Communication and marketing as tools to cultivate the public's health: a proposed "people and places" framework

<p>Abstract</p> <p>Background</p> <p>Communication and marketing are rapidly becoming recognized as core functions, or core competencies, in the field of public health. Although these disciplines have fostered considerable academic inquiry, a coherent sense of precisely how these disciplines can inform the practice of public health has been slower to emerge.</p> <p>Discussion</p> <p>In this article we propose a framework – based on contemporary ecological models of health – to explain how communication and marketing can be used to advance public health objectives. The framework identifies the attributes of people (as individuals, as social networks, and as communities or populations) and places that influence health behaviors and health. Communication, i.e., the provision of information, can be used in a variety of ways to foster beneficial change among both people (e.g., activating social support for smoking cessation among peers) and places (e.g., convincing city officials to ban smoking in public venues). Similarly, marketing, i.e., the development, distribution and promotion of products and services, can be used to foster beneficial change among both people (e.g., by making nicotine replacement therapy more accessible and affordable) and places (e.g., by providing city officials with model anti-tobacco legislation that can be adapted for use in their jurisdiction).</p> <p>Summary</p> <p>Public health agencies that use their communication and marketing resources effectively to support people in making healthful decisions and to foster health-promoting environments have considerable opportunity to advance the public's health, even within the constraints of their current resource base.</p

Can training in advanced clinical skills in obstetrics, neonatal care and leadership, of non-physician clinicians in Malawi impact on clinical services improvements (the ETATMBA project) : a process evaluation

Objectives The ‘enhancing human resources and the use of appropriate technologies for maternal and perinatal survival in sub-Saharan Africa’ (ETATMBA) project is training emergency obstetric and new-born care (EmONC) non-physician clinicians (NPCs) as advanced clinical leaders. Our objectives were to evaluate the implementation and changes to practice. Design A mixed methods process evaluation with the predominate methodology being qualitative. Setting Rural and urban hospitals in 8 of the 14 districts of northern and central Malawi. Participants 54 EmONC NPCs with 3 years’ plus experience. Intervention Training designed and delivered by clinicians from the UK and Malawi; it is a 2-year plus package of training (classroom, mentorship and assignments). Results We conducted 79 trainee interviews over three time points during the training, as well as a convenience sample of 10 colleagues, 7 district officers and 2 UK obstetricians. Trainees worked in a context of substantial variation in the rates of maternal and neonatal deaths between districts. Training reached trainees working across the target regions. For 46 trainees (8 dropped out of the course), dose delivered in terms of attendance was high and all 46 spent time working alongside an obstetrician. In early interviews trainees recalled course content unprompted indicating training had been received. Colleagues and district officers reported cascading of knowledge and initial changes in practice indicating early implementation. By asking trainees to describe actual cases we found they had implemented new knowledge and skills. These included life-saving interventions for postpartum haemorrhage and eclampsia. Trainees identified the leadership training as enabling them to confidently change their own practice and initiate change in their health facility. Conclusions This process evaluation suggests that trainees have made positive changes in their practice. Clear impacts on maternal and perinatal mortality are yet to be elucidated

Compressions Medullaires Lentes (Cml) D\'origine Tumorale Et Pseudo-Tumorale A Yaounde (Cameroun)

But Décrire les aspects cliniques, diagnostics, thérapeutiques et histologiques des compressions médullaires lentes (et de la queue de cheval) d\'origine tumorale et pseudo-tumorale à Yaoundé. Patients et méthodes Tous les dossiers des patients opérés d\'une compression médullaire lente d\'origine tumorale ou pseudo-tumorale à l\'Hôpital Central de Yaoundé entre le premier janvier 2000 et le 31 octobre 2005 ont été revus. Résultats Soixante-sept (67) dossiers ont été retenus. Le sexe masculin était prédominant (64%). La moyenne d\'âge était de 41,3 ans (extrêmes: 11 et 70 ans). L\'atteinte médullaire était complète au moment de la chirurgie chez 27% des patients. L\'imagerie par résonance magnétique étant indisponible dans notre milieu, la myélographie (38%) et le myéloscanner (47,8%) représentaient les explorations diagnostiques de choix. Les étiologies étaient dominées par les métastases (23,7%), les lymphomes (17,9%), les neurinomes (11,9%) et les méningiomes (10,4%). Les métastases étaient le plus souvent d\'origine prostatique. La chirurgie était le traitement de base et le mode de prélèvement rachidien pour le diagnostic histologique dans tous les cas. Quarante-huit pour cent des patients ont été traités par radiothérapie et/ ou chimiothérapie. La pulpectomie était le traitement adjuvant de choix dans les métastases d\'origine prostatique. Conclusion La particularité du profil étiologique des compressions médullaires lentes tumorales et pseudo-tumorales à Yaoundé est la rareté des métastases d\'origine pulmonaire et mammaire, la fréquence relative de l\'origine hépatocellulaire comparée aux séries occidentales. Une prise en charge multidisciplinaire dès la phase pré opératoire permettrait une meilleure codification du traitement adjuvant dont l\'accès reste limité dans notre environnement. Purpose The aim of this study was to describe the clinical, diagnostic, therapeutic and histological aspects of neoplastic and neoplastic-like spinal cord and cauda equina compressions in Yaounde. Patients and methods We retrospectively analysed the files of all patients operated for a neoplastic or neoplastic-like spinal cord compression at the Yaounde Central Hospital from January 1, 2000 to October 31, 2005. Results A total of 67 files were selected. The male sex was predominant (64%). The mean age was 41.3 years (range: 11 to 70 years). Spinal cord compression was complete in 27% of patients at the time of diagnosis. Myelography (38%) and computerised myelography (47.8%) were found to be the most appropriate imaging techniques. Magnetic Resonance Imaging is not yet available in our environment. The most predominant histological types were metastasis (23.7%), lymphoma (17.9%), neurinoma (11.9%) and meningioma (10.4%). Metastases were mostly from the prostate. Surgery was the basic treatment and also served for biopsy and histological confirmation of diagnosis in all cases. Forty-eight per cent had radiotherapy or chemotherapy done. Pulpectomy was the preferred adjuvant therapy for prostate metastases. Conclusion The hallmarks of neoplastic and neoplastic-like spinal cord compressions in Yaounde are the scarcity of lung and breast metastases and the relatively high frequency of liver metastases as compared to western series. A multidisciplinary approach to management, right from the preoperative phase would improve the standardisation of adjuvant treatment which is still limited in our context. Keywords: Progressive cord compressions, tumours, pulpectomy. African Journal of Neurological Sciences Vol. 26 (1) 2007: pp. 14-2

Hydrocéphalie chronique de l’adulte : à propos de 4 cas

Les auteurs rapportent quatre cas d’hydrocéphalie chronique de l’adulte  caractérisée par la triade clinique typique d’Adams-Hakim, confirmée par le scanner cérébral sans injection et traitée par dérivation ventriculo-péritonéale après un test à la ponction lombaire soustractive concluant. L’évolution a été marquée par une  amélioration de la symptomatologie clinique quelques jours après la chirurgie. Ces observations relèvent la méconnaissance de cette entité clinique par les praticiens dans notre  environnement; ce qui est à l’origine d’une arrivée et d’un diagnostic  tardifs dans les services de neurochirurgie.We report the case of fourth patients, who presents a typical Adams – Hakim  syndrom (chronic hydrocephalus of the adult). CT Scan of the brain showed enlarged ventricles; a ventriculo peritoneal shunt was inserted. Clinical symptoms regressed in the next few days. We present these cases because of the poor knowledge on this clinical syndrom by physicians responsible of late consultation and diagnosis in neurosurgery units