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Another World Bank study found that the value of time saved from water collection alone was sufficient to justify investments in rural water supply in most settings (Churchill et al prostate cancer 72 year old trusted 5mg proscar. There are several broad approaches to measuring economic burden of poor water prostate zones purchase cheapest proscar, sanitation and hygiene prostate cancer blogs buy proscar toronto, each with its own limitations prostate 90cc proscar 5 mg amex. The most rigorous would involve experimental designs that empirically measure economic and financial improvements in 86 communities or individuals receiving water mens health quotes purchase proscar 5mg on line, sanitation or hygiene androgen hormone symptoms cheap 5 mg proscar overnight delivery. There is little existing evidence of this type due to the methodological challenges of conducting trials of this type. A second approach is to measure economic outcomes in communities and households with different levels of water, sanitation and hygiene. However, such studies are problematic because household and community economic status confound this relationship, given that poorer households are already likely to have poorer water, sanitation and hygiene. The third approach is to synthesise existing evidence from diverse sources to estimate health and social outcomes potentially attributable to water, sanitation and hygiene, and then estimate the economic and financial costs associated with each. The latter approach was used by Hutton & Haller (2004) to estimate the global economic burden of inadequate water, sanitation and hygiene. The analysis is based on the identification of different risk scenarios which entail different qualities of water, sanitation and hygiene access, based on Pruss and colleagues (2002). The estimates include the economic and financial costs relating to medical treatment costs, lost time from productive activities, lost time from productive activities due to water collection, the economic value of premature mortality, and time saving from improved latrines. This study was an important first step in identifying potential costs associated with inadequate water and sanitation. It also identified key areas where insufficient empirical data are available to make a reliable estimate of economic burden. The authors acknowledge that data are limited in estimating these benefits and rely on assumptions in order to generate preliminary estimates. For instance the study estimated all cases of diarrhoea among children under five result in approximately two work days lost per reported case due to increased caregiver time. Empirical studies of the household cost of diarrhoea in low-income countries generally find that most cases result in no time lost for work and that those who do lose time, lose less than two days (Bentley et al. Similarly, among school-aged children it was assumed that each case would result in three days of missed school without empirical basis. The total costs vary among the countries, primarily based on population size and current level of sanitation. In India, they estimate that the losses due to inadequate sanitation and hygiene cost the equivalent of more than 6 % of Gross Domestic Product. Few studies experimentally estimated the impact of water, sanitation and hygiene on economic outcomes. However, Pattanayak and colleagues (2010) used a rigorous quasi experimental design based on propensity score matching to measure the household economic impact of improved sanitation in Maharashtra, India. A recent study by Baird and colleagues (2011) suggests that controlling intestinal helminths can result in long-term economic gains. The study included long-term follow up of economic productivity in a cohort of Kenyan children from schools where deworming was experimentally phased in between 1998 and 2001. Children in intervention schools engaged in the labour force had earnings 21-29% greater than children in non-intervention schools. While deworming is a different intervention to sanitation and hygiene, it is plausible that these improvements could also lead to long-term economic gains in productivity. It should also be noted that helminth prevalence rates vary widely and the study area in western 87 Kenya has exceptionally high rates. Long-term economic gains may vary due to geography based on underlying helminth prevalence and intensity of infection (Baird et al. One of the most likely economic costs associated with inadequate water access is the economic value of collection time for adults (in the form of lost work) and children (in the form of lost schooling). However, there are several challenges in estimating the economic burden of these losses (Rosen & Vincent 1999). Individuals within households and communities with lower opportunity costs for their time often engage in these activities, making it difficult to estimate the value of lost time. Similarly, estimating the time gains to women or children from improved water access is challenging empirically because water access and time allocation are likely to be confounded at both the between community and within community level. For example, households may have latent characteristics that lead them to have both better water access and more time allocated to productive activities. The studies also include time loss associated with non-fatal health outcomes, including time lost for illness among adults, time lost from school for school-aged children and time lost from work for caregivers of small children. These economic burden studies are based on assumptions about the likelihood that illness leads to time loss from productive activities and the amount of time that is likely to be lost. While there is little doubt that these costs exist, there are few if any empirical studies on which to base them. In addition to the economic benefits of improved sanitation, there is a strong relationship between improved safe water supplies and livelihoods, whether for productive or domestic uses; in wealthier countries, past investment in water infrastructure and the ability to invest more in the present increase water security and, arguably, prosperity (Hunter et al. Cost-benefit analysis compares the monetary investment in the intervention to the monetary value of the resulting stream of benefits. The result is reported as a benefit:cost ratio based on the monetary value of benefits for each unit of cost investment. Cost-effectiveness analysis does not capture non-health benefits, such as improved education, or economic gains, such as increased earnings. Both cost-benefit and cost-effectiveness studies must convert epidemiological and impact data on disease incidence into standardised measures of morbidity and mortality. In the case of cost-benefit analysis, this requires estimating impact of mortality and on disease conditions that incur costs. There are several challenges and uncertainties in this process that affect confidence in the resulting estimates. As a result, all of the studies below rely on extrapolations from diarrhoeal incidence to diarrhoeal mortality, by assuming that the case fatality rate remains constant (Pruss et al. Conversely, if the intervention does not reach these high-risk populations, then the mortality reduction could be substantially less. It is also important to point out that the global cost-effectiveness and cost-benefit studies described below use diarrhoeal mortality estimates that have since been updated. The second challenge in translating epidemiological and impact assessment evidence to health and monetary benefits for economic evaluations relates to which health outcomes will be included. Most global cost-effectiveness and cost-benefit analyses focus on the diarrhoeal impact of the interventions because the existing evidence is strongest for that outcome. However, this leaves out potential impacts on soil-transmitted helminths, nutrition, adolescent sexual health, maternal mortality and schistosomiasis. The study attempts to take into consideration the existing service quality, coverage levels and underlying diarrhoeal mortality, in order to account for expected heterogeneity in health impacts. The benefit estimate approach is based on that presented by Pruss and colleagues (2002). In all regions and for all scenarios, the benefit to cost ratio was greater than 1, and ranged from 2. These results suggest that the estimated monetary value of all of the scenarios provides excellent value for money in all contexts, with the economic value of returns greatly exceeding costs. First, as pointed out in the section above on economic benefits, there is a substantial uncertainty regarding some elements of the estimated economic returns. That is, it is unclear whether improvements in convenience would result in improved incomes. The second largest monetary benefit is that associated with the value of deaths avoided. Given the uncertainty in these key benefit measures, it is unclear whether the quantitative estimates are sufficiently accurate to be able to distinguish between the different scenarios. These estimates would be greatly improved with improved empirical data regarding the assumptions of economic benefits or from rigorous studies that directly measure economic outcomes. Given the high potential economic benefits estimated in the cost-benefit studies, this may result in an underestimate or a biased estimate of the impact of different interventions. For example, if water supply interventions provide substantial time savings, but moderate health benefits, then a cost-effectiveness analysis may show it to be less favourable than hygiene, while a cost-benefit analysis may show it to be more favourable. Site-specific studies of cost-effectiveness can be very informative to local and national sector actors, however heterogeneity in contexts and methods reduces that value in a sector-wide review. The cost estimates are described above and the benefit estimates focus on the expected impact on diarrhoeal mortality. Although these figures do not consider the construction costs of water and sanitation facilities (which would lower cost-effectiveness if included) or the indirect costs of malnutrition (which would increase cost-effectiveness if included). Since non-diarrheal outcomes such as soil-transmitted helminths, trachoma and nutrition are not included, it is unclear whether the relative cost-effectiveness would remain the same. The study accounts for different levels of current coverage and mortality as described for the cost-benefit study above. Most other interventions were determined to be cost-effective as well, but somewhat less favourable. This should not be interpreted as meaning that only point of use should be done, but rather that it may be the most efficient intervention to start with. The cost-effectiveness of investment in any area depends on the underlying burden of disease and what interventions are already in place. Moreover, the dearth of high quality studies to provide the evidence of direct impacts on diarrhoeal diseases for some interventions, make the cost-effectiveness figures reached questionable. Limited empirical data is available on the relative sustainable, long-term costs, and non-diarrhoea benefits. In addition, it is quite likely that relative importance will differ between settings based on the existing dominant transmission pathways. In addition, the sector currently lacks the needed information to maximise the return and value for investments. Probabilistic simulation methods have been recommended and used to estimate the certainty bounds for health and economic benefits of other diarrhoeal prevention interventions (Rheingans et al. Such an effort would capture the diarrhoeal, nutritional and intestinal parasite impacts of interventions. In the absence of such a consensus, current estimates are often seen as being motivated by advocacy rather than objective, evidence based approaches. External scientific scrutiny and review can increase confidence in prioritised investments. In addition to improving the accuracy of estimates there are several areas in which improved economic evaluation information could directly result in improved efficiency of investments and value for money. In particular there is very little evidence to guide decision makers about how to invest efficiently within the sector at a given scale (local, national or regional). Current estimates are regional at best, and the actual value is likely to differ substantially depending on where the investments occur. Decision support models that translate existing evidence on effectiveness and cost-effectiveness could provide decision makers with information where to invest, what interventions are most cost-effective in particular regions, and what makes sense in rural and urban settings. In addition, value for money is likely to vary greatly based on who benefits, based on large within country differences in underlying disease burden based on geography or socio-economic status. Quantitative estimates of cost-effectiveness associated with reaching different regions and risk groups could allow for redirecting investments and maximising value for money. Improved estimates of costs, evidence of additional impacts, and synthesised analyses could improve the inefficiency of investment within the sector and better prioritise decisions between sectors. This section serves to highlight some of these gaps, most of which are addressed elsewhere within the report. Broadly speaking, these gaps can be grouped into the following categories: Impact of sanitation on diarrhoea. There is some evidence, albeit problematic, for the efficacy of water quality, water quantity, and hygiene diarrhoeal diseases based on experimental intervention studies. From the earliest investigations of water-borne outbreaks, such as those conducted by John Snow (1855), it has been clear that understanding the specific pathway for environmental contamination and human exposure to that contamination is essential in determining what intervention is appropriate and likely to lead to the greatest impact. This can lead to overlooking important pathways (such as contamination of complementary foods for infants due to inadequate hygiene) and missed opportunities for maximising health outcomes. This includes potential nutritional impacts associated with chronic exposures, interactions with other infectious diseases. This is understandable given the importance of this outcome on child mortality and the apparent ease in measuring short-term changes in incidence. Investments in 93 understanding the impact of sanitation and hygiene on the effectiveness of nutritional interventions (as mediated by tropical enteropathy for example) is part of this. Evidence from recent rotavirus (and other) vaccine trials suggests that environmental enteric exposures may reduce the immune response to and effectiveness of vaccines (especially live oral ones). Huge investments in the control of these diseases through preventive chemotherapy have largely ignored the environment control dimensions. Lack of water for bathing and cleaning can affect trachoma, wound management associated with lymphatic filariasis, and perhaps most importantly menstrual hygiene management for women and adolescent girls. Poor access to sanitation can also result in the risk of sexual assault for women (Amnesty International 2011), and poor access to water can result in safety risks and large calorific expenditures for women and children. While there is evidence that these effects exist, there is limited evidence for quantifying the magnitude of the burden or assessing the effectiveness of potential interventions. This effect may be through enteric and respiratory infections or it may be through the need for appropriate water and sanitation for menstrual hygiene management for girls. However, most studies remain short-term and do not capture the long term impacts on human development and gender equity. In addition, there is limited systematic information on the magnitude of the problem or what strategies are most effective and cost-effective in addressing it. There is limited quantitative data on the burden within these particular populations and on the most effective and cost-effective strategies for addressing their needs in particular contexts. Behaviour change is central to many hygiene, sanitation and water quality interventions. However, effective methods for creating and sustaining behaviour change at scale remain limited.

Identi cation of the carrier often involves intensive epidemiological and microbiological investigation; eradication of the carrier state is often dif cult and may require multiple courses of speci c antibiotic regimens (see 9 prostate oncology specialists buy proscar in india, B7) prostate cancer 10 year survival rate buy 5 mg proscar free shipping. Dried streptococci reaching the air via contaminated items (oor dust prostate cancer 70 order 5 mg proscar free shipping, lint from bedclothes mens health 90 second ab blaster order cheap proscar line, handkerchiefs) may be viable but apparently do not infect mucous membranes and intact skin prostate qigong discount 5mg proscar. Milk and milk products have been associated most frequently with foodborne outbreaks; egg salad and similar preparations have recently been implicated mens health trx workouts purchase proscar 5mg overnight delivery. Group B organisms that cause human and bovine disease differ biochemically, but group A streptococci may be transmitted to cattle from human carriers, then spread through raw milk from these cattle. Contamination of milk or egg products by humans appears to be the important source of foodborne episodes. With adequate penicillin treatment, transmissibility generally ends within 24 hours. Antibacterial immunity develops against the speci c M-type of group A streptococcus that induced infection and may last for years. No differences in susceptibility have been de ned for men and women; reported racial differences probably relate to environmental factors. Repeated attacks of pharyngitis/tonsillitis or other disease due to different types of streptococci are relatively frequent. Immunity against erythrogenic toxin, and hence against rash, develops within a week after onset of scarlet fever and is usually permanent; second attacks of scarlet fever are rare, but may occur because of the 3 immunological forms of toxin. Some degree of passive immunity to group A streptococcal disease occurs in newborns with transplacental maternal type speci c antibodies. Patients who had one attack of rheumatic fever have a signi cant risk of recurrence of rheumatic fever, often with further cardiac damage follow ing group A streptococcal infections. Those who do not tolerate penicillin may be given sul soxazole orally or erythromycin if necessary. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Obligatory report of epidem ics, Class 4. Search for and treat carriers in well documented epidemics of streptococcal infection and in high risk situations. There has never been a documented penicillin-resistant strain of group A beta-hemolytic streptococci. It may also reduce the risk of acute glomerulonephritis after pha ryngeal infection (not con rmed for acute nephritis after skin infections) and prevent further spread of the organism in the community. Erythromycin is the preferred treatment for penicillin sensitive patients, but strains resistant to this antibiotic have been reported (up to 38%), most notably in Asia and Europe. Clindamycin or a cephalosporin can be used when penicillin and erythromycin are contraindicated. Sulfonamides do not eliminate streptococci from the throat nor do they prevent nonsuppurative complications. Many group A streptococcal strains are resistant to the tetracyclines and these should not be used against streptococcal pharyngitis. Epidemic measures: 1) Determine source and manner of spread (person-to-person, milk, food). Outbreaks can often be traced to an individual with an acute or persistent streptococcal infection or bearing streptococci (nose, throat, skin, vagina or perianal area) through identi cation of the M-type of the streptococcus. Disaster implications: Patients with thermal burns or wounds are highly susceptible to streptococcal infections of the affected area. Late onset disease (7 days to several months) is acquired in about half the cases through person-to-person contact and presents mostly as meningitis or sepsis. Premature babies are more susceptible to Group B streptococci infection than full-term babies, but most babies who get disease from these streptococci (75%) are full term. Advances in neonatal care has led to a fall in the case fatality rate from 50% to 4%. Survivors may have speech, hearing or visual problems, psychomotor retardation or seizure disorders if there has been meningeal involvement. The risk-based method identi es candidates for intrapartum chemoprophylaxis according to the presence of any of the following intrapartum risk factors for early-onset disease: delivery at 37 weeks, intrapartum temperature 38. Women whose culture results are unknown at the time of delivery should be managed according to the risk-based approach mentioned earlier. The administration to women colonized with group B streptococci of intravenous penicillin or ampicillin at the onset and throughout labour interrupts transmission to newborn infants, decreasing infection and mortality. Alternative regimens for allergic women include clindamycin, erytromycin and cefazolin. A vaccine for pregnant women to stimulate antibody production against invasive disease in newborns is under development. In early childhood a characteristic pattern of dental caries occurs, in which maxillary primary incisors are routinely affected with carious lesions, but mandibular primary incisors are rarely involved; involvement of other primary teeth varies. Because of the association of this pattern with a speci c feeding habit, the process was called nursing bottle caries or baby bottle tooth decay, but it also occurs in children using feeding cups. These Gram positive facultative anaerobes produce caries in young experimental animals in the presence of dietary sugar. They are members of the viridans group of streptococci; hemolysis of blood agar is usually alpha or gamma. They require a nonshedding oral surface for colonization and are common residents of dental plaque. Early childhood caries occurs worldwide, with highest prevalence in developing countries. Disadvantaged children, regardless of ethnicity or culture, and those with low birthweight, are most frequently involved; enamel hypoplasia, which may occur because of compromised nutritional status during formative stages of primary dentition, is often associated. Colonization by maternal organisms largely depends on inoculum size; mothers with extensive dental caries usually have high levels of mutans streptococci in their saliva. To prevent dental caries of early childhood, promote good oral hygiene in mothers and encourage early weaning from the bottle. Clinical manifestations include transient dermatitis when larvae of the parasite penetrate the skin on initial infection; cough, rales and sometimes demonstrable pneumonitis when larvae pass through the lungs; or abdominal symptoms caused by the adult female worm in the intestinal mucosa. Symptoms of chronic infection may be mild or severe, depending on the intensity of infection. Classic symptoms include abdominal pain (usually epigastric, often suggesting peptic ulcer), diarrhea and urticaria; sometimes also nausea, weight loss, vomiting, weakness and constipation. Rarely, intestinal autoinfection with increasing worm burden may lead to disseminated strongyloidiasis with wasting, pulmonary involvement and death, particu larly but not exclusively in the immunocompromised host. Diagnosis entails identifying larvae in concentrated stool specimens (motile in freshly passed feces), in the agar plate method, in duodenal aspirates or, occasionally, in sputum. Held at room temperature for 24 hours or more, feces may show developing stages of the parasite, including rhabditiform (noninfective) larvae and lariform (infective) larvae (these must be distinguished from larvae of hookworm species) and free-living adults. They penetrate capillary walls, enter the alveoli, ascend the trachea to the epiglottis and descend into the digestive tract to reach the upper part of the small intestine, where development of the adult female is completed. The adult worm, a parthenogenetic female, lives embedded in the mucosal epithelium of the intestine, especially the duodenum, where eggs are deposited. These hatch and liberate rhabditiform (noninfective) larvae that migrate into the intestinal lumen, exit in feces and develop after reaching the soil into either infective lariform larvae (which may infect the same or a new host) or free-living male and female adults. In some individuals, rhabditiform larvae may develop to the infective stage before leaving the body and penetrate through the intestinal mucosa or perianal skin; the resulting autoinfection can cause persistent infection for many years. Ivermectin is the drug of choice; thiabendazole or albendazole are less ef cient alternatives. The primary lesion (chancre) usually appears about 3 weeks after exposure as an indurated, painless ulcer with a serous exudate at the site of initial invasion. Invasion of the bloodstream precedes the initial lesion; a rm, non uctuant, painless satellite lymph node (bubo) commonly follows. A symmetrical maculopapular rash involving the palms and soles, with associated lymphadenopathy, is classic. Secondary manifestations resolve spontaneously within weeks to 12 months; all untreated cases will go on to latent infection for weeks to years, and one-third will exhibit tertiary syphilis signs and symptoms. In the early years of latency, there may be recurrence of infectious lesions of the skin and mucous membranes. Death or serious disability rarely occurs during early stages; late manifes tations shorten life, impair health and limit occupational ef ciency. The widespread use of antimicrobials has decreased the frequency of late manifestations. Fetal infection results in congenital syphilis and occurs with high frequency in untreated early infections of pregnant women. It frequently causes abortion or stillbirth and may cause infant death through preterm delivery of low birthweight infants or from generalized systemic disease. For screening newborns, serum is preferred over cord blood, which produces more false-positive reactions. Serological tests are usually nonreactive during the early primary stage while the chancre is still present; a dark eld examination of all genital ulcerative lesions can be useful, particularly in suspected early seronegative primary syphilis. Syphilis is usually more prevalent in urban than rural areas, and in some cultures, in males more than in females. Transmission by kissing or fondling children with early congenital disease occurs rarely. Transplacental infection of the fetus occurs during the pregnancy of an infected woman. Transmission can occur through blood transfusion if the donor is in the early stages of disease. Infection through contact with contaminated articles may be theoretically possible but is extraordinarily rare. Health professionals have developed primary lesions on the hands following unprotected clinical examination of infectious lesions. Lesions of secondary syphilis may recur with decreasing frequency up to 4 years after infection, but transmission of infection is rare after the rst year. Transmission of syphilis from mother to fetus is most probable during early maternal syphilis but can occur throughout the latent period. Infected infants may have moist mucocutaneous lesions that are more widespread than in adult syphilis and are a potential source of infection. Emphasis on early detection and effective treatment of patients with transmis sible syphilis and their contacts should not preclude search for people with latent syphilis to prevent relapse and disability due to late manifestations. Congenital syphilis is prevented through serological examination in early pregnancy and again in late pregnancy and at delivery in high prevalence populations; treat those who are reactive. Teach methods of personal prophylaxis applicable before, during and after exposure, especially the correct and consis tent use of condoms. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Case report of early infec tious syphilis and congenital syphilis is required in most countries, Class 2 (see Reporting); laboratories must report reactive serology and positive dark eld examinations in many areas. Patients should refrain from sexual intercourse until treatment is completed and lesions disappear; to avoid reinfection, they should refrain from sexual activity with previous partners until the latter have been examined and treated. The stage of disease determines the criteria for partner noti cation: a) for primary syphilis, all sexual contacts during the 3 months preceding onset of symptoms; b) for secondary syphilis, contacts during the preceding 6 months; c) for early latent syphilis, those of the preceding year, if time of primary and secondary lesions cannot be established; d) for late and late latent syphilis, marital partners, and children of infected mothers; and e) for congenital syphilis, all members of the immediate family.

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Sui androgen for hormonal acne purchase generic proscar line, Elwood and Goodchild 2013) and the ethics of crowdsourcing data in particular (Taylor 2015; Harvey in eds prostate cancer emedicine cheap proscar generic. The only volunteers are those that have a stake in the research and management of this disease androgen hormone replacement therapy buy proscar canada, and their participation is not automatic but active prostate cancer what is it order 5 mg proscar otc. Smartphone ubiquity is beginning to extend into developing countries prostate health supplements buy proscar paypal, promoting social justice by giving an equal digital platform for individuals trapped in poverty prostate mass purchase generic proscar from india. Broken down further, over 57% of individuals under 25 and 55% of individuals 25-34 used a smartphone in Kenya in 2016, a very sharp divide from the 10% of those over 55 years of age (Google 2016). Smartphones facilitate safer financial transactions, especially for women (Suri and Jack 2016). As physical currency is removed from a financial transaction, robbery and violence are less likely to occur. In fact, smartphones now provide financial services relevant to a growing number of individuals at the margins of, or outside, the formal financial system (Villasenor, West, and Lewis 2016). One study in Science indicated that as many as 194, 000 households were lifted out of poverty due to access to mobile money and that access has improved the economic lives of poor women and members of female-headed households (Suri and Jack 2016). These examples would not be possible were it not for the ubiquity of mobile phones and, increasingly, smartphones, and their supporting cellular and data networks. Users can volunteer links to scientific literature, or upload specific disease prevalence after analysis has been performed. Having discussed the growing availability of connected and disconnected mobile devices in developing countries, it is time to look at one specific way of using those devices. Popular epidemiology also promotes the dissemination of high-level information at a local scale. Fischer (2000) posits that popular epidemiology draws attention to otherwise ignored local health disorders and enables communities to press for change by raising consciousness of local health concerns. He argues that popular epidemiology is in and of itself a methodical strategy that can lead to actual political change (Fischer 2000). Despite this positive sentiment, however, popular epidemiology is not without risk. Fischer flips the coin, discussing the difficulty of organizing and nurturing ongoing citizen participation, and laments the loss of quality of participation over time. This raises interesting questions for this research project, namely its feasibility and its potential for future use. Or, would only the negatives be discussed, with little to no recognition of positives that could be applied in future work Since there are no authoritative spatial distributions of tungiasis at local, regional, or global levels, it seems (from an outside perspective) legitimate to use locals to collect the data. Server space, whether physical or cloud-based, requires equipment, electricity, network connectivity, human power in the form of database and network administrators, software (operational and security), and money. The geodatabase also stores relationships between tables and can accommodate attachments like images or documents. Entity Relationship Diagrams the eLibrary uses one single point feature class to visualize the locations of tungiasis studies and research. Tables range from census-derived poverty data to rainfall isopleths, prevalence of livestock by type, location of primary schools (containing attributes from which several operational or interactive layers are derived), water access points, locations of medical facilities, and malaria endemicity. The entity-relationship diagram for the Home Visit table in Figure 13 shows that it contains fourteen fields. Attributes are collected about the shelter to help researchers determine shared risk factors that could be addressed preventatively. The Floor Type field is restricted to a 95 list of coded domains including bare earth or soil, cement or concrete, wood, or other. Whether or not livestock are kept inside overnight (a common practice in areas relying on subsistence agriculture for survival) is recorded using a Yes/No domain in the Livestock Indoors field. The Pets Indoors field is populated with one of the following values: No, Dog, Car, Cog & Cat, and Other. Because rats and mice are such important disease vectors, the present of rats in and around the sleeping shelter is recorded in the Presence of Rats field with available values of Rats, Mice (but not rats) and No. The provision of shoes during the home visit is recorded in the Shoes Provided field, with optional answers of No, Children, Adults, and All Family Members. If volunteers leave a topical treatment at the shelter, it is recorded as one of five values in the Topical Given field: No, Petroleum Jelly, Potassium Permanganate, Ivermectin, and Other. The distance each household must walk to reach safe drinking water is recorded in the Distance to Water field as a measure of how easy or difficult it is to use water to wet floors (an effective method of smothering the fleas and eggs). Values in the coded domain include Indoor Potable Plumbing, Well (<50m), Well (50m to 500m), Well (500m to 1km), Well (1km to 2km), Well (>2km), Open Water (<1km), Open Water (>1km), and Other. Methods of waste disposal are recorded by one of six values in the Wastes Disposal field: Indiscriminate, Leak Tin, Open Latrine, Closed Latrine, Toilet, and Other. Attributes would be collected about patients to help researchers determine shared risk factors that could be addressed preventatively, or used for predictive modeling. The entity-relationship diagram for the Individual Demnographics table shows that it contains 31 fields. The Gender field records whether an individual is male or female, while the Age field provides a domain of descriptors and ranges. Age is recorded as Infant, Toddler, 3-5 years, 6 to 8 years, 9 to 11 years, 12 to 15 years, 16 to 19 years, 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years, 80 to 89 years, and 90+ years. The Infant and Toddler descriptors were used so that aid workers could readily classify a young child without having to ask for a birth date. The use of age ranges was intended to aid in the protection of patient privacy by not using exact age; by reducing specificity a critical identifying detail is reduced to a class, not a number. The Duration field records the length of time the individual has been afflicted with tungiasis, with options of Less than 4 weeks, 1 to 3 months, 3 to 6 months, 6 to 12 months, 1 to 2 years, 2 to 5 years, and 5+ years. The Repeat Infestation field records whether or not the individual has had tungiasis in the past. Whether or not patients own shoes or are being provided with shoes is recorded in the Own Shoes and Given Shoes fields, respectively. The Special Needs field records if the patient has a physical disability, an intellectual disability, both, neither, or if there are age-related special needs. The 99 Shelter Floor Type field uses the same domain as the field of the same name in the Home Visit table. The author acknowledges that this records the same data twice, which is contrary to the fundaments of database normalization. However, there are several scenarios in which an individual might be interviewed for the Individual Demographics table but would not have their home visited for pesticide application. Many aid organizations visit schools to maximize the number of people to whom they can provide relief. Schools are locations known well enough by all community members and generally close enough to walk to such that community engagement can reach a large percentage of the population. The Bedding Type field records data about sleeping conditions in the home shelter to help identify homes where donated bedding might significantly reduce reinfestation. Acceptable answers in the domain include None/Bare Soil, Rags or Cardboard, Bare Mattress on Floor, Wooden Bed without Mattress, Wooden Bed with Mattress, Hammock, and Other. Whether or not the patient wets the bed is recorded in the Bedwetting field, and whether or not bedding is shared with others is recorded in the Share Bedding field. The Is Caretaker field records if the patient provides care to others, providing options of Yes/My Children, Yes/My Grandchildren, Yes/My Parents/Grandparents, Yes/Other, and No. The Needs Caretaker field records if the patient is themselves cared for by others. Education attainment is recorded in the Education field, accepting answers of Beyond School Age, In School, Supposed to be in school but left because of tungiasis. Like in the Home Visit table, the Distance To Water field records how far the patient must travel for access to potable water, and its source. Additionally, the Waste Disposal and Livestock Indoors fields record the same data as the same fields in the Home Visit table. Whether or not an individual has pets is recorded in the Pets field, and the presence of rats is again recorded. Lastly, a comments field permits the input of text up to 50 characters to record additional pertinent information. Except for subtype tables (in the form of coded domains), the only feature class in the database is the article table, visualized as points. The main table is the Tungiasis elibrary, discussed in detail in Chapter 4, Application Development. The three domains created in ArcMap are Country, Article Source, and Article Focus, and are used to 103 organize and query the collected articles. The one-to-many relationships are supported in the latest version of Web AppBuilder (many-to-many relationships are not) and save space in the main dataset by recording single or double-digit numbers in the table instead of textually-longer descriptions. The purposes of the Country, Article Source, and Article Focus domains are described in detail in Section 4. Widgets used to tailor the two apps include Legend, Layer List, Basemap Gallery, Measure, Help/Info, Edit, Query, Chart, Select & Export, Bookmark, Analysis, and Attribute Table. The workflow for producing the web mapping applications is visualized in Figure 16. It is important to re-project all data to be published into the Web Mercator Auxiliary Sphere projection to prevent the web map from having to project data on the fly, which is resource-intensive. Services are published by choosing File > Share As > Service, which opens the Service Editor window. On the General tab, the Service Name, Connection, Type of Server and Type of Service are listed. On the Parameters tab, it is wise to document the location of the Original Document so that it can be found at a later time. This is also where the maximum number of records returned by the server can be increased. The Capabilities tab is where specific map capabilities and functionalities are turned on and off. Feature Access must be checked for the application to allow editing or addition of data to a hosted database. Figure 17 shows the Capabilities tab of the Service Editor window for the Tungiasis eLibrary. Additionally, the Mapping subsection allows the publisher to manage workspaces for dynamic Figure 17 the Capabilities Tab of the Service Editor window 109 layers if per-request modification of layer order and symbology is permitted. The Feature Access subsection of the Capabilities tab is very important for developers creating apps that enable data editing and creation. It is considered best practice to store this information in development documentation. Also important to consider when publishing Feature Services is that by default only 1000 features are loaded when the Service is called. Because a Map Service is functionally an image of data, it is easily cached on the server and is returned to the user with little performance consideration. On the contrary, to load a Feature Service requires significantly more system resources as the Feature Service actually queries the underlying data each time it is called to return all the records of all the features loaded. The number of features that load when the service is called can be increased from 1000 to any number on the Feature Access subsection of the Capabilities Tab.

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Pregnant women should have access to affordable medicines and skilled birth attendants that keep them safe during pregnancy and child birth androgen hormone kidney purchase discount proscar on-line, no matter where they live androgen hormone 1 cost of proscar. Congress should support and provide flexible funding for disease-focused initiatives prostate keyhole surgery buy proscar amex, to promote intersections with maternal and child health prostate young men purchase 5mg proscar visa. Many diseases that affect women and children will not be completely eradicated with currently available tools prostate cancer zometa buy proscar master card. In addition to scaling up current interventions prostate exam discount 5mg proscar fast delivery, additional R&D is urgently needed to improve the health of women and children around the world. It millions of mothers and stunts the cognitive and physical development of millions more children under the age of 5 children and results in lost economic productivity and an increased each year and results in lost health burden on already poor countries. While significant progress has been made in reducing deaths in the linkages between nutrition; children under the age of 5, 6. Better nutrition during the 1, 000 day window can 3 result in a savings of about $20-30 billion annually in health costs. The right nutrition during childhood can increase individual earnings 6 over a lifetime by up to 46 percent. Every $1 invested in nutrition generates as much as $138 in better health and increased 7 productivity. Without urgent action to improve nutrition, progress on disease prevention and treatment and hunger and poverty alleviation will be harder and costlier to achieve. Global Health Briefing Book 2013 | 31 Dominic Sansoni, World Bank Making Progress In 2008, the medical journal the Lancet published a series on maternal and child undernutrition, highlighting the 8 impact on the critical 1, 000 day window and recommending a set of evidence-based interventions. During the last two decades, collaborative efforts at all levels and across sectors have resulted in reducing the 9 deaths of children under age 5 from around 12 million in 1990 to about 6. The number of stunted children dropped by 35 percent, from 253 million in 1990 to 165 million children in 10 2011. However, overall progress is still insufficient and millions of children remain at risk. It now includes 33 countries committed to advancing health and development through improved nutrition. Increased and targeted investments are essential to scaling up evidence based, cost-effective nutrition interventions and leveraging investments in other areas to achieve significant and sustainable reductions in maternal and child undernutrition rates. Bipartisan support is needed to reverse decades of underinvestment in nutrition and enshrine it as a core development priority. Global Health Briefing Book 2013 | 33 Contributors 1, 000 Days Partnership Mannik Sakayan msakayan@thousanddays. Global Health Briefing Book 2013 | 34 Family Planning and Reproductive Health Overview Summary An estimated 222 million women in developing countries want to delay Since 1965, the U. There has been pregnancy related complications are the leading cause of death in the bipartisan support for the developing world for young women 15-19 years old. Other donors, governments from developing countries and civil society organizations have also recognized and prioritized family planning. For example, at the London Summit on Family Planning in July 2012 leaders from around the world, including the U. This funding would also help ensure that those 7 displaced by conflict and natural disasters have full access to lifesaving reproductive health care they require. Congress and the Administration should provide women with access to a range of services and remove limitations to healthcare, family planning and reproductive health services. The provision of a range of services across a continuum of care is cost-effective and allows providers to not only assist women with determining the number, timing and spacing of pregnancies, but also promotes the overall health of women and their children. Open defecation is a determinant of stunting and prevents 13 children from growing tall and becoming healthy productive adults. Interventions, such as nutritional supplements, combined with improved sanitation and handwashing with soap can reduce stunting by 4. Layton Thompson, WaterAid Global Health Briefing Book 2013 | 39 Making Progress While the global community successfully reached the Millennium Development Goal of halving the number of people without access to clean water in 2010, 783 million people still lack access to safe drinking water and 2. The resulting health gains are tremendous: as women no longer get sick from dirty water or poor sanitation, fewer workdays are missed, income and productivity has increased and income is invested in the health and education of the household. The Child Survival Call to Action and the Feed the Future initiative are important tools for the U. A comprehensive and coordinated approach from national governments, multilaterals, the private sector and civil society is necessary to address this challenge. The provision of humanitarian assistance, including health services, should be independent from security or political agendas, A focus on the health needs of delivered in an impartial manner and accessible to affected the most vulnerable groups, communities. Addressing Effective emergency response specific health needs, such as treatment for survivors of gender-based programs can lay the building violence, maternal and newborn care, promoting optimal nutrition, and blocks for stronger and more mental health and psychosocial support, is critical during the response. As low-income countries trend toward urbanization, vulnerable populations, including displaced persons, are at an increased health risk since the health systems in fragile states tend to be overextended and struggle to meet their needs. Emergencies requiring international humanitarian action are often complex and involve multiple actors. In large scale crises, there can be hundreds of humanitarian agencies providing health-related aid. Effective coordination of the response is essential to avoid duplication, address gaps and ensure the greatest impact and accountability. International Medical Corps When emergencies subside and government systems begin to recover, humanitarian aid transitions to longer-term development. Transitions can produce more robust and resilient health systems when humanitarian partners. Global Health Briefing Book 2013 | 43 Making Progress From 2000 to 2010, natural disasters alone affected 2. Response and Strategy Through its support for humanitarian health programs, the United States has been successful in saving the lives of individuals affected by conflict and natural disasters through the provision of essential health care, such as emergency medical interventions, nutritional support, access to clean water and sanitation, and preventing the outbreak of diseases. While many emergencies cannot be predicted or prevented, the resulting loss of life can be reduced through appropriate mitigation and preparedness efforts. International Medical Corps Global Health Briefing Book 2013 | 45 Contributors International Medical Corps Mary Pack mpack@InternationalMedicalCorps. Global Health Briefing Book 2013 | 46 Vaccination Overview Summary Vaccines are responsible for major public health gains over the last Vaccines are a fantastic global century, leading to the eradication of smallpox and putting diseases health investment, cost like polio and measles on the brink of eradication. The past 30 their delivery to resource-poor years have seen global vaccination programs drastically reduce countries. Global mortality attributed to measles, one of the global health requires top five diseases killing children globally, declined by 74 percent sustained political and 3 between 2000 and 2010 thanks to expanded immunization. In spite of these incredible accomplishments, nearly 900, 000 children continue to die every year from rotavirus, Hib meningitis, 4 pneumococcal pneumonia and other vaccine-preventable diseases. Global vaccination programs save lives abroad and protect Americans at home and abroad. Through effective immunization efforts, the United States massively reduces the risk that those diseases will cause harm to U. Cases of pneumonia and diarrheal disease, which are especially threatening to children, have been greatly reduced due to 5 Source: World Health Organization programs that ensure distribution of new vaccines soon after licensure. Investments in expanded vaccine delivery in 72 low and middle-income countries over the next decade are expected to prevent up to 6. Research continues to improve upon existing vaccines, minimizing spoilage by reducing their 9 10 vulnerability to heat and speeding up their manufacture through cutting-edge processes. The United States has also leveraged the domestic expertise of the vaccine development industry, enlisting U. Continued support will be required to transform promising research into the lifesaving vaccines of the future and improve manufacturing and delivery techniques to expand the reach of existing vaccines. Global Health Briefing Book 2013 | 50 Health Research and Development Overview Summary Over the past 50 years, the world witnessed remarkable innovations in Global health research and global health. For instance, adequate drugs, vaccines funding for research programs and diagnostics simply do not exist for many neglected diseases. New and supporting a policy challenges such as drug and insecticide resistance pose a threat to environment conducive to health across the globe. As new global health threats emerge, discovering and developing the operations and implementation research complement biomedical R&D next innovations in global to find the most effective ways to deliver and scale up access to health technologies. Investment from the public sector has been essential, as a lack of a traditional market for global health products has historically deterred many private investors. In particular, the United States has played a key role in these and many other global health breakthroughs, and the nation is poised to accelerate scientific innovation for new technologies. Since 2009, the distribution of over 150 million courses of child-friendly Coartem Dispersible (artemether lumefantrine), codeveloped with Novartis and the Medicines for Malaria Venture, is estimated to have saved 13 340, 000 young lives from malaria. Response and Strategy Thanks to a longstanding commitment to research from the United States, global health R&D is now at a critical juncture, with 365 new global health products in the research pipeline as of April 2012. Major bottlenecks exist in certain areas that could be addressed with better coordination across the U. Policymakers must ensure future federal budgets demonstrate a renewed commitment to global health research, with bolstered funding levels across the U. Fully engaging in the post-2015 consultations should be a priority of the United States to ensure future development frameworks reflect sustainability, efficiency and practicality, while reflecting the values and leadership of the United States. Still, sub-Saharan Africa, the 2 region with the highest under-5 mortality, is unlikely to reach the 2015 target reduction rate. However, funding levels less than the required amount for 7, 8 tuberculosis and malaria interventions threaten these inroads. Consensus-led development planning in the post-2015 consultation process is essential to ensuring sustainability of programs, as well as country ownership and the ability to advance essential global health programs and priorities. Given the focus of the post-2015 consultations on health systems strengthening, opportunities to encourage an approach to health that fosters sustainability and reduces aid dependency will be prevalent. Global Health Briefing Book 2013 | 58 Health Systems Strengthening Overview Summary For over 50 years, the U. Countries need enough skilled health workers, who are equitably distributed and composed of the right mix of providers. Health workers need access to current information, and a safe and supportive work environment that promotes high performance. Accurate, timely health information is essential for monitoring health trends, identifying unmet needs, investing in performance improvements and measuring which approaches have the greatest health impact so they can be expanded. Medicines, vaccines and other health products are crucial for the prevention, diagnosis and treatment of health problems. A functioning health system ensures equitable access to these and other safe, quality products. A good health financing system raises sufficient funds and uses them efficiently to provide needed services. Good financing also protects people from financial ruin or impoverishment due to burdensome out-of-pocket expenses. Competent leadership and effective management systems are critical for health systems facing pressure to produce sustainable results. Effective leadership and governance includes a strategic policy framework, oversight, regulation and accountability. In countries where public and private investments to strengthen frontline health workers have been made, deaths due to preventable causes have decreased and populations are healthier and more stable. Information technologies are increasingly used to support better policies, planning and services. Investments in pharmaceutical supply chains have helped ensure reliable access to medicines. Better information about health financing and increased use of market incentives are improving the use of resources. Leadership training and attention to governance in the health sector are yielding better policy decisions and increased accountability.

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