Table of Contents
Editorial in Public Health Policy
Workplace Health Promotion as a good solution to the negative impact of the financial crisis on healthcare systems
Author: Francesco Chirico1
1 M.D., Health Service Department, State Police, Ministry of Interior, Italy. Prof, Department of Women/Child and Public Health Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
Keywords: Health equity; health care systems; health policy; occupational health; public health; workplace health promotion
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Commentary in Public Health and HIV
An integrated public health approach for a successful strategy against HIV: The case of Swaziland
Authors:Yacob Habboush1, Noor Daoud2
1 M.D., Department of Internal Medicine, Orange Park Medical Center, Jacksonville, FL, USA
2 PA-C., Department of Family Medicine, Baptist Health, Jacksonville, FL, USA
Swaziland is an inland country in the southern Africa with a population of less than 1.5 million. Human immunodeficiency virus (HIV) is the main public health concern in Swaziland as 27.2% of adults are living with HIV infection. Swaziland is known to have the highest prevalence of HIV infected people in the world. However, this might be changing soon as the incidents of new HIV infection are decreasing and the prevalence of HIV infection are stabilizing. This is due to the multiple well-implemented programs that are targeting the different components of HIV transmission including condom availability, HIV education, sex education, male circumcision, and pre-exposure prophylaxis. Although the prevalence of HIV is stabilizing, there are multiple gaps that need to be addressed by new programs to ensure that the prevalence remains stable and aim to decrease it in the future by providing the appropriate antiretroviral treatment and better access to healthcare. However, such programmes cannot be effective without improving the socio-economic and educational levels of people, understanding their beliefs and meeting their needs.
Keywords: Africa; education, incidence, health policy; HIV; Swaziland.
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Commentary in Health Education Policy
Learning to live: The role of education policy for improving the quality of primary and preventative healthcare in the United States
Authors: David Blitzer1, W Rainey Johnson2
1 M.D., Columbia University, New York, USA
2 M.D., Uniformed Services, University of Health Sciences, Bethesda, Maryland. Naval Medical research Center, Silver Spring, Maryland, USA
From a policy standpoint, education and healthcare are often discussed separately in the United States. A review of the current literature reveals that education can be a strong predictor of individual health outcomes, indicating that these two spheres are most interrelated than currently recognized. The ways in which education influence health outcomes are complex and varied, and no single theory can explain the entire interaction. However, with this evidence, one can argue that US policymakers in search of healthcare interventions that improve outcomes without unbearable costs should work within education policy, recognizing that teachers in the US are also some of the country’s most cost effective preventative care providers. Potential policy targets include universal Pre-K access and improved high school graduation rates.
Keywords: Education; educational attainment; primary care; preventative care.
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Original Article in Health Care Policy
Need and utilization of primary health care among long-term unemployed Finns
Authors: Jan Klavus1, Leena Forma2, Jussi Partanen3, Pekka Rissanen4
1 Ph.D., Department of Health Sciences, Faculty of Social Science, University of Tampere, Tampere, Finland
2 Ph.D., Department of Health Sciences, Faculty of Social Science, University of Tampere, Tampere, Finland
3 M.Sc., Department of Health Sciences, Faculty of Social Science, University of Tampere, Tampere, Finland
4 Prof., Department of Health Sciences, Faculty of Social Science, University of Tampere, Tampere, Finland
Introduction: Aim of this paper was to identify the attributes of primary health care utilization among long-term unemployed Finns, and to examine whether access to care and the choice of provider differ with respect to employment status.
Methods: Data on primary health care utilization were derived from two sources; a targeted questionnaire about the use of services and quality of life among long-term unemployed individuals, and the Welfare and Services in Finland Survey, covering the general population. A two-part econometric model was applied in order to separate between the probability and level of utilization. The statistical analysis allowed predicting the monetary costs of primary care utilization. In this context, a non-parametric smearing factor was used to adjust for retransformation bias. In addition, a distinction between the level of costs and number of visits was taken to account for the effect of unit cost variation.
Results: The analyses indicated that the utilization of primary health care services among the long-term unemployed varied with respect to gender, self-rated health status and economic situation, place of residence, marital status and duration of unemployment. The scope of analysis was shown to be fundamental for the interpretation of the comparative results. Taking into account the provision of occupational care services inverted the positive effect of long-term unemployment on primary care utilization. Further, while the costs of utilization were independent of employment status, long-term unemployment had a distinct reducing effect on the number of medical visits.
Discussion and Conclusion: Despite of greater health care needs, the long-term unemployed sought less visits to more costly public primary care services. In order to confront unmet health care needs among the long-term unemployed, public sector interventions should be targeted accordingly, and in particular, involve gender specific social marketing measures.
Keywords: Delivery of health care; health care utilization; long-term unemployment; primary health care; two-part model.
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Original Article in Environmental Public Health
Toward a new interdisciplinary model to understand Alzheimer’s disease: The interplay between neurobiology and socio-economic factors
Authors: Hyun Jee Han1, Clive Shrubsole2
1 Pharmaceutics, School of Pharmacy, University College London, London, UK
2 Honorary Senior Research Associate, The Bartlett School of Environment, Energy and Resources, University College London, London, UK
Introduction: In recent years, there has been emerging evidence that air pollution is a chronic source of neuroinflammation, which contributes to Alzheimer’s Disease (AD) and other forms of dementia, which are an increasingly common and devastating illness affecting elderly populations. Aim of this paper is to develop a new, interdisciplinary and theoretical model based on neurobiology, sociology of medicine and eco-political science for a better understanding of the etiopathogenesis of Alzheimer’s disease and other forms of dementia.
Methods: We carried out a literature review focusing on the following aspects: 1) The causal relationship between PM2.5 (and air pollution) and AD; 2) Regulations and guidelines about air pollution released by organizations across the world; 3) Differences in PM2.5 and educational levels between More Economically Developed Countries (MEDC) and Less Economically Developed Countries (LEDC); 4) Differences of AD incidence between MEDC and LEDC with regard to their levels of social developments.
Results: Our interdisciplinary model depicts a pathway through which specific socio-economic factors (poor residential conditions and geographical sites, low educational levels) and environmental factors (i.e. air pollution exposure) interact to increase the risk of developing Alzheimer’s disease.
Discussion: According to our model, socio-economically disadvantaged individuals and communities are likely to be at higher risk for AD, compared to those in better living conditions, due to greater likelihood of living by the lower-price housing areas and greater exposure to air pollution, and low educational levels. This suggests that the lower the socio-economic development, the higher the chance of being exposed to the PM2.5. These combined socio-economic determinants may result in a greater likelihood of developing AD.
Conclusion: Although our model does not include other well-recognized causes of AD and needs to be tested by further in-depth epidemiological studies, more holistic and realistic views on the current approaches will allow this field to move forward and lead to an improvement to actionable policies.
Keywords: Neuroinflammation; Alzheimer’s diseases; air pollution; Pm2,5; eco-politics; education; Models,theoretical; socioeconomic factors.
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Original Article in Neuroradiology
Intracranial CT findings in traumatic brain injury: A retrospective, cross-sectional study among Igbo population in Nigeria
Authors: Angel-Mary Anakwue1, Felicitas Ugochinyere Idigo1, Uloma Benedicta Nwogu1, Sylvester Osita Ogbu1, Anthony Nnamani1, Kennedy Joseph1, Camillus Chukwuemeka Ugwoke2
1 M.D., Department of Medical Radiography and Radiological Sciences, University of Nigeria Enugu Campus, Nsukka, Nigeria
2 Mr, Federal Medical Center, Umuahia, Abia State, Nigeria
Introduction: Traumatic brain injury (TBI) is a major cause of death and disability and in recent years has been increasingly reported even in developing countries. Computed Tomography (CT) plays a key role in accurate TBI diagnosis and management. The objective of this study was to document the pattern of CT findings in TBI cases reported from Igbo people, in Nigeria.
Method: In this retrospective, cross-sectional study, a sample of 287 patients, who were consecutively referred to the CT Unit of the Radiology Department of Federal Medical Centre in Umuahia, Nigeria, between January 2015 and December 2016, on account of trauma to the head was reviewed. Only CT scan without contrast and intracranial findings were considered. Descriptive statistics (frequency and percentages) and confidential intervals were collected.
Results: After applying exclusion criteria, our sample comprised 242 patients (M = 163, 67.4%; mean age 32.6 ± 17.6 years). The peak age range was 20–29 years. Abnormal findings were reported for 205 patients (84.72%, 95% Confidential Interval [CI] 80.0 to 86.8). Cerebral oedema was the most common finding observed in the study (n = 64, 24.44%, CI 19.03% to 29.85%), followed by subarachnoid haemorrhage (n = 41, 16.94%, CI 12.21% to 21.67%) and epidural haematoma (n = 26, 10.74%, CI 6.84% to 14.64%). Only 37 patients (15.28%) showed normal findings. Main reported causal factors of TBI were: Road Traffic Accidents (RTA) (35.5%), falls (20.2%) and assault (15.7%). Most cases of RTA (34.9%) occurred in the age group of 20–29 years.
Discussion and Conclusion: CT brain without contrast is useful in screening of patients with TBI. In this Nigeria-based study the most common cause of TBI was RTA and cerebral oedema was the most common intracranial finding reported.
Keywords: Computed tomography; craniocerebral trauma; neuroradiology; Nigeria; traumatic brain injury.
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Original Article in Sexual Health Behavior
HIV risk perception and changes in sexual behavior and sexual satisfaction following male circumcision among circumcised males and their female partners from a traditionally non-circumcising community in Kenya, 2012-2014
Authors: Barbara Burmen1, Kennedy Mutai2, George Otieno Olilo3
1 MBChB, MPH, PHD, Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI/CGHR), Kisumu, Kenya
2 MSC Applied Statistics, Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI/CGHR), Kisumu, Kenya
3 Mmed Population Based Field Epidemiology, Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI/CGHR) Kisumu, Kenya
Introduction: The aim of this study was to determine HIV risk perception, sexual satisfaction and condom use among recently-circumcised sexually-active males and their female partners from a traditionally non-circumcising Kenyan community.
Methods: A longitudinal bio-behavioural survey using interviewer-administered structured questionnaires was conducted in Siaya County of Kenya between November 2012 and February 2014 among persons of both genders aged ≥13 years. Male respondents were characterized as ‘recently circumcised’ if they had been circumcised within the 2 years of the interview, ‘previously circumcised’ if prior to this and as ‘uncircumcised’. Sexual satisfaction was measured on a 3-point likert scale (‘satisfied’, ‘no opinion’, ‘dissatisfied’). Logistic regression analysis was carried out to compare self-reported characteristics of the survey respondents by their own (males) or their partners (females) circumcision status.
Results: Of 3,285 men interviewed, 1,001 (30%) were circumcised, of whom 247 (25%) were recently circumcised. Of 4,171 women interviewed, 976 (24%) had primary partners who were circumcised of whom 151 (15%) had ‘recently circumcised’ primary partners. Recently circumcised males were more likely to be younger, single and unemployed; similarly, their female partners were more likely to be younger, single and have attained above primary education (P < 0.05). Most of (≥ 90%) all men and women believed that circumcised men are less likely to get HIV infection and felt that both reducing the number of sex partners, and condom use with a partner with unknown HIV status were still necessary despite male circumcision (MC) being available in their community. Majority of males and females (> 90%) were pleased with their own or their partners recent circumcision, sexual performance and condom use.
Discussion and Conclusion: Messages to promote MC should incorporate information regarding preserved/enhanced sexual satisfaction, ease of condom use, and include women to promote MC, a one-time intervention, which is not associated with risk compensation.
Keywords: Africa; health behavior; HIV; male Circumcision; female views; risk perception; sexual behavior; sexual satisfaction.
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Case Report in Emergency Medicine
Spontaneous splenic rupture in a teenager as first manifestation of acute myeloid leukemia: Case report and literature review
Authors: Antonio Villa1, Simona Rossi2, Isabella Riva3, Cecilia Tedesco4, Francesca Maria Zanchettin5, Rinaldo Chiumento6
1 M.D., Department of Emergency, ASST Monza, PO Desio, Monza, Italy
2 M.D., Department of Pediatrics, ASST Monza, PO Desio, Monza, Italy
3 M.D., Department of Anesthesiology and Critical Care, ASST Monza, PO Desio, Monza, Italy
4 M.D., Department of Radiology, ASST Monza, PO Desio, Monza, Italy
Spontaneous splenic rupture is a well-known, but rare life-threatening complication of hematological malignancies. We describe the case of a 12-year-old boy with a 5-day history of fever and successively left upper quadrant abdominal pain and sudden clinical deterioration necessitating emergency splenectomy. On arrival, a blood dyscrasia was postoperatively confirmed as acute myeloid leukemia. Cases of atraumatic rupture in diseased spleens are widely reported and pathological rupture of the spleen is a rare, but well recognized complication in hematological malignancies. This case report represents a rare and fatal initial presentation of acute myeloid leukemia in an adolescent. Because of the rarity of atraumatic splenic rupture, a high index of clinical suspicion must be maintained in patients with left upper quadrant pain and abnormal differential count on peripheral blood smear.
Keywords: Acute myeloid leukemia; spontaneous splenic rupture; ultrasonography.
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