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Lancet. 2007 Dec 1; 370(9602):1808-1809.Important questions about implementation of the new guidance by WHO and UNAIDS on provider-initiated HIV testing and counselling were raised by Daniel Tarantola and Sofia Gruskin. Their comments and those by other critics centre on individuals' rights to confidentiality, to refuse testing, and to not disclose their status if they fear negative consequences. We are concerned that a singular focus on the individual's rights of refusal overlooks the rights of the individual's sexual partners to protect themselves from HIV. Human rights and public health will be best served by an ethical framework which recognises that both persons in a sexual relationship or exchange have equal rights and responsibilities for their mutual pleasure and protection. Further, these individual rights are meaningless unless each partner respects the rights of the other. Protection of the human rights of both partners needs more commitment from health systems, and from societies, than simply ensuring informed consent and confidentiality. (excerpt)
Evaluation of the World Health Organization's family planning decision-making tool: Improving health communication in Nicaragua.
Patient Education and Counseling. 2007 May; 66(2):235-242.The World Health Organization has led the development of a Decision-Making Tool for Family Planning Clients and Providers (DMT) to improve the quality of family planning counseling. This study investigates the DMT's impact on health communication in Nicaragua. Fifty nine service providers in Nicaragua were videotaped with 426 family planning clients 3 months before and 4 months after attending a training workshop on the DMT. The videotapes were coded for both provider and client communication. After the intervention providers increased their efforts to identify and respond to client needs, involve clients in the decision-making process, and screen for and educate new clients about the chosen method. While the DMT had a smaller impact on clients than providers, in general clients did become more forthcoming about their situation and their wishes. The DMT had a greater impact on sessions in which clients chose a new contraceptive method, as compared with visits by returning clients for a check-up or resupply. The DMT proved effective both as a job aid for providers and a decision-making aid for clients, regardless of the client's level of education. Job and decision-making aids have the potential to improve health communication, even or especially when clients have limited education and providers have limited training and supervision. (author's)
Geneva, Switzerland, WHO, .  p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 2; WHO/CDS/IMAI/2004.2)These principles can be used in managing many diseases or risk conditions. 1. Develop a treatment partnership with your patient. 2. Focus on your patient’s concerns and priorities. 3. Use the 5 A’s: Assess, Advise, Agree, Assist, Arrange. 4. Educate patient on disease and support patient self-management. 5. Organize proactive follow-up. 6. Involve “expert patients,” peer educators and support staff in your health facility. 7. Link the patient to community-based resources and support. 8. Use written information—registers, Treatment Plan, treatment cards and written information for patients—to document, monitor, and remind. 9. Work as a clinical team. 10. Assure continuity of care. (excerpt)
Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2003; 14(3):218-221.Around the world, public health efforts to deal with wide variety of chronic conditions are being undermined by the alarmingly low adherence to therapies, according to a report recently issued by the World Health Organization. Adherence problems are found in all situations where the self-administration of treatment is required, with illnesses that include asthma, hypertension, depression, diabetes, HIV/AIDS, tuberculosis, and dependence on tobacco or other substances. In developed countries, adherence to therapies averages 50%, and the figures are much lower in less developed nations. “Poor adherence is the primary reason for not achieving the full health benefits medicines can provide to patients,” said Dr. Derek Yach, Executive Director, Noncommunicable Diseases and Mental Health, World Health Organization (WHO). It causes medical and psychosocial complications of disease, reduces patients’ quality of life, increases the likelihood of development of drug resistance, and wastes health care resources. Taken together, these direct consequences impair the ability of health care systems around the world to achieve population health goals.” (excerpt)
[Family Planning and Maternal and Child Health Project in Morocco. Phase V. Consultation report. Childhood illness in Morocco: practical representations and therapy] Projet de Planification Familiale et Sante Maternelle et Infantile au Maroc. Phase V. Rapport de consultation. Les maladies de l'enfant au Maroc: representations pratiques et recours therapeutiques.
Rabat, Morocco, John Snow [JSI], 1999 Dec 3. 49 p. (USAID Contract No. 608-C-00-94-00006)Findings are presented from a field study conducted to explore the sociocultural context related to the possibility of implementing the Integrated Management of Childhood Illnesses approach in Morocco. The author reviews local terminology used to describe infant morbidity in Meknes and Agadir regions, routinely employed therapies, the relatively greater dependence upon biomedical therapeutic approaches, factors inducing child caregivers to seek biomedical practitioner assistance for therapy, and the functioning of the biomedical care system, with particular note of nurses' generally negative attitudes toward patients.
Perspectives in Health. 2002; 7(1):26-9.According to UN Children's Fund (UNICEF), more than 10 million children under 5 years old die each year from illnesses that can be readily prevented or treated, including dehydration, acute respiratory infections, measles, and malaria. In response, UNICEF has launched an international public health strategy known as Integrated Management of Childhood Illness (IMCI). The strategy takes advantage of a child's visit to a health center to assess his or her general health status and identify any other problems. The strategy calls on parents to participate more actively in consultations, and it calls on doctors to invest extra time and effort to make a thorough, holistic assessment of each patient's health. The Pan American Health Organization and other supporters of IMCI are working to integrate the strategy into academic programs in medicine, nursing, nutrition, and public health.
In: Issues in reproductive technology I: an anthology, edited by Helen Bequaert Holmes. New York, New York, Garland Publishing, 1992. 11-30. (Garland Reference Library of Social Science Vol. 729)The progestin, levonorgestrel, suppresses ovulation and thickens the cervical mucus. The 1-year pregnancy rate is 0.2/100 users and the 5-year rate is 3.9/100 users. Contraindications of Norplant include abnormal bleeding, cardiovascular conditions, liver tumors, and breast cancer. The most frequent side effect is changes in bleeding patterns. A main concern of women's health advocates is that women are dependent on the medical establishment for insertion and removal of Norplant which affects the provider-client relationship. Family planning programs that do not recognize a woman's right to free choice of existing contraceptives and her right to have Norplant removed at any time may abuse Norplant. Health workers still do not know the long term effects of Norplant and Norplant's effect on the fetus in case of method failure or insertion while pregnant. Most acceptability studies occurred at university-based health clinics or at clinics in urban areas. The clinic environment may affect women's answers. These studies should occur in the community and home of users and nonusers. Another bias of these studies was clinic staff chose women who would tend to continue using Norplant. Thus subjects were not representative of the population. Researchers did not attempt to understand the women's perception of reproduction physiology and mode of action, the women's cost benefit analysis used to determine what method to use, or the consequences of menstruation changes. They also did not report on the information women received about contraceptive choices. The issue of abuse has arisen in Kansas where a state legislator proposed paying any mother on welfare US$500 if she uses Norplant. In California, a judge ordered a woman convicted of child abuse to use Norplant after release from jail and throughout her probation period.
Social Science and Medicine. 1987; 25(6):733-40.In 1978 leaders from 134 governments and 67 UN bodies proclaimed their union of purpose to bring Health For All by 2000. They described health in terms of access to primary health care, not the freedom of disease. The plan they developed was designed to bring all health care providers together, be they medical doctors (MDs) from Western medical schools herbalists, shamans or barefoot doctors. The plan was to create a system of referrals where people would initially turn to their traditional healers for help and then be moved along the system as the complexity of the condition exceeded the ability of attending healer. However, the system failed because of 3 major factors: political resistance, professional and economic inertia, and chauvinism and emulousness called the Jazz Factor. Instead of acting like a funnel to move people along the system from the less advanced to the more advanced healers, it acted like a filter. The political resistance is clearly seen when a careful examination of the AIDS virus is made. Many African nations refused to acknowledge that AIDS was even in their countries. Thailand was so fearful of losing tourism dollars that it covered up the fact that many of their prostitutes are infected. US servicemen are tested and discharged if they are found to be infected. In many US states people's rights to privacy hamper the control of the spread of AIDS. The sexual revolution is founded on liberal principles of freedom. The result is the right of individuals to spread the disease if they so choose. Economics plays its role when we see the linking of profit motive and the public interest in the health care area. The Jazz Factor refers to the practice of considering prestige over practicality. Oral rehydration therapy is an excellent example of this. Today dehydration caused by diarrhea is the single biggest cause of death among children. Yet the cure is so simple, so easy, and so inexpensive that it is within the reach of almost every family on earth. 1 reason given for this fact that there is no profit to be made from ORT. Today health care professionals still prescribe US$400 million worth of antidiarrheal drugs.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1989; 67(4):341-6.Ethical issues in the treatment of cancer patients was the subject of a international conference on supportive care, sponsored by the World Health Organization. Communications deficiencies between patients and doctors cause anguish and create a situation for ethical conflicts and dilemmas. Medical schools must teach the mastery of listening and communicating. In the past 10 years the use of life support systems to prolong life has been questioned by many people in many countries. Those in favor of euthanasia argue that a painless death is more humane that a slow, lingering one that may occur with the withdrawal of life support systems. Those against euthanasia say it is morally wrong, and against medical ethics, and not necessary if palliative care is available. They say if legalized, it would be abused and force people to use euthanasia when they did not wish to. Conditions under which euthanasia is acceptable have been identified by the courts in Japan. In most countries including the US and Canada active euthanasia is a criminal offence equated with murder. It is not clear what to tell patients that are invited to participate in clinical trials in cancer research. There is a conflict between raising false hopes and possible toxicity causing patients to refuse treatment. Many clinical investigators do not understand that patients need adequate information. Some countries stress therapeutic privilege and dispense with informed consent, if the doctor feels it is not in the patient's best interest. When dealing with a very ill or dying person, honesty and compassion are essential in all communications and in the presentation of medical facts.