Intellectual disability: an approach from the health sciences perspective

Intellectual disability (ID) is a complex condition that has not aroused very much interest in the health sciences and medical fields. As a result, a large part of the responsibility for caring for individuals with ID has fallen in the areas of education, social services and volunteering. Nevertheless, intellectual disability is a very significant health problem, whether because of its prevalence, the costs to the public health system, the families and society in general or due to related health complications. ID should be a priority area of study and action in the health field. This article reviews the conceptual, diagnostic and etiological problems that affect intellectual disability, as well as factors related with the health of the persons who are affected. In addition, some recommendations are outlined for improving health care for this population group.     

Dengue outbreak in Hadramout, Yemen, 2010: an epidemiological perspective

We analyzed surveillance data of a dengue outbreak (2010) reported to the Hadramout Health Office (Yemen) and retrospectively analyzed dengue-related epidemiological and entomological events reported in Hadramout from 2005 to 2009. A total of 630 immunoglobulin M (IgM) -confirmed dengue cases of 982 febrile cases was reported during the period from February to June of 2010; 12 cases died, giving case fatality a rate of 1.9%. Among febrile cases, the highest proportion of dengue cases (37.3%) was reported in the 15- to 24-year-old age group. The overall attack rate was 0.89/1,000. The average number of cases reported by month over the preceding 5-year period compared with the 2010 data is consistent with endemicity of dengue in the region and supports epidemic designation for the dengue activity in 2010. Recognition of endemic dengue transmission and potential for substantial dengue epidemics highlight the need for consistent laboratory-based surveillance that can support prevention and control activities accordingly.     

Social participation in health: spaces and actors determining its development]

This paper deals with an analysis of a rural experience of social participation (SP), defined as the possibility of communities gaining real access to the control of processes affecting health. This analysis evidences the relevance of peasant women in the promotion of SP in health, as well as the need to include health education and organization actions in regional organizational process, strengthened by local policies. The creation of a sanitary mediator to serve as a regulatory agent negotiating with the State is proposed.     

Micro-social structural approaches to HIV prevention: a social ecological perspective

To be effective and sustainable, HIV-prevention interventions need to be sufficiently powerful to counteract prevailing social norms and diffuse through the targeted community to provide social reinforcement for behaviour change. Social structural and environmental factors are major influences on HIV-related behaviours yet the dearth of conceptualization and operationalization of these factors impede progress in intervention development. In this paper we propose a social ecological perspective to intervention and highlight relevant theories from social psychology and organizational behaviour literatures. We examine social networks and social settings as micro-structural and environmental influences on HIV risk behaviours, social identities and norms, and as important targets for HIV-prevention intervention. Intervention approaches are proposed that target networks and behavioural settings and provide participants with socially meaningful and rewarding behavioural options that are consistent with valued prosocial identities or roles. Examples are presented on how such an approach has been utilized in prior HIV prevention interventions, including our social network-oriented intervention that trained disadvantaged former and current illicit drug users to conduct peer outreach. We describe how behavioural interventions may enhance or introduce new prosocial identities and social roles, and that network members may confer social approval to reinforce these identities and roles, leading to sustained behavioural risk reduction and changes in risk behaviour norms.     

Partner notification as a prevention strategy: a social system perspective

Provider referral and contact referral are two established means to provide notification of contagious, but treatable diseases, as has been done for tuberculosis and sexually transmitted diseases (e.g., syphilis). Because AIDS is at this time an incurable disease, programs of notification have proved highly controversial. The author examines recent adjustments to the New York State public health law regarding HIV/AIDS notification mechanisms. A literature review supports further discussion of ethical and partner notification issues as they bear on the perception and objections of various constituencies, stigmatization, and principles of confidentiality. Both U.S. and Swedish strategies to partner notification are outlined as well as why these schemes may not be interchangeable based on culture differences; points for general improvement are drawn from this comparison. A social system perspective based on the social functions of adaptation, goal attainment, integration, and latency (pattern maintenance) is introduced as a means to address the barriers inherent in HIV/AIDS notification programs and to enhance counseling programs--the objective being that knowledge and understanding of the patient's culture and social context can give providers additional tools with which to stop the spread of HIV/AIDS and bring people to treatment earlier.     

Community participation as an interactive learning process: experiences from a schistosomiasis control project in Zimbabwe

A schistosomiasis control project was undertaken from 1994 to 1998 in Guruve District, Zimbabwe, based on the active involvement of local communities in the growing and application of the molluscicidal plant Phytolacca dodecandra as a supplement to other control measures such as chemotherapy and health education. The berries of P. dodecandra are highly molluscicidal to the intermediate host snails of schistosomiasis and is rapidly degradable in water. It was observed that plant care fluctuated during the study period. Only a few households participated in snail control activities, although 97% of respondents in a baseline survey had stated a willingness to take part. This invoked an investigation to explore the reality from a user perspective. Focus group discussions, semi-structured interviews and observations were used to solicit information. In spite of a cultural inclination for collective work, many reasons for low-level involvement emerged, inter alia the low perceived value of the project, demands for tangible benefits, inaccessible fields and weak leadership. This study shows that community participation is a complex process upon which a multiplicity of social and cultural determinants have an impact. If community participation is to become successful in development programmes it ought to be viewed as a mutual learning process where obstacles are identified and discussed and solutions shared among community members and project staff.     

Lifestyle and prevention of cardiovascular disease in the elderly: an Italian perspective

The life span of human beings is partially influenced by genetic factors, but outcomes of aging are profoundly influenced by lifestyle and other environmental factors. Age-related modifications of the cardiovascular system are preserved by antiaging lifestyle interventions such as physical activity and caloric restriction. Accordingly, physical activity and low body mass index reduce mortality in older men with cardiovascular diseases. Several mechanisms have been proposed to explain the protective effect of lifestyle interventions against cardiovascular diseases in the elderly, including a reduction of vulnerability (i.e., the age-related reduction of endogenous mechanisms protective against pathologic insults). The age-related reduction of ischemic preconditioning, the most powerful endogenous protective mechanism against myocardial ischemia, is restored by both physical activity and caloric restriction. Thus, older persons can implement lifestyle practices that minimize their risk of death from cardiovascular diseases.     

Teaching pre-clinical medical students an integrated approach to medical interviewing: half-day workshops using actors

Teaching medical students to integrate patient-centered skills into the medical interview is challenging. Longitudinal training requires significant curricular and faculty time. Unsupervised students risk harm if they uncover and inappropriately manage psychosocial issues in actual patients. They fear saying the wrong thing in emotionally charged situations. Two half-day workshops for pre-clinical students integrate patient- and physician-centered interviewing. The first occurs early in the first year. The second, late in the second year, presents interview challenges (e.g., breaking bad news). Ten professional actors portray standardized patients (SPs). Groups of 10 to 15 students interview an SP, each eliciting a part of the patient's story. Qualitative evaluation revealed that, for many students, SPs afford the opportunity to experiment without harming real patients. Students view the workshops as effective (mean score for first-year students, 6.6 [standard deviation (SD), 1.0], second-year students, 7.1 [SD, 0.7] on a Likert-type scale: 1 = not at all effective to 8 = very effective).     

Community participation of the elderly Chicano: a model

The elderly Chicano comprise a population that is distinct in historical background, socialization patterns, coping mechanisms, and patterns of participation in community affairs. These distinctive characteristics have often been overlooked by community planners who know little about elderly Chicanos and assume that all their needs can be met by their families. Several strategies are proposed for the development of participatory processes and systems that take into account the reality of daily life in the barrio. Statistical data should be enriched by qualitative information for decision-making purposes: the calm rationality of one set of people discussing the problems of others should be balanced by the fire of people describing their own experiences.     

Osteoporosis: an updated approach to prevention and management

Osteoporosis is a major public health problem whose impact will only continue to increase in the United States. Current evidence indicates that estrogen therapy will prevent bone loss and reduce the incidence of fractures. The major problem is identification of those most at risk of fracture. Currently, risk factor assessment and bone mass measurement used in combination offer the closest approximation to the ideal, although it is not yet completely clear how good identification is. Together these estimates of risk need only be used for those about whom there is a question concerning the use of estrogen, and need not be used for patients who have either already decided to initiate preventive treatment or have decided not to start such a program.     

Dengue outbreak in Swat and Mansehra,Pakistan 2013;an epidemiological and diagnostic perspective

Objective:To High light some epidemiological,clinical and diagnostic features of dengue fever during an outbreak and the role of different diagnostic techniques to achieve the highest level of accuracy in results.Methods:Blood samples(n=323) were collected along with epidemiological and clinical data from suspected dengue patients who visited different hospitals in Swat and Mansehra district of Pakistan between May-November 2013 during a dengue outbreak.Samples were tested for the detection of viral nucleic acid by real-lime PCR.non structural protein-1(NS1antigen and IgM antibodies by ELISA.Results:Out of 323 cases with clinical dengue infection,304 were positive by one or more diagnostic parameter:201 samples were positive by real-time PCR,209 were positive by NS1 ELISA and 190 were positive by IgM antibodies.Sensitivities of real-time PCR and NS1 F.LISA were comparable for early diagnosis of dengue virus infection.IgM antibody detection assay was found useful for the diagnosis in the samples collected later than day 5 of onset.Conclusions:The use of real-lime PCR or detection of non stnictural protein NS 1 by ELISA followed by IgM antibodies detection can be recommended for early diagnosis of dengue virus infection with a high level of accuracy.     

Barriers to participation in the prevention of mother-to-child HIV transmission program in Gaborone, Botswana a qualitative approach

The existing belief that if money and free antiretroviral drugs were offered to developing countries, people would flock to use the services does seem to hold for the Prevention of Mother-to-Child Transmission of HIV Program (PMTCT) in Botswana. The government offers free counseling, testing, free antiretroviral drugs and free infant formula for babies born to infected mothers and yet some women are reluctant to enroll in this program to protect their infants. A qualitative study on factors that motivated and hindered pregnant women from participating in the PMTCT program was conducted in Gaborone, Botswana. Forty subjects (ten HIV-positive pregnant women who accepted the program, eleven who rejected the program, nine PMTCT health workers and ten key informants) participated in in-depth interviews. Thematic content analysis yielded the following barriers to participation in the program: fear of knowing one's own HIV status, infant feeding distribution stigma, lack of male partners' support and negative attitudes of health workers. Reinforcing factors were: availability of free antiretroviral drugs and free infant formula. In conclusion, stigma and discrimination are still the main impediments to women's participation in the PMTCT program. Mitigating these barriers could reduce AIDS-related infant mortality in this country.