How Does Taking Part in a Community Allotment Group Affect the Everyday Lives, Self Perception and Social Inclusion of Participants
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
About Geography of Health: Reflections on Concepts & Relevant Techniques by D...Priyanka_vshukla
Presentation on About Geography of Health: Reflections on Concepts & Relevant Techniques by Dr. Smita Gandhi during Seminar on Spatial Dimensions on Health Care - Use of GIS in Health Studies Organised by CEHAT and University of Mumbai on 24th Sep 2010
Health related quality of life and multimorbidity in community-dwellingAlfredo Alday
Introduction
Multimorbidity is more common in the elderly population and negatively affects health-related quality of life (QoL). The aims of the study were to report the QoL of users of the Basque telecare public service (BTPS) and to establish its relationship with multimorbidity.
Methods
The EuroQol questionnaire was administered to 1125 users of the service. Their sociodemographic and healthcare characteristics were obtained from BTPS databases and the Basque healthcare service. Multiple regression analysis was performed on the overall questionnaire index to determine the effect of chronic diseases and sociodemographic. Moreover, the effects of the different diseases on specific dimensions of the test were explored by logistic regression.
Results
Of the users interviewed, 82% were women, 88% ≥75 years and 66% lived alone. The average of chronic pathologies was higher among men (5.3 vs. 4.6), for the lower age range and among those not living alone (P < 0.001).>< 0.001).
Conclusions
This study reveals that for the population covered by BTPS the impact of chronic pathologies, multimorbidity and their social context affects QoL very diversely. These diverse social and healthcare needs of community-dwelling elders allow the development and implementation of personalised services, such as telecare that facilitate them to remain at home.
How Does Taking Part in a Community Allotment Group Affect the Everyday Lives, Self Perception and Social Inclusion of Participants
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
About Geography of Health: Reflections on Concepts & Relevant Techniques by D...Priyanka_vshukla
Presentation on About Geography of Health: Reflections on Concepts & Relevant Techniques by Dr. Smita Gandhi during Seminar on Spatial Dimensions on Health Care - Use of GIS in Health Studies Organised by CEHAT and University of Mumbai on 24th Sep 2010
Health related quality of life and multimorbidity in community-dwellingAlfredo Alday
Introduction
Multimorbidity is more common in the elderly population and negatively affects health-related quality of life (QoL). The aims of the study were to report the QoL of users of the Basque telecare public service (BTPS) and to establish its relationship with multimorbidity.
Methods
The EuroQol questionnaire was administered to 1125 users of the service. Their sociodemographic and healthcare characteristics were obtained from BTPS databases and the Basque healthcare service. Multiple regression analysis was performed on the overall questionnaire index to determine the effect of chronic diseases and sociodemographic. Moreover, the effects of the different diseases on specific dimensions of the test were explored by logistic regression.
Results
Of the users interviewed, 82% were women, 88% ≥75 years and 66% lived alone. The average of chronic pathologies was higher among men (5.3 vs. 4.6), for the lower age range and among those not living alone (P < 0.001).>< 0.001).
Conclusions
This study reveals that for the population covered by BTPS the impact of chronic pathologies, multimorbidity and their social context affects QoL very diversely. These diverse social and healthcare needs of community-dwelling elders allow the development and implementation of personalised services, such as telecare that facilitate them to remain at home.
The first of a series of state-of-the-art reviews commissioned to mark Disasters’ 21st anniversary, this paper considers key publications on public health aspects of natural disasters, refugee emergencies and complex humanitarian disasters over the past twenty-odd years. The literature is reviewed and important signposts highlighted showing how the field has developed. This expanding body of epidemiological research has provided a basis for increasingly effective prevention and intervention strategies.
GRF One Health Summit 2012, Davos: Presentation by Andrea Meisser, IEMT-Switzerland, Institute for interdisciplinary research on human-animal relations, Zurich
Series294 www.thelancet.com Vol 380 July 21, 2012L.docxklinda1
Series
294 www.thelancet.com Vol 380 July 21, 2012
Lancet 2012; 380: 294–305
Published Online
July 18, 2012
http://dx.doi.org/10.1016/
S0140-6736(12)60898-8
This is the fi fth in a Series of
fi ve papers about physical activity
*Members listed at end of paper
University of Texas Health
Science Center, Houston School
of Public Health, and University
of Texas at Austin Department
of Kinesiology and Health
Education, Austin, TX, USA
(Prof H W Kohl 3rd PhD);
Canadian Fitness and Lifestyle
Research Institute, Ottawa, ON,
Canada, and School of Public
Health, University of Sydney,
Sydney, NSW, Australia
(C L Craig MSc); UCT/MRC
Research Unit for Exercise
Science and Sports Medicine,
Department of Human Biology,
Faculty of Health Sciences,
University of Cape Town, Cape
Town, South Africa
(Prof E V Lambert PhD); Tokyo
Medical University, Department
of Preventive Medicine and
Physical Activity 5
The pandemic of physical inactivity: global action for
public health
Harold W Kohl 3rd, Cora Lynn Craig, Estelle Victoria Lambert, Shigeru Inoue, Jasem Ramadan Alkandari, Grit Leetongin, Sonja Kahlmeier, for the
Lancet Physical Activity Series Working Group*
Physical inactivity is the fourth leading cause of death worldwide. We summarise present global eff orts to counteract
this problem and point the way forward to address the pandemic of physical inactivity. Although evidence for the
benefi ts of physical activity for health has been available since the 1950s, promotion to improve the health of populations
has lagged in relation to the available evidence and has only recently developed an identifi able infrastructure, including
eff orts in planning, policy, leadership and advocacy, workforce training and development, and monitoring and
surveillance. The reasons for this late start are myriad, multifactorial, and complex. This infrastructure should continue
to be formed, intersectoral approaches are essential to advance, and advocacy remains a key pillar. Although there is a
need to build global capacity based on the present foundations, a systems approach that focuses on populations and
the complex interactions among the correlates of physical inactivity, rather than solely a behavioural science approach
focusing on individuals, is the way forward to increase physical activity worldwide.
The pandemic of physical inactivity should be a
public health priority
Theoretically, prioritisation for public health action is
informed largely by three factors: the prevalence and
trends of a health disorder; the magnitude of the risk
associated with exposure to that disorder; and evidence
for eff ective prevention and control. A practice or
behaviour that is clearly related to a health disorder, is
prevalent, and is static or increasing in its prevalence
should be a primary target for public health policy for
disease prevention and health promotion. Too often,
however, the inertia of tradition, pressure .
One Health: A Holistic Approach to Achieving Global Well-beinggreendigital
Introduction:
In an interconnected world where the boundaries between humans, and animals. and the environment blurred. One Health has emerged as a comprehensive approach to addressing complex health challenges. One Health recognizes the intricate connections between the Health of humans and animals. and ecosystems, emphasizing the need for collaborative efforts across disciplines to achieve optimal well-being for all. This article delves into the fundamental principles of It, and its historical roots. and its potential to revolutionize the way we approach global Health.
Follow us on: Pinterest
Understanding One Health:
A- Definition and Scope:
It is an integrative approach that considers the Health of humans, animals. and the environment as interdependent entities. It acknowledges that the Health of one component influences the Health of the others. and disruptions in any of these systems can have far-reaching consequences. This approach goes beyond traditional silos in health management. and embraces a holistic perspective. recognizing the intricate web of connections that shape our Health.
B- Historical Roots:
The roots of the It concept can traced back to ancient civilizations. where the interconnectedness of human and animal health acknowledged. But, the formal recognition of It as a distinct field gained momentum in the late 20th century. The emergence of zoonotic diseases transmitted between animals. and humans highlighted the need for a collaborative approach to disease prevention and control.
Key Principles of One Health:
A- Interdisciplinary Collaboration:
At the heart of It is interdisciplinary collaboration. This principle involves breaking down the traditional barriers between medical, veterinary. and environmental sciences. Professionals from various fields work together to understand the complex dynamics of Health. and to develop effective strategies for prevention, surveillance, and response to emerging threats.
B- Zoonotic Disease Surveillance:
Given the increasing frequency of zoonotic disease outbreaks. It emphasizes surveillance and early detection. Monitoring diseases at the human-animal-environment interface is crucial for identifying potential threats before. they escalate into global pandemics. This proactive approach involves close collaboration between public health agencies. veterinary services, and environmental monitoring bodies.
C- Environmental Stewardship:
It recognizes the impact of environmental degradation on Health. Climate change, deforestation, and pollution can exacerbate the spread of diseases. affect water and food sources, and compromise the well-being of ecosystems. Integrating environmental stewardship into health policies is essential for safeguarding the Health of present and future generations.
Examples of One Health in Action:
A- Pandemic Preparedness:
The ongoing COVID-19 pandemic has underscored the importance of a It approach. The virus, believed to have originated in bats.
“The Experimental Child”: Child, Family & Community Impacts of the Coronaviru...Université de Montréal
Abstract
Not only is the coronavirus crisis a natural laboratory of stress offering health and social care services a unique historical opportunity to observe its impact on entire populations around the world, but the responses to the crisis by international health authorities, such as the WHO, along with national and local educational institutions and health care and social services, are creating an unprecedented and unpredictable environment for children and youth. This hostile new environment for growth and development is marked by the sudden and unpredictable imposition of confinement and social isolation, cutting off or limiting opportunities for the development of cognitive abilities, peer relationships, and social skills, while exposing vulnerable children and youth to depriving, negligent, or even abusive home environments.
For this reason, this crisis has been renamed a syndemic, encompassing two different categories of disease—an infectious disease (SARS-CoV-2) and an array of non-communicable diseases (NCDs). Together, these conditions cluster within specific populations following deeply-embedded patterns of inequality and vulnerability (Horton, 2020). These pre-existing fault lines of inequity, poverty, mental illness, racism, ableism, ageism create stigma and discrimination and amplify the impacts of this syndemic. And children are the most vulnerable population around the world. The impact on children is part of a cascade of consequences affecting societies at large, smaller communities, and the multigenerational family, all of which impinge on children and youth as the lowest common denominator (Di Nicola & Daly, 2020).
This exceptional set of circumstances—in response not only to the biomedical and populational health aspects but also in constructing policies for entire societies—is creating an “experimental childhood” for billions of children and youth around the world. With its commitment to the social determinants of health and mental health, notably in light of the monumental Adverse Childhood Events (ACE) studies (Felitti & Anda, 2010), social psychiatry and global mental health in partner with child and family psychiatry and allied professions must now consider their roles for the future of these “experimental children” around the world. The parameters for observing the conditions of this coronavirus-induced syndemic in the family and in society, along with recommendations for social psychiatric interventions, and prospective paediatric, psychological, and social studies will be outlined.
Keywords: Children & families, COVID-19, syndemic, ACE Study, confinement, social isolation
OUTBREAK INVESTIGATION 1
OUTBREAK INVESTIGATION 2
Outbreak Investigation
Introduction
Epidemiology deals with the study of the determinants and distribution of disability or disease in the population groups (Szklo & Nieto, 2014). Epidemiology is one of the core areas in public health study and is essential for the evaluation of the efficacy of the new therapeutic and preventive modalities as well in the new organizational health care delivery patterns. I have for a long time developed a lot of interest in the area towards learning more on finding the causes of diseases and health outcomes in populations. Epidemiology views the individuals collectively, and the community is considered to be patient. The area of public health study is systematic, scientific, and data-driven in analyzing the pattern or frequency of the distributions and the risk factors or causes of specific diseases in the neighborhood, city, school, country, and global levels. Epidemiology handles various areas including environmental exposures, infectious diseases, injuries, non-infectious diseases, natural disasters and terrorism (Szklo & Nieto, 2014). Specifically, this paper explores epidemiology in addressing infectious disease, food-borne illness in the community. Also, the paper examines outbreak investigations as an intervention towards addressing the foodborne illness in the society. Further, an evaluation of the intervention and the expected results are discussed to examine or analyze the contributions of the intervention.
Foodborne Illness
Foodborne illness is any illness that results from food spoilage of the contaminated food. Food can be contaminated by the pathogenic bacteria, contaminated food, parasites, or viruses, as well as natural or chemical toxins including several species of beans, and poisonous mushrooms. In the United States, food-borne illness is estimated to impact negatively over 76 million people annually (Jones, McMillian, Scallan et al., 2007). This is translated to 5,2000 deaths, and 325,000 hospitalizations. However, the true incidence of food-borne illness is unknown. The majority of food-borne illness and most of the deaths are linked to “unknown agents” following the difficulties encountered in the diagnosis a foodborne disease. An estimated $7 billion is lost regarding productivity and medical expenses and is attributed to the most prevalent but diagnosable foodborne illnesses. Comment by Vetter-Smith, Molly J: Reference needed for this statement Comment by Vetter-Smith, Molly J: References needed for these statements
The under diagnosis in foodborne illnesses is further contributed by the majority who has the symptoms and signs of the disease but totally fail to seek medical attention. This circumstance coupled with the global and national distribution of foo.
The first of a series of state-of-the-art reviews commissioned to mark Disasters’ 21st anniversary, this paper considers key publications on public health aspects of natural disasters, refugee emergencies and complex humanitarian disasters over the past twenty-odd years. The literature is reviewed and important signposts highlighted showing how the field has developed. This expanding body of epidemiological research has provided a basis for increasingly effective prevention and intervention strategies.
GRF One Health Summit 2012, Davos: Presentation by Andrea Meisser, IEMT-Switzerland, Institute for interdisciplinary research on human-animal relations, Zurich
Series294 www.thelancet.com Vol 380 July 21, 2012L.docxklinda1
Series
294 www.thelancet.com Vol 380 July 21, 2012
Lancet 2012; 380: 294–305
Published Online
July 18, 2012
http://dx.doi.org/10.1016/
S0140-6736(12)60898-8
This is the fi fth in a Series of
fi ve papers about physical activity
*Members listed at end of paper
University of Texas Health
Science Center, Houston School
of Public Health, and University
of Texas at Austin Department
of Kinesiology and Health
Education, Austin, TX, USA
(Prof H W Kohl 3rd PhD);
Canadian Fitness and Lifestyle
Research Institute, Ottawa, ON,
Canada, and School of Public
Health, University of Sydney,
Sydney, NSW, Australia
(C L Craig MSc); UCT/MRC
Research Unit for Exercise
Science and Sports Medicine,
Department of Human Biology,
Faculty of Health Sciences,
University of Cape Town, Cape
Town, South Africa
(Prof E V Lambert PhD); Tokyo
Medical University, Department
of Preventive Medicine and
Physical Activity 5
The pandemic of physical inactivity: global action for
public health
Harold W Kohl 3rd, Cora Lynn Craig, Estelle Victoria Lambert, Shigeru Inoue, Jasem Ramadan Alkandari, Grit Leetongin, Sonja Kahlmeier, for the
Lancet Physical Activity Series Working Group*
Physical inactivity is the fourth leading cause of death worldwide. We summarise present global eff orts to counteract
this problem and point the way forward to address the pandemic of physical inactivity. Although evidence for the
benefi ts of physical activity for health has been available since the 1950s, promotion to improve the health of populations
has lagged in relation to the available evidence and has only recently developed an identifi able infrastructure, including
eff orts in planning, policy, leadership and advocacy, workforce training and development, and monitoring and
surveillance. The reasons for this late start are myriad, multifactorial, and complex. This infrastructure should continue
to be formed, intersectoral approaches are essential to advance, and advocacy remains a key pillar. Although there is a
need to build global capacity based on the present foundations, a systems approach that focuses on populations and
the complex interactions among the correlates of physical inactivity, rather than solely a behavioural science approach
focusing on individuals, is the way forward to increase physical activity worldwide.
The pandemic of physical inactivity should be a
public health priority
Theoretically, prioritisation for public health action is
informed largely by three factors: the prevalence and
trends of a health disorder; the magnitude of the risk
associated with exposure to that disorder; and evidence
for eff ective prevention and control. A practice or
behaviour that is clearly related to a health disorder, is
prevalent, and is static or increasing in its prevalence
should be a primary target for public health policy for
disease prevention and health promotion. Too often,
however, the inertia of tradition, pressure .
One Health: A Holistic Approach to Achieving Global Well-beinggreendigital
Introduction:
In an interconnected world where the boundaries between humans, and animals. and the environment blurred. One Health has emerged as a comprehensive approach to addressing complex health challenges. One Health recognizes the intricate connections between the Health of humans and animals. and ecosystems, emphasizing the need for collaborative efforts across disciplines to achieve optimal well-being for all. This article delves into the fundamental principles of It, and its historical roots. and its potential to revolutionize the way we approach global Health.
Follow us on: Pinterest
Understanding One Health:
A- Definition and Scope:
It is an integrative approach that considers the Health of humans, animals. and the environment as interdependent entities. It acknowledges that the Health of one component influences the Health of the others. and disruptions in any of these systems can have far-reaching consequences. This approach goes beyond traditional silos in health management. and embraces a holistic perspective. recognizing the intricate web of connections that shape our Health.
B- Historical Roots:
The roots of the It concept can traced back to ancient civilizations. where the interconnectedness of human and animal health acknowledged. But, the formal recognition of It as a distinct field gained momentum in the late 20th century. The emergence of zoonotic diseases transmitted between animals. and humans highlighted the need for a collaborative approach to disease prevention and control.
Key Principles of One Health:
A- Interdisciplinary Collaboration:
At the heart of It is interdisciplinary collaboration. This principle involves breaking down the traditional barriers between medical, veterinary. and environmental sciences. Professionals from various fields work together to understand the complex dynamics of Health. and to develop effective strategies for prevention, surveillance, and response to emerging threats.
B- Zoonotic Disease Surveillance:
Given the increasing frequency of zoonotic disease outbreaks. It emphasizes surveillance and early detection. Monitoring diseases at the human-animal-environment interface is crucial for identifying potential threats before. they escalate into global pandemics. This proactive approach involves close collaboration between public health agencies. veterinary services, and environmental monitoring bodies.
C- Environmental Stewardship:
It recognizes the impact of environmental degradation on Health. Climate change, deforestation, and pollution can exacerbate the spread of diseases. affect water and food sources, and compromise the well-being of ecosystems. Integrating environmental stewardship into health policies is essential for safeguarding the Health of present and future generations.
Examples of One Health in Action:
A- Pandemic Preparedness:
The ongoing COVID-19 pandemic has underscored the importance of a It approach. The virus, believed to have originated in bats.
“The Experimental Child”: Child, Family & Community Impacts of the Coronaviru...Université de Montréal
Abstract
Not only is the coronavirus crisis a natural laboratory of stress offering health and social care services a unique historical opportunity to observe its impact on entire populations around the world, but the responses to the crisis by international health authorities, such as the WHO, along with national and local educational institutions and health care and social services, are creating an unprecedented and unpredictable environment for children and youth. This hostile new environment for growth and development is marked by the sudden and unpredictable imposition of confinement and social isolation, cutting off or limiting opportunities for the development of cognitive abilities, peer relationships, and social skills, while exposing vulnerable children and youth to depriving, negligent, or even abusive home environments.
For this reason, this crisis has been renamed a syndemic, encompassing two different categories of disease—an infectious disease (SARS-CoV-2) and an array of non-communicable diseases (NCDs). Together, these conditions cluster within specific populations following deeply-embedded patterns of inequality and vulnerability (Horton, 2020). These pre-existing fault lines of inequity, poverty, mental illness, racism, ableism, ageism create stigma and discrimination and amplify the impacts of this syndemic. And children are the most vulnerable population around the world. The impact on children is part of a cascade of consequences affecting societies at large, smaller communities, and the multigenerational family, all of which impinge on children and youth as the lowest common denominator (Di Nicola & Daly, 2020).
This exceptional set of circumstances—in response not only to the biomedical and populational health aspects but also in constructing policies for entire societies—is creating an “experimental childhood” for billions of children and youth around the world. With its commitment to the social determinants of health and mental health, notably in light of the monumental Adverse Childhood Events (ACE) studies (Felitti & Anda, 2010), social psychiatry and global mental health in partner with child and family psychiatry and allied professions must now consider their roles for the future of these “experimental children” around the world. The parameters for observing the conditions of this coronavirus-induced syndemic in the family and in society, along with recommendations for social psychiatric interventions, and prospective paediatric, psychological, and social studies will be outlined.
Keywords: Children & families, COVID-19, syndemic, ACE Study, confinement, social isolation
OUTBREAK INVESTIGATION 1
OUTBREAK INVESTIGATION 2
Outbreak Investigation
Introduction
Epidemiology deals with the study of the determinants and distribution of disability or disease in the population groups (Szklo & Nieto, 2014). Epidemiology is one of the core areas in public health study and is essential for the evaluation of the efficacy of the new therapeutic and preventive modalities as well in the new organizational health care delivery patterns. I have for a long time developed a lot of interest in the area towards learning more on finding the causes of diseases and health outcomes in populations. Epidemiology views the individuals collectively, and the community is considered to be patient. The area of public health study is systematic, scientific, and data-driven in analyzing the pattern or frequency of the distributions and the risk factors or causes of specific diseases in the neighborhood, city, school, country, and global levels. Epidemiology handles various areas including environmental exposures, infectious diseases, injuries, non-infectious diseases, natural disasters and terrorism (Szklo & Nieto, 2014). Specifically, this paper explores epidemiology in addressing infectious disease, food-borne illness in the community. Also, the paper examines outbreak investigations as an intervention towards addressing the foodborne illness in the society. Further, an evaluation of the intervention and the expected results are discussed to examine or analyze the contributions of the intervention.
Foodborne Illness
Foodborne illness is any illness that results from food spoilage of the contaminated food. Food can be contaminated by the pathogenic bacteria, contaminated food, parasites, or viruses, as well as natural or chemical toxins including several species of beans, and poisonous mushrooms. In the United States, food-borne illness is estimated to impact negatively over 76 million people annually (Jones, McMillian, Scallan et al., 2007). This is translated to 5,2000 deaths, and 325,000 hospitalizations. However, the true incidence of food-borne illness is unknown. The majority of food-borne illness and most of the deaths are linked to “unknown agents” following the difficulties encountered in the diagnosis a foodborne disease. An estimated $7 billion is lost regarding productivity and medical expenses and is attributed to the most prevalent but diagnosable foodborne illnesses. Comment by Vetter-Smith, Molly J: Reference needed for this statement Comment by Vetter-Smith, Molly J: References needed for these statements
The under diagnosis in foodborne illnesses is further contributed by the majority who has the symptoms and signs of the disease but totally fail to seek medical attention. This circumstance coupled with the global and national distribution of foo.
Inclusive health and fitness education for sustainable developmentoircjournals
Health and fitness is viewed as both an enabler and an
End for sustainable development.Health and fitness
is a rapidly growing area of focus for people across the
world. The popularity of health services on media news
and talk shows,high tech health and fitness tracking
devices and stress management workshops are
just but a few of the indicators of a growing interest in whole
person well-being. For individuals with intellectual and
developmental disabilities, the benefits of quality health
and fitness areas great as those experienced by the rest of the
human population. However,the opportunities to access
quality health and fitness information and resources are not necessarily
as available. There are many options for engaging in health and
fitness activities in communities, and disability should not exclude a person from
participation. However, in reality there are too few fitness
opportunities that are of high quality and truly inclusive.
This paper therefore aims to help readers advocate for inclusive
Health and fitness opportunities in their communities by providing a list of key characteristics of quality, inclusive programs, as well as a set of tips for
individuals with disabilities.The paper has reviewed well researched sources
in Kenya and the world over highlighting how and why health must be more present, more integral, and more influential.Despite a broad agenda and steep competition for attention health and fitness remains a prominent and vital component of the development agenda and this can only be possible through inclusive quality
health and fitness education.The results will be focus on health and fitness
for individuals with physical, social, vocational, spiritual, emotional, and psychological disabilities. It offers ways in which disability service providers, health and fitness professionals, community fitness and recreation programs and employers among others can help ensure what opportunities to choose and engage in health and fitness activities through inclusive education is achieved.
Introduction to public health, definition, Preventive medicine vs public health, social medicine, community medicine, role of public health, public health practices, core activities
REPLY1 An area of public health (non-COVID-19) that you w.docxchris293
REPLY1
An area of public health (non-COVID-19) that you would like to learn more about is behavior and cultural issues. If we wish to help a community improve its health, we must learn to think like the people of that community. People around the world have beliefs and behaviors related to health and illness that stem from cultural forces and individual experiences and perceptions. Cultural behaviors have important implications for human health. Culture, a socially transmitted system of shared knowledge, beliefs and/or practices that varies across groups, and individuals within those groups, has been a critical mode of adaptation. Understanding how behaviors are rooted in an individual’s unique cultural experience and as a response to social pressures can better equip medical professionals with the context, skills and empathy necessary for holistic care.
REPLY2
An area of public health that I would like to learn more is infection prevention and control. Especially in our current times, preventing disease and spread is of high importance. Preventing the reoccurrence of old diseases especially preventable ones are high on the list of public health efforts. Infection preventionist registered nurses have been in high demand in different types of organizations and health care setting since 1941, after the British Medical Council suggested the need for this role (Weston 2008). Infection preventionist work to prevent central line infections, catheter associated infections, hospital acquired pressure ulcers, and hospital acquired pneumonia, including ventilator associated pneumonia.
Infection prevention specialist also work closely with local, state, and federal public health agencies in the reporting, managing, and possible testing and treatment of diseases. Disease threats are difficult to predict especially new disease, but due to an increase in emerging new diseases the return of old diseases is unavoidable. “Microorganisms previously unknown or unrecognized or thought to only cause diseases in animals can and have evolved to produce more virulent strains which can also affect humans (Weston, 2008, pp.4). Preventing disease including infectious agents is associated with public health.
The Centers for Disease prevention and Control (CDC) is an excellent source of information for all healthcare workers. The resources provided include basic principles of infection prevention and control (Centers for Infection Prevention and Control, 2020). Topics range from injection safety, sharps, and of high importance hand hygiene. Training and educational resources are also provided on CDC (Centers for Infection Prevention and Control, 2020).
.
Building health, social and economic capabilities among adolescents threatene...
Expanding antiretroviral therapy provision in resource constrained settings-603791 -924967318
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Expanding antiretroviral therapy provision in resource-constrained
settings: social processes and their policy challenges
Steven Russella; Janet Seeleya; Alan Whitesideb
a
School of International Development, University of East Anglia, Norwich, UK b Health Economics
and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
Online publication date: 02 August 2010
To cite this Article Russell, Steven , Seeley, Janet and Whiteside, Alan(2010) 'Expanding antiretroviral therapy provision in
resource-constrained settings: social processes and their policy challenges', AIDS Care, 22: 1, 1 — 5
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2. AIDS Care
Vol. 22, No. Supplement 1, 2010, 1Á5
EDITORIAL
Expanding antiretroviral therapy provision in resource-constrained settings: social processes and
their policy challenges
The international policy and research context stigma? How are people adjusting to a new chance of
Political pressure to provide antiretroviral therapy life, to living with HIV as a chronic condition, and
(ART) in poor countries, alongside falling drug what challenges do they face in rebuilding their social
and economic lives as they return to the harsh
prices, led to a dramatic increase in ART delivery
realities of poverty? How is ART delivery affecting
from 2002. In that year the Global Fund for AIDS,
the working and personal lives of health workers and
TB and Malaria was established. In 2003, President
what are the implications for health systems?
George W. Bush pledged US$15 billion towards his
This issue presents papers presented at a con-
Presidential Emergency Programme for AIDS Relief
ference: Expanding antiretroviral therapy provision in
(PEPFAR) and the World Health Organisation
resource-limited settings: social dynamics and policy
(WHO) launched the ‘‘3 )5’’ campaign aiming to
challenges, held in May 2009 at the University of East
place three million people on treatment by 2005.
Anglia (UEA), UK. The conference was organised by
Although the WHO goal was not achieved, the
the School of International Development, UEA, and
investment meant by the end of 2008 about four
the Health Economics and HIV/AIDS Research
million people in low- and middle-income countries
Division (HEARD) of University of KwaZulu-Natal.
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were receiving ART.
It brought together international research organisa-
Research to inform and evaluate ART expansion
tions and partnerships to share original social science
in resource-constrained settings has, perhaps inevita-
research on ART delivery and its effects in resource-
bly, focused on the impact of different drug combina-
constrained settings. This is one of the first collections
tions and clinical outcomes, related public health
of social research on patients’ and health workers’
questions, and on the effectiveness and costs of
responses to ART and its effects on their lives and
different modes of delivery. Social or behavioural
livelihoods.
science research has tended to focus on the important
question of patient adherence. Social research has
recently started to explore the effects of ART on Summary of themes and papers
stigma, sexual relationships, new identities, political The diverse topics covered by these papers follow a
activism, and the inequalities that underlie HIV- broad analytical theme of social actions and processes
infection and undermine ART delivery (Bunnell surrounding ART delivery and uptake, and their (often
et al., 2006; Castro & Farmer, 2005; Domek, 2006; unintended) implications for policy. The papers exam-
Robins, 2005; Seeley et al., 2009, for example). ine social actors and processes from the perspective of
However, research about the social processes unfold- those accessing and taking the treatment, often
ing as a result of ART has been relatively rare people coming back from near-biological and social
(Russell et al., 2007). As social scientists, we expect death and striving to build a new life on ART, and
the provision of an effective drug for a previously those delivering or funding ART interventions. They
terminal, feared and highly stigmatised disease to are organised into three themes: ART and changing
have profound implications and meanings for social identities; ART and living with HIV; and ART and
and economic aspects of life; for individuals, families, its effects for health services.
communities and health services, and for wider social
norms, expectations and behaviours. These unfolding
social changes will affect society, but also specifically ART and changing identities
ART programme processes and outcomes, for exam- ART provides effective treatment for a previously
ple, reductions in stigma and increasing numbers of untreatable and terminal disease. It leads to improved
support groups can speed up uptake and increase health and enables a return to normal activities.
adherence. These social facts could have profound implications
In this special edition we consider several broad for the way a society applies meaning to and ‘‘socially
areas of enquiry. How is ART affecting the social constructs’’ the disease and labels or categorises those
construction of the disease, people’s identities and people with that disease. Across societies, HIV has
ISSN 0954-0121 print/ISSN 1360-0451 online
# 2010 Taylor & Francis
DOI: 10.1080/09540121003786078
http://www.informaworld.com
3. 2 Editorial
been characterised by high levels of stigma and HIV affects mainly marginal and stigmatised groups
discrimination. While stigma must be conceptualised (sex workers, gay men and drug-users). Public
as a social process arising from structural inequalities resource constraints mean moral-economic judge-
and the exertion of power and control (Castro & ments construct ART as a diverter of scarce funds
Farmer, 2005; Parker & Aggleton, 2003), the nature away from more ‘‘socially deserving’’ conditions.
of the disease itself makes it open to social processes Structural obstacles to finding work add to feelings
of labelling and the categorisation of ‘‘undesirable’’ of disempowerment and dependency. HIV and ART
or ‘‘undeserving’’ ‘‘others’’. In most societies’ moral are cast as threats to both the social and economic
frameworks it is associated with perceived ‘‘deviant’’ fabric of the country. They conclude that HIV
or ‘‘immoral’’ behaviour and groups; it is seen as the treatment is insufficient alone to reduce stigma and
responsibility of the individual; it is contagious and a needs to be supported by complementary employ-
threat to the community; it was the equivalent of ment and social support interventions enabling
a death sentence with no treatment; and death was PLHIV to lead more empowered economic and social
slow and painful (Alonzo & Reynolds, 1995). ART lives.
cannot necessarily address the structural inequalities Kielmann and Cataldo examine how collective
or moral frameworks that drive processes of stigma- action around access to ART, involving political
tisation and discrimination, but does offer a chance claims for social justice, human rights and health
to counteract some of the above processes through care, have forged new individual and group identities
prolonged life and improved health and appearance. among PLHIV. Associated processes have con-
The papers on this theme consider ART’s structed them as ‘‘expert’’ patients and ‘‘empowered
implications for the social construction of the disease citizens’’, important actors at the inter-section of
and the identity of those people living with HIV health services and communities. They argue that
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(PLHIV). Does ART necessarily reduce people’s fear constructions of PLHIV as ‘‘responsible patients and
of getting tested or disclosing their status and reduce public health citizens’’ are key but may not be
the stigma? How have political struggles for treat- applicable in all treatment settings, and the involve-
ment affected identity and the place of PLHIV in ment of patients in health systems raises further
public health discourse? Does a ‘‘medicalisation’’ of ethical, political and policy questions.
HIV through ART offer new opportunities for HIV Busher explores how ART delivery expansion in
organisations to link up with communities in the north-east Namibia is changing the way HIV orga-
‘‘fight against HIV’’? nisations and programmes are perceived by tradi-
Virginia Bond draws on 20 years of living and tional leaders and fit within the wider socio-moral
working in a high HIV prevalence country, Zambia, cultural framework. Traditional leaders view inter-
to explore the reasons that lie behind people’s limited ventions involving discussions of sex and condoms as
uptake of HIV testing or public disclosure of their a threat to local moral values and social order,
status, despite increased availability of ART since preventing their involvement in these activities.
2004. She describes how PLHIV must carefully However, the rapid expansion of ART after 2004
negotiate the pragmatic advantages of testing and meant the emphasis shifted to advice about accessing
disclosing alongside the fear of the result and a tests and effective treatment. A new set of signs and
permanent shift to their identity following disclosure. meanings about HIV has enabled traditional leaders
When it is spoken, Bond argues, the ‘‘possibility’’ of to engage with the fight against HIV, without under-
infection, the ‘‘implicit knowing’’ of others becomes mining their role as cultural guardians.
reality and a person’s HIV status becomes a promi-
nent and fixed identity. Disclosure is a complex
matter, taking many forms and often a gradual and ART and living with HIV
careful process to a limited circle. Silence is often an ART means HIV has become a manageable chronic
easier option, perhaps with the presence of HIV condition rather than a terminal illness. The second
implicitly known but not spoken. Better understand- theme looks more closely at the effects of this change
ing of disclosure processes is needed to inform safe for the social and economic lives of individuals and
disclosure procedures in the VCT and ART pro- their families in resource-constrained settings.
grammes being rolled out in Sub-Saharan Africa. Restored health enables people to return to work,
Bernays, Rhodes and Terzic present qualitative
´ ´ re-engage with family and participate in social
findings from Serbia to look at the effects of activities. Numerous changes are required in the lives
treatment on stigma. Their analysis reveals that of PLHIV as they move from a situation of sickness
structural factors continue to make HIV a stigma- and social isolation to a second chance at life. There
tised disease despite the availability of ART. Here, are challenges to this adjustment, especially in
4. AIDS Care 3
settings of poverty and where ART delivery systems new outlook, new personal aims, new social roles and
offer varying degrees of support or security (Rhodes, a new status (Pierret, 2007; Robins, 2005). The key
Bernays, & Terzic, 2009; Russell et al., 2007). Patients
´ ´ policy challenge is to provide support for people
who may have managed to accept their HIV status working to restore their social and economic lives, to
must now incorporate the treatment regimen into accompany the medical intervention.
their daily lives Á for the rest of their life. Chileshe and Bond also explore people’s efforts to
When ART became more widely available in access ART and manage their condition under
resource-constrained settings there was widespread conditions of extreme poverty in a rural setting.
concern about adherence levels. A feature of some They had experienced the long-term economic shock
ART programmes in Sub-Saharan Africa is the and impoverishment caused by a prolonged and
requirement for patients to choose a treatment serious illness, TB. Subsequent HIV diagnosis and
supporter or medicine companion (MC) to improve access to ART was undermined by this pre-existing
adherence. Foster, Nakamanya, Amurwan and col- poverty. High transport costs to ART clinics, and a
leagues report on the characteristics and roles of MCs health service system requiring four visits before
chosen for adherence support by Ugandan patients being enrolled on ART, posed serious economic
enrolling on ART. Women were more likely to barriers. Stigma, a recurring theme in this special
choose one of their children and men more likely to edition, also presented barriers. The authors argue
choose their spouse. An important part of the MC programmes delivering ART in poor rural areas need
system is that it entails disclosure of one’s HIV status, to consider the impact of transport and food costs on
which as Bond argues in this edition can pose a treatment adherence and appreciate how many poor
serious dilemma for people wishing to start ART. households enter the ART programme with already
Foster and colleagues note that women may have depleted household resources.
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been less likely to choose husbands as their MC
because they had not yet disclosed their status to the
husband. Such a disclosure can have serious con- ART and its effects for health services
sequences for women in Uganda. These conclusions Large-scale investment in ART delivery expansion in
echo those of Bond: ART programmes must consider poor settings has changed the lives of health workers
the pros and cons of the requirement of disclosure and generated considerable changes for health ser-
carefully. vices. The scale of funding has also affected wider
Adjustment to living with HIV as a chronic illness processes of health policy governance.
also requires people to make changes in their Schneider and Lehmann describe the expansion of
economic, social and personal lives. The challenges lay health workers in the South African health
of rebuilding a livelihood, relationships and hope system, which now outnumber professional nurses.
devastated by HIV are considerable, but vitally They consider the implications for the organisation of
important for individual clients and the success of the health system and professional relations between
ART programmes. People need to be leading mean- lay workers and health care professionals. Counsel-
ingful economic and social lives to live with and ling and home-based care are routine roles for lay
manage the disease, and more specifically to go on health workers, and they occupy a ‘‘mediating layer’’
adhering to ART (Nam et al., 2008). They need to between citizens and the formal health and social
live with, as well as manage their chronic illness, and welfare systems. While they are essential to the
the management will be affected by the ‘‘living with’’ delivery and functioning of health care, their prolif-
(Strauss, 1990). eration has been uncoordinated and unregulated by
Seeley and Russell’s paper explores people’s the state, causing numerous organisational and hu-
efforts to rebuild social relationships and social lives man resource difficulties. The authors argue that
following a period of profound disruption caused by research is needed to understand this complex phe-
HIV. They use the concept of ‘‘transition’’ to explore nomenon, to inform measures that can better harness
people’s narratives of recovery and change on ART, the potential of lay workers.
and the related idea of ‘‘getting back to normal’’. Namakhoma and colleagues examine the pres-
Transition refers to a person’s adjustment towards sures of delivering ART for already over-stretched
incorporating a chronic illness and treatment regimen health workers in Malawi, and the difficulties faced
into their lives, their identity and their interactions by health workers taking ART themselves as they
with others (Kralik, 2002). They also consider the wrestle with fears of disclosure.
transformative effects of HIV and ART, and the idea George and colleagues examine the effects of
of ‘‘rebirth’’, a process whereby the illness is per- ART delivery expansion on health workers at two
ceived as an opportunity to live a better life, with a ART sites in South Africa. Survey results comparing
5. 4 Editorial
ART and non-ART workers show that ART workers to scale-up ART delivery the important focus on
are less likely to regard their workload as heavy, have clinical priorities must not ‘‘over-medicalise’’ the
higher levels of job satisfaction, lower rates of agenda and forget other notions of well-being.
sickness absenteeism and see more opportunities for These social processes must be placed into the
professional development. This evidence contradicts wider context of funding for ART expansion and the
that found in Malawi noted above, and many other immense challenges to long-term success. First,
studies that show ART scale-up creates additional treatment coverage needs to expand further. Only
burdens and stress for health workers. Qualitative about 40% of those who need treatment in middle-
interviews explored the reasons for these findings and and low-income countries are getting it. The number
found that higher satisfaction and morale and lower of people needing drugs will continue to rise each
stress were related to their ability to bring treatment year, and over time people will need more expensive
and hope to patients, delay deaths due to AIDS, and second-line regimens. Funding is also needed for the
better training opportunities. The wider political complementary social and economic interventions
context and better resource levels in South Africa discussed in this special edition. A key question for
also explain these findings. development agencies also centres on their long-term
Kudale and colleagues examine the ways social obligations to people supported on ART in resource-
and political actors within the ART delivery setting poor settings: will ART be guaranteed for life,
affected the evolution of ART delivery systems in two regardless of the increased cost of different treatment
high prevalence settings in Maharashtra and Andhra regimens required as resistance develops?
Pradesh in 2005 and 2009. The study goes beyond a Second, against these growing resource demands
static analysis of resource constraints to consider the is a situation in which current funding for ART
roles of different actors, the wider political context expansion in Africa is time-limited. Long-term fund-
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and questions of leadership and ownership of the ing commitments for ART had not been embraced
HIV programmes, and how these processes affected even before the current international economic reces-
quality of care and patient pathways to accessing sion. Major HIV/AIDS donors may be forced to
ART. They conclude that the evolution of ART reduce their commitments due to acute budget
programmes within local health systems must con- constraints, and the global economic crisis will also
sider the wider socio-political environment. affect domestic economies and government budget
Hanefeld moves to the wider shifts in health policy resources.
processes brought about by the advent of support for Third, even if donor support were guaranteed,
ART by PEPFAR and the Global Fund. She explores health system weaknesses in many countries raise
the role of these two global organisations in Zambia concerns about the feasibility of continued ART roll-
and South Africa over the past five years, focusing on out, particularly in rural and unstable areas. The
their influence on policy content and the implemen- foundation upon which success depends Á the assur-
tation of ART programmes. Hanefeld highlights their ance of an uninterrupted, affordable and accessible
influence on governance at national and sub-national supply of medication and care Á remains absent in
level, showing how because of the intervention of many countries.
global players the actual implementation of policy Finally, there is the question of donor depen-
bypasses the state. dency. In many countries the provision of treatment
is undertaken by donors and significant numbers of
people’s lives depend on the largesse of decision
The longer term challenge
makers in Washington, London, Geneva and Paris.
The social processes examined here that are arising This is a unique situation which needs careful and
from the dramatic expansion of ART for PLHIV in immediate attention.
resource-constrained settings point to the need for a
vision for ART scale-up that must be broadened to Acknowledgements
go beyond medicine to incorporate complementary
social, economic and health facility interventions that We are grateful to the organisations that have provided
funding for this special edition: Boehringer Ingelheim,
consider complex questions of identity, stigma reduc-
Merck, HEARD, the Evidence for Action Research Pro-
tion and disclosure requirements, economic and
gramme Consortium (RPC), the Team for Applied Re-
social measures that support people’s adjustment to search Generating Effective Tools and Strategies for
living with HIV as a chronic condition, and measures Communicable Disease Control (TARGETS) RPC (RPCs
that can address the needs of health workers involved are funded by the UK Department for International
in ART delivery. The sustainability of ART pro- Development), and the School of International Develop-
grammes depends on this broader vision: in the rush ment, University of East Anglia, UK.
6. AIDS Care 5
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