Asia-Pacific Journal of Public Health current issue

Diversity in Public Health Issues

Low, W. Y. — Fri, 25 Sep 2009 01:30:00 PDT

Review Paper: Gender Competencies in the Medical Curriculum: Addressing Gender Bias in Medicine

Wong, Y.-L. — Fri, 25 Sep 2009 01:30:00 PDT

Gender inequalities in health and gender bias in medicine are interrelated challenges facing health care providers and educators. Women and girls are disadvantaged in accessing health care because of their low social status and unequal treatment in medical care. Gender bias has long been inherent in clinical practice, medical research, and education. This can be traced to the medical curriculum that shapes the perceptions, attitudes, and behavior of the future doctor. The author advocates medical curricula change to address gender inequalities in health and gender bias in medicine. She analyses the reasons for integration of gender competencies in the medical curriculum, discusses what gender competencies are, and reviews ways to in-build gender competencies and their assessment. Efforts to change and gender sensitize medical curricula in developed and developing countries are also reviewed. The review hopes to contribute to strategic medical curriculum reform, which would lead to gender-sensitive health services and equity in health.

Politicians in Apron: Case Study of Rebel Health Services in Nepal

Devkota, B., van Teijlingen, E. R. — Fri, 25 Sep 2009 01:30:00 PDT

This article presents the findings of a systematic review on the health consequences of Nepal’s armed conflict waged by the Maoists and the development and trajectory of their health workers. Nepal’s decade-long violent conflict resulted in more than 13 000 deaths, the destruction of more than 1000 health posts and poor health services delivery. At present, most of the former rebel health workers live in remote/rural areas and some are running health centers. The review found that the Maoists had trained more than 2000 health workers, who can be categorized into 4 levels. However, there is little evidence on their competencies and career motivation. The Maoists demand restructuring of the Nepalese health sector and the integration of their health workforce into the national health system. However, there has been no national discussion in Nepal of what kind of health reform and integration model is appropriate for a sustainable peace and improved service delivery.

Prevalence of Diabetes Mellitus, Glycemic Control, and Associated Factors in a Malay Population in Singapore

Fri, 25 Sep 2009 01:30:00 PDT

There is substantial heterogeneity regarding diabetes mellitus prevalence and glycemic control in Asian populations. The authors examined a population-based sample of 3000 adults (52% women) of Malay ethnicity (40-80 years) in Singapore. The age-standardized prevalence of diabetes mellitus was 18.4% (95% confidence interval = 17.0% to 19.8%). Being overweight, presence of hypertension, presence of cardiovascular disease, and family history of diabetes were found to be positively associated with diabetes mellitus. Higher education, employment status, and current smoking were found to be inversely associated with diabetes mellitus. Among those treated for diabetes, 29% achieved the optimal glycemic goal (glycosylated hemoglobin <7%). Lower levels of low-density lipoprotein cholesterol, total cholesterol, and systolic and diastolic blood pressure were associated with good glycemic control. Nearly 1 in 5 middle-aged Malay adults living in a developed Asian society had diabetes mellitus and a substantial proportion had suboptimal glycemic control.

Health Promotion Financing With Mongolia's Social Health Insurance

Bayarsaikhan, D., Nakamura, K. — Fri, 25 Sep 2009 01:30:00 PDT

Health promotion is receiving more attention in Mongolia. A survey is undertaken to examine health promotion in terms of health-related information, education, counseling, screening, and preventive and medical checkups. Almost all (97.5%) the participants feel that access to reliable and systematically organized health-related information is important. About 60% of the participants said that the amount of currently available information is inadequate. There are several factors that limit the implementation of public health programs. These include inadequate focus on promoting health at the individual level, lack of funds, and limited incentives to promote health. This article examines social health insurance as an option to address these issues. Three hypothetical benefits package options expanded to health promotion were developed and simulated by a computerized tool. The simulations show that all 3 options are financially sustainable at the existing level of contribution if Mongolia will gain near universal health insurance coverage and improve revenue collection practices.

Cardiovascular Disease Risk in a Semirural Community in Malaysia

Chia Yook Chin, , Pengal, S. — Fri, 25 Sep 2009 01:30:01 PDT

Background and aim. It has been argued that cardiovascular disease (CVD) is not very prevalent in developing countries, particularly in a rural community. This study examined the prevalence of CVD risk of a semirural community in Malaysia through an epidemiological survey. Methods. Subjects were invited to a free health screening service carried out over a period of 6 weeks. Then, a follow-up study of the initial nonresponders was done in the villages that showed a poorer response. The survey was conducted using a standardized questionnaire. Hypertension was defined as blood pressure ≥140/90 mm Hg. The Framingham Coronary Disease Risk Prediction Score (FRS) was used as a measure of CVD risk. Results. A total of 1417 subjects participated in this survey. The response rate was 56%. A follow-up survey of the nonresponders did not show any differences from the initial responders in any systematic way. The prevalence of CVD risk factors was high in both men and women. The mean (±SD) FRS was 9.4 (±2.5) and 11.3 (±4.1) for men and women, respectively. The mean predicted coronary heart disease (CHD) risk was high at 20% to 25% for men and medium at 11% to 13% for women. Overall, 55.8% of the men had >20% risk of having a CHD event in the next 10 years whereas women’s risk was lower, with 15.1% having a risk of ≥20%. Conclusion. The prevalence of CVD risk even in a semirural community of a developing country is high. Every effort should be made to lower these risk factors.

Correlates of College Students' Physical Activity: Cross-Cultural Differences

Seo, D.-C., Torabi, M. R., Jiang, N., Fernandez-Rojas, X., Park, B.-H. — Fri, 25 Sep 2009 01:30:01 PDT

This study examined cross-cultural differences in personal and behavioral determinants of vigorous-intensity and moderate-intensity physical activity (PA) among college students living in distinctly different cultures, that is, the United States, Costa Rica, India, and South Korea. Participants of this study were recruited from randomly chosen public universities in the 4 countries during the 2006-2007 academic year. A total of 4685 students participated in the study (response rate 90%). Vigorous-intensity PA was measured by asking on how many of the past 7 days the participants participated in PA for at least 20 minutes that made them sweat or breathe hard. For moderate-intensity PA, participants were asked on how many of the past 7 days they participated in PA for at least 30 minutes that did not make them sweat or breathe hard. Findings indicate that whereas perceived overweight and fruit and vegetable consumption are relatively culture-free predictors of PA, gender and TV/video watching are culture-specific predictors. Binge drinking was not predictive of meeting the vigorous-intensity and moderate-intensity PA guidelines in any of the 4 countries.

Alcohol Expectancies Among High School Students in Inner Mongolia, China

Shell, D. F., Newman, I. M., Qu, M. — Fri, 25 Sep 2009 01:30:01 PDT

Objective. This study examines differences in Chinese high school students’ alcohol expectancies by drinking status (nondrinker, occasional drinker, regular drinker) and gender (male, female). Method. The authors administered the Chinese Adolescent Alcohol Expectancy Questionnaire (CAEQ) to a convenience sample of 1244 high school students (M = 627; F = 617) from schools in Huhhot City and Tongliao City in Inner Mongolia, China. Results. Differences were found in the 8 CAEQ factors (3 negative and 5 positive factors). Regular drinkers had lower negative consequences and higher positive perception expectancies than nondrinkers or occasional drinkers. Nondrinkers had higher harm to person/reputation expectancies than occasional or regular drinkers. Occasional drinkers had higher beneficial/moderation and lower harm to person/ reputation expectancies than nondrinkers. Boys had higher positive perception expectancies than girls. Conclusions . Expectancies are associated with Chinese adolescents’ drinking. Identifying the characteristics of alcohol consuming youth can inform the development of prevention interventions and alcohol policies.

Factors Contributing to Utilization of Health Care Services in Malaysia: A Population-Based Study

Fri, 25 Sep 2009 01:30:01 PDT

Objective. This paper examines the factors contributing to the under utilisation of health care services in the Malaysian population. Methodology. Using data derived from Malaysian Mental Health Survey (MMHS) information on utilisation of four basic health services in the previous three months, namely contact with health care professionals, ward admissions, having diagnostic or laboratory tests done and being on any medications were obtained. Results. A total of 2202 out of 3666 or 60% of the MMHS participants were included in this study. Thirty percent of the subjects (n = 664) had contacts with health care professionals. Those with health complications, disabilities and those aged 50 years and above utilised health services more significantly as compared to those who lacked health facilities near their homes, had little family support during illnesses and were from the Chinese ethnic group. Conclusion. Factors leading to the under utilisation of health care services need to be further studied and needs in certain groups in the population should be addressed. Healthcare providers must be prepared to fulfil these needs.

Sexual Behavior Model Among Young Thai Women Living in Slums in Bangkok, Thailand

Powwattana, A. — , 01 Oct 1664 00:00:00 PST

There has been a dramatic drop in age at first intercourse and concurrent rise in HIV infections among young Thai women living in slums. The participants included 492 young Thai women (average age = 19.7 years). They provided detailed self-perception, emotion, sexual self-efficacy, cognitive strategies, and power in relationships. Logistic regression analysis was used to explore sexual behavior model. Findings highlight the extreme vulnerability of Thai female adolescents who engage in risky sexual behaviors: 55.8% were sexually active with 41.8% having vaginal sex without using condom. Significant enabling factors included perceived ability to precautions (odds ratio [OR] = 1.7), relational gain thinking (OR = 1.5), and curious gain thinking (OR = 1.3). The significant protective factors were decision-making dominance (OR = 0.3), perceived ability to say no (OR = 0.7), and ethical-related punishment avoidance thinking (OR = 0.8). These findings contribute to greater understanding of factors involved in sexual risk taking. Implications for behavioral modification addressing cognition and power in relationships are discussed.

A Phase II Randomized Controlled Trial to Evaluate the Safety and Efficacy of Praneem Polyherbal Vaginal Tablets Compared With Betadine Vaginal Pessary in Women With Symptoms of Abnormal Vaginal Discharge

Salhan, S., Tripathi, V., Sehgal, R., Kumar, G., Talwar, G. P., Chatterjee, A. — Fri, 25 Sep 2009 01:30:01 PDT

Abnormal vaginal discharge (AVD) caused by a variety of reproductive tract infections is a widespread syndrome among women in India and in other developing countries. The purpose of this study was to determine whether a polyherbal formulation, Praneem, can be used for the regression of the syndrome. A phase II randomized controlled study was carried out with Praneem polyherbal tablets and Betadine vaginal pessary in 99 women with AVD. The authors found that 92% of women using Praneem were relieved of their symptoms of AVD as against 81.6% women using Betadine. Significant reduction was also seen with both treatments in lower abdominal pain, vaginal itching, and dysuria. Thus, the study indicates the efficacy of Praneem for the treatment of AVD and provides a rationale for planning a further Phase III study on a larger sample size for definitive conclusions.

Public Health and Health Services Development in Postconflict Communities: A Case Study of a Safe Motherhood Project in East Timor

Marlowe, P., Mahmood, M. A. — Fri, 25 Sep 2009 01:30:01 PDT

Armed conflict causes suffering in many countries; it contributes to poor health and hinders health services development. The effects of conflict are evidenced by weakened community structures and can make reconstruction efforts challenging. East Timor has a history of prolonged conflict and saw a resurgence of internal violence in 2006. This participant observation study discusses considerations for implementing public health and health systems development projects in postconflict settings using a case study of a maternal and child health project. It illustrates the importance of appreciating the historical context and community dynamics when implementing development projects. The sequelae of conflict are often characterized by reduced human resource development capacity, distrust of hierarchy, and limited capacity for resource mobilization. Working in such postconflict communities requires flexibility in program design, stronger efforts for community capacity building, and rebuilding trust between various stakeholders.

Key Quality Aspect: A Fundamental Step for Quality Improvement in a Resource-Poor Setting

Su, T. T., Sax, S. — Fri, 25 Sep 2009 01:30:01 PDT

The objective of the study is to identify user’s perception of key quality aspects of the hospital and its influence on willingness to pay. The study was conducted in 2001 in Dhading District Hospital, Nepal. This was a descriptive, cross-sectional study design using quantitative and qualitative methods: questionnaire exit interview and focus group discussions with inpatients and outpatients, focus group discussion with service providers, and key informant interviews. The research identified attitude, technical and interpersonal skills of health personnel, availability of drugs and services as important quality aspects to be improved. Users were motivated to use this hospital and were ready to pay if they received proper treatment from skilled and communicative staff. This study highlights the importance of identifying the quality factors important to service users as a first step in improving quality. For the users within this study, this meant improving attitude, interpersonal skills, and technical skills of service personnel.

The Association Between Socioeconomic Status and Overweight/Obesity in a Malay Population in Singapore

Sabanayagam, C., Shankar, A., Saw, S. M., Tai, E. S., Wong, T. Y. — Fri, 25 Sep 2009 01:30:01 PDT

In developed countries in the West, lower socioeconomic status (SES) is associated with a higher prevalence of overweight/obesity. The authors examined the association between SES defined by education and income and overweight/obesity in a population-based cohort of 2807 individuals of Malay ethnicity (age 40-80 years, 51% women) in Singapore. The prevalence of overweight/ obesity (body mass index ≥25 kg/m²) in men and women was 50.4% and 65.1%, respectively. In women, the prevalence of overweight/obesity increased with lower levels of education and income. Compared with the higher categories of SES, the odds ratio (95% confidence interval) of overweight/obesity in women was 1.42 (1.06-1.89) for education and 2.08 (1.33-3.26) for income. In contrast, in men, the prevalence of overweight/obesity decreased with lower levels of education and income (P interaction by gender <.05 for all SES variables). Lower SES was positively associated with overweight/obesity in Malay women, and the association was in the opposite direction in Malay men.

Migration and Hypertension: A Cross-Sectional Study Among Neo-Migrants and Settled-Migrants in Delhi, India

Kusuma, Y., Gupta, S., Pandav, C. — Fri, 25 Sep 2009 01:30:01 PDT

Understanding the blood pressure (BP) distribution within populations is fundamental to an understanding of the etiology of cardiovascular diseases and to develop effective preventive strategies. This study focuses on whether the BP levels and hypertension prevalence differ between neo-migrants and settled-migrants in the city of Delhi. Data on BP, anthropometry, social variables, and demographic variables were collected from a cross-sectional sample of 226 settled-migrants and 227 neo-migrants. Men possessed significantly higher BP levels than women. Settled-migrants possessed higher BP levels, except diastolic BP in males. The prevalence of hypertension ranges from 15% (neo-migrant women) to 25% (settled-migrant men), with no significant gender differences. Group differences were significant for men. Hypertension was more prevalent in older settled-migrants and younger neo-migrants. Recent migration was found to be a significant contributor to hypertension prevalence. Age contributed significantly to BP variation in both groups except in neo-migrant men. Pulse rate also contributed to systolic BP among neo-migrant women and settled-migrant men. Thus, urban residence and migration to urban areas can be a leading cause of increased prevalence of hypertension. Neo-migrants were subjected to more lifestyle insults and the stress generated during the adjustment process may be contributing to rise of BP even at younger ages.

A Survey of Occupational Exposure to Blood and Body Fluids in Physiotherapists in Western Australia

von Guttenberg, Y., Spickett, J. — Fri, 25 Sep 2009 01:30:01 PDT

The aim of this pilot project was to investigate the occurrence of occupational exposure to blood and body fluids in registered physiotherapists in Western Australia. Surveys were sent to physiotherapists with questions regarding personal background, exposure characteristics, and contributing factors included. Descriptive statistical methods were used to identify the area of practice posing the highest risk of exposure to physiotherapists. The authors found that 56.1% of surveyed physiotherapists recorded one or more exposures within the past 5 years. Work in hospitals was found to carry the highest rate of exposure for the physiotherapy profession. Other areas of practice, including community work, private practice, nursing homes/hostels, and work at sporting events carry comparable but lower risks of exposure. In private practice, 50% of exposures were associated with acupuncture. In nursing homes, 60% of exposures were brought on by exposure to contaminated materials, whereas in the community setting most exposures (64%) were attributed to unpredictable/uncontrollable situations. At sporting events, 90% of all exposures were associated with already existing sources of blood and body fluids (wounds). Within the hospital setting, the 3 dominant immediate causes reported were unpredictable situations (33.3%), existing sources (28.4%), and procedural causes (22.2%). The use of personal protective equipment for prevention of exposure is investigated and discussed. Data collected for this survey were not enough to draw conclusive assumptions regarding hazard management. A repeat of this study on a larger scale may provide physiotherapists with the tools and knowledge to minimize the likelihood of exposure and harm arising from exposure.

Book Review: Teng CL, Khoo EM, Ng CJ, eds. Family Medicine, Healthcare & Society: Essays by Dr MK Rajakumar. Kuala Lumpur, Malaysia: Academy of Family Physicians of Malaysia; 2008

Wong, W. C. W. — Fri, 25 Sep 2009 01:30:01 PDT