State of environment indicators of 'river health': exploring the metaphor

1. Indicators are crucial to many socio-political schemes for portraying environmental influences of society. For example, the OECD model for State of the Environment Reporting uses three different sorts of indicators (pressure, condition, response) to differentiate the present condition of the environment from the anthropogenic pressures upon it and from any societal responses made to alleviate those pressures (thereby improving aspects of the overall condition). 2. These sorts of indicators have a fundamental technical basis in the science supporting their exposition and usage. However, the criteria used in interpreting the indicator values are likely to be set by considerations that go beyond scientific grounds. That is, indicators are socially determined in the end. However, many scientists find it difficult to involve the public in such reporting. 3. Scientists who are uncomfortable with this non-technical use of their indicator constructs should recognize that it is merely another manifestation of the overall broadening of environmental concern termed ‘ecosystem health’. The emerging field of ecosystem health seeks to take our technical understanding of how the environment functions and combine it with socio-economic goals, using a human health metaphor and an ethical underpinning. 4. River health might be better served by adopting a veterinary approach rather than the model of human health. This is because, like animals, riverine environments come in many different forms and cannot complain of ill health. Desirable interventions will vary with the uses to which we wish to put a river and our reasons for being concerned about a river’s health. A framework for this diagnostic approach is presented. 5. An enormous challenge lies ahead in integrating the various measurements of riverine attributes that might together constitute ‘river health’. We need ways to cater for the pluralism of modern societies, and we need more dynamic assessments of river condition, possibly founded on studies of key ecological processes.     

Systemic Negligence: Why It Is Morally Important for Developing World Bioethics

In the context of clinical and non‐clinical biomedical practices, negligence is usually understood as a lapse of a specific professional duty by a healthcare worker or by a medical facility. This paper tries to delineate systemic negligence as another kind of negligence in the context of health systems, particularly in developing countries, that needs to be recognized and addressed. Systemic negligence is not just a mere collection of stray incidences of medical errors and system failures in a health system, but is proposed in this paper as a more pervasive kind of neglect. Several non‐medical factors, such as lack of social and political will, also contribute to it and hence is more difficult to address in a health system. This paper argues that recognizing systemic negligence and including it research agenda have special moral importance for researchers in developing world bioethics, public health ethics and for health activists in the developing world. For, it can be a potent health system barrier, and can seriously impair efforts to ensure patient safety, particularly in the weaker health systems. As it erodes accountability in a health system, addressing it is also important for the twin goals of ensuring patient safety and improving health system performance. Above all, it needs to be addressed because the tolerance of its persistence in a health system seems to undervalue health as a social good.     

大学生口腔保健知识态度行为调查与研究

目的:评价大学生口腔保健知识、态度、行为情况,为实施口腔健康指导计划提供基线资料。方法:采用随机抽样的方法,对314名青岛大学新生进行了口腔保健知识、态度、行为的问卷调查;其中男生151名,占总数的48%,女生163名,占总数的52%。结果:大学生对龋病知识的知晓率高,但牙周知识及牙周状况差。大学生认为定时拜访牙医有助于口腔疾病预防,口腔健康与全身健康密切相关,但约一半学生害怕就医或推迟就医。只有55.7%的大学生一天刷牙两次,25.5%的大学生没有接受过专业刷牙指导。在口腔保健知识、态度及行为方面,女生优于男生。结论:大学生缺乏牙周方面基础口腔保健知识,缺少专业的口腔卫生指导。结构合理的口腔健康教育系统亟需实施。     

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.     

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.     

Care Giver Perception of Children's Obesity‐Related Health Risk: A Study of African American Families

Objective: To examine care giver perception of children's weight‐related health risk in African American families. Research Methods and Procedures: One‐hundred and eleven families (representing 48 boys and 63 girls) screened for participation in a diabetes prevention study participated. Care givers completed a health awareness questionnaire that assessed their perception of the child's weight, eating habits, appearance, exercise habits, and health risk. The care givers also reported each subject's family history of obesity, diabetes, and other chronic diseases. After a physical examination, height and weight were used to compute an age‐ and sex‐adjusted body mass index for each child. Results: Despite the fact that a substantial number of children were obese (57%) and super‐obese (12%), only 44% of the care givers perceived the child's weight to be a potential health problem. Regression analysis showed that 21% of the variance in parental perception of obesity‐related health risk could be predicted by child age, body mass index, perception of frame size, and perception of exercise habits. Discussion: A number of reasons for the apparent minimization of child health risk are discussed, including cultural differences in the acceptance of a large body habitus, lack of knowledge about the connection between childhood obesity and future health risk, and an optimistic bias in the perception of personal health risk.     

Animal board invited review: Dairy cow lameness expenditures,losses and total cost

Lameness is one of the most costly dairy cow diseases, yet adoption of lameness prevention strategies remains low. Low lameness prevention adoption might be attributable to a lack of understanding regarding total lameness costs. In this review, we evaluated the contribution of different expenditures and losses to total lameness costs. Evaluated expenditures included labor for treatment, therapeutic supplies, lameness detection and lameness control and prevention. Evaluated losses included non-saleable milk, reduced milk production, reduced reproductive performance, increased animal death, increased animal culling, disease interrelationships, lameness recurrence and reduced animal welfare. The previous literature on total lameness cost estimates was also summarized. The reviewed studies indicated that previous estimates of total lameness costs are variable and inconsistent in the expenditures and losses they include. Many of the identified expenditure and loss categories require further research to accurately include in total lameness cost estimates. Future research should focus on identifying costs associated with specific lameness conditions, differing lameness severity levels, and differing stages of lactation at onset of lameness to provide better total lameness cost estimates that can be useful for decision making at both the herd and individual cow level.     

Wuhan, China and Pittsburgh, USA: Urban Environmental Health Past, Present, and Future

This article briefly reviews environmental history in the “Sister Cities” of Wuhan, China and Pittsburgh, USA. Specifically, it analyzes key changes in air, water, land, and sustainability in each of the two cities in terms of both “driving forces” and of the actions of key stakeholders (policymakers, educators, industry/business, nongovernmental organizations [NGOs], and the public). It concludes by discussing prospects for synergies between the two cities in continuing to improve environmental health, and the implications of these ideas for other cities in both the “developing” and the “developed” world.     

Public mental health: the time is ripe for translation of evidence into practice

Public mental health deals with mental health promotion, prevention of mental disorders and suicide, reducing mental health inequalities, and governance and organization of mental health service provision. The full impact of mental health is largely unrecognized within the public health sphere, despite the increasing burden of disease attributable to mental and behavioral disorders. Modern public mental health policies aim at improving psychosocial health by addressing determinants of mental health in all public policy areas. Stigmatization of mental disorders is a widespread phenomenon that constitutes a barrier for help-seeking and for the development of health care services, and is thus a core issue in public mental health actions. Lately, there has been heightened interest in the promotion of positive mental health and wellbeing. Effective programmes have been developed for promoting mental health in everyday settings such as families, schools and workplaces. New evidence indicates that many mental disorders and suicides are preventable by public mental health interventions. Available evidence favours the population approach over high-risk approaches. Public mental health emphasizes the role of primary care in the provision of mental health services to the population. The convincing evidence base for population-based mental health interventions asks for actions for putting evidence into practice.     

Tackling the threat of antimicrobial resistance: from policy to sustainable action

Antibiotics underpin all of modern medicine, from routine major surgery through to caesarean sections and modern cancer therapies. These drugs have revolutionized how we practice medicine, but we are in a constant evolutionary battle to evade microbial resistance and this has become a major global public health problem. We have overused and misused these essential medicines both in the human and animal health sectors and this threatens the effectiveness of antimicrobials for future generations. We can only address the threat of antimicrobial resistance (AMR) through international collaboration across human and animal health sectors integrating social, economic and behavioural factors. Our global organizations are rising to the challenge with the recent World Health Assembly resolution on AMR and development of the Global Action plan but we must act now to avoid a return to a pre-antibiotic era.     

Brazilian public policies for reproductive health: family planning, abortion and prenatal care

This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom.     

Focus: Health Equity: Financial Protection Indexes and the Iranian Health Transformation Plan: A Systematic Review

Background: On May 5, 2014, the Iranian Ministry of Health and Medical Education launched the Health Transformation Plan (HTP) as a major healthcare reform to curb out-of-pocket (OOP) expenses and protect people from catastrophic health expenditures (CHEs). Therefore, in this study, we conducted a comprehensive literature search with the aim of systematically investigating the impacts of HTP on OOP and CHE after the implementation of the plan. Method: Web of Science, PubMed, Scopus, Embase, and Iranian bibliographic thesauri and repositories such as MagIran, Elmnet, and Scientific Information Database were searched. Studies published between May 2014 and December 2020 that reported the impact of HTP on the financial indicators under investigation in this study (OOP and CHEs) that were conducted in Iran. Estimated pooled change both for OOP and CHEs was calculated as effect size utilizing meta-analytical techniques. Also, heterogeneity among studies was assessed with the I² statistics. Results: Seventeen studies were included, nine of which evaluated the OOP index, six studies assessed the CHEs index, and two studies examined both the OOP and CHEs indexes. The OOP was found to decrease after the implementation of the HTP (with an estimated decrease of 13.02% (95% CI: 9.09-16.94). Also, CHEs experienced a decrease of 5.80% (95% CI: 3.85-7.74). Conclusion: The findings show that the implementation of HTP has reduced health costs. In this regard and in order to keep reducing the costs that many people are unable to pay, the government and other organizations involved in the health system should provide sustainable financial resources in order to continue running HTP. However, there remain gaps and weaknesses that can be solved through discussion with all the actors involved.     

LINKING INTERNATIONAL RESEARCH TO GLOBAL HEALTH EQUITY: THE LIMITED CONTRIBUTION OF BIOETHICS

Health research has been identified as a vehicle for advancing global justice in health. However, in bioethics, issues of global justice are mainly discussed within an ongoing debate on the conditions under which international clinical research is permissible. As a result, current ethical guidance predominantly links one type of international research (biomedical) to advancing one aspect of health equity (access to new treatments). International guidelines largely fail to connect international research to promoting broader aspects of health equity – namely, healthier social environments and stronger health systems. Bioethical frameworks such as the human development approach do consider how international clinical research is connected to the social determinants of health but, again, do so to address the question of when international clinical research is permissible. It is suggested that the narrow focus of this debate is shaped by high‐income countries' economic strategies. The article further argues that the debate's focus obscures a stronger imperative to consider how other types of international research might advance justice in global health. Bioethics should consider the need for non‐clinical health research and its contribution to advancing global justice.     

Remarkable Shrimps: Adaptations and Natural History of the Carideans

A histology-based fish health assessment protocol was used in 2009–2010 to assess the health status of Clarias gariepinus from Pongolapoort Dam, South Africa. Nineteen fish were collected by angling. The histology of liver, kidney, gills and testes or ovaries was semi-quantitatively assessed and compared to that of fish from a reference site in the Okavango Panhandle, Botswana. Necropsy observations indicated that C. gariepinus from Pongolapoort Dam were in poorer condition than those from the Okavango Panhandle. Microscopic analysis showed that the mean liver index (I _L), gill index (I _G), testis index (I _T) and ovary index (I _O) were higher, although not statistically significant, in fish from the Okavango Panhandle. The difference in the results between the necropsy-based observations and semi-quantitative histological results was due to the external abnormalities detected in the necropsy analysis, including parasites and skin lesions, not expressing as changes to cell and tissue structure. According to the parameters measured, C. gariepinus from Pongolapoort Dam were in a healthy state.     

Beyond the Hazard: The Role of Beliefs in Health Risk Perception

This article addresses how beliefs about health risks cluster and how these relate to perceptions of risk among Canadians. A principal components analysis conducted on items reflecting various beliefs from the Canadian National Health Risk Perception Survey extracted four underlying dimensions: Cancer Dread, Trust in Regulators, Environmental Concern, and Personal Agency. Factor scores were then used to investigate relationships between belief factors and the perceived health risk of various hazards with gender, education, income, and province of residence as covariates. Environmental and Therapeutic health risk perceptions were significantly higher in respondents with high Cancer Dread and high Environmental Concern, but lower in respondents with high Trust in Regulators. Environmental health risk perceptions were lower in respondents with high Personal Agency, whereas Social health risk perceptions were higher in respondents with high Cancer Dread and Personal Agency. Results suggest that information about health risk–related beliefs can be useful in improving our understanding of the public's perceived risk of health hazards.     

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.     

生态系统健康评价:方法与方向

生态系统为人类提供了自然资源和生存环境两个方面的多种服务功能。生态系统服务功能是人类生存和发展的基础。同时,一个生态系统只有保持了结构和功能的完整性,并具有抵抗干扰和恢复能力,才能长期为人类社会提供服务,因此,生态系统健康是人类社会可持续发展的根本保证。生态系统健康是指一个生态系统所具有的稳定性和可持续性,即在时间上具有维持其组织结构、自我调节和对胁迫的恢复能力。它可以通过活力、组织结构和恢复力等3个特征进行定义。影响生态系统健康的原因有很多,多为人类活动所致。例如,污染物排放、非点源污染、过度捕捞、围湖造田、水土流失、外来种入侵和水资源不合理利用等是影响水生态系统健康的主要原因。评价生态系统健康需要基于功能过程来确定指标,特别是评价其受干扰后的恢复能力。包括其完整性、适应性和效率。生态系统健康评价方法尚处于实验和发展阶段,有必要对现有成果进行及时总结,提出方向,以促进生态系统健康研究的发展。生态系统健康评价主要包括指示物种和指标体系两种方法。在生态系统健康研究中,指示物种的选择应该谨慎,要综合考虑到它们的敏感性和可靠性,即要明确它们对生态系统健康指示作用的强弱。在水生态系统研究中,己被选择的指示物种有,浮游生物、底栖无脊椎动物、鱼类和不同水平生物的综合。建立生态系统健康评价指标体系大可以从两方面选择指标,即生态系统内部指标,包括生态毒理学、流行病学、生态系统医学等方面和不同尺度指标的综合;以及生态系统外部指标,比如社会经济指标。但是,其它指标可能也适于进行生态系统健康评价,如景观格局、土地利用变化。到目前为止,对几乎所有的生态系统类型都进行过健康评价。但是,由于生态系统健康研究是一个新领域,有关它的概念、评价的指示物处和指标体系等方面存在各种争论,生态系统健康评价正在不断的争论中走向成熟。其未来发展方向是结合经济学、社会学和健康科学煌定量化生物学途径。生态系统健康评价的目的不是为生态系统诊断疾病,而定义生态系统的一个期望状态,确定生态系统破坏的阈限,并在文化、道德、政策、法律、法规的约束下,实施有效的生态系统管理。     

Focus: Preventive Medicine: Pre-Participation Screening of Athletes: Primary Health Care Physicians’ Knowledge,Experience, and Approach in Turkey

Pre-participation screening (PPS) is crucial for assessing the competitive athletes since their risk of sudden death is higher than non-athletes. In Turkey, PPS is performed at the primary health care setting by primary care physicians (PCPs) who are family medicine specialists (FMSs) or general practitioners (GPs). Although there are national guidelines, there is no legal regulation for this process. This study aims to evaluate PCPs’ knowledge, experience, and approach about PPS. We prepared an online survey for PCPs and used non-probabilistic sampling. PPS attitudes and practices were analyzed and compared according to factors such as experience, education, and being GP or FMS. Of the 214 PCPs included in the study, 39.3% were female. The mean age was 44.9 years (SD:8.88). The average work experience was 7.9 years. Most participants were aware of their authorization to perform PPS (89.7%) and had previously prepared it (90.2%). However, 6.5% of them felt confident in performing PPS. Only 13.1% were aware of the guidelines. Almost 25% of the participants stated being informed about the subject at some part of their career, but this did not affect the confidence or referral decisions. In addition to medical history and physical examination, further testing was considered necessary by 96.3% of the participants. Significantly more tests were ordered by GPs than FMSs (p=0.026 and p=0.011, respectively). The accurate referral decision ratio was 59.3%, without difference between FMSs and GPs (p=0.216). We found that awareness of the guidelines was low among PCPs who lack confidence in PPS. These factors collectively increased the tendency for unnecessary further testing and referral. Therefore, the PPS implementation into medical school and residency curriculums and national legal regulation for the process is a necessity in Turkey.