Global health strategies versus local primary health care priorities- a case study of national immunisation days in southern Africa

Building on the successful eraclication of smallpox, the World Health Organisation, together with other agencies, is now moving quickly to the eradication of poliomyelitis, originally aimed for the year 2000. Plans for the subsequent global eradication of measles are in an advanced stage. Eradication of both polio and measles incorporate as a fundamental strategy high routine coverage, surveillance and special national immunisation days (NIDs), which are supplementary to routine vaccination services.There has been a lively debate on whether poor countries, with many health problems that could be controlled, should divert their limited resouxces for a global goal of eradication that may have low priority for their children. From a costeffectiveness perspective, NIDs are fully justifiable. However, field observations in sub-saharan Africa show that NIDs divert resources and, to a certain extent, attention from the development of comprehensive primary health care (PHC). The routine immunisation coverage rates dropped on average since the introduction of NIDs in 1996, which is contrary to what was observed in the western Pacific and other regions.The additional investment to be made when moving from disease control to eraclication may exceed the financial capacity of an individual country. Since the industrialised countries benefit most from eradication, they should take responsibility for covering the needs of those countries that cannot afford the investment. The WHO's frequent argument that NIDs are promotive to PHC: is not confirmed in the southern African region. The authors think that the WHO should, therefore, focus its attention on diminishing the   negative side-effects of NIDs and on getting the positive side effects incorporated in the integrated health services in a sustainable way

Hanging Out in the Past: Looking for Trouble or Romance? An Exploration of the Practice and Meaning of Hanging Out for Young Dutch People in 1930–60

Young people’s ‘hanging out’ has had different meanings in the recent and distant past in various countries and cultures, including delinquency or a common social phenomenon. Although there is evidence for hanging out as social behaviour in various countries, Dutch research on hanging out as a common social phenomenon is scarce. This article retrospectively explores the practice and meaning of hanging out for young people in the Netherlands between 1930 and 1960. Semi-structured qualitative interviews (n = 60) were analysed using the Constant Comparative Method, resulting in three key themes: familiarity, features and the meanings assigned to hanging out. Results indicate that hanging out was practised and known by most respondents, and included particular features (time, location, gender and routines). Meet, flirt with and date other young people was the most frequently mentioned meaning associated with hanging out. Accordingly, hanging out can indeed be considered to have been a common social phenomenon

Expectations and Perceptions of Dutch Pharmacy Staff Regarding a New Framework for Continence Care:A Focus Group Study

Based on complaints that patients with urinary incontinence were not receiving the correct medical aids, the Dutch Ministry of Health, Wellbeing, and Sports requested further exploration. This resulted in a new framework based on considering individual activities of daily living when providing continence products. We aimed to explore the expectations of pharmacy staff regarding this new framework for continence care in the Netherlands and to establish the facilitators and barriers associated with that care. In total, 15 participants from 7 different pharmacies participated in 2 focus groups. Data analysis was by thematic content analysis. Pharmacy employees were positive about the idea of considering individual daily activities when providing continence products in the new framework, but they did have some reservations about the feasibility of implementation in daily practice. Barriers to optimal continence care included low reimbursement for patients with incontinence, especially with non-standard needs, and poor communication between the various stakeholders in continence care. Efforts must be extended to review the current reimbursement system and to change the policies and information provided by stakeholders in continence care, before the new framework will make a real impact in clinical practice

Safeguarding resettlement: global expectations and local experiences in Cambodia

Planned community relocation or “resettlement” is not new, however the contexts in which people are being relocated and the safeguards in place to protect them are changing. Multilateral development banks are under competing pressures to minimise the negative impacts of community resettlement without over-burdening the governments of borrowing countries. Intensive debates are underway about what rights should be afforded to resettled people and what safeguards are most effective. Similar concerns are being voiced by policy-makers working on climate change adaptation, who are looking to the World Bank and Asian Development Bank (ADB) to identify ways to safeguard communities being resettled in response to climate change. One of the most important tensions shaping these debates, is how resettlement safeguards developed at an international or “global” level can cater to the needs and aspirations of affected people in different local settings. As a contribution to this debate, this thesis explores a resettlement scheme for an ADB co-financed railway project in Cambodia in which advocacy interventions resulted in improvements in the resettlement sites over the eight years of the project from 2006 to 2014. Drawing on the railway project as a case study, the research focuses on understanding how safeguards, developed at a “headquarter level”, aligned and misaligned with community needs and aspirations at different points in time. It investigates how advocacy interventions altered the course of the project and considers the implications of relying on resettlement safeguards in a country where domestic legal protections are otherwise not well-established

Disturbed Vitamin A Metabolism in Non-Alcoholic Fatty Liver Disease (NAFLD)

Vitamin A is required for important physiological processes, including embryogenesis, vision, cell proliferation and differentiation, immune regulation, and glucose and lipid metabolism. Many of vitamin A’s functions are executed through retinoic acids that activate transcriptional networks controlled by retinoic acid receptors (RARs) and retinoid X receptors (RXRs).The liver plays a central role in vitamin A metabolism: (1) it produces bile supporting efficient intestinal absorption of fat-soluble nutrients like vitamin A; (2) it produces retinol binding protein 4 (RBP4) that distributes vitamin A, as retinol, to peripheral tissues; and (3) it harbors the largest body supply of vitamin A, mostly as retinyl esters, in hepatic stellate cells (HSCs). In times of inadequate dietary intake, the liver maintains stable circulating retinol levels of approximately 2 μmol/L, sufficient to provide the body with this vitamin for months. Liver diseases, in particular those leading to fibrosis and cirrhosis, are associated with impaired vitamin A homeostasis and may lead to vitamin A deficiency. Liver injury triggers HSCs to transdifferentiate to myofibroblasts that produce excessive amounts of extracellular matrix, leading to fibrosis. HSCs lose the retinyl ester stores in this process, ultimately leading to vitamin A deficiency. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is a spectrum of conditions ranging from benign hepatic steatosis to non-alcoholic steatohepatitis (NASH); it may progress to cirrhosis and liver cancer. NASH is projected to be the main cause of liver failure in the near future. Retinoic acids are key regulators of glucose and lipid metabolism in the liver and adipose tissue, but it is unknown whether impaired vitamin A homeostasis contributes to or suppresses the development of NAFLD. A genetic variant of patatin-like phospholipase domain-containing 3 (PNPLA3-I148M) is the most prominent heritable factor associated with NAFLD. Interestingly, PNPLA3 harbors retinyl ester hydrolase activity and PNPLA3-I148M is associated with low serum retinol level, but enhanced retinyl esters in the liver of NAFLD patients. Low circulating retinol in NAFLD may therefore not reflect true “vitamin A deficiency”, but rather disturbed vitamin A metabolism. Here, we summarize current knowledge about vitamin A metabolism in NAFLD and its putative role in the progression of liver disease, as well as the therapeutic potential of vitamin A metabolites

Magma Design Automation: Component placement on chips; the "holey cheese" problem.

The costs of the fabrication of a chip is partly determined by the wire length needed by the transistors to respect the wiring scheme. The transistors have to be placed without overlap into a prescribed configuration of blockades, i.e. parts of the chipthat are beforehand excluded from positioning by for example some other functional component, and holes, i.e. the remaining free area on the chip. A method to minimize the wire length when the free area is a simply connected domain has already been implemented by Magma, but the placement problem becomes much more complex when the free area is not a simply connected domain anymore, forming a ``holey cheese''. One of the approaches of the problem in this case is to first cluster the transistors into so-called macro's in such a way that closely interconnected transistors stay together, and that the macro's can be fit into the holes. One way to carry out the clustering is to use a graph clustering algorithm, the so-called Markov Cluster algorithm. Another way is to combine the placement method of Magma on a rectangular area of the same size as the total size of the holes, and a min cut-max flow algorithm to divide that rectangle into more or less rectangular macro's in such a way that as little wires as possible are cut. It is now possible to formulate the Quadratic Assignment Problem that remains after clustering the original problem to one with 100 up to 1000 macros. There exists a lot of literature on finding the global minimum of the costs, but nowadays computational possibilities are still too restrictive to find an optimal solution within a reasonable amount of time and computational memory. however, we believe it is possible to find a solution that leads to a acceptable local minimum of the costs

Sickness absence frequency among women working in hospital care

Background Frequent short sickness absences result in understaffing and interfere with work processes. We need more knowledge about factors associated with this type of absence. Aims To investigate associations between the frequency of previous sickness absence and self-reported perceptions of health and work. Methods Cross-sectional study of female hospital care workers in which health, work characteristics and coping styles were assessed by questionnaire and linked to the number of sickness absence episodes recorded in the preceding 5 years using negative binomial regression analysis for counts distinguishing between short (1-7 days) and long (>7 days) episodes of absence after adjusting for age and duration of employment in December 2007 and hours worked between 2003 and 2007. Results Of 350 women employed for at least 5 years, 237 (68%) answered the questionnaire. The hours worked over the 5 year period [rate ratio (RR) = 1.2] and problem solving coping style score (RR = 1.1) were positively associated with the number of short sickness absence episodes. Age (RR = 0.8) and good general health (RR = 0.7) were inversely related to the number of both short and long episodes. Self-reported mental health and work characteristics were not shown to be related to the frequency of sickness absence. Conclusions Hours worked, problem-solving coping style, age and general health showed associations with the frequency of previous sickness absence among women who had worked at least 5 years in health care. Future prospective studies on the frequency of sickness absence should consider the impact of these factors further