Evaluating quality of contraceptive counseling: An analysis of the method information index

The Method Information Index (MII) is calculated from contraceptive users\u27 responses to questions regarding counseling content-whether they were informed about methods other than the one they received, told about method-specific side effects, and advised what to do if they experienced side effects. The MII is increasingly reported in national surveys and used to track program performance, but little is known about its properties. Using additional questions, we assessed the consistency between responses and the method received in a prospective, multicountry study. We employed two definitions of consistency: (1) presence of any concordant response, and (2) absence of discordant responses. Consistency was high when asking whether users were informed about other methods and what to do about side effects. Responses were least consistent when asking whether side effects were mentioned. Adjusting for inconsistency, scores were up to 50 percent and 30 percent lower in Pakistan and Uganda, respectively, compared to unadjusted MII scores. Additional questions facilitated better understanding of counseling quality

Long-term care cost drivers and expenditure projection to 2036 in Hong Kong

<p>Abstract</p> <p>Background</p> <p>Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC) expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036.</p> <p>Methods</p> <p>We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions.</p> <p>Results</p> <p>Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure.</p> <p>Conclusion</p> <p>The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning.</p

Urbanization and international trade and investment policies as determinants of noncommunicable diseases in Sub-Saharan Africa

There are three dominant globalization pathways affecting noncommunicable diseases in Sub-Saharan Africa (SSA): urbanization, trade liberalization, and investment liberalization. Urbanization carries potential health benefits due to improved access to an increased variety of food imports, although for the growing number of urban poor, this has often meant increased reliance on cheap, highly processed food commodities. Reduced barriers to trade have eased the importation of such commodities, while investment liberalization has increased corporate consolidation over global and domestic food chains. Higher profit margins on processed foods have promoted the creation of ‘obesogenic’ environments, which through progressively integrated global food systems have been increasingly ‘exported’ to developing nations. This article explores globalization processes, the food environment, and dietary health outcomes in SSA through the use of trend analyses and structural equation modelling. The findings are considered in the context of global barriers and facilitators for healthy public policy.Department of HE and Training approved lis

Environmental impacts of food retail: A framework method and case application

© 2015 Elsevier Ltd. The food retail sector is the gatekeeper between consumers and producers and has substantial influence on consumption and production choices via procurement and provision decisions. Food provision and consumption systems embody huge environmental impacts worldwide. Food retailers as gatekeepers have a key role to play to enable sustainable consumption and provision to become common practice. In this paper, a framework to attribute emissions and water use to individual and all food retail businesses and their products by geographical area and postcode of cities is presented. As far as the current authors are aware, such a framework has not been generated for food retail sector businesses before, primarily due to barriers to input-output modelling of the sector. The scientific value added is that a novel approach to overcome barriers is presented as well as the required framework. The framework is illustrated for Southampton, but can be applied in other regions of the world where similar data exist. The value of a business's product emissions estimates (generated by the framework) is they can be a first step in informing product prioritisation for focussing information searches or more detailed life cycle analysis to make sustainable procurement and choice editing decisions. The approach has value to government, businesses and non-government organisations (NGOs) in developing strategy and planning sustainable provision and procurement; by helping benchmark sustainable shopping provision, prioritisation of retail businesses and product categories for sustainable procurement/choice editing

Multidisciplinary and participatory workshops with stakeholders in a community of extreme poverty in the Peruvian Amazon: Development of priority concerns and potential health, nutrition and education interventions

<p>Abstract</p> <p>Background</p> <p>Communities of extreme poverty suffer disproportionately from a wide range of adverse outcomes, but are often neglected or underserved by organized services and research attention. In order to target the first Millennium Development Goal of eradicating extreme poverty, thereby reducing health inequalities, participatory research in these communities is needed. Therefore, the purpose of this study was to determine the priority problems and respective potential cost-effective interventions in Belen, a community of extreme poverty in the Peruvian Amazon, using a multidisciplinary and participatory focus.</p> <p>Methods</p> <p>Two multidisciplinary and participatory workshops were conducted with important stakeholders from government, non-government and community organizations, national institutes and academic institutions. In Workshop 1, participants prioritized the main health and health-related problems in the community of Belen. Problem trees were developed to show perceived causes and effects for the top six problems. In Workshop 2, following presentations describing data from recently completed field research in school and household populations of Belen, participants listed potential interventions for the priority problems, including associated barriers, enabling factors, costs and benefits.</p> <p>Results</p> <p>The top ten priority problems in Belen were identified as: 1) infant malnutrition; 2) adolescent pregnancy; 3) diarrhoea; 4) anaemia; 5) parasites; 6) lack of basic sanitation; 7) low level of education; 8) sexually transmitted diseases; 9) domestic violence; and 10) delayed school entry. Causes and effects for the top six problems, proposed interventions, and factors relating to the implementation of interventions were multidisciplinary in nature and included health, nutrition, education, social and environmental issues.</p> <p>Conclusion</p> <p>The two workshops provided valuable insight into the main health and health-related problems facing the community of Belen. The participatory focus of the workshops ensured the active involvement of important stakeholders from Belen. Based on the results of the workshops, effective and essential interventions are now being planned which will contribute to reducing health inequalities in the community.</p

"Before we used to get sick all the time": perceptions of malaria and use of long-lasting insecticide-treated bed nets (LLINs) in a rural Kenyan community

<p>Abstract</p> <p>Background</p> <p>Malaria is a leading global cause of preventable morbidity and mortality, especially in sub-Saharan Africa, despite recent advances in treatment and prevention technologies. Scale-up and wide distribution of long-lasting insecticide-treated nets (LLINs) could rapidly decrease malarial disease in endemic areas, if used properly and continuously. Studies have shown that effective use of LLINs depends, in part, upon understanding causal factors associated with malaria. This study examined malaria beliefs, attitudes, and practices toward LLINs assessed during a large-scale integrated prevention campaign (IPC) in rural Kenya.</p> <p>Methods</p> <p>Qualitative interviews were conducted with 34 IPC participants who received LLINs as part of a comprehensive prevention package of goods and services. One month after distribution, interviewers asked these individuals about their attitudes and beliefs regarding malaria, and about their use of LLINs.</p> <p>Results</p> <p>Virtually all participants noted that mosquitoes were involved in causing malaria, though a substantial proportion of participants (47 percent) also mentioned an incorrect cause in addition to mosquitoes. For example, participants commonly noted that the weather (rain, cold) or consumption of bad food and water caused malaria. Regardless, most participants used the LLINs they were given and most mentioned positive benefits from their use, namely reductions in malarial illness and in the costs associated with its diagnosis and treatment.</p> <p>Conclusions</p> <p>Attitudes toward LLINs were positive in this rural community in Western Kenya, and respondents noted benefits with LLIN use. With improved understanding and clarification of the direct (mosquitoes) and indirect (e.g., standing water) causes of malaria, it is likely that LLIN use can be sustained, offering effective household-level protection against malaria.</p

Ten commandments for the future of ageing research in the UK: a vision for action

Increases in longevity resulting from improvements in health care and living conditions together with a decrease in fertility rates have contributed to a shift towards an aged population profile. For the first time the UK has more people over age 60 than below 16 years of age. The increase in longevity has not been accompanied by an increase in disease-free life expectancy and research into ageing is required to improve the health and quality of life of older people. However, as the House of Lords reported, ageing research in the UK is not adequately structured and a clear vision and plan are urgently required. Hence, with the aim of setting a common vision for action in ageing research in the UK, a 'Spark Workshop' was organised. International experts from different disciplines related to ageing research gathered to share their perspectives and to evaluate the present status of ageing research in the UK. A detailed assessment of potential improvements was conducted and the prospective secondary gains were considered, which were subsequently distilled into a list of 'ten commandments'. We believe that these commandments, if followed, will help to bring about the necessary implementation of an action plan for ageing research in the UK, commensurate with the scale of the challenge, which is to transform the manifold opportunities of increased longevity into actual delivery of a society living not only for longer, but also healthier, wealthier and happier

The business of death: a qualitative study of financial concerns of widowed older women

BACKGROUND: The feminisation of ageing and increasing number of widowed women in contemporary society has significant implications. Older women are at risk of poor health, social, and economic outcomes upon widowhood. The aim of the study was to describe women’s experiences in the period soon after their husbands’ death, including their financial issues and concerns, and the ways in which these experiences impacted on the transition to widowhood late in life. METHODS: This was a longitudinal study using serial in-depth semi-structured interviews with 21 community-dwelling women over the age of 65 in Australia. Verbatim transcripts underwent Interpretive Phenomenological Analysis. RESULTS: Thematic analysis revealed: 1) administrative burden increases vulnerability; 2) gender roles impact on transitions; and 3) financial adjustments render housing insecurity and health risk. High administrative burden within the context of significant grief and mourning was a defining feature of the early bereavement period. Complicated protracted administrative processes, insensitive interactions, and reminders of loss contributed to distress, anxiety and feelings of demoralisation. Several women identified assumption of household financial management as the most difficult aspect of coping with their husband’s death. CONCLUSIONS: Older women may have unmet needs for assistance with administrative, financial, and legal issues immediately following spousal death and potentially for years afterward. Lack of familiarity and absence of instrumental support with financial and legal issues signal the need for policy reform, resources to improve financial literacy in women throughout the life course, increased advocacy, and consideration of different support and service models