The role of international NGOs in health systems strengthening: the case of Timor-Leste.

Achieving the United Nations Millennium Development Goals for health will require that programs supporting health in developing countries focus on strengthening national health care systems. However, the dominant neoliberal model of development mandates reduced public spending on health and other social services, often resulting in increased funding for nongovernmental organizations (NGOs) at the expense of support for government systems. East Timor, later Timor-Leste, is an example of a post-crisis country where international NGO efforts were initially critical to providing relief efforts to a traumatized population. Those groups were not prepared to help develop and support a standardized Timorese national health plan, however, and the cost of their support was unsustainable in the long term. In response, local authorities designed and implemented a post-crisis NGO phase-over plan that addressed risks to service disruption and monitored the process. Since then, some NGOs have worked collaboratively with the Ministry of Health to support specific efforts and initiatives under a framework provided by the ministry. Timor-Leste has shown that ministries of health can facilitate an effective transition of NGO support from crisis to development if they are allowed to plan and manage the process.

Built environment interventions for human and planetary health: integrating health in climate change adaptation and mitigation.

OBJECTIVES: Human-generated climate change is causing adverse health effects through multiple direct pathways (e.g. heatwaves, sea-level rise, storm frequency and intensity) and indirect pathways (e.g. food and water insecurity, social instability). Although the health system has a key role to play in addressing these health effects, so too do those professions tasked with the development of the built environment (urban and regional planners, urban designers, landscapers and architects), through improvements to buildings, streets, neighbourhoods, suburbs and cities. This article reports on the ways in which urban planning and design, and architectural interventions, can address the health effects of climate change; and the scope of climate change adaptation and mitigation approaches being implemented by the built environment professions. Type of program or service: Built environment adaptations and mitigations and their connections to the ways in which urban planning, urban design and architectural practices are addressing the health effects of climate change. METHODS: Our reflections draw on the findings of a recent review of existing health and planning literature. First, we explore the ways in which 'adaptation' and 'mitigation' relate to the notion of human and planetary health. We then outline the broad scope of adaptation and mitigation interventions being envisioned, and in some instances actioned, by built environment professionals. RESULTS: Analysis of the review's findings reveals that adaptations developed by built environment professions predominantly focus on protecting human health and wellbeing from the effects of climate change. In contrast, built environment mitigations address climate change by embracing a deeper understanding of the co-benefits inherent in the interconnectedness of human health and wellbeing and the health of the ecosystem on which it depends. In the final section, we highlight the ethical transition that these approaches demand of built environment professions. LESSONS LEARNT: Built environment interventions must move beyond simple ecological sustainability to encouraging ways of life that are healthy for both humans and the planet. There are key challenges facing this new approach.

Feeding experiences and growth status in a Rett syndrome population.

OBJECTIVES: Feeding difficulties in Rett syndrome are complex and multifactorial. In this study, we describe the feeding experiences in Rett syndrome and examine the factors affecting growth. MATERIALS AND METHODS: Using questionnaire data related to a population-based cohort, ages 2 to 29 years (n = 201), we measured the feeding experiences, growth, and factors affecting growth (enteral nutritional support, mutations, mobility, breath-holding, hyperventilation) in subjects with Rett syndrome. RESULTS: The mean weight, height, and body mass index z scores in subjects with Rett syndrome were below that of their age group and decreased steadily with age. Twenty percent of subjects had enteral nutrition support, and it was more common in the older age group. Those with truncating mutations had significantly less enteral nutrition support than the other mutation groups. Furthermore, those with low mobility had lower mean body mass index z scores than those with higher mobility, and increased frequency of breath-holding and hyperventilation also was associated with lower body mass index z scores. CONCLUSIONS: Routine monitoring of growth should continue to determine the severity of nutritional problems in Rett syndrome. Active nutritional management is recommended to ensure females affected with Rett syndrome have the best opportunity to reach their growth potential.

Dietary management of galactosemia.

Galactosemia is detected by newborn screening in New South Wales and managed by the metabolic team at the Children's Hospital at Westmead. Infants with the Duarte variant are not treated. Management is based on the Handbook for Galactosemia prepared in 1998. This handbook provides information for the family on the dietary management, inheritance and ovarian function. The major dietary sources of galactose are milk and milk products. Breastfeeding must be ceased and replaced with a soy formula. Once solid foods are commenced certain foods should be avoided. Other foods, which may contain some free galactose are recommended in limited quantities only. There is no restriction on other fruits and vegetables. An ongoing issue with dietary management is adequate nutrient intake, particularly of calcium. Intake of milk substitutes and calcium supplements is often inadequate.

The Healthy Built Environments Program: a joint initiative of the NSW Department of Health and the University of NSW.

The built environment is increasingly viewed as an important determinant of human health. Consequently creating environments that promote health and wellbeing is one of the NSW Department of Health's key preventive health priorities. This article describes a new program focused on improving health through the quality of the built environment. Recently established in the City Futures Research Centre, Faculty of the Built Environment, University of NSW, the Healthy Built Environments Program receives funding from the NSW Department of Health. The Program will foster cross-disciplinary research, deliver education and workforce development, and advocate for health as a primary consideration in built environment decision making. The Program brings the combined efforts of researchers, educators, practitioners and policymakers from the built environment and health sectors to the prevention of contemporary health problems. The Program's vision is that built environments will be planned, designed, developed and managed in ways that promote and protect the health of all people.

Mutational analysis does not support the existence of a putative tertiary structural element in the left terminal domain of Potato spindle tuber viroid.

Comparative sequence analysis suggests that the left terminal domain of Potato spindle tuber viroid (PSTVd) and other large pospiviroids may assume a branched tertiary structure containing two pseudoknots. To search for evidence of such a structure in vivo, the nucleotide sequences proposed to interact were mutagenized, tomato seedlings were inoculated with mixtures of potentially infectious PSTVd RNA transcripts and the resulting progeny were screened for compensatory sequence changes. Positions 6-11 and 330-335 tolerated only limited sequence variation, and compensatory changes consistent with formation of an intact pseudoknot were observed in only two of the plants examined. No variation was detected at positions 14-16 or 29-31. Passage of selected variants in Rutgers tomato led to an increase in virulence only upon reversion to wild-type PSTVd_Intermediate. The ability of the left terminal domain to assume a branched conformation containing pseudoknots does not appear to be an important determinant of PSTVd fitness.