The future of public health: the importance of workforce

Health workforce has become a major concern and a significant health policy issue around the world in recent years. With recent international and national initiatives and models being developed and implemented in Australia and other countries, it is timely to understand the need and the rationale for a better trained and educated public health workforce for the future. Much more attention should also be given to evaluation and research in this field

Depression as a predictor of work resumption following myocardial infarction (MI): a review of recent research evidence

Background Depression often coexists with myocardial infarction (MI) and has been found to impede recovery through reduced functioning in key areas of life such as work. In an era of improved survival rates and extended working lives, we review whether depression remains a predictor of poorer work outcomes following MI by systematically reviewing literature from the past 15 years.Methods Articles were identified using medical, health, occupational and social science databases, including PubMed, OVID, Medline, Proquest, CINAHL plus, CCOHS, SCOPUS, Web of Knowledge, and the following pre-determined criteria were applied: (i) collection of depression measures (as distinct from \u27psychological distress\u27) and work status at baseline, (ii) examination and statistical analysis of predictors of work outcomes, (iii) inclusion of cohorts with patients exhibiting symptoms consistent with Acute Coronary Syndrome (ACS), (iv) follow-up of work-specific and depression specific outcomes at minimum 6 months, (v) published in English over the past 15 years. Results from included articles were then evaluated for quality and analysed by comparing effect size.Results Of the 12 articles meeting criteria, depression significantly predicted reduced likelihood of return to work (RTW) in the majority of studies (n = 7). Further, there was a trend suggesting that increased depression severity was associated with poorer RTW outcomes 6 to 12 months after a cardiac event. Other common significant predictors of RTW were age and patient perceptions of their illness and work performance.Conclusion Depression is a predictor of work resumption post-MI. As work is a major component of Quality of Life (QOL), this finding has clinical, social, public health and economic implications in the modern era. Targeted depression interventions could facilitate RTW post-MI. <br /

Implication of Diet and Nutrition for Growth and Prevalence of Anemia in Rural Preschool-Aged Children in Shandong Province, China

A nutrition surveillance and nutritional improvement programme through nutrition field worker training, nutrition education and encouraging the utilization of home gardens was undertaken among rural preschool-aged children in the four counties of Linshu, Caoxin, Zoucheng and Yucheng in Shandong Province in China from 1990 to 1995. A baseline survey was conducted in 1990. This included physical and biochemical measurements being taken on 3474 children aged 0–5 years and dietary household surveys being taken on a random subsample of 312 children. The baseline survey showed that the average height and weight of the subjects was lower than the World Health Organization (WHO) standard with the prevalence of stunting, underweight and wasting being 24.2, 12.5 and 2.1%, respectively (using the Z score

Die "Neue Innerlichkeit" zwischen Vermarktung und Pädagogisierung : Eine Analyse von Szenezeitschriften

Introduction. The distribution and severity of dental caries among preschool children vary according to the socio-economic and ethnic differences within and between countries. Understanding socio-economic influences on child oral health could inform early interventions to reduce the oral health burden throughout the life-cycle. The aim of this study is to examine the socio-economic and ethnic influences on oral health among preschoolers in Kegalle, Sri Lanka. Methods. The study involved 784 children aged between 48-72 months recruited from 84 pre-schools in the Kegalle district in Sri Lanka. Cross-sectional data were collected by means of an oral examination of the children and a self-administered questionnaire to their parents/caregivers. The Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess Oral Health related Quality of Life (OHQoL). Univariate and multivariate models of Poisson regression were used to investigate the associations between the variables. Results: Compared to children whose fathers had tertiary education, those whose fathers did not study beyond grade 5, had more caries measured in terms of decayed, missing and filled surfaces (dmfs) (IRR = 2.30; 95% CI: 1.30, 4.06; p < 0.01) and experienced poor OHQoL at child (IRR = 2.52; 95% CI: 1.20, 5.31; p < 0.05) and family (IRR = 1.59; 95% CI: 1.11, 2.27; p < 0.05) levels. However, lower educational attainment among mothers was associated with better OHQoL among children. Compared to the Sinhalese ethnic group, Tamils had more gingival bleeding (bleeding surfaces) (IRR = 3.04; 95% CI: 1.92, 4.81; p < 0.001) and poor OHQoL at child level (IRR = 2.07; 95% CI: 1.19, 3.60; p < 0.01), whereas Muslims had poor OHQoL at family level (IRR = 1.42; 95% CI: 1.10, 1.84; p < 0.01). Children of low-income families had more gum bleeding (IRR = 1.00; 95% CI: 0.99, 1.00; p < 0.05) compared to children of high-income families. Conclusions: Socio-economic and ethnic differences in oral health outcomes exist among this population of preschoolers. Interventions targeting children of fathers with low educational levels and ethnic minority groups are required to reduce inequalities in oral health in Sri Lanka and other similar countries

Post-translational generation of constitutively active cores from larger phosphatases in the malaria parasite, Plasmodium falciparum: implications for proteomics

BACKGROUND: Although the complete genome sequences of a large number of organisms have been determined, the exact proteomes need to be characterized. More specifically, the extent to which post-translational processes such as proteolysis affect the synthesized proteins has remained unappreciated. We examined this issue in selected protein phosphatases of the protease-rich malaria parasite, Plasmodium falciparum. RESULTS: P. falciparum encodes a number of Ser/Thr protein phosphatases (PP) whose catalytic subunits are composed of a catalytic core and accessory domains essential for regulation of the catalytic activity. Two examples of such regulatory domains are found in the Ca(+2)-regulated phosphatases, PP7 and PP2B (calcineurin). The EF-hand domains of PP7 and the calmodulin-binding domain of PP2B are essential for stimulation of the phosphatase activity by Ca(+2). We present biochemical evidence that P. falciparum generates these full-length phosphatases as well as their catalytic cores, most likely as intermediates of a proteolytic degradation pathway. While the full-length phosphatases are activated by Ca(+2), the processed cores are constitutively active and either less responsive or unresponsive to Ca(+2). The processing is extremely rapid, specific, and occurs in vivo. CONCLUSIONS: Post-translational cleavage efficiently degrades complex full-length phosphatases in P. falciparum. In the course of such degradation, enzymatically active catalytic cores are produced as relatively stable intermediates. The universality of such proteolysis in other phosphatases or other multi-domain proteins and its potential impact on the overall proteome of a cell merits further investigation

Characterisation and expression of a PP1 serine/threonine protein phosphatase (PfPP1) from the malaria parasite, Plasmodium falciparum: demonstration of its essential role using RNA interference

BACKGROUND: Reversible protein phosphorylation is relatively unexplored in the intracellular protozoa of the Apicomplexa family that includes the genus Plasmodium, to which belong the causative agents of malaria. Members of the PP1 family represent the most highly conserved protein phosphatase sequences in phylogeny and play essential regulatory roles in various cellular pathways. Previous evidence suggested a PP1-like activity in Plasmodium falciparum, not yet identified at the molecular level. RESULTS: We have identified a PP1 catalytic subunit from P. falciparum and named it PfPP1. The predicted primary structure of the 304-amino acid long protein was highly similar to PP1 sequences of other species, and showed conservation of all the signature motifs. The purified recombinant protein exhibited potent phosphatase activity in vitro. Its sensitivity to specific phosphatase inhibitors was characteristic of the PP1 class. The authenticity of the PfPP1 cDNA was further confirmed by mutational analysis of strategic amino acid residues important in catalysis. The protein was expressed in all erythrocytic stages of the parasite. Abrogation of PP1 expression by synthetic short interfering RNA (siRNA) led to inhibition of parasite DNA synthesis. CONCLUSIONS: The high sequence similarity of PfPP1 with other PP1 members suggests conservation of function. Phenotypic gene knockdown studies using siRNA confirmed its essential role in the parasite. Detailed studies of PfPP1 and its regulation may unravel the role of reversible protein phosphorylation in the signalling pathways of the parasite, including glucose metabolism and parasitic cell division. The use of siRNA could be an important tool in the functional analysis of Apicomplexan genes

Age-related changes relevant to health in women: design, recruitment, and retention strategies for the Longitudinal Assessment of Women (LAW) Study

Objectives: The primary aim was to assess the age-related changes that occur in older women. This paper describes the study rationale and methods, recruitment, and retention strategies. Methods: The Longitudinal Assessment of Women (LAW) Study was a longitudinal, observational, and multidisciplinary evaluation of a population-based cohort of urban-living women, aged between 40 and 80 years at recruitment and randomly invited from a district in Brisbane (a city in Australia) via the electoral roll. Five hundred eleven women were recruited and stratified into four age groups (40-49, 50-59, 60-69, 70-79 years) and were assessed on three or four occasions each year, using interviews and diagnostic instruments (echocardiography, applination tonometry, dual-energy x-ray absorptiometry [DEXA]) Retention strategies included flexibility, accessibility, personalized attention, and feedback. Results: From a sample frame of 1598 names, there were 1082 respondents, of whom 511 (47%) were successfully recruited from those eligible to participate. Recruitment was quickest for the oldest age group, 70-79 years, and slowest for the age group 40-49 years; all age groups achieved their required quota. A scheduling program was developed to minimize the number of visits and maximize the use of allocated time. The largest dropout was seen in year 1 of the study, with very few thereafter. Of the 9 deaths, cancer was the cause in 7. The retention rate after 5 years was 95.5%. Conclusions: The design of the present study, with careful attention to coordination and a personal approach, facilitated the completion of a 5-year study, enabling a collection of a set of wide-ranging data from almost all the women recruited. The information thus collected will form the basis of cross-linking analysis of the risk factors associated with health problems in aging women

A systematic review of real-world diabetes prevention programs: Learnings from the last 15 years

Background The evidence base for the prevention of type 2 diabetes mellitus (T2DM) has progressed rapidly from efficacy trials to real-world translational studies and practical implementation trials over the last 15 years. However, evidence for the effective implementation and translation of diabetes programs and their population impact needs to be established in ways that are different from measuring program effectiveness. We report the findings of a systematic review that focuses on identifying the critical success factors for implementing diabetes prevention programs in real-world settings. Methods A systematic review of programs aimed at diabetes prevention was undertaken in order to evaluate their outcomes using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. A search for relevant articles was carried out using PubMed (March 2015) and Web of Science, MEDLINE, CENTRAL, and EMBASE. A quality coding system was developed and included studies were rated independently by three researchers. Results Thirty eight studies were included in the review. Almost all (92 %) provided details on participation; however, only 18 % reported the coverage of their target population (penetration). Program intensity or implementation—as measured by frequency of contacts during first year and intervention duration—was identified in all of the reported studies, and 84 % of the studies also reported implementation fidelity; however, only 18 % of studies employed quality assurance measures to assess the extent to which the program was delivered as planned. Sixteen and 26 % of studies reported ‘highly’ or ‘moderately’ positive changes (effectiveness) respectively, based on weight loss. Six (16 %) studies reported ‘high’ diabetes risk reduction but ‘low’ to ‘moderate’ weight loss only. Conclusion Our findings identify that program intensity plays a major role in weight loss outcomes. However, programs that have high uptake—both in terms of good coverage of invitees and their willingness to accept the invitation—can still have considerable impact in lowering diabetes risk in a population, even with a low intensity intervention that only leads to low or moderate weight loss. From a public health perspective, this is an important finding, especially for resource constrained settings. More use of the PIPE framework components will facilitate increased uptake of T2DM prevention programs around the world

Situationsklassifikation und Bewegungsprognose in Verkehrssituationen mit mehreren Fahrzeugen

Käfer E. Situationsklassifikation und Bewegungsprognose in Verkehrssituationen mit mehreren Fahrzeugen. Bielefeld: Universitätsbibliothek Bielefeld; 2013.Fahrerassistenzsysteme sind in der heutigen Zeit einer der erfolgversprechendsten Beiträge zu mehr Sicherheit auf unseren Straßen. Die intelligenten Helferlein unterstützen den Fahrer aktiv in kritischen Situationen oder erhöhen den Komfort während der Fahrt. Sie sind ein Meilenstein auf dem Weg zu der Vision vom unfallfreien Fahren. Mit Sensoren wie Stereokamera und Radarsystemen ausgestattete Fahrzeuge sind in der Lage die Umwelt wahrzunehmen und die Bewegungsrichtung der Verkehrsteilnehmer zu schätzen. Mit Methoden der künstlichen Intelligenz erfolgt eine Bewertung der Verkehrssituation auf Kritikalität. Je nach Kritikalität einer Situation werden unterschiedliche Warn- und Unterstützungskonzepte eingesetzt. Das Ziel ist es, den Fahrer auf eine gefährliche Situation hinzuweisen oder bei einem unvermeidbaren Unfall die Aufprallenergie durch einen Bremseingriff zu reduzieren. Gegen Auffahrunfälle im Längsverkehr gibt es bereits ein aktives Sicherheitssystem, den Bremsassistenten. Diese Arbeit hat das Ziel die Situationsanalyse für heutige Sicherheitssysteme auf Kreuzungssituationen zu erweitern. Dazu werden Algorithmen zur frühzeitigen Erkennung von gefährlichen Kreuzungssituationen vorgeschlagen. Der Fokus des ersten Ansatzes liegt auf der Analyse aller Fahreraktionen zweier kreuzender Fahrzeuge. Die kollisionsfreien Kombinationen von Bewegungsoptionen spannen einen zusammengesetzten Aktionsraum zweier Fahrer auf. Aus diesem Aktionsraum wird eine Wahrscheinlichkeit für die Gefahr einer Situation abgeleitet. In einem Versuchsträger integriert zeigt unsere Gefahrenschätzung im Realverkehr eine hohe Performanz und Zuverlässigkeit. Die Vermeidung der Falschwarnungen solcher Systeme ist eine der Herausforderungen, die es hier zu minimieren gilt. Gemessene Bewegungsmuster eines Fahrzeugs werden im zweiten Ansatz als Wissensbasis für eine Prognose eingesetzt. Bei mehreren Fahrzeugen lässt sich in den meisten Kreuzungssituationen eine Interaktion der Fahrer beobachten. Ein Modell für das Interaktionsverhalten ermöglicht eine realistischere Bewegungsprognose für mehrere Fahrzeuge. Im letzten Ansatz werden Bewegungsmuster zweier kreuzender Fahrzeuge in Betracht gezogen. Ein Interaktionsverhalten zwischen den Fahrern liegt dort bereits in den Daten vor. Eine anschauliche und kompakte Repräsentation der interaktiven Bewegungsmuster zweier Fahrzeuge fungiert als Wissensbasis für eine Situationserkennung und Bewegungsprognose