Sexually transmitted diseases and native Americans: trends in reported gonorrhea and syphilis morbidity, 1984-88

Native Americans experienced higher reported gonorrhea and syphilis morbidity than did non-Native Americans from 1984 through 1988 in 13 States with large Native American populations. Gonorrhea rates among American Indians and Alaska Natives were approximately twice the rates for non-Indians. The highest gonorrhea rate was reported among Alaska Natives, with a 5-year average of 1,470 cases per 100,000, more than five times the average non-Native rate in Alaska. The average primary and secondary (P&S) syphilis rate from 1984 through 1988 was more than two times higher among Native Americans, largely due to high syphilis morbidity in Arizona and New Mexico. In Arizona the average American Indian P&S syphilis case rate was seven times higher than the non-Indian rate. True rates for sexually transmitted diseases (STD) among Native Americans may be higher than those reported due to racial misclassification of Native American cases, particularly in nonreservation areas. Improved recognition and reporting of STD cases among Native Americans are needed to target STD prevention and education more effectively.     

Strengthening public health nutrition research and training capacities in West Africa: Report of a planning workshop convened in Dakar, Senegal, 26-28 March 2009

A three-day workshop was convened in Dakar, Senegal, to provide participants from West African and international academic and research institutions, public health agencies, and donor organisations an opportunity to review current public health nutrition research and training capabilities in West Africa, assess needs for strengthening the regional institutional and workforce capacities, and discuss appropriate steps required to advance this agenda. The workshop included presentations of background papers, experiences of regional and international training programmes and small group discussions. Participants concluded that there is an urgent need to: (1) increase the throughput of public health nutrition training programmes, including undergraduate education, pre-service and in-service professional training, and higher education in public health nutrition and related research skills; and (2) enhance applied research capacity, to provide the evidence base necessary for nutrition program planning and evaluation. A Task Team was appointed to inform the regional Assembly of Health Ministers of the workshop conclusions and to develop political and financial support for a regional nutrition initiative to: (1) conduct advocacy and nutrition stewardship; (2) survey existing training programmes and assist with curriculum development; and (3) develop a plan for a regional applied research institute in Public Health Nutrition.     

Accelerating and Strengthening Native American Health Research Through a Collaborative NIH Initiative

This paper is intended to provide an overview of the considerations that informed the development of a National Institutes of Health funding opportunity to promote health and prevent disease in Native Americans, including American Indian, Alaska Native, and Native Hawaiian communities. NIH Institute staff thoughtfully considered epidemiologic research findings and feedback from constituents regarding the need for more published research overall and stronger prevention efforts to address persistent health concerns affecting many Native communities. This led to the publication of four funding announcements supported by multiple NIH Institutes and one NIH Office. Through the efforts of researchers, tribal leaders, community collaborators, and NIH leadership and staff, a growing body of knowledge regarding culturally informed approaches to supporting health in Native Americans is emerging. This article describes how staff who developed the funding opportunities envisioned a process to support high impact science through ensuring methodological rigor, responsiveness to prevention needs, and respect for community heritage, values, and history with non-Native peoples. In addition, this article highlights the growth of the researchers and collaborators within a community of scientists expanding the knowledge base further by sharing their research resources, instruments, and strategies for engaging in scientific inquiry that meets the needs of Native communities and those of funding organizations.

     

Continuing education on teaching skills for health professionals. Evaluation of training the trainers

Effective Patient Teaching (EPT), a health professions continuing education course, improves educators' teaching skills when presented by its developers. This study aimed to determine whether others could teach EPT with similar effectiveness. Four nurse managers who provide staff training and supervision for multiple hospital diabetes care units presented EPT to health care professionals at seven such sites; another seven served as controls. The evaluation included observations of trainers conducting EPT programs in the field, teaching skills ratings of health professionals in both groups, and knowledge test administered to patients. Six months after training, teaching skills scores of health professional EPT participants were better (p < .05) than controls. The EPT program improves participants' teaching skills and maintains these effects in field settings, when presented by faculty not involved in its development.     

Skills,knowledge, and abilities of graduates from accredited environmental health science and protection undergraduate programs

The National Environmental Health Science and Protection Accreditation Council (EHAC) has the mission of enhancing the education and training of students who intend to become environmental health science and protection practitioners/professionals. Academic programs that demonstrate compliance with EHAC guidelines can become accredited with the expectation that graduates of accredited programs will have the knowledge, skills, and abilities needed for professional success. The study reported on here reviewed these guidelines in light of results from a survey of program graduates and their supervisors. The survey results were found to establish that the current approach is quite successful, and that graduates of the programs have the potential to make substantial professional contributions in protecting environmental health.     

Smokeless tobacco use among Native American school children

Seven published and two unpublished surveys of Native American school children's use of smokeless tobacco (ST) are reviewed. The surveys represent school children in the States of South Dakota, Montana, Nebraska, Washington, Arizona, New Mexico, and Alaska. This review describes and discusses the survey methods, prevalence, duration, and intensity of ST use, and ST health effects documented in these studies. Prevalence of regular ST use ranges from 18 percent in kindergartners through 6th graders to 55.9 percent among 9th and 10th graders. In two studies that surveyed kindergartners, regular use was reported at 13 percent in one study and 21 percent in the other. Comparisons to use by non-Native Americans, as reported in surveys, demonstrate the severity of the problem in Native American communities. There appear to be three significant findings related to Native American ST use: (a) young age of onset of ST use, (b) similar prevalence of use among adolescent boys and girls, and (c) higher overall prevalence of ST use when compared to non-Native American populations. Acceptance of the habit, peer pressure, and addiction seem to be contributing to the high ST use in Native American communities.     

Ethnic variation in cholecystectomy rates and outcomes, Manitoba, Canada, 1972-84.

We used population-based data from the Province of Manitoba's universal health insurance plan to compare the cholecystectomy experience of Native Americans and non-Natives from 1972 to 1984. The age-adjusted cholecystectomy rates for Native females were higher than for non-Native females with the peak rate occurring at age 30-39 for Native Americans and at age 60-69 for non-Natives. The rates for males were three times lower than for females and did not differ between Natives and non-Natives. Native Americans were more likely readmitted to hospital for surgical complications than non-Natives and this held true after controlling for age, sex, rural versus urban residence, teaching versus non-teaching hospital, multiple discharge diagnoses or complex versus simple cholecystectomy (relative odds 1.46, 95 per cent confidence interval 1.17, 1.18). The explanation for the relatively high rates of cholecystectomy among Native American females may be related to high rates of known risk factors for gallstone disease (such as obesity and high parity). However, the higher rates of surgical complications require further study.     

Communication between Health Professionals and Community Residents in Fukushima: A Focus on the Feedback Loop

ABSTRACT

Interactive communication and the ability to consider feedback are critical for linking health professionals and the community. Goto and colleagues developed and conducted health literacy training workshops for public health nurses after the 2011 nuclear accident in Fukushima to improve their communication skills. The present study aimed to examine the association between past workshop attendance and nurses’ attitudes toward feedback from community residents. We conducted a questionnaire survey with 723 public health nurses in Fukushima and analyzed differences in feedback acceptance, work environment, basic characteristics, and health literacy levels between health literacy workshop attendees and non-attendees. Among 582 respondents, 19.4% were past attendees and showed a higher likelihood of accepting feedback from community residents (amount: adjusted odds ratio [aOR] = 1.87, 95% confidence interval [CI]: 1.21–2.88; specificity: aOR = 1.69, 95%CI: 1.09–2.61; satisfaction: aOR = 2.34, 95%CI: 1.50–3.65) than did non-attendees after adjusting for other variables. Furthermore, work engagement was associated with positive feedback acceptance (amount: aOR = 1.43, 95%CI: 1.03–1.98; specificity: aOR = 1.57, 95%CI: 1.12–2.20; satisfaction: aOR = 1.97, 95%CI: 1.38–2.81). We note the importance of creating a better work environment as well as a training system at the organizational level that encourages public health nurses to learn about health literacy and to improve their communication skills. This could improve professional/community relationships, increase the accessibility of health information for the public, and ultimately improve community health.     

Public health engineering education in India: current scenario, opportunities and challenges

Public health engineering can play an important and significant role in solving environmental health issues. In order to confront public health challenges emerging out of environmental problems we need adequately trained public health engineers / environmental engineers. Considering the current burden of disease attributable to environmental factors and expansion in scope of applications of public health / environmental engineering science, it is essential to understand the present scenario of teaching, training and capacity building programs in these areas. Against this background the present research was carried out to know the current teaching and training programs in public health engineering and related disciplines in India and to understand the potential opportunities and challenges available. A systematic, predefined approach was used to collect and assemble the data related to various teaching and training programs in public health engineering / environmental engineering in India. Public health engineering / environmental engineering education and training in the country is mainly offered through engineering institutions, as pre-service and in-service training. Pre-service programs include diploma, degree (graduate) and post-graduate courses affiliated to various state technical boards, institutes and universities, whereas in-service training is mainly provided by Government of India recognized engineering and public health training institutes. Though trainees of these programs acquire skills related to engineering sciences, they significantly lack in public health skills. The teaching and training of public health engineering / environmental engineering is limited as a part of public health programs (MD Community Medicine, MPH, DPH) in India. There is need for developing teaching and training of public health engineering or environmental engineering as an interdisciplinary subject. Public health institutes can play an important and significant role in this regard by engaging themselves in initiating specialized programs in this domain.     

Providing Comprehensive Sexual Health Care in Spinal Cord Injury Rehabilitation: Implementation and Evaluation of a New Curriculum for Health Care Professionals

A grant from the Paralyzed Veterans of America funded the development, implementation, and evaluation of a three-day interdisciplinary continuing education and training program in comprehensive sexual health care. The program was targeted toward health care professionals working in spinal cord injury (SCI) rehabilitation. The major goal of the program was to offer participants an opportunity to increase the knowledge, comfort, and skills necessary to understand and manage the sexual health care needs of people with SCI. The curriculum included clearly stated goals, behavioral objectives in operational terms, and multiple quantitative and qualitative program evaluations. In addition, the comprehensive curriculum incorporated extensive skills training including state-of-the-art standardized patient training techniques. Evaluation results indicated statistically significant and qualitatively important positive gains in knowledge, comfort, and skills. The five month follow-up study indicated that skills learned over the three-day workshop were successfully transferred to the work environment.     

Developing leaders in public health: the role of executive training programs

The growing complexity of the nation's health care system is creating new challenges and opportunities for public health officials, and a renewed concern for leadership training among these officials. A focus group conducted with public health officials at local, state, and national levels reveals perceptions about the predominant trends effecting public health practice, the leadership skills required for effective public health practice, and the strategies that are needed for providing appropriate leadership training to public health executives. Officials indicate that public health practice is undergoing substantial changes in response to the growth of managed care and integrated delivery systems, changes in public health funding sources and levels, and efforts to privatize the delivery of public health services. The skills identified as critical for effective leadership in this environment include the ability to guide organizational behavior and cultivate interorganizational relationships; apply scientific knowledge to public health problems, and build and sustain community coalitions. In light of these skills, public health officials identify four essential components of an optimally effective executive training program in public health leadership: exposure to the core scientific disciplines within public health; exposure to organization theory and management science; training in community development and empowerment; and training in ethics and social justice. All of the officials agree with the need for distance learning programs for executives in public health leadership, and most officials also support the need for doctoral-level training in public health practice.     

Extending Professional Education to Health Workers at Grass Root Level: An Experience from All India Institute of Medical Sciences,New Delhi

Background:

In India, the opportunities for professional education of the grass root level health workers are grossly inadequate. Capacity building of all categories of health workers is needed for enhancing health outcomes.

Objectives:

To plan and implement a professional development training program for all categories of allied health workers and to assess its outcomes in terms of knowledge and skills

Materials and Method:

We planned and organized a ‘one week’(15 h) training program for 10 categories of allied health workers (1260) working in our hospital. The program included nine generic skills/topics: the prestige of AIIMS, sterilization & infection control, universal precaution, biomedical waste management, public health, life style & healthy nutrition, fire safety, communication skills and office procedure besides subject specific skills. Trainers were drawn from 12 departments. Training methodology included interactive lectures, narratives, demonstrations, videos, PPT slides, and informal discussions with participants. The effectiveness of the program was judged on the basis of participants’ feedback, feedback from the supervisors, and our own observations post training.

Results:

Feedback from the participants and their supervisors after training was encouraging. The participants described training as a “life time experience”. The supervisors reported improvement in confidence, communication skills, and awareness of workers.

Conclusion:

The success of the program was due to the use of interactive methods, involvement of multidisciplinary team, and commitment from leadership. We recommend that professional education should be linked with career advancement. Academic institutions can play a key role in taking such initiatives.     

The Association of Health and Functional Status with Private and Public Religious Practice among Rural, Ethnically Diverse, Older Adults with Diabetes

PURPOSE: This analysis describes the association of health and functional status with private and public religious practice among ethnically diverse (African American, Native American, white) rural older adults with diabetes. METHODS: Data were collected using a population-based, cross-sectional, stratified, random sample survey of 701 community-dwelling elders with diabetes in two rural North Carolina counties. Outcome measures were private religious practice, church attendance, religious support provided, and religious support received. Correlates included religiosity, health and functional status, and personal characteristics. Statistical significance was assessed using multiple linear regression and logistic regression models. FINDINGS: These rural elders had high levels of religious belief, and private and public religious practice. Religiosity was associated with private and public religious practice. Health and functional status were not associated with private religious practice, but they were associated with public religious practice, such that those with limited functional status participated less in public religious practice. Ethnicity was associated with private religious practice: African Americans had higher levels of private religious practice than Native Americans or whites, while Native Americans had higher levels than whites. CONCLUSIONS: Variation in private religious practice among rural older adults is related to personal characteristics and religiosity, while public religious practice is related to physical health, functional status, and religiosity. Declining health may affect the social integration of rural older adults by limiting their ability to participate in a dominant social institution.     

Health knowledge of Native Indian youth in central Alberta.

This paper is the first report of health knowledge among Native Indian youth in central Alberta and, in the absence of comparable information for Native youth in other regions of Canada, provides a unique basis for comparison of the health knowledge of Native youth attending junior high school with that of non-Native young Canadians included in the Canada Health Knowledge Survey. The results of our survey of 229 Native Indian youth from seven different reserves in central Alberta indicate that a higher proportion of the Native youth were more knowledgeable about dental health, fire safety, and the effects of smoking, alcohol and drugs. However, they generally scored lower on items related to knowledge of first aid for burns, nutrition, communicable diseases, and personal health. Factors contributing to these differences and suggestions for future action are suggested on the basis that accurate information of this kind is essential for health promotion efforts directed toward reducing risky health behaviours and promoting healthier lifestyles among youth of Native Indian communities.     

Meeting the Training Needs of Aging Network Nutrition Program Professionals: Past,Present, and Future

Aging network nutrition professionals must continuously adapt knowledge and skills in order to maintain the provision of high quality, appropriate, and targeted services able to address the evolving demographic, home- and health care–needs of the older Americans of today and tomorrow. This evolution must be supported by ready access to contemporary training and technical assistance. Since the passage of the Older Americans Act in 1972, the Administration on Aging has provided a diverse and contemporary array of supportive program development modalities for aging network nutrition professionals, ranging from the establishment of nutrition training centers and institutes, to the formation of action learning collaboratives. A sustainable and broad funding base is needed to support the training needs of aging network professionals and assure their continued acquisition of the skills, knowledge, and business acumen needed to integrate food and nutrition services into home and community-based social, health, and long-term care systems.     

Through indigenous eyes: Native Americans and the HIV epidemic

This article examines the phenomenon of HIV within the context of a Native American culture. Native Americans have some risk factors for HIV transmission that differ from those found in other populations. In addition, prevention and intervention activities with this population must consider cultural variables to maximize their effectiveness. Brief anecdotes are used to illustrate various concepts related to HIV and Native Americans and to include a human face along with facts and statistics. The author's unique perspective, coupled with a broad discussion of relevant issues enables non-Native American readers to understand better the phenomenon of HIV as it exists within a Native American context.     

Planning the teaching of community health (COPC) in an MPH program

The Community Medicine approach, focussed on an active assessment of health status with a subsequent provision of health care directed to the community as a whole, is recommended today as a means for addressing the fragmentation of health services. In parallel, in recent years the Community Medicine approach has been incorporated in a growing number of health academic institutions. In this paper it is suggested that the teaching of Community Medicine should be an active process in a practical environmental in which students could be involved with real life situations. Our teaching methods are illustrated by the experience of the Community Oriented Primary Care (COPC) Workshop of the School of Public Health and Community Medicine in Jerusalem. This Workshop is included in the curriculum after the core courses in the Israeli and in the International MPH Program at the Braun SPH. The central component of the workshop are the workgroups of 6-8 students with the assistance of a tutor member of the School's staff. The group, resembling a health team, focussed its work in the assignment of planning a proposal for the development of a community health program in the students' communities. The workshop is an illustration of the problem-based learning method carried out by public health workers of different professions background and with diverse practical experience reproducing a real life situation in a classroom environment. Repeated evaluations done by students has shown a positive assessment as measured by a reported adequate acquisition of knowledge, having an useful experience and practicing skills.     

Reconciling pedagogy and health sciences to promote indigenous health

OBJECTIVES: To increase knowledge and skills regarding Indigenous learning styles. To raise awareness within the tertiary education sector that Aboriginal students learn differently and that Indigenous cultures and pedagogy have validity and strength. To examine pedagogical strategies that assist both tertiary students capacity for learning and university lecturers' delivery and evaluation of teaching and learning strategies. METHODS: A qualitative, ethnographic framework using personal observations, field and classroom experience, interviews and review of literature in the fields of education, public health and Indigenous cultural perspectives. RESULTS: Aboriginal people are the receivers of services and programs that will be delivered, in the majority of cases, by university-educated, non-Aboriginal, professional health care providers. Indigenous students face specific challenges in obtaining an effective education for working in the Aboriginal and wider community in the field of public health; the challenges relate to culture, health paradigms and community. CONCLUSION: Lecturers in health and human science courses for Aboriginal students need to both examine and appreciate the cultural constraints on learning faced by their students within the context of mainstream curriculum, and to build on the large pool of knowledge and learning styles that Aboriginal society bequeaths to Aboriginal students. IMPLICATIONS: Academics can apply the cultural differences and knowledge base of the Indigenous community as a force to promote health through learning.     

Effects of health facilitator performance and attendance at training sessions on the acquisition of tobacco refusal skills among multi-ethnic, high-risk adolescents

The study examined the effectiveness of a psycho-social tobacco use prevention intervention with a refusal skills training component on the refusal skills of high-risk adolescents, and investigated skill acquisition as related to subject demographics, performance of health facilitators and attendance at skills training sessions. Tobacco refusal skills were assessed for a group (n = 389) of high-risk, seventh-grade students participating as intervention and control subjects in Project SHOUT, a large tobacco use prevention program in the San Diego area. In addition, subject demographics, ratings of health facilitator performance and information about subjects' attendance at skills training sessions were collected. Subjects' responses to audiotaped peer offers of cigarettes and smokeless tobacco were coded for content and quality. Greater tobacco refusal skills among intervention subjects was hypothesized. Further health facilitator performance, attendance at training sessions and subject demographics were thought to be related to skill acquisition. High-risk intervention subjects gave significantly higher quality tobacco-refusal responses than did controls, although the differences between means were small. Results suggested that Hispanic adolescents were particularly receptive to the refusal skills training. The association between health facilitator performance and skill acquisition varied by subject ethnicity, as did the relationship between attendance at training sessions and skill acquisition.     

延安基层卫计医务人员优生知识技能现状及参与式教学效果分析

目的：调查陕西省延安市基层卫计医务人员优生相关知识与技能现状,分析参与式教学的效果,为进一步指导优生评估和有效预防出生缺陷提供科学依据。方法2015年10月,随机抽取延安市各区县及乡镇63名基层卫计医务人员进行优生相关知识技能的现状基线调查,之后采用参与式教学方法（ PTM）进行优生知识技能教学培训。教学后统一采用10分制不记名自填式问卷进行效果评估。结果延安市基层卫计医务人员优生知识技能掌握程度欠缺,授课前平均得分仅（5．1±1．7）分,对“预防出生缺陷的个体化营养素补充”、“药物对妊娠的危险性分级”、“神经管缺陷发生的关键时期”的知晓率最低,分别为7．9％、11．1％、31．7％;卫计人员的年龄、职称、服务机构、专业年限与其优生知识技能得分均显著相关（r1＝0．258,r2＝0．427,r3＝0．353,r4＝0．260,均P＜0．05）,且高年龄、高职称水平和县区级服务机构卫计人员总的知识技能水平高于低年龄、低职称及乡镇级技术人员。参与式教学后,平均得分为（8．8±1．5）分,比教学前增高3．7分,显著高于教学前（t＝13．112,P＜0．001）,且总得分6分以上的比率显著增高（93．6％vs．23．8％,χ2＝66．706,P＜0．001）。 PTM教学干预突破了教学前年龄、职称、专业年限与优生知识技能得分的关联,转变为教学后的无显著性相关（r1后＝－0．208,r2后＝－0．222,r4后＝－0．162,均P＞0．05）,从而全面提高了各类学员的知识技能水平。结论延安市基层卫计医务人员对优生相关知识与技能操作知晓率普遍较低,参与式优生教学效果显著,可明显提高其专业知识技能水平,应持续在基层卫计医务人员培训中推广使用。