Introducing Indonesian Medical Students to Rainforest Conservation and Community Health in the Field: A Practicum Experience in East Kalimantan

This article describes a practicum experience developed between a conservation organization (The Nature Conservancy) and a medical school (The Faculty of Medicine at Mulawarman University in East Kalimantan). Through this practicum, groups of medical students from Mulawarman have assisted with baseline and follow-up community evaluations in remote villages along the Kelay River, Berau District. These evaluations were done in conjunction with the Kelay Conservation Health Program, a program designed to improve health and healthcare for local people, mostly former hunter–gatherers, in an area of rainforest that the conservation organization seeks to protect. Besides gaining experience in community health assessment, through this practicum medical students also gained field experience and knowledge in rural and remote area health and healthcare in Indonesia and had an opportunity to explore linkages between conservation and health. At the conclusion of their time with the program, participating students also presented individual problem-based reports on relevant topics to students and faculty at the Medical School and to the District Health Department. This partnership between a conservation agency and a medical school in a developing country is unusual, but has been very well received by all stakeholders involved. Because of this, Mulawarman is now planning to make Kelay into a formal training site for its students. This experience may serve as a model for other groups interested in promoting ecosystem health education to future health professionals in the developing world.     

Reflections on the development of health economics in low- and middle-income countries

Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623–1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost–benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country''s economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding.     

Including Ethnic Minorities in Mental Health Intervention Research: A Practical Approach to a Long-Standing Problem

This paper examines a controversy that arose while developing a supplement to Mental Health: A Report of the Surgeon General that was focused on ethnic minority mental health. The controversy involved whether and how to make recommendations about ethnic minorities seeking mental health care. We found that few studies provided information on outcomes of mental health care for ethnic minorities. In this paper, we discuss outcomes of mental health care for ethnic minorities and how to proceed in developing an evidence base for understanding mental health care and minorities. We conclude that entering representative (based on population) numbers of ethnic minorities in efficacy trials is unlikely to produce useful information on outcomes of care because the numbers will be too small to produce reliable findings. We also conclude that while conducting randomized efficacy trials for all mental health interventions for each ethnic group would be impractical, innovative and theoretically informed studies that focus on specific cultural groups are needed to advance the knowledge base. We call for theory-driven research focused on mental health disparities that has the potential for understanding disparities and improving outcomes for ethnic minority populations.     

The spiral of disadvantage: Ethnolinguistic discrimination,acculturative stress and health in Nahua indigenous communities in Mexico

Objectives

The aim of this study was to test the hypothesis that ethnic and ethnolinguistic discrimination, and Post-Traumatic Stress Disorder (PTSD) related to being Indigenous as well as different aspects of acculturative stress, are associated with poorer health and higher levels of depression among the Nahua Indigenous communities.

Materials and methods

Our quantitative survey was carried out in four different regions inhabited by the Nahua people in Mexico. Self-rated health and depression, the symptoms of PTSD, two facets of acculturative stress and ethnolinguistic discrimination were assessed by questionnaires. The data were analyzed using binary logistic regression models.

Results

The symptoms of PTSD and acculturative stress experienced in the workplace were significantly associated with a higher risk of poor self-rated health, adjusted for various socio-demographic characteristics. Acculturative stress, discouragement of language use, language avoidance and ethnolinguistic discrimination were related to a higher risk of depression and PTSD.

Discussion

Our research implies that ethnic and linguistic discrimination, acculturative stress and the memory of harm linked to being Indigenous reflected in the symptoms of PTSD, are important predictors of poorer health and depression among Nahua groups in Mexico. These adverse effects could be significantly counteracted by effective dealing with stigmatization and discrimination against Indigenous people in Mexico and by replacing strong assimilation pressures with integrational approaches that respect ethnolinguistic diversity and reduce socioeconomic marginalization.     

白洋淀生态系统健康评价

涵盖热力学指标的指标体系可全面表征湖泊生态系统在受扰条件下的健康状态。本文在实地监测的基础上,应用浮游植物生物量(BA)、浮游动物生物量/浮游植物生物量(BZ/BA)浮游植物群落初级生产量(P)、能质(Ex)、结构能质(Exst)和浮游植物对TP的缓冲能力(βp)表征白洋淀的健康状态,并通过集成健康综合指数,确定了白洋淀14个水域的健康等级。结果表明,白洋淀大部分水域健康受损较为严重。枣林庄和采蒲台水域处于亚健康状态,烧车淀、光淀张庄和东田庄水域处于不健康状态,其余9个水域均处于病态。结合各水域人类干扰活动的分布可知,白洋淀健康退化的程度与人类干扰强度密切相关。府河和淀内居民生活及水产养殖污水排放是造成白洋淀健康受损的主要原因。该结果可为白洋淀生态系统的管理和修复提供一定的科学依据。     

英国健康服务整合进展及对中国的启示

通过万方、知网、PUMED和谷歌学术搜索,查阅获取近年来有关英国健康服务整合的文献和政策文件,分析了健康服务整合的内涵,归纳总结了英国健康服务整合实践的政策历程,目前的整合实践模式,并归纳分析了英国健康服务整合的应对策略,最后结合中国实际,提出对健康和社会保健相关职能部门进行整合,对中央和地方的责权利进行合理划分,从而落实健康服务的整合供给,通过信息化和多媒体,建立以患者为中心的健康保健提供的激励约束机制,建立现代化的健康和社会保健服务的人才保障机制。     

21世纪初农业生态系统健康研究方向

农业生态系统健康是指农业生态系统免受发生“失调综合症”,处理胁迫的状态和满足持续生产农产品的能力,目前,农业生态系统健康研究范围主要涉及农业生态系统健康评价方法,土壤质量和水质与农业生态系统健康的联系,农业生态系统健康与人类健康的关系,害虫生态管理对农业生态系统健康的贡献,杂草综合管理在农业生态系统健康中的作用,从生态病理学到农业生态系统健康,线虫群落作为农业生态系统健康指示生物的研究,转基因作物对农业生态系统健康的生态影响评价,农业投入政策对农业生态系统健康的影响,景观生态学在农业生态系统健康评价中的应用,农业生态系统健康与绿色食品开发等,首先论述了农业生态系统健康研究的现状,介绍了农业生态系统健康研究实例-土壤健康的生物指标,最后提出了今后农业生态系统健康的研究方向,为保障农产品安全和增进人类健康提供依据。     

Lessons learned in developing community mental health care in Africa

This paper summarizes the findings for the African Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview of mental health policies, plans and programmes in the African region; a summary of relevant research and studies; a critical appraisal of community mental health service components; a discussion of the key challenges, obstacles and lessons learned, and some recommendations for the development of community mental health services in the African region.     

Effectiveness of a free folic acid supplement program in family planning clinics

BACKGROUND: Adequate periconceptional folic acid consumption lowers the risk for neural tube defects. We report the results of an evaluation of a folic acid intervention in Georgia family planning clinics that provided free folic acid supplements or fortified breakfast cereal. METHODS: Six family planning clinics participated in the evaluation. Three clinics provided folic acid pills and educational materials to clients, two provided super-fortified cereal and educational materials, and one clinic provided educational materials only. Participants between the ages of 18 and 45 who visited the clinics in 2000 completed a brief survey and provided a blood sample. Of the 1093 women who participated, we evaluated the 165 women who had returned to the clinic at least once during the study period. We compared participants' survey and serum folate data from their first and subsequent visits. RESULTS: Participation in the intervention was associated with increased knowledge about folic acid, (odds ratio, 1.94; 95% confidence interval, 1.37-2.76), but was not directly associated with increased self-reported folic acid consumption or increased serum folate levels. Reported use of folic acid supplements or cereal within two days of a visit was associated with higher serum folate levels. Knowledge about folic acid was one of the best predictors of self-reported folic acid consumption. CONCLUSIONS: Participation in the intervention increased clients' knowledge about folic acid but did not directly increase reported folic acid consumption. Because knowledge predicted folic acid consumption, the intervention may be indirectly associated with increased consumption of folic acid.     

Long-term effects of birth weight and breastfeeding duration on inflammation in early adulthood

Chronic inflammation is a potentially important physiological mechanism linking early life environments and health in adulthood. Elevated concentrations of C-reactive protein (CRP)—a key biomarker of inflammation—predict increased cardiovascular and metabolic disease risk in adulthood, but the developmental factors that shape the regulation of inflammation are not known. We investigated birth weight and breastfeeding duration in infancy as predictors of CRP in young adulthood in a large representative cohort study (n = 6951). Birth weight was significantly associated with CRP in young adulthood, with a negative association for birth weights 2.8 kg and higher. Compared with individuals not breastfed, CRP concentrations were 20.1%, 26.7%, 29.6% and 29.8% lower among individuals breastfed for less than three months, three to six months, 6–12 months and greater than 12 months, respectively. In sibling comparison models, higher birth weight was associated with lower CRP for birth weights above 2.5 kg, and breastfeeding greater than or equal to three months was significantly associated with lower CRP. Efforts to promote breastfeeding and improve birth outcomes may have clinically relevant effects on reducing chronic inflammation and lowering risk for cardiovascular and metabolic diseases in adulthood.     

Chinese NGOs in action against HIV/AIDS

Chinese nongovernmental organizations （NGOs） have played a significant role in the battle against AIDS in the People＇s Republic of China. This article provides a brief overview of the structure of these organizations, as well as an analysis of their principle accomplishments. Of great significance in this analysis is the fact that Chinese NGOs have effectively dealt with many sensitive health education areas that government authorities have felt reluctant to handle directly. As such, they have provided an indispensable component in the HIV/AIDS prevention and control calculus on the mainland.     

北京市居住区林木健康评价

为了揭示北京市居住区林木健康变化特征及影响因素,提供北京市居住区林木健康经营对策。对北京市85个居住区林木进行健康特征调查,在建立林木健康评价模型评价林木健康状况的基础上,采用方差分析法和多重比较法分析不同类型居住区林木健康差异。结果表明:不同类型居住区林木健康指标差异显著(P0.05),各指标变化规律不完全一致;不同类型居住区地表覆盖情况、光污染程度、树干倾斜度、栽植截干、树势、冠形、干形等方面普遍较差。北京市居住区林木健康指数在0.60—0.80之间,健康等级呈现右偏正态分布特点,健康林木比例为3. 65%,亚健康林木(56. 07%)最多,其次是中等健康林木(36.68%),不健康林木有3.50%,濒死林木仅占0.10%。居住区林木健康指数在不同区域和不同来源间差异不显著(P0.05),在不同时期间差异显著(P0.05),健康指数大小分别为:三—四环=四—五环五—六环二环内=二—三环;福利房商品房保障房;2009—2013年2003—2008年=1998—2002年=1991—1997年1956—1990年。北京市居住区林木生长处于亚健康状态,潜在影响因子如地表覆盖情况、光污染程度、树干倾斜度等指标是限制北京市居住区林木生长的重要因子。适当减小夜间照明影响、增加有机地表覆盖、避免过度的修枝截干和加强林木养护管理是当前北京市居住区林木健康生长的保障。     

Barriers and errors in the implementation of community psychiatry in Slovenia

Background Slovenian psychiatry is predominantly hospital based. A programme for the development of general community psychiatric services was proposed to improve access to and quality and comprehensiveness of psychiatric care according to the modern standards of delivery of psychiatric services.Aim The aim of the paper is to present the programme for developing community services that was proposed to the Slovenian government, and to describe the barriers to its implementation that were encountered, as well as the errors made by the programme authors, that contributed to the rejection of the programme last year.Conclusions There are historical, political, professional and service organisation characteristics that impede the development of community psychiatry in Slovenia. These are to be addressed through coordinated action involving primary care professionals, non-government organisations with service users and carers, the Health Insurance Agency and politicians involved in the planning of health services.     

Moderate and Severe Obesity Have Large Differences in Health Care Costs

Objective: To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old. Research Methods and Procedures: Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days. Results: The results indicated that there were large differences in obesity‐related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50% increase) than a BMI of 30 to 35 (about a 25% increase); a BMI of over 40 doubled health care costs (～100% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services. Discussion: Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.     

Chinese NGOs in action against HIV/AIDS

Chinese nongovernmental organizations (NGOs) have played a significant role in the battle against AIDS in the People‘s Republic of China. This article provides a brief overview of the structure of these organizations, as well as an analysis of their principle accomplishments. Of great significance in this analysis is the fact that Chinese NGOs have effectively dealt with many sensitive health education areas that government authorities have felt reluctant to handle directly. As such, they have provided an indispensable component in the HIV/AIDS prevention and control calculus on the mainland.     

我国贫困地区医疗卫生服务体系建设探讨

健康扶贫是提高贫困地区人民群众的健康水平、实现健康中国的重要途径。构建和完善中国贫困地区的医疗服务体系,要重点加强医疗卫生机构标准化建设、公共卫生服务网络建设、远程医疗服务体系建设和中医药服务能力建设等方面,形成与当地经济发展和健康需求相适应的医疗卫生服务体系,保障贫困人群的健康,最终实现全民健康。     

Chinese NGOs in action against HIV/AIDS

INTRODUCTION The AIDS epidemic continues its seemingly inexorable spread throughout the world. It is now very clear that the virus represents not only a medical problem, but also a challenging and multifaceted social problem. Because of this fact, it is imperative that nongovernmental organiza- tions outside of, or tangential to, the medical arena be- come involved in prevention and control efforts. The Chinese government is supportive of the development of such organizations on the mai…     

我国省级层面分级诊疗文件比较分析

通过访问各省（区、市）卫生计生委的官方网站,获取有关分级诊疗政策的文件,在获取国家卫计委和万方、知网的相关分级诊疗文献的基础上,对各省（区、市）2016年2月28日以前的分级诊疗文件进行分析研究,通过对比各省分级诊疗文件的基本情况和实施措施等具体内容,分析不同省份在分级诊疗文件内容设定中存在的问题,从而为未来的分级诊疗决策和实践提供经验。