Social and economic impact of violence in the Americas

Violence is a social and a public health problem that has grown in the Americas in recent decades that has negative effects on social, health, and the economy of countries, communities, families, and individuals. More than 115,000 people are murdered every year, the majority of them are men; other 55,000 commit suicide. In 20 to 60% of households some form of domestic violence against girls, boys, women, and the elderly occurs; juvenile gangs, involved in violent and criminal activities, increases at alarming rate. Other forms of violence are wars and internal or international conflicts, political violence, abductions, lynching, multinational violence by organized crime units involved in narcotic trafficking, sexual trade or smuggling of weapons. The public health approach is based on a methodology of work, as follows: 1. Characterization of the problem in its basic variables of person, place, time, circumstances, and related situations; 2. Identification of causes, associations, or risk factors; 3. Proposal of interventions and their evaluation; 4. Extension of the evaluated interventions. Violence is an intentional act of multicausal origin. Various factors are interconnected showing the relations among them. Those which have been primarily studied or that have shown greater evidence are discussed. A historical look is proposed, that integrates the repression and control, the prevention and the recovery of the social fabric. Violence demands an expenditure of money that represents a significant proportion of the GDP that was estimated in $168 billion dollars for Latin America. Violence can be prevented. Primary prevention projects are driven to avoid the occurrence of a violent act, but if it has already occurred it is necessary to avoid its repetition, through secondary prevention projects. Tertiary prevention is applied in order to avoid major damages; it aims at improving the quality of life of those already traumatized. The programs should be comprehensive and sustained in the medium and long terms. Finally, comments have been made on PAHO and WHO policies, in particular the recently launched World Report on Violence and Health, a working tool for violence prevention.     

Chronic illness and functional limitation in Ontario children: findings of the Ontario Child Health Study.

The Ontario Child Health Study (OCHS) was based on interviews of 1869 Ontario families who were selected by means of a stratified, multistaged sampling method from the 1981 census of Canada. Its primary purpose was to determine the prevalence and distribution of mental health problems in Ontario children aged 4 to 16 years and their families, but it also allowed an estimate of other significant medical conditions and provided an overview of these children''s use of health care, education and social services. Our results are based on questionnaire responses concerning 3294 children. Limitation of function without a chronic illness or medical condition was reported in 1.9%, the converse in 14.0%, and a chronic illness or medical condition with limitation of function in 3.7%. When the three groups are considered together, 19.6% of Ontario children had a chronic health problem. Children of lower socioeconomic status were much more likely to have chronic health problems. Overall, children with chronic health problems were more likely to use physician, special education, social and mental health services. These findings have implications for those who provide services for children, plan community programs or train professionals in caring for children.     

Single mothers in Ontario: sociodemographic,physical and mental health characteristics

OBJECTIVE: To examine the sociodemographic, physical and mental health characteristics of single mothers in Ontario. DESIGN: Cross-sectional. SETTING: Ontario. PARTICIPANTS: Ontario residents aged 15 years or older who participated in the Ontario Health Supplement survey conducted between December 1990 and April 1991; of 9953 eligible participants, 1540 were mothers with at least 1 dependent child (less than 16 years of age). OUTCOME MEASURES: Prevalence rates of sociodemographic, physical and mental health characteristics. RESULTS: Single mothers were significantly more likely than the mothers in 2-parent families to be poor, to be 25 years of age or less, to have mental health problems (dissatisfaction with multiple aspects of life, affective disorder ever and 1 or more psychiatric disorders in the past year or ever) and to use mental health services. When compared by income level, poor single mothers had a higher prevalence of all mental health outcomes measured; the difference was significant for anxiety disorder in the past year or ever and for 1 or more psychiatric disorders in the past year or ever. In a logistic regression analysis, single-mother status was found to have the strongest independent effect on predicting mental health morbidity and utilization of mental health services; the next strongest was low income. CONCLUSIONS: Single mothers are more likely to be poor, to have an affective disorder and to use mental health services than mothers in 2-parent families. The risk of mental health problems is especially pronounced among poor single mothers. Further studies are needed to determine which aspects of single motherhood, apart from economic status, affect mental health outcomes.     

HIV/AIDS programmes should focus on improved access

This paper discusses the need for HIV/AIDS programs in sub-Saharan countries to focus more on improved access to information to empower poor people living in remote areas. It is noted that despite Glaxo Wellcome's move to reduce the cost of antiretroviral therapy, it is unlikely to have an impact on most of those infected with or affected by HIV/AIDS, since concerns regarding lack of sustainability, bureaucratic administration, and communication difficulties predominate in the country. In this regard, it is therefore recommended that national HIV/AIDS programs be balanced with the needs of both the community and the individual and in prevention and care. Health workers should be explicit in confronting traditional beliefs, such as those about gender roles and traditional medicine, in prevention campaigns. Moreover, there is also an urgent need to improve access to condoms; strengthen health programs such as directly observed treatment short-term (DOTS) courses for tuberculosis and the syndromic approach to sexually transmitted disease treatment; and improve practical support to communities caring for those who are sick and the orphans. Lastly, all partners working with prevention programs should use the more positive community attitudes towards HIV/AIDS issues seen in many sub-Saharan countries to develop evidence-based programs that focus more on improved access and less on sustainability.     

Self-efficacy and the promotion of health for depressed single mothers

Single mothers are a vulnerable population at risk for poor mental and physical health. This paper discusses the mental and physical health of single mothers, as well as the psychosocial and socio-economic risk factors placing single mothers at risk for poor health outcomes. Some of these include, gender, income level, educational status, social support, stress and certain personality characteristics. Theoretical models with the potential to explore ways to promote health in depressed single mothers will also be presented. The paper concludes with the application of these models to primary prevention and the promotion of health for single mothers along with recommendations for future research.     

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

Summary Points

• HIV prevention programs for sex workers, especially female sex workers, are cost-effective.
• There are opportunities to further increase the impact of HIV prevention programs for sex workers and to adapt interventions to a changing context.
• Many sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; receive limited domestic financing in many countries; are inadequately codified to ensure consistency and quality; and have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile and internet-based sex workers.
• We recommend increasing our understanding of HIV epidemic transmission dynamics, improving situation analyses and programmatic mapping, increasing domestic financing for sex worker HIV prevention programs where feasible, delivering well-codified, comprehensive programs using “Science of Delivery” principles and developing more effective models to reach informal sex workers, male and transgender sex workers, and mobile and internet-based sex workers.
• Given their marginalization, concerted efforts must be made to ensure sex workers have equitable access to HIV prevention, care, and treatment services, as well as wider health services, particularly for STIs, mental health, and addictions.

     

A New World With AIDS—Health Promotion as a Catalyst for Change

Preventing the acquired immunodeficiency syndrome (AIDS) requires an unprecedented response from public health professionals, particularly educators and communicators involved with health promotion. Health promotion is defined and discussed in the light of recent experience in a broad range of public health programs. Increased sophistication is needed in the application of social science within health promotion and increased facility in mobilizing cross-sectorial resources to achieve public health objectives and generate confidence in approaching AIDS prevention.     

Socialization strategies and disease transmission in captive colonies of nonhuman primates

In captive research environments for nonhuman primates (NHP), social housing strategies are often in conflict with protocols designed to minimize disease transmission. This is particularly true in breeding colonies, and is especially relevant when attempting to eliminate specific pathogens from a population of primates. Numerous strategies have been used to establish such specific pathogen free (SPF) breeding colonies (primarily of macaques), ranging from nursery rearing of neonates to single housing of socially reared yearlings to the rearing of infants in large social groups. All these strategies attempt to balance the effects of the chosen socialization strategy on parameters related to disease transmission, including the ultimate elimination of the target pathogens. Such strategies may affect the overall disease states of NHP breeding colonies through selective breeding processes. This can occur either by creating subpopulations of animals that do not have target diseases (SPF colonies), but may have other issues; or by creating situations in which the "best" animals are sold and the breeding colony is stocked with animals that may be more disease susceptible than those that were sold. The disease states of NHP research colonies also may be affected by selective utilization programs, in which animals removed from the breeding colony for health/behavior reasons, are preferentially chosen for use in scientific investigations. Such utilization criteria raise the question of whether ideal subjects are being chosen for use in research. Finally, captive primate colonies, where both socialization and disease states are intensely managed, may provide opportunities for those testing predictions from models of the interactions of socialization and disease transmission in the evolution of wild populations of NHP. This would be especially true for some extreme conditions of these disease ecology models, given the exceedingly high social densities and levels of pathogen control that exist in many captive nonhuman primate colonies.     

The Holy Spirit in the Household: Pentecostalism, Gender, and Neoliberalism in Mozambique

The recent expansion of Pentecostalism and independent churches in Africa has generated growing interest among social scientists. This attention parallels a renewed interest among Africanists on witchcraft and occult activities, also believed by many to be increasing. Some suggest the two trends may be related, but it remains unclear how and why. Drawing on a study of Pentecostalism and health in the city of Chimoio, Mozambique, in 2002–03 that focused on attitudes toward recent social change, we argue that structural adjustment economic reforms have deepened economic inequality and exacerbated household stresses that affect men and women differently. Women increasingly seek spiritual help for reproductive health problems from Pentecostal churches, whereas men disproportionately pay traditional healers to engage "occult" practices to manage misfortune related to employment. The increased resort to both spiritual resources reveals social distress caused by economic adjustment, with important implications for health programs.     

MENTAL HEALTH—A Discussion of Various Program Approaches Used in California and the Basic Assumptions Involved

The nation''s Number One health problem, mental illness, compels careful reevaluation of past and current methods of attack. It also invites consideration of the ways and means of integrating preventive measures that emphasize the conservation of mental health with prophylactic efforts that stress the avoidance of mental illnesses.A review of the development of both local and statewide mental health programs in California reveals that three fundamentally different approaches have been used: (1) The traditional approach which confines itself to the protection of society from the “insane” by the state, and to the treatment of those who are not legally insane through “private enterprise”; (2) the public health approach which seeks to minimize the causes and/or spread of selected types of psychiatric disorder regarded as mass phenomena; and (3) the sociological approach which stresses the importance of social factors both in the causation and in the rehabilitation of those mental conditions that are considered to be symptomatic of a “sick” society.An approach that combines the theoretical and practical implications of all three viewpoints offers some new solutions to the problems of (1) fitting mental health programs to populations; (2) financing; and (3) balancing preventive and clinical services.Mental illness is not a single disease-entity but a long list of distinctly different conditions. The causes and manifestations are multiple. Biological, psychological and social components in either mental health or mental illness cannot be dissociated in any attempt to understand and deal with so wide a range of illnesses and states of comparative health. Therefore, many professions and multiple public and private agencies are involved in planning, developing and administering a mental health program.     

Benefits of family reunions: social support in secondary greylag goose families

Social interactions are among the most potent stressors. However, social allies may diminish stress, increase success in agonistic encounters and ease access to resources. We studied the role of social support as a major mechanism for individual stress management in families of free-ranging greylag geese (Anser anser). Greylag geese are long-term monogamous, live in a female-bonded social system, and fledged offspring stay with their parents until the next breeding season (‘primary families’). Should parents then fail to fledge young, subadults might rejoin them in summer after molt is completed (‘secondary families’). We have previously shown that primary greylag goose families reap benefits from active social support in agonistic encounters, and also excrete lower levels of immuno-reactive corticosterone metabolites (CORT, ‘passive social support’). Here we investigated how far active and passive social support continues in secondary goose families. Although we found that active support in agonistic encounters was almost absent in secondary families, subadult male geese won an increased number of agonistic encounters due to the mere presence of their secondary family. Particularly adult and subadult females benefited from passive social support through decreased CORT, whereas males did not. Decrease in the hormonal stress response during challenging situations, induced by social allies, may help the females' long-term energy management, thereby improving the odds for successful future reproduction. We discuss whether joining a secondary family may be an alternative tactic for young geese towards optimizing their start into a complex social life.     

Focus: Sex and Gender Health: Beyond the Pap Smear: Gender-responsive HIV Care for Women

Women comprise nearly one-quarter of all people living with human immunodeficiency virus (HIV) in the U.S. and 20 percent of incident annual cases. Though women overall are more likely than men to be diagnosed with HIV and engage in care, they are as unlikely to successfully achieve viral suppression with antiretroviral therapy, suggesting gender-based disparities that should be addressed by gender-responsive policies and programs. Using the socioecological model of health and syndemics theory, we comprehensively reviewed published literature to evaluate reasons for and ways to address gender differences in HIV risk and treatment. We discuss the biologic, sociocultural, interpersonal, and behavioral contexts of HIV risk that affect women, comprehensive healthcare for women with HIV that includes pregnancy planning or prevention, and policy implications.     

Female sex worker social networks and STI/HIV prevention in South China

Background

Reducing harm associated with selling and purchasing sex is an important public health priority in China, yet there are few examples of sustainable, successful programs to promote sexual health among female sex workers. The limited civil society and scope of nongovernmental organizations circumscribe the local capacity of female sex workers to collectively organize, advocate for their rights, and implement STI/HIV prevention programs. The purpose of this study was to examine social networks among low-income female sex workers in South China to determine their potential for sexual health promotion.

Methods/Principal Findings

Semi-structured interviews with 34 low-income female sex workers and 28 health outreach members were used to examine how social relationships affected condom use and negotiation, STI/HIV testing and health-seeking behaviors, and dealing with violent clients. These data suggested that sex worker''s laoxiang (hometown social connections) were more powerful than relationships between women selling sex at the same venue in establishing the terms and risk of commercial sex. Female sex workers from the same hometown often migrated to the city with their laoxiang and these social connections fulfilled many of the functions of nongovernmental organizations, including collective mobilization, condom promotion, violence mitigation, and promotion of health-seeking behaviors. Outreach members observed that sex workers accompanied by their laoxiang were often more willing to accept STI/HIV testing and trust local sexual health services.

Conclusions/Significance

Organizing STI/HIV prevention services around an explicitly defined laoxiang social network may provide a strong foundation for sex worker health programs. Further research on dyadic interpersonal relationships between female sex workers, group dynamics and norm establishment, and the social network characteristics are needed.     

Animal lectins: a historical introduction and overview

Some proteins we now regard as animal lectins were discovered before plant lectins, though many were not recognised as carbohydrate-binding proteins for many years after first being reported. As recently as 1988, most animal lectins were thought to belong to one of two primary structural families, the C-type and S-type (presently known as galectins) lectins. However, it is now clear that animal lectin activity is found in association with an astonishing diversity of primary structures. At least 12 structural families are known to exist, while many other lectins have structures apparently unique amongst carbohydrate-binding proteins, although some of those "orphans" belong to recognised protein families that are otherwise not associated with sugar recognition. Furthermore, many animal lectins also bind structures other than carbohydrates via protein-protein, protein-lipid or protein-nucleic acid interactions. While animal lectins undoubtedly fulfil a variety of functions, many could be considered in general terms to be recognition molecules within the immune system. More specifically, lectins have been implicated in direct first-line defence against pathogens, cell trafficking, immune regulation and prevention of autoimmunity.     

Prevention of suicide.

We reviewed the epidemiologic features of suicide in Canada and evaluated suicide prevention programs. Three groups were found to be at increased risk for suicide: men aged 70 years or more, women aged 65 to 69 and men aged 20 to 24. The other groups, in decreasing order of risk, were the mentally ill, people who have attempted suicide, those with a life-threatening illness, native people, people with a family history of suicide and prisoners. Studies that evaluated suicide prevention programs showed that none significantly reduced the incidence of suicide; however, the studies were found to be methodologically inadequate or used noncomparable systems of data collection. On the basis of our findings we recommend that primary care physicians routinely evaluate suicide risk among patients in high-risk groups and that intervention include counselling, follow-up and, if necessary, referral to a psychiatrist. Close follow-up is recommended for newly discharged psychiatric patients and those who recently attempted suicide.     

Traffic accidents-chronic medical conditions as a cause

From comparatively scanty information, an increased traffic accident risk appears to be associated with several chronic medical conditions including alcoholism, cardiovascular disease, epilepsy, diabetes and mental illness. Further study probably will show that medical handicaps other than alcoholism are a factor in from 5 to 10 per cent of traffic accidents. However, in about half of the accidents caused by heart attacks, the individual has no previous knowledge of his illness, and prevention of the accident would not be possible. A selective program for identifying high risk drivers with medical conditions is feasible and warranted, but a program of mass medical examinations for all drivers is not.A very strong relationship has been shown between drunk driving and traffic accidents, and 50 to 75 per cent of all severe and fatal traffic accidents involve the use of alcohol. However, studies have shown that drivers with alcoholism rather than social drinkers represent the preponderance, but not the entirety, of those who get into trouble. A major reduction in the traffic accident toll may thus depend on the early identification and treatment of alcoholism.     

浑河流域2010-2014年的鱼类群落和水生态健康变化分析

为了解浑河流域鱼类群落结构的变化趋势和水生态健康变化,分别于2010年和2014年对浑河流域46个采样点进行了鱼类和环境因子调查。其中2010年采集到鱼类15039尾,隶属于6目9科32种;2014年采集到鱼类10483尾,隶属于6目10科41种。Mann-Whitney U检验表明从2010年到2014年鱼类总物种数、香农多样性指数、底层物种数百分比、植食性和肉食性个体数百分比等鱼类特征参数显著上升。典型对应分析（CCA）结果表明,2010年显著影响鱼类群落结构的环境因子为流速、电导率、河流等级和钙离子浓度;而2014年显著影响鱼类群落结构的环境因子则为电导率、河流等级和氨氮浓度。2010年和2014年的鱼类完整性指数（FIBI）评分分别为48.7624.82和50.4117.35,与2010年的评价结果相比,2014年F-IBI结果稍有改善,其中极好和好的点位数分别少3个和1个,一般的点位数多9个,而极差和差的点位分别少4个和1个。     

Traffic Accidents—Chronic Medical Conditions as a Cause

From comparatively scanty information, an increased traffic accident risk appears to be associated with several chronic medical conditions including alcoholism, cardiovascular disease, epilepsy, diabetes and mental illness. Further study probably will show that medical handicaps other than alcoholism are a factor in from 5 to 10 per cent of traffic accidents. However, in about half of the accidents caused by heart attacks, the individual has no previous knowledge of his illness, and prevention of the accident would not be possible. A selective program for identifying high risk drivers with medical conditions is feasible and warranted, but a program of mass medical examinations for all drivers is not.A very strong relationship has been shown between drunk driving and traffic accidents, and 50 to 75 per cent of all severe and fatal traffic accidents involve the use of alcohol. However, studies have shown that drivers with alcoholism rather than social drinkers represent the preponderance, but not the entirety, of those who get into trouble. A major reduction in the traffic accident toll may thus depend on the early identification and treatment of alcoholism.