Community Health Perspective Research Articles

What is known about adolescent dysmenorrhoea in (and for) community health settings?

Dysmenorrhoea affects many adolescents with significant impacts on education and well-being. In the UK, most of the adolescents who seek care (and many never do), will do so through general practice (primary care). Knowing how best to care for adolescents reporting menstrual pain is an area where UK general practitioners would like better guidance and resources. This mixed-methods narrative synthesis collates community and specialist evidence from 320 papers about adolescent dysmenorrhoea, with a UK general practice community health perspective. We report a narrative summary of symptoms, cause, consequences and treatments for adolescent dysmenorrhoea. We highlight areas of tension or conflicted evidence relevant to primary care alongside areas of uncertainty and research gaps identified through this synthesis with input from lived experience advisers. There is little evidence about primary care management of adolescent dysmenorrhoea or specific resources to support shared-decision making in general practice, although there are evidence-based treatments to offer. Primary care encounters also represent potential opportunities to consider whether the possibility of underlying or associated health conditions contributing to symptoms of dysmenorrhoea, but there is little epidemiological evidence about prevalence from within community health settings to inform this. The areas where there is little or uncertain evidence along the care journey for adolescent dysmenorrhoea, including at the interface between experience and expression of symptoms and potential underlying contributory causes warrant further exploration. https://www.crd.york.ac.uk/PROSPEROFILES/256458_STRATEGY_20210608.pdf, identifier (CRD42021256458).

Go-along interview assessment of community health priorities for neighborhood renewal.

Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go-along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents' community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra- and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self-worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well-being by being valid and meaningful to the community of focus.

Research progress on the wastewater-based epidemiology (WBE) in SARS-CoV-2 surveillance and early warning system from a community health perspective

The continuously spreading of SARS-CoV-2 poses a threat not only to public health but also to all aspects of socio-economics. Current public health measures are costly and have potential health risks, thus, it is imminent that developing efficient and economical early warning surreillance tools from a public health perspective. In this review, we summarized the current COVID-19 epidemiological surveillance measures and the efficiency, economic, and cutting edge of wastewater-based epidemiology (WBE). The WBE-based surveillance is organized and reviewed from three aspects: early warning system for the timing of epidemic, routine epidemic surveillance, and parameters determination of predicting epidemiological models of COVID-19. It reveals the application value of WBE as an early warning and surveillance system of public health, and then, discussing its current weakness and strength, adding literature for a WBE-based surveillance system for COVID-19 epidemic in China.

Effect of Oral Health Promotional Program on Knowledge, Attitudes and Practices Regarding Dental Caries among Primary School Children In Minia City, Egypt

Background: For optimal health and well-being, oral health is a fundamental element. Dental caries is a prevalent disease both from a community and individual health perspectives. Also, families have to deal with a young child suffering from toothache. The basic mission of oral health educators is to improve information and behaviour in the community. Such understanding requires knowledge that represents the human conviction that has been translated into actions. Positive behavior is the outcome of the sustained action. The aim of the study was to evaluate the effect of oral health promotional program on knowledge, attitude and practices regarding dental caries among primary school children in Minia city, Egypt. Design: quasi-experimental pre-post-test method was used. Settings: The research was applied in Saad Zaghlol and Huda Sharawy Primary Schools affiliated to Minia City of Minia Governorate, Egypt. Sample: cluster random sample of 400 participant child who were recruited using multi-stage random sample technique. Tools: I-Socio-Demographic Questionnaire. II-Oral Health Knowledge Questionnaire. III- Dental Behavioral Inventory (HU-DBI) questionnaire at Hiroshima University IV- Questionnaire on Oral Health practice. Results: the present study showed that the oral health promotional program(OHPP) become efficient in enhancing awareness, attitude, and skills toward oral health; as the mean scores of knowledge, attitudes and practices were 7.83 ± .488, 6.63± 1.7 and 9.33±1.1 respectively with highly statistical difference before and after oral health promotion program. High statistically significant difference between children about oral health knowledge, attitudes and practices pre and post the assigned program (P= .000**) were noticed. Conclusion: There was improvement of level of knowledge, positive attitudes and satisfactory practices among the majority of the participants children after implementation of oral health promotion program. Recommendations: Integration of OHPP into the school curriculum for enhancing knowledge, attitude, practices regarding oral health and dental caries prevention. Health care decision makers and authorities should provide continuous support to promote the efficient make use of school teachers for oral health promotion of students.

Community health perspective of gas flaring on communities in Delta region of Nigeria: narrative review

<p>The Nigerian gas flares emit as many imaginable pollutants that cause several health concerns. However, there is no comprehensive study done on the health impact of gas flaring on humans in Delta state. Hence, this paper seeks to identify the risks associated with gas flaring in relation to human health and the knowledge of gas flaring in the communities of Delta region of Nigeria. Following a non-systematic approach to develop this narrative, <strong>s</strong>tudies that link various diseases such as hypertension, cancers, birth defects, diabetes, respiratory problems, cardiovascular and kidney disease to gas flaring in the region, the risk perception and the policies and regulations were examined. Findings from most of the papers reviewed show an association between gas flaring and the diseases identified and prevalence of most of the diseases in oil and gas communities compared to areas where gas flaring is not practiced. In conclusion, insufficient data on the prevalence and association of diseases such as hypertension, cancers, birth defects, diabetes, respiratory problems, cardiovascular and kidney disease with gas flaring were some of the gaps identified. These results necessitate the need for epidemiological studies on the health effects of gas flaring on humans.</p>

Associations between COVID-19-Related Digital Health Literacy and Online Information-Seeking Behavior among Portuguese University Students.

We aim to evaluate the associations between digital health literacy (DHL) related to COVID-19 and online information-seeking behavior among university students. Methods: A total of 3.084 students (75.7% women), with an average age of 24.2 (SD = 7.5) participated in this cross-sectional study, most of whom (36.5%) were from social sciences and pursued a bachelor’s degree (50.7%). Data on COVID-19-related DHL and online information-seeking behavior were collected using an online questionnaire. Logistic regression models were performed. Results: As the pandemic progressed, participants showed a lower chance of achieving a sufficient DHL (OR = 0.7; 95% CI = 0.6; 0.9). Using search engines more often (e.g., Google) (OR = 0.7; 95% CI = 0.5; 0.9), Wikipedia (OR = 0.7; 95% CI = 0.6; 0.9) and social media (e.g., Facebook) (OR = 0.7; 95% CI = 0.6; 0.9) decreased the likelihood of achieving sufficient DHL related to COVID-19. More frequent use of websites of public bodies (OR = 1.7; 95% CI = 1.1; 2.5) increased the odds of reporting sufficient DHL. Conclusion: DHL is associated with university students’ online information-seeking behavior in the time of COVID-19. From a community and public health perspective, programs aiming at improving DHL should be highlighted.

Challenges and Assets for Promoting Early Childhood Development in Indonesia: A Health Statistics Review from a Community Health Perspective

Background: Although early childhood development is important, there are limited health statistics reviews related to the early childhood development in Indonesia. This study organized statistical health information across 33 Indonesian provinces to assess ongoing challenges and existing assets for improving early childhood development. Information about early childhood development in Indonesia between 2007 and 2013 was obtained through data supplied by the Indonesian Ministry of Health and the Indonesian Central Bureau of Statistics. Methods: The information collected was organized into five domains of early childhood development: health, nutrition, responsive care giving, early learning, and security and safety. Challenges and assets in Indonesia were assessed in terms of early childhood development. Results: Our results indicated that although the child mortality rate decreased between 2007 and 2013, it remained higher than the global average, with large disparities between provinces. Background factors influencing child mortality rates included the limited availability of health services, large catchment areas for puskesmas (community health centers), parents' limited caregiving responsiveness, and limited opportunities for parents to achieve advanced education. However, our results also revealed several important assets, including the existence of community health posts, alert village programs, community volunteers, and a large number of nurses and midwives; Conclusions: To improve early childhood development in Indonesia, it is important to empower parents to utilize these community health-related assets. Nurses and kaders (community health volunteers) should promote parents' enhanced awareness of child health and development.

Incorporación de la perspectiva de género en la salud comunitaria. Informe SESPAS 2018

The concepts of community health and gender perspective are often misunderstood or interpreted differently between different sectors and disciplines. For this reason, this article starts with the definition of both concepts and continues with a proposal for the incorporation of a gender perspective in community health. The gender norms determine different pathways and opportunities for people according to their sex, which are associated with gender inequalities in health and therefore must be incorporated in community health interventions. The gender perspective requires considering gender inequalities in power, in the access to and control over resources, the sexual division of labour and gender socialization in all phases of community health strategy implementation. Incorporating a gender perspective in community health is not only a matter of ethics and justice but also of the effectiveness of interventions.

Inuit food security in canada: arctic marine ethnoecology

Quantitative Seascape Ethnoecology practice is considered through a community-based food security lens. Fish and marine mammal records obtained from a wide range of Inuit co-management agreements are, for the first time combined to calculate an Inuit-culture marine ecological footprint, targeted on calendar year 2008. A reflexive, participatory and inclusive education/governance strategy for Arctic coastal food security is presented, particularly in Nunavut; considering caloric marine catch may average as high as 40% of human basal metabolic requirements for some communities. The current work provides a foundation to mitigate food insecurity for the Inuit in what may be the most insecure indigenous food setting in any country that is generally considered as developed. Four large marine ecosystems are considered within Food and Agricultural Organization (FAO) areas 18 and 21. Initial fish catch reconstructions for 1950–2001 are combined with mammal harvest records. Food system changes and planning are examined from a community health and management perspective. The relationship between food security, gender, livelihoods and ecosystem capacity are discussed within current management challenges and the related mandates for Canadian government agencies, based in part upon the 2007, United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). A process to combine academic ecological knowledge with traditional ecological knowledge (TEK) and an Inuit Qaujimajatuqangit (IQ) is suggested within a beneficiary-led marine protected area network. A re-evaluation of Canada’s northern (Nunavut) transfer and land claim agreements are suggested, with a goal to provide redress for UNDRIP compliance. Therein, consideration should be given to dedicated funds for reflexive and participatory development of university-level Ethnoecology programming and community-based offices for Nunavut food security science.

Clinical Practice in Community Medicine: Challenges and Opportunities.

Clinical practice with community health perspective makes community medicine a unique specialty. In their health centers, community physicians not only implement disease prevention programs, assess community health needs, manage healthcare teams and advocate for health promoting policies but also diagnose and treat diseases. However, participation of community medicine faculty in the delivery of clinical care varies from place to place due to administrative constraints. Health centers attached with medical college are not dependent on community medicine faculty for clinical service as these centers have their own medical and paramedical staff; whereas, other clinical departments in medical colleges depend on their faculty for delivery of clinical care in the hospital. Consequently, a perception is gaining ground that community medicine is a para-clinical specialty. Strategies for a fixed tenured rotation of faculty in the health centers should be evolved. All faculty members of community medicine must also provide clinical care in the health centers and the quantum of clinical services provided by each one of them should be reported widely to all stakeholders. Community medicine residency programs must ensure that trainee community physicians acquire competency to deliver comprehensive primary health care (promotive, preventive, curative, and rehabilitative) in a health center.

Integrating the community health perspective into the health care provision system: the Basque Country case

Introduction : Integrated care has been recognized as a useful strategy to avoid the existing gaps in health care provision and, consequently, to improve the efficacy of the provided care and to improve patients’ health outcomes, quality of life and satisfaction. Community care is based on the assessment and intervention over the local health determinants, needs and resources. This process, in order to constitute a true community health approach, needs to be performed in a participatory manner by professionals and community stakeholders. Even though integration is being facilitated and promoted though numerous health systems, frequently is focused around care levels (primary care and specialized care) or adjacent health systems (primary care and mental health care), and rarely considers other related aspects as social care or community health. The Basque Country Health Department, since 2013 has been developing an overall strategy aimed to generalize some integrative experiences previously tested. At this point all health care organization at the Basque Health System has functionally integrated primary and secondary care, and several plans are being developed in order to advance towards a comprehensive integration of systems. One of these specific plans is aimed to integrate the community health perspective into the primary care health system and this process and the first results are the subject of this communication. Short description of practice change implemented, aims, target population and key stakeholders involved With the aim of integrating community health perspective into the primary care network, the Public Health Department and Osakidetza (the Public Basque Health System), constituted a work team appointed to lead the necessary process. This group was constituted by health promotion, primary care and research professionals of both institutions. The group proposed a plan based on three main elements: communication of the interest of integrated community care practice; capacitation of professionals; provision of a theoretical framework fitting the Basque Country reality. All these three elements were oriented to promote the integration of health professionals (primary care and health promotion) in local health networks (already existing or newly developed) working in the assessment and intervention over the main local health determinants. The local health network was considered key of the whole process. Key findings : results, outcomes and impact. Regarding the three main elements of the plan, the communication of the interest of integrating community health was based on multilevel plenary sessions attended by the managers of care organizations and primary care units. Also a work cafe was celebrated with the participation of interdisciplinary stakeholders from the health system but also from the local authorities, education, social system and citizenship. Regarding capacitation of professionals, a peer based education process is being developed. Around 70 professionals are taking part on it and at the same time that theoretical contents are being provided, each attendant is putting on place at his/her own local community the lessons learned. Finally a guide for the integration of community health perspective has been composed by some of the members of the team. This guide is based on published evidence and its being used as the base for the education process. It dedicates special attention to the evaluation of the process and the local networks results. Highlights: (discussions, lessons learned from the process of implementation, timeline, contingencies developed) Community care was not a new issue for several health organizations. Abundant experiences were already put in place and, for the professionals already involved, this new plan constitutes a great opportunity to consolidate their advances. It is very important to consider these previous experiences, never neglect them and use that knowledge to improve the new initiative. The process to participate in local health networks is difficult for non-trained professionals. It is necessary to capacitate health professionals in participatory techniques in order to made them feel comfortable with the task and also to enable them to play an active role in the participatory processes. Health care managers need to facilitate the participation of health professionals in local health networks as the key point to integrate community care in the health system. Community stakeholders welcome health professionals to be a part of the existing networks and are willing to promote and work on new ones. Conclusion: (include comments on sustainability and on transferability) Integration of community perspective in the health care provision is a complex task that only can be tackled through the dedication and work of health professionals, the facilitation of the managers and the determination of the whole health system.

Perceptions on healthcare in people with self-identified mental health problems in the rural areas of Peru

Person-centered health and community health perspectives on its needs and resources are mandatory in healthcare policies in highly cultural diverse contexts. From this point of view, epidemiology needs to be centered not only on the disease, but also on the health diagnosis and its context, including the points of view of people and the community about their problems and needs. This article describes and qualitatively analyzes the views of adults with self-identified mental health disorders (MHD) in rural regions on the coast, highlands, and jungle of Peru, as causal factors, personal resources, and healthcare expectations from health facilities, using the narrative approach of ideographic formulation proposed by the World Psychiatric Association. The database of mental health epidemiological studies from the National Mental Health Institute was used. The qualitative analysis on answers from 235 people reveals that a large part of MHD is linked to the dynamics of troubled families and to the loss of loved ones. The presence of scarce community resources that help overcome these problems is noted. Counseling is stressed among the expectations of healthcare at facilities; nevertheless, many people do not know what to expect from such healthcare. We believe that the narrative approach is an important tool as regards to community- and person-centered medicine and intervention strategy planning.

Per-Capita Medicare Expenditures, Primary Care Access, Mortality Rates, and the Least Healthy Cities in America

PurposeTo determine whether several measures of health care expenditures, access, and outcomes for the 25 recently identified “least healthy cities in America” differed from those in the rest of America. MethodsFor 2004 and 2013, we obtained publicly available price-, age-, sex-, and race-adjusted hospital service area per-capita Medicare expenditures; age-, sex-, and race-adjusted Medicare mortality rates; and 2 indicators of primary care access: the proportion of enrollees having at least one ambulatory visit to a primary care clinician and the per-capita discharge rate for ambulatory care sensitive conditions. Using population weighting, we used Student t test for expenditure data and the chi-squared test for access and outcomes data to compare results of the 25 least healthy cities in aggregate to the rest of America. ResultsIn both years examined, the 25 least healthy cities had substantially (about $500 per capita per year) and statistically significantly higher total per-capita Medicare Part A and Part B expenditures than the rest of America: about 4/5 of this difference was due to higher hospital and skilled nursing facility expenditures; physician expenditures were modestly lower in the 25 least healthy cities. While a greater proportion of Medicare beneficiaries in the least healthy cities had a primary care clinician both years, mortality and ambulatory care sensitive condition admission rates were substantially higher in the least healthy cities. ConclusionsPolicymakers and health system executives should work together to determine the best asset allocation across determinants of health that maximizes value creation from a community health perspective.

Effects of fasting on Blood pressure in normotensive males

Muslims all over the world fast in the holy month of Ramadan. Fasting means abstinence from drinking any liquids, eating, smoking and taking anything parenterally. It is intermittent in nature from the start of dawn to end at dusk. Fasting has various physiological effects on different biological parameters of the human body. Previous studies that look at effect of Ramadan fasting on blood pressure have focused mainly on hypertensive patients and patients with already established heart disease.(1,2)There is very limited data regarding the effect of fasting on the normal population. (3,4) A few previous studies have advocated a hypotensive role of fasting.(5) In our study published in Journal of Ayub Medical College Abbottabad (JAMC) in 2015, “Effects of Ramadan Fasting on Blood pressure in normotensive males”, we investigated the effect of Ramadan fasting on blood pressure of normotensive men. We conducted a repeated measure observational study in Karachi, Pakistan on 70 individuals who were normotensive, non-smokers between the ages of 18–50 years. . Blood pressure, pulse, BMI of each participant was recorded one week before the start of Ramadan and in the first, second and third week of Ramadan. The results of our study show that intermittent fasting has a hypotensive effect in normotensive males as proven in animal models and certain human population. There was an average drop of 8/3 mmHg and while the results are significant, their clinical relevance needs to be analysed. Studies on animal models have suggested atrial natriuretic peptide, catecholamines, opiates and body mass index as possible reasons for the decrease in blood pressure due to fasting.(3, 6) Dewanti et al suggested that the cause of drop in blood pressure was the drop in BMI however in our study we found that a drop in BMI only occurred before Iftar towards the end of the fast. There was no significant drop in post-Iftar BMI although there was a significant drop in blood pressure post-Iftar. At the same time ANP has been investigated and found to have no relationship with the phenomenon. We observed a drop in both pre and post Iftar period blood pressure readings. From the community health perspective these results cast doubt on the results of screening for hypertension in the month of Ramadan. Our study has some limitations. First of all, our results cannot be generalized to women and individuals suffering from chronic diseases. Secondly, one cannot exclude the confounding effect of the type of food taken during the breaking of the fast for example individuals taking stimulants like coffee and tea might have yielded readings that were confounded.

Restoring the Blessings of the Morning Star: Childbirth and Maternal-Infant Health for First Nations near Edmonton, Alberta

It is not only remote Aboriginal communities in Canada that have poorer maternal-infant health status than Canadian averages; residents of First Nation communities located close to large urban centres also experience this health status gap. Alexander, Alexis, Enoch, and Paul First Nations are located within an hour of healthcare services in greater Edmonton. The narratives of 75 predominantly Cree and Stoney women from these communities were gathered through seven talking circles and five semi-structured interviews. The participants described their experiences of loss and separation as pregnancy care and childbirth moved out of the community and into the hospital over the last two generations. This shift was not only a geographic relocation; it also disconnected the childbirth experience from elders, family and community, traditional teachings, and spiritual meaning. Conversely, the participants’ hospital experiences were characterized by a limited sense of cultural safety. Participants highlighted the urgent need to reintegrate culturally based community support and health perspectives into the childbirth experience. The implementation of such a culturally integrated healthcare model in all Aboriginal communities—remote, rural, suburban, and urban—may be the key finally to closing the gap between Aboriginal and non-Aboriginal maternal and infant health status in Canada.

Editorial: Domestic violence – time for a rethink?

Editorial: Domestic violence – time for a rethink?

Preface

This odyssey began with an email from Bruce Theirs asking me to consider editing a special issue of Dermatology Clinics dedicated to dermatoepidemiology. We quickly decided to broaden the focus to include public health—making this the first issue of any Clinics of North America series specifically devoted to topic of public health. I solicited potential articles from colleagues and members of the dermatoepidemiology list serve maintained by Martin Weinstock at Brown University. Manuscripts were submitted and peer reviews in the fall of 2008. Reviewers were given the option of revealing or not revealing their identity to the authors and to our readers. I thank the peer reviewers listed below for their attention to detail and for the hundreds of comments they offered that have vastly improved this issue: Adam Asarch (two articles), Maged Kamel Boulos, David Buller, Avanta Collier, Lori Crane (3 articles), Guy Eslick, Rod Hay, Whitney High, Alexa Kimball, Kristie McNealy (2 articles), David Norris, Rachael Simmons, Hywel Williams (two articles), and others who remain anonymous. While hot button issues in both fields are discussed, the articles in the end treat dermatologic public health topics more than epidemiology. Alireza Khatami and Miguel San Sebastian lead off this issue discussing the community health perspective on skin disease as a neglected public health problem. Angela Sauaia and I next address disparities in dermatologic health care. Bridgit Nolan and Steven Feldman review behavioral study topics particularly relevant to dermatology: tanning addiction and medication compliance. Adam Asarch and colleagues summarize the principles of sound survey research. Karl Vance and colleagues describe the potential of social website marketing for dermatologic public health messages. Marlies Wakkee and Tamar Nijsten review the increasing importance of comorbidities in dermatologic research. Raja Sivamani and colleagues examine UV tanning public health messaging. Linh Lu and colleagues make the case for increased nickel regulation to reduce the most common cause of allergic contact dermatitis. Shalya Francis and colleagues examine and classify US statutes governing dermatologic scope of practice. Yakir Levin and Erin Warshaw review the emerging field of teledermatology. Heather Hoch and colleagues expose the growing influence of health care consumers on dermatology. Luigi Naldi and Liliane Chatenoud describe registry research examples, opportunities, and pitfalls and provide guidelines for the reporting of this type of research. Rachel Simmons and colleagues describe online dermatology resources. Christina Neslon and colleagues suggest guidelines for manuscript and publication review suggestions. And lastly Marianne Berwick and colleagues outline the epidemiology and public health issues of one of dermatology’s gravest problems, melanoma. This issue of Dermatology Clinics also initiates the use of podcasts [1] by a dermatology journal. I thank Chis Mavergames and Mike Clark for teaching an exciting workshop on the importance of this new technology at the Cochrane Colloquium in Freiberg Germany in October 2008. I thank Bruce Theirs for the invitation to edit this issue. I thank Carla Holloway for her professional editorial assistance. I thank the University of Colorado Denver, School of Medicine for interdisciplinary academic enrichment funds that supported discussion sessions among some of the authors and the National Cancer Institute for a career development grant that supported some of my salary while working on this project. And lastly I thank my wife, Lisa, and children, Natalia and Eric, for accommodating the time and effort this project directed away from their company and love.

Milk Helps Build Strong Teeth and Promotes Oral Health

A great deal of research into the benefits of milk consumption has gone largely under the radar for many decades. There is a wealth of studies both in the United States and abroad to suggest that milk consumption is largely anti-cariogenic when combined with a typical routine of oral hygiene. This effect can be mostly attributed to several factors: tooth remineralization, inhibition of bacterial colonization, and biofilm inhibition. These abilities have been studied in detail and are likely due to numerous proteins found in milk. An attractive feature of milk from the community health perspective is its widespread consumption throughout the world. For this reason, studies have been initiated to investigate the possibilities of using milk to deliver fluoride and antibacterial antibodies to high-risk populations worldwide. This review will focus on the various components of milk, which promote oral health, and will also discuss common approaches to improve upon the oral health benefits of milk consumption.

The impact of the introduction of treated water on aspects of community health in a rural community in Kwazulu-Natal, South Africa

A project was designed by Umgeni Water (funded by the Water Research Commission of South Africa) to monitor the implementation of water reticulation in Vulindlela and evaluate the Water Supply Scheme from a community and environmental health perspective. The findings would hopefully contribute toward the development of criteria for Health Impact Assessment on Water Reticulation Projects. One objective of this study was to evaluate the usefulness of diarrhoeal disease as opposed to other health indicators for water-associated diseases. The innovative methodology followed in the study, a "stepped wedge design", compared four discrete areas of water reticulation implementation in Vulindlela over a 15-month period. Five surveys, including a baseline and four follow-ups at each household, were carried out. Analysis (microbiological, chemical) was carried out of samples from the household drinking water and from the source of the water. Each survey included health questionnaires, the respondent being the head of the household in each case. Overall, there was no direct correlation proved between water quality and diarrhoea per se. However, there was a marked decrease in diarrhoea with the introduction of the new water supply. There was definite correlation between hygiene behaviours and diarrhoea. Diarrhoea would seem to be the health impact associated with water, of choice.

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.