Search

Individuals with dementia frequently report poor quality of life (QOL), which declines as their disease progresses. Some evidence suggests that physical activity may help maintain cognitive function in older age, but it is unclear whether physical activity affects quality of life in older adults with dementia. The purpose of this review paper is to explore whether and how physical activity impacts QOL in patients with diagnosed dementia in different residential settings. To conduct this systematic review, the following search terms were inputted into the search bars of three databases:(dementia OR Alzheimer) AND (walking OR physical activity OR exercise OR fitness) AND (community OR nursing home OR independent living OR green care) AND (Quality of Life). A total of ten articles met the study inclusion criteria. Several studies reported a positive correlation between physical activity intervention programs and QOL outcome measures, pertaining to socialization and positive emotions, and an increase in physical endurance capacity among program participants. However, most results were not statistically significant. We conclude that more large studies need to be conducted in order to establish whether there is a significant positive dose-response relationship between physical activity intervention programs and QOL measures among individuals with diagnosed dementia.

RAHI–SATHI presents an innovative twinning model of global health academic partnership, resulting in a number of successful research activities, that features trainees or students as the driving force, complemented by strategic institutional support from both sides of the partnership. Others can promote similar student-led initiatives by: (1) accepting an expanded role for trainees in global health programs, (2) creating structured research and program opportunities for trainees, (3) developing a network of faculty and trainees interested in global health, (4) sharing extramural global health funding opportunities with faculty and trainees, and (5) offering seed funding., Background: In recent years there has been a surge in the number of global health programs operated by academic institutions. However, most of the existing programs describe partnerships that are primarily faculty-driven and supported by extramural funding. Program Description: Research and Advocacy for Health in India (RAHI, or “pathfinder” in Hindi) and Support and Action Towards Health-Equity in India (SATHI, or “partnership” in Hindi) are 2 interconnected, collaborative efforts between the University of Massachusetts Medical School (UMMS) and Charutar Arogya Mandal (CAM), a medical college and a tertiary care center in rural western India. The RAHI–SATHI program is the culmination of a series of student/trainee-led research and capacity strengthening initiatives that received institutional support in the form of faculty mentorship and seed funding. RAHI–SATHI's trainee-led twinning approach overcomes traditional barriers faced by global health programs. Trainees help mitigate geographical barriers by acting as a bridge between members from different institutions, garner cultural insight through their ability to immerse themselves in a community, and overcome expertise limitations through pre-planned structured mentorship from faculty of both institutions. Trainees play a central role in cultivating trust among the team members and, in the process, they acquire personal leadership skills that may benefit them in their future careers. Conclusion: This paradigm of trainee-led twinning partnership promotes sustainability in an uncertain funding climate and provides a roadmap for conducting foundational work that is essential for the development of a broad, university-wide global health program.

BackgroundCommon mental disorders (CMD) are a constellation of mental health conditions that include depression, anxiety, and other related nonpsychotic affective disorders. Qualitative explanatory models of mental health among reproductive-aged women in India reveal that distress is strongly associated with CMD. The relationship of perceived stress and CMD might be attenuated or exacerbated based on an individual's sociodemographic characteristics.ObjectivesTo screen for Common Mental Disorders (CMD) among reproductive-aged women from rural western India and explore how the relationship between perceived stress and CMD screening status varies by sociodemographic characteristics.MethodsCross-sectional survey of 700 women from rural Gujarat, India. CMD screening status was assessed using Self-Reported Questionnaire 20 (SRQ-20). Factors associated with CMD screening status were evaluated using multivariable logistic regression. Effect modification for the relationship of perceived stress and CMD screening status was assessed using interaction terms and interpreted in terms of predicted probabilities.FindingsThe analytic cohort included 663 women, with roughly 1 in 4 screening positive for CMD (157, 23.7%). Poor income, low education, food insecurity, and recurrent thoughts after traumatic events were associated with increased risk of positive CMD screen. Perceived stress was closely associated with CMD screening status. Higher education attenuated the relationship between high levels of stress and CMD screening status (82.3%, 88.8%, 32.9%; P value for trend: 0.03). Increasing income and age attenuated the link between moderate stress and CMD.ConclusionsOur findings suggest a high burden of possible CMD among reproductive-aged women from rural western India. Higher education might mitigate the association between elevated stress and CMD. Future efforts to improve mental health in rural India should focus on preventing CMD by enhancing rural women's self-efficacy and problem-solving capabilities to overcome challenging life events and stressors, thereby reducing the risk of CMD.

Background Disability is not a category of disease but rather relates to the physical, sensory, cognitive, and/or mental disorders that substantially limit one or more major life activities. These functional limitations have been found to be predictive of suicide, with psychiatric comorbidities increasing the risk for suicide. Enormous gaps exist in the understanding of the relationship between disability and suicide. Objective We reviewed the current literature addressing the prevalence of and risk factors for suicide among persons with three major disabling conditions and identify priorities for future research. Methodology We performed a literature review investigating the relationship between three major disabilities (intellectual disability, spinal cord injury, multiple sclerosis) and suicide. To ensure thorough evaluation of the available literature, we searched PubMed, the Cochrane Library, and Google Scholar with terms including “suicide,” “disability,” “intellectual disability,” “spinal cord injury,” “multiple sclerosis,” and permutations thereof. By this method we evaluated 110 articles and included 21 in the review. Results Suicide rates are significantly higher among persons with multiple sclerosis and spinal cord injury than in the general population. A more nuanced picture of suicide rates and risk factors exists for the intellectual disability population, in which it appears that rates of suicide risk factors are higher than among the general population while suicide rates may be lower. The highest rates of suicide are reported among study populations of persons with multiple sclerosis, followed by persons with spinal cord injury, and then individuals with intellectual disability. Conclusions Suicide among persons with disabilities is a complex and pressing public health concern. Urgent research priorities include (1) valid estimates of suicide rates among persons with disabilities by age cohort; (2) assessment of the predictive importance of suicide risk factors; and (3) determination of best practices in preventing suicide. Working toward these objectives will reduce the unacceptable burden of this preventable cause of death and help children and adults with disabilities to lead happier, healthier, and longer lives.

Migrants have been found to be at enhanced risk for the Human Immune Deficiency Virus (HIV) in comparison with settled populations. As they migrate, they often bring with them their traditions and cultural values, which may influence the ways they access or make sense of health promotion interventions in the host country. In the diaspora, should they experience compromised citizenship, marked by an unresolved immigration status, some may need to remain invisible and this may include not accessing or presenting late for vital health care interventions. Addressing the needs of such invisible populations is key to health promotion work and paramount to public health interests. This paper describes how ever-changing “traditions”, in particular the notions of Pachedu and Zenzele, were harnessed to develop ethically grounded sexual health care interventions amongst Zimbabweans in Luton, Bedfordshire, England. These interventions were delivered in mundane settings that formed some of the key everyday networks of this population. The reinvention of “tradition” for the purposes of delivering health and social care interventions has been one of the cornerstones of health promotion interventions in Africa, where the rates of HIV are some of the highest in the world. The concept of Pachedu harnessed confidentiality in the delivery of sexual health interventions with Zenzele calling for communal involvement in such initiatives. A key point that resulted in the success of this intervention was partnership work between statutory providers and the local Zimbabwean population throughout the project’s life span. Rather than being construed as passive recipients of health and social care interventions, local Zimbabweans and their statutory partners were engaged in mutual capacity building initiatives. Local Zimbabweans were also engaged and consulted throughout, from the conceptualization of the project, delivery, monitoring, and dissemination of the findings.

Declining cancer incidence and mortality rates in the United States (U.S.) have continued through the first decade of the twenty-first century. Reductions in tobacco use, greater uptake of prevention measures, adoption of early-detection methods, and improved treatments have resulted in improved outcomes for both men and women. However, Black Americans continue to have the higher cancer mortality rates and shorter survival times. This review discusses and compares the cancer mortality rates and mortality trends for Blacks and Whites. The complex relationship between socioeconomic status and race and its contribution to racial cancer disparities is discussed. Based on current trends and the potential and limitations of the Patient Protection and Affordable Care Act (ACA) with its mandate to reduce health care inequities, future trends and challenges in cancer mortality disparities in the United States are explored.

Per World Health Organization (WHO) data, 1 million people commit suicide yearly, with more than 80% occurring in lowand middle-income countries; India and China alone account for 60% of worldwide occurrences. In India, suicide deaths among women are equivalent in number to deaths from perinatal causes and double those due to HIV/AIDS. Despite worldwide prevalence disparities, the literature on suicide continues to comprise studies conducted in Western, high-income countries. Only 1.3% of studies published on suicide originate from India or China. Suicide is a crime in India and thus under-reporting and general stigma likely contribute to the paucity of relevant literature; there is a critical need to study suicide in India. We present descriptive findings from a cross-sectional survey conducted in rural Gujarat, India, that expands the discussion on suicide among young women and poses the question: Are there two types of suicidal ideation among women in rural India? 94 95 96 97 98 METHODS

Pragmatic moves have been proposed to democratize deliberation about health care within states while putting aside questions of equity. Wealthy countries are being advised that they must, in the context of globalization, adopt stringent market-led disciplines, long familiar to less developed countries subject to structural adjustment programmes. Decisions affecting inequalities in health are being made by undemocratic trans-national regulatory organizations pursuing a market based project, including the World Trade Organisation (WTO). Inequalities in income and health are pronounced in the United States, where market liberalism is entrenched. Accounts of globalization differ regarding the scope attributable to individual states to carry out sustainable redistributive policy. Critics of free-market globalization argue that states can co-operate to challenge democratic deficits in trans-national regulatory bodies to counter the growth in inequality.

Objectives To develop ways of reaching house-bound people and enabling them to give their views in planning and monitoring health and social care. Strategy HealthLINK ‐ a project based in a community health council ‐ explored ways of involving older house-bound people in the London Borough of Camden, in planning and monitoring health and social care using community development techniques. Results HealthLINK set up an infrastructure to enable housebound people to have access to information and to enable them to give their views. This resulted in access for health and local authorities to the views of house-bound older people and increased the self esteem and quality of life of those who became involved. Conclusions Community development approaches that enable an infrastructure to be established may be an eAective way of reaching marginalized communities. However, there are tensions in this approach between the diAerent requirements for public involvement of statutory bodies and of users, and between representation of groups and listening to individual voices.

This article considers how health promotion can use planning as a tool to enhance healthy eating choices. It draws on research in relation to the availability and concentration of fast food outlets in a London borough. Current public health policy is confining planning to local settings within a narrow framework drawing on discourses from social psychology and libertarian economics. Policy is focusing on behaviour change, voluntary agreements and devolution of the public health function to local authorities. Such a framework presents barriers to effective equity-based health promotion. A social determinant-based health promotion strategy would be consistent with a national regulatory infrastructure supporting planning. RESUMO - Este o artigo aborda o modo como a promoção da saúde pode usar o planeamento como uma ferramenta para se comer de modo mais saudável. A pesquisa centra-se na disponibilidade e na concentração de “outlets” de “fast food” em Londres. A política pública de saúde limita o planeamento às estruturas locais, dentro de um desenho teórico estreito que vai desde a psicologia social à economia liberal. A política está centrada na mudança do comportamento, nos acordos voluntários e na devolução da função saúde pública às autoridades locais. Tal estrutura apresenta barreiras a uma eficaz promoção da saúde baseada na equidade. Uma estratégia apoiada nos determinantes sociais seria consistente com um planeamento de apoio à infraestrutura reguladora nacional. info:eu-repo/semantics/publishedVersion

As rates of childhood obesity and overweight rise around the world, researchers and policy makers seek new ways to reverse these trends. Given the concentration of the world’s population, income inequalities, unhealthy diets, and patterns of physical activity in cities, urban areas bear a disproportionate burden of obesity. To address these issues, in 2008, researchers from the City University of New York and London Metropolitan University created the Municipal Responses to Childhood Obesity Collaborative. The Collaborative examined three questions: What role has city government played in responding to childhood obesity in each jurisdiction? How have municipal governance structures in each city influenced its capacity to respond effectively? How can policy and programmatic interventions to reduce childhood obesity also reduce the growing socioeconomic and racial/ethnic inequities in its prevalence? Based on a review of existing initiatives in London and New York City, the Collaborative recommended 11 broad strategies by which each city could reduce childhood obesity. These recommendations were selected because they can be enacted at the municipal level; will reduce socioeconomic and racial/ethnic inequalities in obesity; are either well supported by research or are already being implemented in one city, demonstrating their feasibility; build on existing city assets; and are both green and healthy.

Health impact assessment (HIA) is both an effective tool for promoting healthy public policies and one that has the potential to help hold accountable for their actions those who create unhealthy public policies. This article identifies some of the issues that arise in considering the application of HIA to the operation of the International Monetary Fund (IMF), especially in the context of sub-Saharan Africa. The authors do this in the belief that the IMF's lending conditionalities and macroeconomic policies constitute an important social determinant of health. The recent report of the Commission on Social Determinants of Health has created helpful and timely policy space for the development of a health equity– and human rights–oriented accountability framework for the IMF.

Health impact assessment (HIA) is a set of tools, methods, and processes for policy making. It does this by examining potential consequences for health of policy options. This chapter explores HIA as applied to globalization. It outlines what HIA is, points to debate about its nature, and gives an example of its use in the European Union. The European Union's use of HIA provides opportunities to examine consequences for less powerful players in global policy formation. Migrant communities in high-income regions such as the European Union can be key participants in HIAs relating to global policy.

Les decisions d'interet public dans le domaine social et economique ont un impact enorme sur la sante des populations. Compte tenu de cet effet et de la distribution tres inegale des pouvoirs et des ressources dans le monde, les evaluations d'impact sanitaire pourraient jouer un role cle dans la prise de decisions de politique etrangere et d'interet public concernant l'ensemble du monde. Les gouvernements, les organismes multilateraux et les societes internationales doivent etre tenus de prendre en compte les impacts sanitaires de leurs politiques et de leurs pratiques. Pour atteindre cet objectif, il est notamment possible d'integrer aux evaluations de l'impact sanitaire une evaluation du respect des droits de l'homme les normes et les instruments internationaux en faveur du respect de ces droits pouvant servir d'outils d'inspection au niveau mondial. Des problemes methodologiques peuvent limiter l'efficacite des evaluations de l'impact sanitaire dans la promotion de l'equite en matiere de sante. Ces problemes peuvent resulter notamment de l'application de procedures favorisant, dans le processus politique,les detenteurs de pouvoir ou des procedures ne respectant pas les valeurs d'equite et de participation. La recherche et l'apport d'elements prenant en compte les interets des groupes les moins puissants constituent une priorite pour l'evaluation de l'impact sanitaire et cette priorite sera favorisee par le developpement d'une methode pour effectuer cette evaluation fondee sur le respect des droits de l'homme. Comme elle envisage tous les types de politiques et etudie tous les determinants potentiels de la sante publique, l'evaluation de l'impact sanitaire pourra favoriser la prise en consideration des droits des personnes dans l'elaboration des politiques etrangeres et dans la prise de decisions d'interet mondial. Le droit humain a la sante etant conditionne par les determinants sanitaires, le developpement de liens entre le droit a une evaluation sanitaire (c'est-a-dire a une evaluation de l'impact des politiques sur le droit a la sante) et l'evaluation de l'impact sanitaire, comme l'a recemment propose le rapporteur special des Nations Unies sur les droits de l'homme, pourrait etayer la mise au point des politiques etrangeres et des decisions d'interet mondial. De tels liens doivent etre recherches et appliques a l'elaboration des politiques etrangeres et au fonctionnement des organismes multilateraux.

hile the importance of civil and political rightsto health advocates is widely acknowledged, eco-nomic and social rights are not yet securely onadvocates’ agenda. Health impact assessment is an approachthat can promote an appreciation of their importance. Thispaper introduces health impact assessment, gives examplesof how it is being used, links its development to a focus oninequalities in health status, indicates the insufficiency ofcivil and political rights to protect health, and shows that theuse of health impact assessment draws attention to economicand social rights. While civil and political rights are an as-tonishing social achievement, they are not in themselvessufficient to promote health.Health impact assessment has been defined as “the esti-mation of the effects of a specified action on the health of adefined population.”

Background and aims Health-care seeking behavior is affected by various socio-economic, physical and cultural factors. A proper understanding of such factors can improve access to health-care and focus the development of health outreach programs. We determined factors that influence and differentiate health-seeking behaviors for children compared to care for mothers among women in rural India. Method Cross-sectional health survey of women, 18–45 years conducted by female interviewers in a hospital clinic and in sixteen surrounding villages in rural Gujarat, India. As a part of the survey, respondents identified the “most significant factor” that influences their decision when selecting a health-care provider. Additionally, respondents with a living child were also asked the same question in regards seeking care for their children. Results 681 women completed the survey, of which 496 reported having a living child. Of these 496, 193 (39%) identified cost as “most significant factor” when choosing a provider for themselves compared with only to 73 (15%) for their children (χ 2 , p 2 , p Conclusion Health-seeking behavior is an important variable in the success of outreach health programs. Mothers in this area of India consider quality of care more and cost less when selecting provider for their children’s care in contrast to their own.

OBJECTIVES: To develop ways of reaching house-bound people and enabling them to give their views in planning and monitoring health and social care. STRATEGY: HealthLINK - a project based in a community health council - explored ways of involving older house-bound people in the London Borough of Camden, in planning and monitoring health and social care using community development techniques. RESULTS: HealthLINK set up an infrastructure to enable house-bound people to have access to information and to enable them to give their views. This resulted in access for health and local authorities to the views of house-bound older people and increased the self esteem and quality of life of those who became involved. CONCLUSIONS: Community development approaches that enable an infrastructure to be established may be an effective way of reaching marginalized communities. However, there are tensions in this approach between the different requirements for public involvement of statutory bodies and of users, and between representation of groups and listening to individual voices.