Validation of the primary care alcohol severity measure

Alcohol-related disorders are common in primary care settings; many primary care physicians are ill-equipped to manage patients with alcohol-related disorders. The objective of this prospective cohort study was to develop and validate a patient-based measure, the Primary Care Alcohol Severity Measure, to determine which primary care patients with alcohol-related disorders would benefit from referral to alcohol treatment services. Four Boston-area Department of Veterans Affairs ambulatory care clinics were chosen as study sites. Two hundred seventy-eight male patients, mean age 55.5 years, 89.9% Caucasian, 42.5% married, all with CAGE Questionnaire scores greater than or equal to 2 and drinking within past year, participated in the study. We developed a multidimensional, 30-item measure that contained 2 subscales that assessed 2 symptom clusters of alcohol-related disorders: Physical and Behavioral. Each subscale's score was higher (more severe) for patients with a current Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised diagnosis of alcohol dependence or abuse: P < .01 for the physical subscale and P < .0001 for the behavioral subscale. Patients with more physical symptoms had poorer physical and mental health status, whereas patients with more behavioral symptoms had poorer mental health status. Scores on the 2 subscales, along with age and history of prior treatment, predicted the use of alcohol treatment services in the following year: c = 0.90 in logistic regression. The Primary Care Alcohol Severity Measure is a valid measure of alcohol severity in primary care patients and predicts the use of alcohol treatment services. It is relatively brief and easy to use, requiring only standard medical history items and patient reports of behavioral symptoms. It may be a useful tool to improve the quality of care for primary care patients with alcohol-related disorders.     

Improving neonatal health in South-East Asia

The countries in South-east Asia have wide disparities in socio-economic and health indicators. This region accounts for almost one-third of global mortality in neonates and children under 5 years of age, and many countries in the region are unlikely to attain Millennium Development Goal 4. Over the past decade, several countries have initiated innovative projects with the aim of improving child health. This paper examines the innovations in neonatal health in four countries--Bangladesh, India, Sri Lanka and Thailand--and analyses the extent to which these have been successful in meeting their goals. This case study will inform national governments and donor agencies wishing to scale up or modify existing neonatal health interventions.     

Public health in South-East Asia in the 21st century

This paper presents the proceedings of the Regional Conference on Public Health in Southeast Asia in the 21st Century, held in Calcutta, India, on November 22-24, 1999. Organized by the WHO, the conference reviewed the progress in Public Health education and training, practice and research in the countries of the region. Discussions were focused on the quality of the Schools of Public Health, professional capacities, societal commitment, shrinking resources for health and the resultant need for greater efficiency of interventions and the realization of national Public Health goals. It also stressed the importance of Public Health for national, socioeconomic and political development. Moreover, the participants identified key strategies and initiatives for strengthening Public Health in the region. These measures include focusing on the promotion of health in all settings; social mobilization and community action; strengthening the scientific and ethical foundation for evidence-based policy formulation in Public Health; and the creation of an Executive Management Team.     

Mosquito-borne haemorrhagic fevers of South and South-East Asia

During the past decade outbreaks of a severe haemorrhagic disease caused by dengue viruses of multiple types have been reported in the Philippines, Thailand, Malaysia, Viet-Nam and eastern India. In many of these outbreaks chikungunya virus, a group A arbovirus, was simultaneously the cause of similar but probably milder disease. Both these viruses appear to be able to be able to produce classical dengue fever in some individuals and disease with haemorrhagic manifestations in others. Because of the growing public health importance and the progressive spread of this disease a unified review of its clinical and epidemiological features has been needed. This paper presents the history and salient clinical features of mosquito-borne haemorrhagic fever and summarizes recent epidemiological studies and current diagnostic and control methods.     

Hepatitis A shifting epidemiology in South-East Asia and China

A review of the epidemiology of hepatitis A virus (HAV) infection over the last 20 years shows shifting patterns in the prevalence of antibodies to HAV (anti-HAV) throughout South-East Asia and China. A number of countries have shifted from high to moderate and from moderate to low endemicity, with a corresponding increase in the age of exposure from childhood to early adulthood. The changes have resulted from improvements in hygiene, sanitation and the quality of drinking water, reflecting improvements in living standards and socioeconomic progress. In general in the late 1970s and early 1980s, 85-95% of the population of developing countries like the Philippines, Korea, China and Thailand were anti-HAV-positive by age 10-15 years, compared with only about 50% in the more affluent countries like Malaysia and Singapore. In the early 1990s, 85-95% of the population were immune by age 30-40 years in the Philippines, Korea, China and Thailand, and by 50 years of age and above in Malaysia and Singapore. Similar trends were noted in Hong Kong, Taiwan and Japan. Exposure to HAV at a later age may be associated with an increase in hepatitis A morbidity and a greater propensity for outbreaks.     

Monitoring the progress of health-for-all strategies: the situation in South-East Asia

Analysis of the results of the recent monitoring and evaluation of the HFA strategies of the 11 countries in WHO's South-East Asia Region shows that, in most cases, the process adopted for implementing the strategy has been the extension of coverage by health services operated by trained personnel. This process has not necessarily resulted in the equitable provision of health care, since it does not take into account the widely varying needs of different population groups within a country. For example, the infant mortality rate (IMR) for India was 96 per 1,000 live births (1986), but state-by-state analysis shows that the range by state is from 27 to 132. The figure for urban IMR at the national level is 62, compared to 105 for rural areas. Similarly, the IMR of 28.4 for Sri Lanka (1983) obscures extremes of variation between districts of 10.2-51.5. The health needs of disadvantaged areas or population groups can only be met in collecting and analysing data at lower levels than the national. This should not be difficult or expensive to achieve through suitable reorientation of peripheral and intermediate-level personnel. Improvements in the collection of data on some of the global indicators are documented by tables showing reported levels of coverage with maternal and child health care in 1983 (first monitoring), 1985 (first evaluation) and 1988 (second monitoring). Obtaining data on the birthweight of newborns appears to be difficult for some countries, and it is suggested that this indicator be replaced by one that asks whether the baby is healthy or not.(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV / AIDS in South-East Asia: an update

As of July 1, 1996, 1,393,649 cumulative AIDS cases in adults and children had been reported to the World Health Organization (WHO) from 193 countries since the beginning of the pandemic. HIV infection is a serious public health and developmental problem in southeast Asia, with the WHO estimating more than 3.7 million people to be infected with HIV in the region. This infection extends into the general population and is not confined among people who practice high risk behaviors. As of July 1, 1996, Thailand, India, and Myanmar had reported the largest number of AIDS cases: 41,230, 2940, and 1093, respectively. However, WHO estimates that 2.5 million people are actually infected in India, 800,000 in Thailand, 350,000 in Myanmar, and 95,000 in Indonesia. While Bhutan and North Korea have not yet reported AIDS cases, people in Bhutan have been diagnosed with HIV infection. The health and socioeconomic impact of HIV/AIDS, national plans and programs, the 100% condom use program in Thailand, peer education among sex workers in Calcutta, WHO support for country responses, advocacy and support, promoting appropriate HIV prevention strategies and interventions, HIV/AIDS care as part of primary health care, HIV/AIDS and STD surveillance, and the future role of WHO are discussed.