International Health Programs Research Articles

The Impact of the COVID-19 Pandemic on Women's Perinatal Mental Health: Preliminary Data on the Risk of Perinatal Depression/Anxiety from a National Survey in Italy.

Increasing evidence suggests that during the COVID-19 pandemic, anxiety and depression during the perinatal period increased. The aim of the study is to estimate the prevalence of risk for both maternal depression and anxiety among women attending 18 healthcare centres in Italy during the SARS-COV-2 pandemic and to investigate the psychosocial risks and protective factors associated. It was divided into a retrospective phase (2019, 2020, and the first nine months of 2021) and a prospective phase (which began in November 2021 and it is still ongoing), which screened 12,479 and 2349 women, respectively, for a total of 14,828 women in the perinatal period. To evaluate the risk of anxiety and depression, the General Anxiety Disorder-7 (GAD-7), the Edinburgh Postnatal Depression Scale (EPDS), and an ad hoc form were used to collect sociodemographic variables. In the prospective study, the average age of the women is 31 (range 18-52) years. Results showed that the percentage of women who had EPDS score ≥9 increased from 11.6% in 2019 to 25.5% in the period ranging from November 2021 to April 2022. In logistic regression models, the variables associated with the risk of depression at a level ≤0.01 include having economic problems (OR 2.16) and not being able to rely on support from relatives or friends (OR 2.36). Having the professional status of the housewife is a lower risk (OR 0.52). Those associated with the risk of anxiety include being Italian (OR 2.97), having an education below secondary school level (OR 0.47), having some or many economic problems (OR 2.87), being unable to rely on support from relatives or friends (OR 2.48), and not having attended an antenatal course (OR 1.41). The data from this survey could be useful to determine the impact of the SARS-COV-2 pandemic on women and to establish a screening program with common and uniformly applied criteria which are consistent with national and international women's mental health programs.

2 DEVELOPING AN INTERNATIONAL SCHOOL MENTAL HEALTH PROGRAM FOR THE WHO: LESSONS LEARNT

I will describe the process of development of an international school mental health program for the World Health Organization (WHO) in the Eastern Mediterranean region and implications for the United States and elsewhere.

Core Values at Work-Essential Elements of a Healthy Workplace.

This paper explores core values at work—those values that give meaning to people’s lives and their work, that allow each person to experience their work with passion, commitment, dignity, and respect. Though core values may appear to be simple and obvious, supporting them at work can be more complex and difficult than expected. These values are not only ethical and moral, but also social and cultural; they are intrinsically related to the same factors that promote health across the globe, including family, community, and work. Three seminars outlined the nature and importance of core values within occupational health and well-being; these sessions were held during the International Commission on Occupational Health (ICOH) conferences between 2015 and 2020. A non-exhaustive, literature review explored these findings further. Perspectives from international, national, and local occupational health programs have begun to demonstrate how core values underpin workers’ well-being. These essential core values impact worker health positively when they are included and respected, and negatively when they are missing or corrupted. Within occupational safety and health (OSH), people’s awareness of these values and their importance at work is now clearly emerging, offering opportunities to honor and protect each worker and help them to experience their core values through their work.

Social marketing: can we utilize marketing concepts and techniques for the promotion of social objectives?

Social marketing emerged as a valuable commercial tactic in the 1970s; it was created by Philip Kotler and Gerald Zaltman. Its basic notion is that the same marketing ideologies that utilized to sell consumer goods can also be employed to promote concepts, attitudes, and behaviors. Rather than aiming to persuade the public to buy whatever the firm happens to be selling, both marketing methods aim to understand what consumers want, need, and then provide it. In contrast to consumer marketing, social marketing "seeks to influence social behaviors not for the advantage of the marketer, but for the benefit of the target audience and society as a whole ." This method has proven to be immensely effective for states, politicians, and social strategists; it can also help in fighting addiction, terrorism and promoting peace among any target sample. Moreover, social marketing techniques can be considered a vital factor international health programs, especially for such diverse topics as drug abuse, heart disease, and organ donation . The effectiveness of social marketing relies heavily on techniques from marketing that are used to persuade consumers to purchase products and services. In addition to various kinds of advertising, other strategies like market segmentation, product design, etc. can be valuable. Similar to traditional marketing, the primary focus of social marketing is based on the consumer. The planning process of social marketing takes the elements of the “marketing mix,” which refers to (1) the conception of a Product, (2) Price, (3) distribution (Place), and (4) Promotion. The marketing mix is often called the “Four Ps” of marketing . Social marketing: can we utilize marketing concepts and techniques for the promotion of social objectives?

Social marketing: can we utilize marketing concepts and techniques for the promotion of social objectives?

Social marketing emerged as a valuable commercial tactic in the 1970s; it was created by Philip Kotler and Gerald Zaltman. Its basic notion is that the same marketing ideologies that utilized to sell consumer goods can also be employed to promote concepts, attitudes, and behaviors. Rather than aiming to persuade the public to buy whatever the firm happens to be selling, both marketing methods aim to understand what consumers want, need, and then provide it. In contrast to consumer marketing, social marketing "seeks to influence social behaviors not for the advantage of the marketer, but for the benefit of the target audience and society as a whole ." This method has proven to be immensely effective for states, politicians, and social strategists; it can also help in fighting addiction, terrorism and promoting peace among any target sample. Moreover, social marketing techniques can be considered a vital factor international health programs, especially for such diverse topics as drug abuse, heart disease, and organ donation . The effectiveness of social marketing relies heavily on techniques from marketing that are used to persuade consumers to purchase products and services. In addition to various kinds of advertising, other strategies like market segmentation, product design, etc. can be valuable. Similar to traditional marketing, the primary focus of social marketing is based on the consumer. The planning process of social marketing takes the elements of the “marketing mix,” which refers to (1) the conception of a Product, (2) Price, (3) distribution (Place), and (4) Promotion. The marketing mix is often called the “Four Ps” of marketing . Social marketing: can we utilize marketing concepts and techniques for the promotion of social objectives?

Residents' Reflections on Cost-Conscious Care after International Health Electives: A Single-Center Qualitative Study.

Estimates suggest 30% of health care expenditures are wasteful. This has led to increased educational interventions in graduate medical education (GME) training aimed to prepare residents for high value, cost-conscious practice. International health electives (IHE) are widely available in GME training and may be provide trainees a unique perspective on principles related to high value, cost-conscious care (HVCCC). The purpose of this study was to explore how trainee reflections on IHE experiences offer insight into HVCCC. The authors conducted an applied thematic analysis of narrative reflective reports of GME trainees' IHE experiences to characterize their perceptions of HVCCC. The Mayo International Health Program (MIHP) supports residents and fellows from all specialties across all Mayo Clinic sites. We included 546 MIHP participants from 2001 to 2020. The authors collected post-elective narrative reports from all MIHP participants. Reflections were coded and themes were organized into model for transformative learning during IHEs, focusing on HVCCC. GME trainees across 24 different medical specialties participated in IHEs in 73 different countries. Three components of transformative learning were identified: disorienting dilemma, critical reflection, and commitment to behavior change. Within the component of critical reflection, three topics related to HVCCC were identified: cost transparency, resource stewardship, and reduced fear of litigation. Transformation was demonstrated through reflection on future behavioral change, including cost-aware practice, stepwise approach to health care, and greater reliance on clinical skills. IHEs provide rich experiences for transformative learning and reflection on HVCCC. These experiences may help shape trainees' ideology of and commitment to HVCCC practices.

Pregravidary preparation

Preconception care is an essential component of promoting maternal and child health at the national and international levels. The term “preconception care” is found both in various recommendations of the World Health Organization and in practical recommendations for the protection of maternal and child health. Although programs and guidelines may differ depending on local needs (endemic diseases, financial security, educational level of the population, etc.), the general concept of preconception care is present in developing and developed countries within different health systems and does not depend on political, cultural or religious beliefs. In addition, the history of incorporating various preconception strategies and ideologies into international maternal and child health programs and policies spans nearly 30 years, demonstrating the long-term recognition of the relative importance of this approach as a means of optimizing pregnancy outcomes. However, at present there is a large proportion of women who do not know about the importance of preparing for pregnancy.The purpose of this review was to study international experience in the implementation of preconception care in the practice of practical health care professionals. The main tools were highlighted – motivated counseling and reflective practice. Since the United States of America is the world health leader in improving pregnancy outcomes, the information sources were selected from PubMed and the Centers for Disease Control. This review provides evidence of the importance of motivated counseling, identifies the main stages of establishing a trusting relationship between a doctor and a woman or a married couple.Conclusions. Correct pregravid behavior will improve the demographic indicators of the country, however, systematic work is needed with regard to the social responsibility of married couples and the interest of medical personnel in high-quality motivated counseling.

The Power of Mobile Health: The Girl With the Gadgets in Uganda.

Medical-grade ultrasound devices are now pocket sized and can be easily transported to underserved parts of the world, allowing health care providers to have the tools to optimize diagnoses, inform management plans, and improve patient outcomes in remote locations. Other great advances in technology have recently occurred, such as artificial intelligence applied to mobile health devices and cloud computing, as augmented reality instructions make these devices more user friendly and readily applicable across health care encounters. However, broader awareness of the impact of these mobile health technologies is needed among health care providers, along with training on how to use them in valid and reproducible environments, for accurate diagnosis and treatment. This article provides a summary of a Mayo International Health Program journey to Bwindi, Uganda, with a portable mobile health unit. This article shows how point-of-care ultrasonography and other technologies can benefit remote clinical diagnosis and management in underserved areas around the world.

Complementary and Alternative Medicine Use by Patients From the Gulf Region Seen in the International Practice of a Tertiary Care Medical Center.

BackgroundPatients from various countries may have unique patterns of using complementary and alternative medicine (CAM) and unique reasons for using it.ObjectiveOur objective was to assess the use of CAM among patients from the Gulf region attending the Executive and International Health Program of the Department of General Internal Medicine at Mayo Clinic in Rochester, Minnesota.MethodsThis cross-sectional survey was administered to all patients who were from the Gulf region and were undergoing outpatient evaluation in the Executive and International Health Program. After their initial medical evaluation by a physician, the patients were invited to anonymously complete the modified International Complementary and Alternative Medicine Questionnaire.ResultsThe survey was completed by 69 patients (41 women, 27 men; mean age, 45.4 years). The most frequently seen providers for CAM treatments were physicians (71.0% of patients), spiritual healers (29.0%), and chiropractors (20.3%). CAM treatments most frequently received from a physician were massage therapy (51.0%), hijama (38.8%), spiritual healing (24.5%), and acupuncture or herbs (16.3%). The most frequently used dietary supplements were ginger (42.0%), bee products (30.4%), and garlic (27.5%). The most common self-help therapies were prayers for health (68.1%), meditation (15.9%), and relaxation techniques (11.6%). CAM therapy, including visits to CAM providers, was used by 92.8% of patients. CAM was mainly used to improve well-being and long-term health conditions rather than for acute illnesses.ConclusionThe use of CAM was high among our patients from the Gulf region, and the CAM therapies used by this population differed from the ones used by US patients. Physicians providing care to patients from the Gulf region should be aware of how the use of CAM may affect the care needs of these patients.

Assessment of Climate-Health Curricula at International Health Professions Schools

Researchers have published surveys on health professionals' perceptions of the possible association between climate change and health (climate-health) and assessed climate-health or planetary health curricula in medical schools. However, curricula on climate-health are still lacking and gaps in knowledge persist. To understand the state of climate-health curricula among health professions institutions internationally. A survey of 160 institutional members of the Global Consortium on Climate and Health Education, which includes international health professions schools and programs, was conducted from August 3, 2017, to March 1, 2018. The survey, hosted by Columbia University Mailman School of Public Health, used an online survey tool for data collection. The survey assessed climate-health curricular offerings across health professions institutions internationally, including existing climate-health educational offerings, method of teaching climate-health education, whether institutions are considering adding climate-health education, whether institutions received a positive response to adding climate-health curricula and/or encountered challenges in adding curricula, and opportunities to advance climate-health education. Overall response rate to the survey was 53%, with 84 of 160 institutional responses collected; 59 of the responses (70%) were from schools/programs of public health, health sciences, or health professions; 15 (18%) were from medicine; 9 (11%) were from nursing; and 1 (1%) was from another type of health profession institution. Among respondents, 53 (63%) institutions offer climate-health education, most commonly as part of a required core course (41 [76%]). Sixty-one of 82 respondents (74%) reported that climate-health offerings are under discussion to add, 42 of 59 respondents (71%) encountered some challenges trying to institute the curriculum, and most respondents have received a positive response to adding content, mainly from students (39 of 58 [67%]), faculty (35 of 58 [60%]), and administration (23 of 58 [40%]). Current climate-health educational offerings appear to vary considerably among health professions institutions. Students, faculty, and administration are important groups to engage when instituting curricula, and awareness, support, and resources may be able to assist in this effort.

Dealing With Patient Death on International Health Electives: A Qualitative Study of Residents' Experiences.

International health electives (IHEs) provide numerous educational benefits; potential harms are less well understood. One potential harm is trainee distress associated with increased patient death during IHEs. The purpose of this study was to explore residents' and fellows' IHE experiences with patient death. The authors used applied thematic analysis to explore residents' and fellows' IHE experiences with patient death. The Mayo International Health Program supports IHEs from all specialties across three Mayo Clinic sites. Data were collected and analyzed in two steps. First the authors collected, coded, and analyzed narrative reflections from 43 postrotation reports gathered in 2001-2017 and identified themes relating to experiences with patient death. Second, in 2016-2017 the authors conducted semistructured interviews with six previous participants to refine thematic analysis. Participants described impacts of experiencing increased patient death and identified themes in two domains: difficult experiences with patient death and potential interventions to help residents process their experiences. They identified four themes illustrating why these experiences were difficult: lack of preparation for increased exposure to death, lack of closure, consequences of limited resources, and differences in cultural beliefs regarding death. While pretrip preparation for dealing with death was viewed as important, trainees identified support during and debriefing after IHEs as additional important interventions. Given the popularity of IHEs, residency programs should consider the effect on trainees of increased exposure to patient death. Study findings can inform IHE preparation, support, and debriefing to minimize distress associated with witnessing patient deaths on IHEs.

Evaluation of students' mental and social health promotion educational programs: A systematic review

INTRODUCTION:Various programs are implemented internationally to promote the mental and social health of the students in schools. This study systematically reviewed and categorized all resources, indicators, and criteria for evaluating mental and social programs of schools.MATERIALS AND METHODS:This systematic review was conducted by collecting data from the PubMed, Google Scholar, Scopus, ProQuest, and Web of Science databases using the keywords of “evaluation, mental health program, social health program, behavioral and emotional program.” In the initial review, 4295 studies were found, which reduced to 75 after removing the repetitions and evaluating the studies’ quality. The articles were selected using the PRISMA chart.RESULTS:The findings resulted in three main categories of structure, process, and outcome; 16 subcategories; and 166 codes. The category of structure included the subcategories of human resources, physical space, facilities, training, needed committees and teams, financing, and implementing mental and social programs. The subcategories of process category were functional indicators, guidelines and protocols, communication, documentation, planning/coordination, time management, and monitoring. The subcategories of behavioral-therapeutic, satisfaction, and educational outcomes were associated with the outcome category.CONCLUSION:Application of the structure, process, and outcome indicators, derived from the findings of this study, will greatly improve evaluation of the international mental health programs in schools.

Contributions of master in international health & nutrition policies alumni to African development.

This study aims to analyze how graduates, coming from low income Francophone countries, of the Master in International Health and Nutrition Policies program at the Senghor University are a new human capital bringing an original contribution to the global development of African communities. A secondary analysis of qualitative findings responded to the research question about the evidences of the impact of this new human capital over the community development of countries where the graduates worked. Findings also revealed graduates' potential to contribute to future endeavors in global health. The analysis was conceptually framed by the population health promotion model and the dyad of human and social capital. Findings were analyzed applying the thematic analysis method focusing on four themes: profile of human capital, impacts and results, review of contextual conditions and expected results. Accounts of 70 graduates indicated an emergence of a new profile of human capital due the reinforcement of their qualities, valorization of their assets and consolidation of their skills. As multi-level knowledge brokers, the graduates brought an original contribution to the African development by enhancing individuals' competencies. Graduates contributed to all social actors by socializing knowledge they acquired, as well as by integrating themselves in social relations at all levels resulting in the mobilization and promotion of individuals' competencies. Thus, graduates reinforced the positive actions of the existing human capital.

Transformative Learning and Professional Identity Formation During International Health Electives: A Qualitative Study Using Grounded Theory.

International health electives (IHEs) are widely available during residency and provide unique experiences for trainees. Theoretical models of professional identity formation and transformative learning may provide insight into residents' experiences during IHEs. The purpose of this study was to explore transformative learning and professional identity formation during resident IHEs and characterize the relationship between transformative learning and professional identity formation. The authors used a constructivist grounded theory approach, with the sensitizing concepts of transformative learning and professional identity formation to analyze narrative reflective reports of residents' IHEs. The Mayo International Health Program supports residents from all specialties across three Mayo Clinic sites. In 2015, the authors collected narrative reflective reports from 377 IHE participants dating from 2001 to 2014. Reflections were coded and themes were organized into a model for transformative learning during IHEs, focusing on professional identity. Five components of transformative learning were identified during IHEs: a disorienting experience; an emotional response; critical reflection; perspective change; and a commitment to future action. Within the component of critical reflection, three domains relating to professional identity were identified: making a difference; the doctor-patient relationship; and medicine in its "purest form." Transformation was demonstrated through perspective change and a commitment to future action, including continued service, education, and development. IHEs provide rich experiences for transformative learning and professional identity formation. Understanding the components of transformative learning may provide insight into the interaction between learner, experiences, and the influence of mentors in the process of professional identity formation.

DETEKSI MOLEKULER Mycobacterium tuberculosis DI DAHAK CARA POLYMERASE CHAIN REACTION

tuberculosis is a chronic infectious disease which is found in developing and developed country. It is one of community healthproblems which become priority in national and international health programs. Microbiologic examination is used to establish thediagnosis of tuberculosis beside clinical examination and radiologic examination. Conventional microscopic and culture examinationhave many limitation ie: such as for example low sensitivity, specificity and need a lot of time. New Molecular technique gives morevalue in sensitivity, specificity and the time for examination. the aim of this study was to know the diagnostic value of PolymeraseChain Reaction for detection of Mycobacterium tuberculosis in sputum. the sputum was collected from twenty eight patients suspectedtuberculosis based on the clinical and radiological examination. the study was performed from September 2006 until July 2007. Wedid the conventional culture technique as a diagnostic gold standard and molecular technique to detect the Mycobacterium tuberculosisin the sputum. For molecular technique, we used Polymerase Chain Reaction (PCR) with a set of IS6110 region primer which is specificfor the Mycobacterium tuberculosis Complex. the sensitivity of PCR with IS6110 region primer is 100% (very high), specificity is 82.4%(high), positive predictive value is 89.7% and negative predictive value is 100%. there was statistically no significant difference betweenthe result of PCR and conventional culture method. Based on the result, the Polymerase Chain Reaction examination with primer IS6110region primer can be used as the screening tool for tuberculosis infection, while the clinician waits for culture result.

Use and Misuse of Stunting as a Measure of Child Health

The term "stunting" has become pervasive in international nutrition and child health research, program, and policy circles. Although originally intended as a population-level statistical indicator of children's social and economic deprivation, the conventional anthropometric definition of stunting (height-for-age z scores <-2 SD) is now widely used to define chronic malnutrition. Epidemiologists often portray it as a disease, making inferences about the causes of growth faltering based on comparisons between stunted (i.e., undernourished) and nonstunted children. Stunting is commonly used to monitor public health and nutrition program effectiveness alongside calls for the "elimination of stunting." However, there is no biological basis for the -2 SD cutoff to define stunting, making it a poor individual-level classifier of malnutrition or disease. In fact, in many low- and middle-income countries, children above and below the threshold are similarly affected by growth-limiting exposures. We argue that the common use of stunting as an indicator of child linear growth has contributed to unsubstantiated assumptions about the biological mechanisms underlying linear growth impairment in low- and middle-income countries and has led to a systematic underestimation of the burden of linear growth deficits among children in low-resource settings. Moreover, because nutrition-specific short-term public health interventions may result in relatively minor changes in child height, the use of stunting prevalence to monitor health or nutrition program effectiveness may be inappropriate. A more nuanced approach to the application and interpretation of stunting as an indicator in child growth research and public health programming is warranted.

Critical evaluation of international health programs: Reframing global health and evaluation.

Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions; midstream evaluation focusing on the "who" and "how" of selecting program objectives; and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the path of its health development. A prerequisite of success, regardless of technical outcomes, is that programs must address communities' high priority concerns. Current participatory methods still seldom practice community ownership of program selection because they are vulnerable to funding agencies' predetermined priorities. In addition to critiquing evaluation practices and proposing an alternative framework, we acknowledge likely challenges and propose directions for future research.

Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews.

Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews.

Outside the Family of Nations: First Thoughts on Writing a History of Public Health from the Perspective of Outlier Nations

Notwithstanding the current declarations by spokesmen for and proponents of global health, there remain “outlier” countries: countries unwilling to accede to monitoring or surveillance (e.g. China and avian flu; China and SARS); countries lacking the infrastructural and professional capacity to join cooperative global programs to fight epidemics; countries/regions that have populations with divergent approaches to health goals and practices. What, if any, are the historical precedents of the idea of “outliers”? The paper will argue that in the three decades between 1920 and 1950, internationally-minded statesmen, working in philanthropies with transnational “reach” or in international health agencies, operated with two additional categories of outliers. First, countries with political systems judged “inimical” to democracy (e.g. Soviet Russia, post-war Germany). International public health statesmen often engaged such countries by hiving off (at least notionally) the political system from public health. What was the cost to the understanding of public health of the hiving off of the political? At other times, international health spokesmen explicitly linked transnational cooperation/assistance they offered to a program of democratization. To what extent was that linkage accepted by leading health voices in the target countries? Second, there were countries whose health “civilizations” had not yet progressed fully beyond nineteenth century public hygiene. Including these countries in international health programs involved nothing less than pushing out the frontiers of civilization. In dealing with these countries, health statesmen operated with the initial assumption that capacity and orientation to social medicine could be shaped from the outside. Extended experience on the ground (site visits, field work, cooperative programs) convinced those statesmen of the value of local (and regional) approaches and of the possibility of combining those approaches with international ways of conceptualizing public health. What factors shaped the inclusion/exclusion of countries from the category of “civilized” nations?

International Elective Opportunities in United States Anesthesia Residency Programs

Global health is a recognized component of medical education and is increasingly included in residency programs. International electives have the potential to improve global health training by providing exposure to different populations and the challenges of health disparities. The objective of this study was to describe international elective opportunities in US anesthesiology residency training programs, including an assessment the types of programs offered and the obstacles to providing this type of training. An electronic survey was sent to 122 anesthesiology programs. The survey defined an international experience as "a time in which a current US anesthesiology resident traveled outside of the US to pursue a healthcare-related experience." Details describing international opportunities were collected. Responses were stratified by geographic region, program size, and by the availability of international electives. The websites of all surveyed programs were then reviewed to determine specific mention of international or global health programs. These results were compared to the survey responses. In the website review, 33.6% of programs' websites described international electives for residents. Among all surveyed programs, 56 (45.9%) completed surveys were returned, with 39 (69.6%) of these programs offering international electives. Not all programs with electives described the offering on their websites. There was no relationship between program size or location and the availability of an elective. At most programs with international electives, at least 4 residents participated annually. Funding was the primary barrier to providing international electives. Perceptions of international electives were generally positive. A large proportion of US anesthesia residency programs offer international electives, and perceptions of global health in anesthesiology are positive. This is consistent with developments in global health in other subspecialty fields.