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City tuberculosis control coordinators` perspectives of patient adherence to DOT in Sao Paulo State, Brazil, 2005

ARCENCIO, R. A.; OLIVEIRA, M. F.; CARDOZO-GONZALES, R. I.; RUFFINO-NETTO, A.; PINTO, I. C.; VILLA, T. C. S.
Fonte: INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D) Publicador: INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D)
Tipo: Artigo de Revista Científica
ENG
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SETTING: Thirty-six priority cities in Sao Paulo State, Brazil, with a high incidence of tuberculosis (TB) cases, deaths and treatment default. OBJECTIVE: To identify the perspectives of city TB control coordinators regarding the most important components of adherence strategies adopted by health care teams to ensure patient adherence in 36 priority cities in the State of Sao Paulo, Brazil. DESIGN: Qualitative research with semi-structured interviews conducted with the coordinators of the National TB Control Programme involved in the management of TB treatment services in the public sector. RESULTS: The main issues thought to influence adherence to directly observed treatment (DOT) by coordinators include incentives and benefits delivered to patients, patient-health care worker bonding and comprehensive care, the encouragement given by others to follow treatment (family, neighbours and health professionals), and help provided by health professionals for patients to recover their self-esteem. CONCLUSION: The main aspects mentioned by city TB control coordinators regarding patient adherence to treatment and to DOT in Sao Paulo are improvements in communications, relationships based on trust, a humane approach and including the patients in the decision-making process concerning their health.

Epidemiology training: a necessity for primary health care.

Shah, U
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1985 EN
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In spite of planned development and expansion of health services, especially in rural areas in India, mortality due to preventable conditions has remained unacceptably high. Important reasons for failure of the health system to detect the problems early are centrally planned programmes based on inadequate data and time-bound numerical targets for achievement. This promotes a tendency for passive implementation which destroys initiative and incentive for conceptualisation of problems and strategies. For health programmes to be far more successful, the entire health team needs to be given training in epidemiology appropriate to the level of each category, so that programme planning based on epidemiologically determined local needs can be done at district level by the District Health Organisation. Participation of health workers and the community will then be more active and relevant to the needs of the community.

Trends in maternal and infant health in poor urban neighborhoods: good news from the 1990s, but challenges remain.

Howell, Embry M.; Pettit, Kathryn L. S.; Kingsley, G. Thomas
Fonte: Association of Schools of Public Health Publicador: Association of Schools of Public Health
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
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OBJECTIVES: During the 1990s, numerous public policy changes occurred that may have affected the health of mothers and infants in low-income neighborhoods. This article examines trends in key maternal and child health indicators to determine whether disparities between high-poverty neighborhoods and other neighborhoods have declined. METHODS: Using neighborhood-level vital statistics and U.S. Census data, we categorized "neighborhoods" (Census tracts) as being high poverty (greater than 30% of population below the federal poverty level in 1990) or not. We compared trends in four key indicators--births to teenagers, late prenatal care, low birth-weight; and infant mortality--over the 1990s among high-poverty and other neighborhoods in Cuyahoga County, Ohio; Denver, Colorado; Marion County, Indiana; and Oakland, California. RESULTS: In all four metropolitan areas, trends in high-poverty neighborhoods were more favorable than in other neighborhoods. The most consistently positive trend was the reduction in the rate of teen births. The metropolitan areas with the most intensive programs to improve maternal and child health--Cuyahoga County and Oakland-saw the most consistent improvement across all indicators. Still, great disparities between high-poverty and other neighborhoods remain...

Reducing the Gap Between the Economic Costs of Tobacco and Funds for Tobacco Training in Schools of Public Health

Rovniak, Liza S; Johnson-Kozlow, Marilyn F; Hovell, Melbourne F
Fonte: Association of Schools of Public Health Publicador: Association of Schools of Public Health
Tipo: Artigo de Revista Científica
Publicado em //2006 EN
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Tobacco use costs approximately $167 billion annually in the U.S., but few tobacco education opportunities are available in schools of public health. Reasons for the discrepancy between the costs of tobacco use and the creation of tobacco training opportunities have not been well explored. Based on the Behavioral Ecological Model, we present 10 recommendations for increasing tobacco training in schools of public health. Six recommendations focus on policy changes within the educational, legislative, and health care systems that influence funds for tobacco training, and four recommendations focus on strategies to mobilize key social groups that can advocate for change in tobacco control education and related policies. In addition, we present a model tobacco control curriculum to equip public health students with the skills needed to advocate for these recommended policy changes. Through concurrent changes in the ecological systems affecting tobacco control training, and through the collaborative action of legislators, the public, the media, and health professionals, tobacco control training can be moved to a higher priority in educational settings.

The Use of Biomonitoring Data in Exposure and Human Health Risk Assessments

Albertini, Richard; Bird, Michael; Doerrer, Nancy; Needham, Larry; Robison, Steven; Sheldon, Linda; Zenick, Harold
Fonte: National Institute of Environmental Health Sciences Publicador: National Institute of Environmental Health Sciences
Tipo: Artigo de Revista Científica
EN
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Biomonitoring uses analytic methods that permit the accurate measurement of low levels of environmental chemicals in human tissues. However, depending on the intended use, biomonitoring, like all exposure tools, may not be a stand-alone exposure assessment tool for some of its environmental public health uses. Although biomonitoring data demonstrate that many environmental chemicals are absorbed in human tissues, uncertainty exists regarding if and at what concentrations many of these chemicals cause adverse health outcomes. Moreover, without exposure pathway information, it is difficult to relate biomonitoring results to sources and routes of exposure and develop effective health risk management strategies. In September 2004, the Health and Environmental Sciences Institute, U.S. Environmental Protection Agency, Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry, and International Council of Chemical Associations co-sponsored the International Biomonitoring Workshop, which explored the processes and information needed for placing biomonitoring data into perspective for risk assessment purposes, with special emphasis on integrating biomarker measurements of exposure, internal dose, and potential health outcome. Scientists from international governments...

Can the Health-Care System Meet the Challenge of Pandemic Flu? Planning, Ethical, and Workforce Considerations

Levin, Peter J.; Gebbie, Eric N.; Qureshi, Kristine
Fonte: Association of Schools of Public Health Publicador: Association of Schools of Public Health
Tipo: Artigo de Revista Científica
Publicado em //2007 EN
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The federal pandemic influenza plan predicts that 30% of the population could be infected. The impact of this pandemic would quickly overwhelm the public health and health-care delivery systems in the U.S. and throughout the world. Surge capacity for staffing, availability of drugs and supplies, and alternate means to provide care must be included in detailed plans that are tested and drilled ahead of time. Accurate information on the disease must be made available to health-care staff and the public to reduce fear. Spokespersons must provide clear, consistent messages about the disease, including actions to be taken to contain its spread and treat the afflicted. Home care will be especially important, as hospitals will be quickly overwhelmed. Staff must be prepared ahead of time to assure their ability and willingness to report to work, and public health must plan ahead to adequately confront ethical issues that will arise concerning the availability of treatment resources. The entire community must work together to meet the challenges posed by an epidemic. Identification and resolution of these challenges and issues are essential to achieve adequate public health preparedness.

Experiences in Developing and Implementing Health Clubs to Reduce Hypertension Risk among Adults in a South African Population in Transition

Puoane, Thandi R.; Tsolekile, Lungiswa; Igumbor, Ehimario U.; Fourie, Jean M.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
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Chronic noncommunicable diseases (NCDs) are increasing substantially as a cause of death and disability in all strata of the South African society, particularly among the urbanised poor. Hypertension is a risk factor for many of these diseases and becoming a burden in a growing population in a Cape Town township, Khayelitsha. To alleviate healthcare demands at clinics in this area, a health club was initiated and community health workers (CHWs) were trained to empower community members about NCDs and create public awareness. After training, a health club was initiated. Three months after initiation of the health club, 76 participants had been recruited of whom 22 were regular attenders. New members joined the health club weekly. Anthropometric and blood pressure measurements were taken, and various hypertension topics were covered at the club meetings which included healthy behaviours, such as the benefits of being physically active and eating healthy. Nutrition education sessions based on the South African food-based dietary guidelines were also held. Consequent to the initial group that was established, two more clubs were formed in the area. Health clubs are sustainable and culturally appropriate when facilitated by local people who have an insight and deeper understanding of the culture and environment of the people they serve.

Health needs assessment for medical genetic services for congenital disorders in middle- and low-income nations

Christianson, A.; Zimmern, R.; Kristoffersson, U.; Schmidtke, J.; Kent, A.; Raouf, R.; Barreiro, C.; Nippert, I.
Fonte: Springer Berlin Heidelberg Publicador: Springer Berlin Heidelberg
Tipo: Artigo de Revista Científica
EN
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Medical genetic services for the care and prevention of congenital disorders have received little attention in most middle- and low-income countries to date. In 2010, the World Health Organisation prioritized services for the care and prevention of birth defects in these nations, emphasising their importance in assisting such countries to reach their Millennium Development Goals. Health Needs Assessment is an inclusive, rational, epidemiological-assisted approach for providing information to plan, introduce and beneficially change health care services to improve the health of populations. It is intrinsic to much of the development of health care systems in industrialised nations. Its use by middle- and low-income countries to introduce and develop medical genetic services commensurate with their needs and circumstances would be beneficial. An approach to applying Health Needs Assessment in these circumstances is described.

Elevated Transferrin Saturation, Health-Related Quality of Life and Telomere Length

Mainous, Arch G.; Wright, Robert U.; Hulihan, Mary M.; Twal, Waleed O.; McLaren, Christine E.; Diaz, Vanessa A.; McLaren, Gordon D.; Argraves, W. Scott; Grant, Althea M.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
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We sought to examine the relationship between elevated transferrin saturation (TS) and measures of health status (telomere length and patient-reported health-related quality of life) to assess whether elevated TS is associated with negative patient outcomes beyond increased risk for morbidity and mortality, using a cross-sectional analysis of the Hemochromatosis and Iron Overload Screening Study supplemented with assays for leukocyte telomere length in adults ≥25 years old (n=669). Among individuals with elevated TS (≥45% for women and ≥50% for men), who also had a usual source of care, only 5.2% reported ever being told by a doctor that they had an elevated iron condition. In a fully adjusted general linear regression model controlling for demographic characteristics as well as health conditions associated with iron overload, elevated TS versus non-elevated TS was associated with worse general health status (60.4 vs. 63.8, p<0.05), mental health status (76.5 vs. 82.2, p<0.0001) and shorter telomere length (241.4 vs. 261.3, p<0.05). Increased surveillance of elevated TS may be in order as elevated TS is associated with decreased health status and very few patients with elevated TS are aware of their condition.

Health expenditures in major industrialized countries, 1960-87

Schieber, George J.
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em //1990 EN
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35.72%
In this article, levels and changes in health care expenditures for Canada, France, the Federal Republic of Germany, Italy, Japan, the United Kingdom, and the United States are analyzed. First, the levels and changes in the share of gross domestic product (GDP) devoted to health are reviewed in terms of the health-to-GDP ratio, nominal health expenditure and GDP growth, and changes in population and prices. Second, absolute levels of health spending denominated in U.S. dollars are compared over time. Finally, some concluding observations are made.

A Health Impact Assessment of a Proposed Bill to Decrease Speed Limits on Local Roads in Massachusetts (U.S.A.)

James, Peter; Ito, Kate; Banay, Rachel Frances; Buonocore, Jonathan James; Wood, Benjamin; Arcaya, Mariana C
Fonte: MDPI AG Publicador: MDPI AG
Tipo: Artigo de Revista Científica
EN_US
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35.72%
Decreasing traffic speeds increases the amount of time drivers have to react to road hazards, potentially averting collisions, and makes crashes that do happen less severe. Boston’s regional planning agency, the Metropolitan Area Planning Council (MAPC), in partnership with the Massachusetts Department of Public Health (MDPH), conducted a Health Impact Assessment (HIA) that examined the potential health impacts of a proposed bill in the state legislature to lower the default speed limits on local roads from 30 miles per hour (mph) to 25 mph. The aim was to reduce vehicle speeds on local roads to a limit that is safer for pedestrians, cyclists, and children. The passage of this proposed legislation could have had far-reaching and potentially important public health impacts. Lower default speed limits may prevent around 18 fatalities and 1200 serious injuries to motorists, cyclists and pedestrians each year, as well as promote active transportation by making local roads feel more hospitable to cyclists and pedestrians. While a lower speed limit would increase congestion and slightly worsen air quality, the benefits outweigh the costs from both a health and economic perspective and would save the state approximately $62 million annually from prevented fatalities and injuries.

Public health specializations and education needs to support homeland security

Landguth, David C.
Fonte: Monterey, California. Naval Postgraduate School Publicador: Monterey, California. Naval Postgraduate School
Tipo: Tese de Doutorado
Relevância na Pesquisa
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CHDS State/Local; Understanding and identifying critical public health human capital needs and their appropriate knowledge base for homeland security is necessary to help our Nation to prepare for and respond to acts of terrorism and natural disasters. Understanding what deficiencies exist by specializations and identifying an appropriate knowledge base for these individuals is necessary to meet the future force requirements to support homeland security. Personal interviews were conducted with 24 individuals throughout Tennessee and various components of the federal government. This was done to discern what these professionals believe are the necessary specializations to respond to homeland security mandates and the education these specialists needed to discharge their duties. For this study, public health was defined as: any individuals responsible for safeguarding and enhancing the health of the community in relation to homeland security. This is consistent with Dennis Raphaelâ s definition which defined public health as â the science and art of preventing disease, prolonging life and promoting the health of the population through organized efforts of societyâ 1. The results of this study may help aid policymakers to attract...

An analysis of alternatives for reducing outpatient military health care costs for active duty members and their families: implementing a recommended savings strategy using defense acquisition principles

Jaime, Ricardo; Rupert, Joshua W.
Fonte: Monterey California. Naval Postgraduate School Publicador: Monterey California. Naval Postgraduate School
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MBA Professional Report; Rising health care costs are placing a considerable burden on Government and Department of Defense resources. At the current rate, health care costs will likely impact the overall readiness and future force structure of the Department of Defense. In efforts to reduce or contain the costs of the military health care system, this project will propose two cost savings alternatives for providing outpatient care to active duty personnel and their dependents. In addition to analyzing the current system as an alternative (status quo), the two proposed cost-sharing alternatives are a standard co-payment and a monthly allotment program. These strategies are primarily designed to reduce Department of Defense costs by influencing the attitudes of beneficiaries toward outpatient health care, restricting their access to options with higher costs, and shifting a portion of outpatient care costs through co-payments. This project provides an in-depth analysis for each alternative using a set of assumptions for treatment possibilities based on three likely scenarios, and provides quantitative and qualitative data to arrive at a recommendation. Using acquisition principles, this project provides an implementation process for the proposed alternative that should minimize disruption in the current military health care system. This project highlights the hypothesis by implementing a cost-saving strategy to active duty and dependent outpatient care; thus...

The Military Health Service System: beneficiary satisfaction and an option for change

Fite, Amalie Ruth
Fonte: Monterey, California: Naval Postgraduate School Publicador: Monterey, California: Naval Postgraduate School
Tipo: Tese de Doutorado
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Approved for public release; distribution is unlimited.; This thesis investigates several factors associated with the current military health benefit. These included: (1) beneficiary satisfaction with military as well as civilian medical treatment facilities, (2) the number of active duty military personnel who choose to use military facilities and the personal cost incurred in making that decision, (3) the number of active duty military personnel who would purchase civilian health insurance, (4) and the benefits of retaining the current military health benefit as opposed to instituting a civilian group health insurance plan in its place. Five hundred forty-nine officers completed a questionnaire that was developed to address these issues. Trends noted were: (1) a slight rise in the level of dissatisfaction with the care provided by the current military health care benefit as time in service increases and (2) an increase in the use of civilian services in the military health service system, such as medical care for military beneficiaries at civilian treatment facilities and the use of commercial insurance plans for psychiatric treatment. The arguments presented in this thesis on this very sensitive issue will continue to be debated by both the Department of Defense and the legislative branch of the government.

Managerial work roles of health care executives in the changing environment of academic medical centers

Guo, Kristina Lu
Fonte: FIU Digital Commons Publicador: FIU Digital Commons
Tipo: Artigo de Revista Científica
EN
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The current U.S. health care system faces numerous environmental challenges. To compete and survive, health care organizations are developing strategies to lower costs and increase efficiency and quality. All of these strategies require rapid and precise decision making by top level managers. The purpose of this study is to determine the relationship between the environment, made up of unfavorable market conditions and limited resources, and the work roles of top level managers, specifically in the settings of academic medical centers. Managerial work roles are based on the ten work roles developed by Henry Mintzberg, in his book, The Nature of Managerial Work (1973). ^ This research utilized an integrated conceptual framework made up of systems theory in conjunction with role, attribution and contingency theories to illustrate that four most frequently performed Mintzberg's work roles are affected by the two environment dimensions. The study sample consisted of 108 chief executive officers in academic medical centers throughout the United States. The methods included qualitative methods in the form of key informants and case studies and quantitative in the form of a survey questionnaire. Research analysis involved descriptive statistics...

Perceived affordability of health insurance and medical financial burdens five years in to Massachusetts health reform

Zallman, Leah; Nardin, Rachel; Sayah, Assaad; McCormick, Danny
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
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Introduction: Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. Methods: We conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured. Results: We found that despite having higher incomes, higher cost-sharing plan recipients were less satisfied with their insurance plans and perceived more difficulty affording their insurance than those with low cost-sharing plans. Higher cost-sharing plan recipients also reported more difficulty affording medical and non-medical health care as well as insurance premiums than those with commercial insurance. In contrast...

The impact of ethnicity, family income, and parental education on children's health and use of health services.

Flores, G; Bauchner, H; Feinstein, A R; Nguyen, U S
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /07/1999 EN
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OBJECTIVES: This study characterized ethnic disparities for children in demographics, health status, and use of services; explored whether ethnic subgroups (Puerto Rican, Cuban, and Mexican) have additional distinctive differences; and determined whether disparities are explained by differences in family income and parental education. METHODS: Bivariate and multivariate analyses of data on 99,268 children from the 1989-91 National Health Interview Surveys were conducted. RESULTS: Native American, Black, and Hispanic children are poorest (35%, 41% below poverty level vs 10% of Whites), least healthy (66%-74% in excellent or very good health vs 85% of Whites), and have the least well educated parents. Compared with Whites, non-White children average fewer doctor visits and are more likely to have excessive intervals between visits. Hispanic subgroup differences in demographics, health, and use of services equal or surpass differences among major ethnic groups. In multivariate analyses, almost all ethnic group disparities persisted after adjustment for family income, parental education, and other relevant covariates. CONCLUSIONS: Major ethnic groups and subgroups of children differ strikingly in demographics, health, and use of services; subgroup differences are easily overlooked; and most disparities persist even after adjustment for family income and parental education.

The Concept of Sasang Health Index and Constitution-Based Health Assessment: An Integrative Model with Computerized Four Diagnosis Methods

Kim, Jaeuk U.; Ku, Boncho; Kim, Young-Min; Do, Jun-Hyeong; Jang, Jun-Su; Jang, Eunsu; Jeon, Young Ju; Kim, Keun Ho; Kim, Jong Yeol
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
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35.72%
Sasang constitutional medicine (SCM) shares its philosophy with that of personalized medicine: it provides constitution-specific treatment and healthcare individualized for each patient. In this work, we propose the concept of the Sasang Health Index (SHI) as an attempt to assess the individualized health status in the framework of SCM. From the target population of females in their fifties and older, we recruited 298 subjects and collected their physiological data, including complexion, radial pulse, and voice, and their questionnaire responses. The health status of each subject was evaluated by two Korean medical doctors independently, and the SHI model was obtained by combining all the integrative features of the phenotype data using a regression technique. As a result, most subjects belonged to either the healthy, subhealthy, or slightly diseased group, and the intraclass correlation coefficient between the two doctors' health scoring reached 0.95. We obtained an SHI model for each constitution type with adjusted R-squares of 0.50, 0.56, and 0.30, for the TE, SE, and SY constitution types, respectively. In the proposed SHI model, the significant characteristics used in the health assessment consisted of constitution-specific features in accordance with the classic literature and features common to all the constitution types.

Implementation of the International Health Regulations (2005) Through Cooperative Bioengagement

Standley, Claire J.; Sorrell, Erin M.; Kornblet, Sarah; Fischer, Julie E.; Katz, Rebecca
Fonte: Frontiers Media S.A. Publicador: Frontiers Media S.A.
Tipo: Artigo de Revista Científica
Publicado em 13/10/2015 EN
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Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency’s Cooperative Biological Engagement Program, the State Department’s Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public health capacities. This article examines the extent to which cooperative bioengagement projects address public health capacity building under the revised International Health Regulations and alignment with the Global Health Security Agenda action packages.

Soccer and sexual health education: a promising approach for reducing adolescent births in Haiti

Kaplan,Kathryn C; Lewis,Judy; Gebrian,Bette; Theall,Katherine
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2015 EN
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OBJECTIVE: To explore the effect of an innovative, integrative program in female sexual reproductive health (SRH) and soccer (or fútbol, in Haitian Creole) in rural Haiti by measuring the rate of births among program participants 15-19 years old and their nonparticipant peers. METHODS: A retrospective cohort study using 2006-2009 data from the computerized data-tracking system of the Haitian Health Foundation (HHF), a U.S.-based nongovernmental organization serving urban and rural populations in Haiti, was used to assess births among girls 15-19 years old who participated in HHF's GenNext program, a combination education-soccer program for youth, based on SRH classes HHF nurses and community workers had been conducting in Haiti for mothers, fathers, and youth; girl-centered health screenings; and an all-female summer soccer league, during 2006-2009 (n = 4 251). Bivariate and multiple logistic regression analyses were carried out to assess differences in the rate of births among program participants according to their level of participation (SRH component only ("EDU") versus both the SRH and soccer components ("SO") compared to their village peers who did not participate. Hazard ratios (HRs) of birth rates were estimated using Cox regression analysis of childbearing data for the three different groups. RESULTS: In the multiple logistic regression analysis...