Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project

BACKGROUND: The 4-year (2007 2011) Revitalizing Health for All international research program (http://www. globalhealthequity.ca/projects/proj_revitalizing/index.shtml) supported 20 research teams located in 15 lowand middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. Teams were organized in a triad comprised of a senior researcher, a new researcher, and a 'research user' from government, health services, or other organizations with the authority or capacity to apply the research findings. Multiple regional and global team capacityenhancement meetings were organized to refine methods and to discuss and assess cross-case findings. OBJECTIVE: Most research projects used mixed methods, incorporating analyses of qualitative data (interviews and focus groups), secondary data, and key policy and program documents. Some incorporated historical case study analyses, and a few undertook new surveys. The synthesis of findings in this report was derived through qualitative analysis of final project reports undertaken by three different reviewers. RESULTS: Evidence of comprehensiveness (defined in this research program as efforts to improve equity in access, community empowerment and participation, social and environmental health determinants, and intersectoral action) was found in many of the cases. CONCLUSION: Despite the important contextual differences amongst the different country studies, the similarity of many of their findings, often generated using mixed methods, attests to certain transferable health systems characteristics to create and sustain CPHC practices. These include: 1. Well-trained and supported community health workers (CHWs) able to work effectively with marginalized communities 2. Effective mechanisms for community participation, both informal (through participation in projects and programs, and meaningful consultation) and formal (though program management structures) 3. Co-partnership models in program and policy development (in which financial and knowledge supports from governments or institutions are provided to communities, which retain decision-making powers in program design and implementation) 4. Support for community advocacy and engagement in health and social systems decision making These characteristics, in turn, require a political context that supports state responsibilities for redistributive health and social protection measures.IS

Modes of Random Lasers

In conventional lasers, the optical cavity that confines the photons also determines essential characteristics of the lasing modes such as wavelength, emission pattern, ... In random lasers, which do not have mirrors or a well-defined cavity, light is confined within the gain medium by means of multiple scattering. The sharp peaks in the emission spectra of semiconductor powders, first observed in 1999, has therefore lead to an intense debate about the nature of the lasing modes in these so-called lasers with resonant feedback. In this paper, we review numerical and theoretical studies aimed at clarifying the nature of the lasing modes in disordered scattering systems with gain. We will discuss in particular the link between random laser modes near threshold (TLM) and the resonances or quasi-bound (QB) states of the passive system without gain. For random lasers in the localized regime, QB states and threshold lasing modes were found to be nearly identical within the scattering medium. These studies were later extended to the case of more lossy systems such as random systems in the diffusive regime where differences between quasi-bound states and lasing modes were measured. Very recently, a theory able to treat lasers with arbitrarily complex and open cavities such as random lasers established that the TLM are better described in terms of the so-called constant-flux states.Comment: Review paper submitted to Advances in Optics and Photonic

Polarization entangled photon-pair source based on quantum nonlinear photonics and interferometry

We present a versatile, high-brightness, guided-wave source of polarization entangled photons, emitted at a telecom wavelength. Photon-pairs are generated using an integrated type-0 nonlinear waveguide, and subsequently prepared in a polarization entangled state via a stabilized fiber interferometer. We show that the single photon emission wavelength can be tuned over more than 50 nm, whereas the single photon spectral bandwidth can be chosen at will over more than five orders of magnitude (from 25 MHz to 4 THz). Moreover, by performing entanglement analysis, we demonstrate a high degree of control of the quantum state via the violation of the Bell inequalities by more than 40 standard deviations. This makes this scheme suitable for a wide range of quantum optics experiments, ranging from fundamental research to quantum information applications. We report on details of the setup, as well as on the characterization of all included components, previously outlined in F. Kaiser et al. (2013 Laser Phys. Lett. 10, 045202).Comment: 16 pages, 7 figure

Quantum photonics at telecom wavelengths based on lithium niobate waveguides

International audienceIntegrated optical components on lithium niobate play a major role in standard high-speed communication systems. Over the last two decades, after the birth and positioning of quantum information science, lithium niobate waveguide architectures have emerged as one of the key platforms for enabling photonics quantum technologies. Due to mature technological processes for waveguide structure integration, as well as inherent and efficient properties for nonlinear optical effects, lithium niobate devices are nowadays at the heart of many photon-pair or triplet sources, single-photon detectors, coherent wavelength-conversion interfaces, and quantum memories. Consequently, they find applications in advanced and complex quantum communication systems, where compactness, stability, efficiency, and interconnectability with other guided-wave technologies are required. In this review paper, we first introduce the material aspects of lithium niobate, and subsequently discuss all of the above mentioned quantum components, ranging from standard photon-pair sources to more complex and advanced circuits

Reflections on the ethics of recruiting foreign-trained human resources for health

<p>Abstract</p> <p>Background</p> <p>Developed countries' gains in health human resources (HHR) from developing countries with significantly lower ratios of health workers have raised questions about the ethics or fairness of recruitment from such countries. By attracting and/or facilitating migration for foreign-trained HHR, notably those from poorer, less well-resourced nations, recruitment practices and policies may be compromising the ability of developing countries to meet the health care needs of their own populations. Little is known, however, about actual recruitment practices. In this study we focus on Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities.</p> <p>Methods</p> <p>We conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations.</p> <p>Results and discussion</p> <p>We describe the methods that recruiters used to recruit foreign-trained health professionals and the systemic challenges and policies that form the working context for recruiters and recruits. HHR recruiters' reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts.</p> <p>Conclusions</p> <p>We suggest that the concept of corporate social responsibility may provide a useful approach at the local organizational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels.</p

On Passion and Sports Fans:A Look at Football

The purpose of the present research was to test the applicability of the Dualistic Model of Passion (Vallerand et al., 2003) to being a sport (football) fan. The model posits that passion is a strong inclination toward an activity that individuals like (or even love), that they value, and in which they invest time and energy. Furthermore, two types of passion are proposed: harmonious and obsessive passion. While obsessive passion entails an uncontrollable urge to engage in the passionate activity, harmonious passion entails a sense of volition while engaging in the activity. Finally, the model posits that harmonious passion leads to more adaptive outcomes than obsessive passion. Three studies provided support for this dualistic conceptualization of passion. Study 1 showed that harmonious passion was positively associated with adaptive behaviours (e.g., celebrate the team’s victory), while obsessive passion was rather positively associated with maladaptive behaviours (e.g., to risk losing one’s employment to go to the team’s game). Study 2 used a short Passion Scale and showed that harmonious passion was positively related to the positive affective life of fans during the 2006 FIFA World Cup, psychological health (self-esteem and life satisfaction), and public displays of adaptive behaviours (e.g., celebrating one’s team victory in the streets), while obsessive passion was predictive of maladaptive affective life (e.g., hating opposing team’s fans) and behaviours (e.g., mocking the opposing team’s fans). Finally, Study 3 examined the role of obsessive passion as a predictor of partner’s conflict that in turn undermined partner’s relationship satisfaction. Overall, the present results provided support for the Dualistic Model of Passion. The conceptual and applied implications of the findings are discussed

Apolipoprotein B is a novel marker for early tau pathology in Alzheimer's disease

INTRODUCTION: We examine the role of brain apolipoprotein B (apoB) as a putative marker of early tau pathology and cognitive decline. METHODS: Cerebrospinal fluid (CSF) samples from cognitively normal and Alzheimer's disease (AD) participants were collected to measure protein levels of apoB and AD biomarkers amyloid beta (Aβ), t-tau and p-tau, as well as synaptic markers GAP43, SYNAPTOTAGMIN-1, synaptosome associated protein 25 (SNAP-25), and NEUROGRANIN. CSF apoB levels were contrasted with positron emission tomography (PET) scan measures of Aβ (18F-NAV4694) and Tau (flortaucipir) along with cognitive assessment alterations over 6 to 8 years. RESULTS: CSF apoB levels were elevated in AD participants and correlated with t-tau, p-tau, and the four synaptic markers in pre-symptomatic individuals. In the latter, CSF apoB levels correlated with PET flortaucipir-binding in entorhinal, parahippocampal, and fusiform regions. Baseline CSF apoB levels were associated with longitudinal visuospatial cognitive decline. DISCUSSION: CSF apoB markedly associates with early tau dysregulation in asymptomatic subjects and identifies at-risk individuals predisposed to develop visuospatial cognitive decline over time

Toward a Consensus on Guiding Principles for Health Systems Strengthening

Based upon a review of the literature, Robert Chad Swanson and colleagues present a set of guiding principles for health systems strengthening

The (Mis)appropriation of HIV/AIDS advocacy strategies in Global Mental Health: towards a more nuanced approach

Background: Mental health is increasingly finding a place on global health and international development agendas. Advocates for Global Mental Health (GMH), and international organizations such as the World Health Organization (WHO) and the World Bank, argue that treatments available in high-income countries should also be made available in low- and middle-income countries. Such arguments are often made by comparing mental health to infectious diseases, including the relative disease and economic burdens they impose, and pointing to the applicability of the right to access treatment for mental health, not only infectious diseases. HIV/AIDS advocacy in particular has been held up by GMH advocates as offering an appropriate strategy for generating global commitment. Discussion: There is a need to assess how health issues are framed not only in relation to social goods outside of health (such as human rights, security or development), but also in relation to other health or disease models, and how health policy and practice is shaped as a result. The article debates the merits and consequences of likening mental health to HIV/AIDS, and identifies four major problems with the model for GMH advocacy being developed through these analogies: 1. An inappropriately universalizing global approach to context-specific problems; 2. A conception of human rights that focuses on the right to access treatment at the expense of the right to refuse it; 3. A tendency to treat poverty as a psychiatric issue, rather than recognizing that mental distress can be the result of poverty and other forms of inequality; 4. The prioritization of destigmatization of disease over social justice models. Conclusion: There are significant problems with the wholesale adoption of an (often simplified) version of HIV/AIDS advocacy as a model for GMH. Yet critical engagement with the important and nuanced differences between HIV/AIDS and mental health may nevertheless point to some possibilities for productive engagement and cross-fertilisation between advocates, activists and scholars in both fields