5%) barbers were disagreed that unsterilized blade can transmit skin diseases and 26 (21.3%) of them believed disinfection is enough to avoid microbes from sharp objects. Ninety two (76.7%) barbers were using sterilization in their establishment. According to Likert scaling almost all sterilization and disinfection procedures were riskily practiced and respondents had poor level of knowledge. No significant association was found to influence the decontamination and sterilization of barbering equipments except monthly income, pre and post colony count of microbes identified. The isolation of normal skin flora in the pre-and post- sterilization and disinfectant procedures and less average percent colony reduction showed that sterilization and disinfectant practices in barbershop were generally. CONCLUSION: This study has revealed the presence of potential risk of HIV and other blood borne disease transmission among the barbers of the study areas. Thus continuous and intensified public health strategies on health education, training, supervision and monitoring are needed to facilitate the adoption of effective methods of sterilization and /or disinfection.     

基本公共卫生服务均等化绩效考核指标体系信度和效度分析

目的评价基本公共卫生服务均等化绩效考核指标体系的信度和效度。方法主要采用德尔菲专家咨询法,通过克朗巴赫系数（Cronbach’sα系数）、因子分析（factoranalysis）等方法检验指标体系的信度和效度。结果基本公共卫生服务均等化绩效考核指标体系条目总的Cronbach’sα系数为0．875,因子分析90．16％的总方差可以由6个潜在因子解释。通过四次方最大旋转对因子载荷起到了明显分离作用,使前5个公因子具有较明确的专业意义。结论基本公共卫生服务均等化绩效考核指标体系具有较好的信度与效度,适合作为基层医疗卫生机构绩效考核的测评工具。     

Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia

At the beginning of the 21st century, planning the public health workforce requirements came into the focus of policy makers. The need for improved provision of essential public health services, driven by a challenging non-communicable disease and causes of death and disability within Serbia, calls for a much needed estimation of the requirements of the public health professionals. Mid and long-term public health specialists’ supply and demand estimations out to 2025were developed based on national staffing standards and regional distribution of the workforce in public health institutes of Serbia. By 2025, the supply of specialists, taking into account attrition rate of −1% reaches the staffing standard. However, a slight increase in attrition rates has the impact of revealing supply shortage risks. Demand side projections show that public health institutes require an annual input of 10 specialists or 2.1% annual growth rate in order for the four public health fields to achieve a headcount of 487 by 2025 as well as counteract workforce attrition rates. Shortage and poor distribution of public health specialists underline the urgent need for workforce recruitment and retention in public health institutes in order to ensure the coordination, management, surveillance and provision of essential public health services over the next decade.