Mental health system in China: history, recent service reform and future challenges

This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.     

Evaluation of Genetic Consultations in the public health service

Summary Work of the Genetic Consultation Group at the Institute of Medical Genetics, USSR Academy of Medical Sciences is analyzed and evaluated from the viewpoint of working out organizational principles for counseling. During three years (from July 1973 to June 1976) 1145 families were referred to us, of which 76% were referred by physicians and 24% were self-referrals.Reasons for referral were progeny prognosis (75.7%), health prognosis (1.5%), more precise diagnosis (18.1%), treatment (2.7%), and other reasons (2%). The main cause of referral was birth of a sick child (75%). People seeking advice were divided according to disease group as follows: chromosome diseases and congenital malformations (45.4%), monogenic diseases (15.4%), diseases with hereditary predisposition (14.6%), repeated miscarriages and infertility (11.5%), and others (13.1%).For counseling, 1145 families required additional cytogenetic (987) and biochemical (138) investigations. At evaluation of genetic risk, 16 types of genetic problems were encountered.It was concluded that genetic counseling should be organized firstly in pediatric and obstetric-gynecologic services, both in general and specialized hospitals. To facilitate referrals to the consultation center, spread of genetic knowledge among physicians and the population is necessary. The most effective form of propaganda among physicians is distribution of special literature with a list of indications for referral to consultation centers; most effective among the population are articles in newspapers and magazines.     

Mycobacteria in drinking water distribution systems: ecology and significance for human health

In contrast to the notorious pathogens Mycobacterium tuberculosis and M. leprae, the majority of the mycobacterial species described to date are generally not considered as obligate human pathogens. The natural reservoirs of these non-primary pathogenic mycobacteria include aquatic and terrestrial environments. Under certain circumstances, e.g., skin lesions, pulmonary or immune dysfunctions and chronic diseases, these environmental mycobacteria (EM) may cause disease. EM such as M. avium, M. kansasii, and M. xenopi have frequently been isolated from drinking water and hospital water distribution systems. Biofilm formation, amoeba-associated lifestyle, and resistance to chlorine have been recognized as important factors that contribute to the survival, colonization and persistence of EM in water distribution systems. Although the presence of EM in tap water has been linked to nosocomial infections and pseudo-infections, it remains unclear if these EM provide a health risk for immunocompromised people, in particular AIDS patients. In this regard, control strategies based on maintenance of an effective disinfectant residual and low concentration of nutrients have been proposed to keep EM numbers to a minimum in water distribution systems.     

The public health and safety consequences of sleep disorders

Sleep deprivation and medical disorders of sleep are common in today's society and have significant public health implications. In this article, we address 3 specific issues related to the public health and safety consequences of sleep disorders. First, we review data that has linked sleep restriction to a variety of adverse physiologic and long-term health outcomes including all-cause mortality, diabetes, and cardiovascular disease. Second, we will review recent data that has demonstrated that therapy for obstructive sleep apnea (the most common respiratory disorder of sleep) is an extremely efficient use of healthcare resources (in terms of dollars spent per quality adjusted life year gained), and compares favorably with other commonly funded medical therapies. Finally, we will review data that illustrate the potential adverse patient and occupational safety impacts of the extreme work schedules of housestaff (physicians in training).     

Identified and unidentified challenges for reproductive biotechnologies regarding infectious diseases in animal and public health.

The aim of the present paper is to review the known and theoretical risks for in vivo derived and in vitro produced embryos as well as for nuclear transferred or transgenic embryos in terms of animal diseases or diseases of public health consequence. For in vivo derived embryos, a considerable number of experiments and scientific investigations have resulted in recommended guidelines and procedures that ensure a high level of safety. The effectiveness of these measures has been validated by field experience with the safe transfer of several million embryos over the past three decades. In vitro produced embryos have several characteristics that differentiate them from the former, in particular a structure of the zona pellucida that results in a more frequent possible association of pathogens with the embryo. However, the guidelines prescribed by the IETS, the international standard setting body (OIE) and existing national regulatory frameworks are in place to minimize the risk of disease transmission. No specific public health risks have been identified to date with respect to in vivo or in vitro derived embryos. In regard to nuclear transferred and transgenic embryos, theoretical risks have been identified in relation to the potential effects on some intrinsic viruses such as endogenous retroviruses but very little targeted experimental work has been carried out on infectious diseases that could have adverse consequences on animal or human health. Although there has been no report of such adverse consequences associated with the limited number of animals produced to date by such reproductive technologies, a precautionary approach is warranted given the potential negative impacts and it would be prudent to restrict at this stage, the international movement of such "manipulated" embryos.     

Disseminating the best available evidence: New challenges in public reporting of health care

As a direct benefit of the Health Care Reform Act (2010), concerted effort has been deployed to define and characterize the process by which the best available evidence for diagnosis or treatment intervention prognosis can be obtained. The science of research synthesis in health care has established the systematic research protocol by which randomized clinical trials and other clinical studies must be reviewed and compared for the level and quality of the evidence presented, as well as the consensus of the best available evidence synthesized and shared. This process of systematic review yields a reliable and valid approach in comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions in terms of efficacy, and or of effectiveness. The resulting bioinformation outcome of comparative effectiveness and efficacy research review of the available clinical data is expressed as a consensus of the best available evidence, which finds its way in evidence-based clinical practice guidelines, standards of care and eventually, in policies: hence, the acronym CEERAP (comparative effectiveness and efficacy review and policy). The methodological and the procedural criteria that determine and regulate the public reporting dissemination of this sort of bioinformation, and the extent of benefit to the patient's health literacy, which have remained a bit more elusive to this date, are investigated and discussed in this paper.     

Solid waste treatment and disposal: effects on public health and environmental safety

The safety and acceptability of many widely used solid waste management practices are of serious concern from the public health point of view. Such concern stems from both distrust of policies and solutions proposed by all tiers of government for the management of solid waste and a perception that many solid waste management facilities use poor operating procedures. Waste management practice that currently encompasses disposal, treatment, reduction, recycling, segregation and modification has developed over the past 150 years. Before that and in numerous more recent situations, all wastes produced were handled by their producers using simple disposal methods, including terrestrial dumping, dumping into both fresh and marine waters and uncontrolled burning. In spite of ever-increasing industrialisation and urbanisation, the dumping of solid waste, particularly in landfills, remains a prominent means of disposal and implied treatment. Major developments have occurred with respect to landfill technology and in the legislative control of the categories of wastes that can be subject to disposal by landfilling. Even so, many landfills remain primitive in their operation. Alternative treatment technologies for solid waste management include incineration with heat recovery and waste gas cleaning and accelerated composting, but both of these technologies are subject to criticism either by environmentalists on the grounds of possible hazardous emissions, failure to eliminate pathogenic agents or failure to immobilise heavy metals, or by landfill operators and contractors on the basis of waste management economics, while key questions concerning the effects of the various practices on public health and environmental safety remain unanswered. The probable and relative effects on both public health and environmental safety of tradition and modern landfill technologies will be evaluated with respect to proposed alternative treatment technologies.     

It's not just science: challenges for public health intervention in Ebola epidemics in the Democratic Republic of Congo

正The Democratic Republic of Congo (DRC) is suffering from the world’s second largest and most prolonged Ebola virus disease (EVD) epidemic on record (Figure 1). The current prevalence of EVD in the DRC makes this the 10th (and largest) EVD epidemic in the DRC since the first discovery of the Zaire Ebola virus in 1976 (Ilunga Kalenga, 2019).Globally, it is the second worst outbreak in the history of Ebola epidemics, and is only superceded by the EVD epi-     

The challenges of offering public second trimester abortion services in South Africa: health care providers' perspectives

Around 25% of abortions in South Africa are performed in the second trimester. This study aimed to better understand what doctors, nurses and hospital managers involved in second trimester abortion care thought about these services and how they could be improved. Nineteen in-depth interviews with abortion-related service providers and managers in the Western Cape Province, South Africa, were undertaken. Data were analysed using a thematic analysis approach. Participants expressed resistance to the dilation and evacuation (D&E) procedure, as this required more active provider involvement. Medical abortion was preferred as it required less provider involvement in the abortion process. A shortage of providers willing to perform D&E resulted in most public sector services being outsourced to private sector doctors. Respondents noted an increased demand for services and a concomitant lack of infrastructure, physical space and personnel to respond to these demands, sometimes resulting in fragmented or poor quality care. At medical induction sites, most thought introducing the combined mifepristone-misoprostol regimen would improve service capacity, although they were concerned about cost. Improving contraceptive services was also seen as a much-needed intervention to improve care and prevent abortion. Ongoing training, including values clarification, as well as emotional support and team-building for providers are needed to ensure sustainable, high-quality second trimester abortion services.