Resilience as a double-edged health promotion goal: examples from Lao PDR.

Individual and community resilience are undoubtedly important targets for health enhancement and invaluable aspirational outcomes in the health promotion endeavour especially in disaster contexts. However, overreliance on resilience as a proxy for positive well-being has serious personal and political implications in many contexts, as illustrated in research findings on women's quality of life in southern Lao PDR. Case studies derived from focus group interviews with ethnic minority Lao women about their quality of life are used to exemplify how overt signs of resilience may mask, rather than mirror, covert existential reality leaving women without a voice. The political implications of this silencing are profound. Private troubles remain hidden rather than being identified as public issues subject to public policy. This conundrum is not confined to third world countries. Structural limitations to achieving profound fulfilment abound in affluent countries also, yet neo-liberal governments rely heavily on the resilience of populations to minimize public spending. The challenge for health promotion researchers, policy makers and practitioners is to explore the nexus between individual agency and structural change in each specific context to ensure that health promotion initiatives do not inadvertently perpetuate disparities in access to power and resources.

Home delivery in Southern Lao PDR: Challenges to achieving MDG 4 and 5 targets

@#<p style="text-align: justify;">This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets.</p> <p style="text-align: justify;">A descriptive cross-sectional study was used. First, face-to-face questionnaires were used to collect demographic and reproductive health and health care experience data from 166 village woman (120 with a child born in the previous year, and 46 who were currently pregnant). In-depth individual interviews then followed with 23 purposively selected woman, to probe personal experiences and perspectives on why women preferred home birthing.</p> <p style="text-align: justify;">The majority of the woman had given at home, assisted by untrained birth attendants (relatives or neighbours). While seventy percent had accessed some antenatal services, postpartum follow-up attendance was very low (17 percent). Limited finances, lack of access to transport and prior negative health service experiences were important factors influencing women's decision making. Giving birth at home was seen by many, not just as unavoidable, but, as the preferred option.</p> <p style="text-align: justify;">Recent top-down maternal health initiatives have had little impact in this region. Improving maternal and child-health strategies requires much greater community participation and use of participatory action methodologies, to increase women's engagement in policy and planning and subsequent usage of health service developments.</p>

Using clinical trial data and linked administrative health data to reduce the risk of adverse events associated with the uptake of newly released drugs by older Australians: a model process.

BACKGROUND: The study was undertaken to evaluate the contribution of a process which uses clinical trial data plus linked de-identified administrative health data to forecast potential risk of adverse events associated with the use of newly released drugs by older Australian patients. METHODS: The study uses publicly available data from the clinical trials of a newly released drug to ascertain which patient age groups, gender, comorbidities and co-medications were excluded in the trials. It then uses linked de-identified hospital morbidity and medications dispensing data to investigate the comorbidities and co-medications of patients who suffer from the target morbidity of the new drug and who are the likely target population for the drug. The clinical trial information and the linked morbidity and medication data are compared to assess which patient groups could potentially be at risk of an adverse event associated with use of the new drug. RESULTS: Applying the model in a retrospective real-world scenario identified that the majority of the sample group of Australian patients aged 65 years and over with the target morbidity of the newly released COX-2-selective NSAID rofecoxib also suffered from a major morbidity excluded in the trials of that drug, indicating a substantial potential risk of adverse events amongst those patients. This risk was borne out in post-release morbidity and mortality associated with use of that drug. CONCLUSIONS: Clinical trial data and linked administrative health data can together support a prospective assessment of patient groups who could be at risk of an adverse event if they are prescribed a newly released drug in the context of their age, gender, comorbidities and/or co-medications. Communication of this independent risk information to prescribers has the potential to reduce adverse events in the period after the release of the new drug, which is when the risk is greatest.Note: The terms 'adverse drug reaction' and 'adverse drug event' have come to be used interchangeably in the current literature. For consistency, the authors have chosen to use the wider term 'adverse drug event' (ADE).

Maternity waiting homes in Southern Lao PDR: the unique 'silk home'.

The concept of maternity waiting homes (MWH) has a long history spanning over 100 years. The research reported here was conducted in the Thateng District of Sekong Province in southern Lao People's Democratic Republic (PDR) to establish whether the MWH concept would be affordable, accessible, and most importantly acceptable, as a strategy to improve maternal outcomes in the remote communities of Thateng with a high proportion of the population from ethnic minority groups. The research suggested that there were major barriers to minority ethnic groups using existing maternal health services (reflected in very low usage of trained birth attendants and hospitals and clinics) in Thateng. Unless MWH are adapted to overcome these potential barriers, such initiatives will suffer the same fate as existing maternal facilities. Consequently, the Lao iteration of the concept, as operationalized in the Silk Homes project in southern Lao PDR is unique in combining maternal and infant health services with opportunities for micro credit and income generating activities and allowing non-harmful traditional practices to co-exist alongside modern medical protocols. These innovative approaches to the MWH concept address the major economic, social and cultural barriers to usage of safe birthing options in remote communities of southern Lao PDR.

Gender and health promotion: a multisectoral policy approach.

Women and men are different as regards their biology, the roles and responsibilities that society assigns to them and their position in the family and community. These factors have a great influence on causes, consequences and management of diseases and ill-health and on the efficacy of health promotion policies and programmes. This is confirmed by evidence on male-female differences in cause-specific mortality and morbidity and exposure to risk factors. Health promoting interventions aimed at ensuring safe and supportive environments, healthy living conditions and lifestyles, community involvement and participation, access to essential facilities and to social and health services need to address these differences between women and men, boys and girls in an equitable manner in order to be effective. The aim of this paper is to (i) demonstrate that health promotion policies that take women's and men's differential biological and social vulnerability to health risks and the unequal power relationships between the sexes into account are more likely to be successful and effective compared to policies that are not concerned with such differences, and (ii) discuss what is required to build a multisectoral policy response to gender inequities in health through health promotion and disease prevention. The requirements discussed in the paper include i) the establishment of joint commitment for policy within society through setting objectives related to gender equality and equity in health as well as health promotion, ii) an assessment and analysis of gender inequalities affecting health and determinants of health, iii) the actions needed to tackle the main determinants of those inequalities and iv) documentation and dissemination of effective and gender sensitive policy interventions to promote health. In the discussion of these key policy elements, we use illustrative examples of good practices from different countries around the world.