[The integrated programs in medical education: modern trends and development prospects].

The article considers possibilities of forming integrated educational programs of personnel training. The integration supposes interdisciplinary approach and inclusion within curricula, besides medical subjects, disciplines from different fields of science. As practice demonstrates, this approach provides larger spectrum of professional knowledge, skills and competencies and contributes into better career guidance and subsequent employment of graduates.

The Total Worker Health® (TWH) approach: a systematic review of its application in different occupational settings.

BACKGROUND: The National Institute for Occupational Safety and Health (NIOSH), in 2011, developed the "Total Worker Health®" (TWH) as a holistic approach to protect and promote the workers' safety, health, and well-being. After over ten years from the TWH development, the aim of the present systematic review is to provide a comprehensive overview of the worldwide TWH initiatives. METHODS: PubMed, Scopus and ISI Web of Science were searched for TWH studies published up to the 31st of July 2023, and 43 investigations could be included. The review was registered on the International prospective register of systematic reviews PROSPERO with the reference number CRD42023416972. RESULTS: Issues that emerged as relevant for the TWH operationalization were the awareness about the TWH approach and fundamentals, the leadership commitment, and a participatory engagement of the workforce: these aspects all contributed to acceptable and effective setting oriented TWH plans, specifically tailored on the peculiarities of the workplace, including small enterprises and multiemployer worksites. Evaluation and continual improvement were reported as fundamental for the successful implementation of TWH initiatives. Limited resources for safety and health initiatives, in terms of time, people, and funds, together with difficulties in the identification of safety and health priorities and a poor participatory culture were recognized as obstacles to the TWH application. Training resulted the core component of the TWH leadership and workforce preparedness, with beneficial results in terms of safety culture and adoption of preventive measures. CONCLUSIONS: Although interesting aspects emerged from our review, future longitudinal investigations should confirm the effectiveness, easy integration, and long-term sustainability of TWH models in different workplaces, in order to effectively support safe and health-enhancing works able to improve innovation and productivity.

The role of integrated programs in the prevention of COVID-19 in a humanitarian setting.

The COVID-19 pandemic has caused a severe depletion to health systems worldwide. In the South Kordofan state, a war-torn humanitarian region in Sudan, the United Nations High Commissioner for Refugees and the WHO Emergencies Programme have led the development of integrated programs for health, peace and rehabilitation by training rapid response teams to strengthen both surveillance system and response capacities, engaging the communities at risk with health education and promotion activities, as well as following proper infection, prevention and control measures during case investigation. Also, Early Help Assessment coordinators met with health services managers and recruited 14 teams who were trained to ensure a rapid response to COVID-19. Also, the implementation of water, sanitation and hygiene services was upscaled. Although the local community of South Kordofan is fragile and at high risk of infectious diseases, the limited numbers of detected cases of COVID-19 and COVID-19 deaths could be attributed to the early preparation and integration of programs that helped to prevent the local spread of COVID-19. This lesson needs to be thoroughly investigated to estimate whether it is cost-effective and to determine the feasibility of it being successfully implemented in other humanitarian settings.

National Evaluation of Canadian Multi-Service FASD Prevention Programs: Interim Findings from the Co-Creating Evidence Study.

Since the 1990s, a number of multi-service prevention programs working with women who have substance use, mental health, or trauma and/or related social determinants of health issues have emerged in Canada. These programs use harm reduction approaches and provide outreach and "one-stop" health and social services on-site or through a network of services. While some of these programs have been evaluated, others have not, or their evaluations have not been published. This article presents interim qualitative findings of the Co-Creating Evidence project, a multi-year (2017-2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol exposure. The evaluation utilizes a mixed-methods design involving semi-structured interviews, questionnaires, focus groups, and client intake/outcome "snapshot" data. Findings demonstrated that the programs are reaching vulnerable pregnant/parenting women who face a host of complex circumstances including substance use, violence, child welfare involvement, and inadequate housing; moreover, it is typically the intersection of these issues that prompts women to engage with programs. Aligning with these results, key themes in what clients liked best about their program were: staff and their non-judgmental approach; peer support and sense of community; and having multiple services in one location, including help with mandated child protection.

Levels and predictors of participation in integrated treatment programs for pregnant and parenting women with problematic substance use.

BACKGROUND: Women who are seeking services for problematic substance use are often also balancing responsibilities of motherhood. Integrated treatment programs were developed to address the diverse needs of women, by offering a holistic and comprehensive mix of services that are trauma- and violence-informed, and focus on maternal and child health promotion and the development of healthy relationships. METHODS: Using system-level administrative data from a suite of outpatient integrated programs in Ontario, Canada, we described the clients and rates and predictors of treatment participation over a 7-year period (2008-2014; N = 5162). RESULTS: All participants were either pregnant or parenting children under 6 years old at admission to treatment. Retention (length of time between the first and last visit) averaged 124.9 days (SD = 185.6), with episodes consisting of 14.6 visits (SD = 28.6). The vast majority of women attended more than one visit (87.2%), typically returning within 2 weeks (mean 12.3 days, SD = 11.1). In addition to being pregnant or new mothers experiencing problematic substance use, most were unemployed, on social assistance, and single. CONCLUSIONS: Programs appeared to be able to successfully engage most women in treatment once they accessed the programs. Although rates of treatment participation did vary across subgroups defined by sociodemographic and admission characteristics, effect sizes tended to be small on average, providing little evidence in general of sociodemographic inequities in participation. Further work is needed to study the influence of program-level factors on participation, and how these link to maternal and child outcomes.

Integrated sexual healthcare: the development and review of one model of service delivery.

Sexual health is topical with many factors impacting upon its concept and hence provision. In 1995 the Sexual Health Service in East Berkshire was formed by the integration of the clinical services of Family Planning, Genitourinary and HIV Medicine with Sexual Health Promotion. The philosophy of the service is to provide holistic sexual healthcare in one visit, on one site by one clinical team. This article outlines the practical developments and the strengths and weaknesses of this model of service.

PIP: In 1995, the Sexual Health Service in East Berkshire, UK, was formed by the integration of the clinical services of Family Planning, Genitourinary, and HIV Medicine with Sexual Health Promotion. The philosophy of the service was to provide holistic sexual health care in one visit, in one site, by one clinical team. In an outline of the practical developments and the strengths and weaknesses of such a model of service, the critical success factors in the process of developing the service were identified. These include the business case, changing the culture, training, common conditions of service, consumer view, and engineering the patient process. Moreover, the strengths and weaknesses of the model were considered from the viewpoint of the patient, the staff, the public health, and finance. It is noted that the concept of patient-focused care, where related services are brought to the patient, instead of the traditional model of making the patient do the work, has demonstrable effect.

Implementing the integration of component services for reproductive health.

In the wake of the 1994 International Conference on Population and Development in Cairo, considerable activity has occurred both in national policymaking for reproductive health and in research on the implementation of the Cairo Program of Action. This report considers how effectively a key component of the Cairo agenda--integration of the management of sexually transmitted infections, including human immunodeficiency virus, with maternal and child health-family planning services--has been implemented. Quantitative and qualitative data are used to illuminate the difficulties faced by implementers of reproductive health programs in Ghana, Kenya, South Africa, and Zambia. In these countries, clear evidence is found of a critical need to reexamine the continuing focus on family planning services and the nature of the processes by which managers implement reproductive health policies. Implications of findings for policy and program direction are discussed.

Integration of prevention and care of sexually transmitted infections with family planning services: what is the evidence for public health benefits?

It has been widely believed that, by combining the services for preventing and treating sexually transmitted infections (STI) with those for family planning (FP), STI coverage would increase and the combined service would be of higher quality and more responsive to the needs of women. So far, there is little concrete evidence that integration has had such an impact. Besides the absence of documentation, a clear definition of integration is lacking. We therefore carried out a comprehensive review of concrete experiences with integrated services, and present a summary of our findings in this article. The results indicate that the tasks of STI prevention, such as education for risk reduction and counselling, have been integrated into family planning services much more frequently than the tasks of STI diagnosis and treatment. Some STI/FP integration efforts appear to have been beneficial, for instance when the integration of STI/HIV prevention had a positive impact on client satisfaction, and on the acceptance of family planning. Less clear is whether STI prevention, when concentrated among traditional FP clients, is having a positive impact on STI risk behaviours or condom use. A few projects have reported increases in STI caseloads following integration. In some projects, FP providers were trained in STI case management, but few clients were subsequently treated.

Management of childhood illness in Africa. Early evaluations show promising results.

PIP: This article reports the positive evaluation results of the integrated management of childhood illness (IMCI) strategy for the last 3 years of operation in 28 countries in Africa. The strategy aimed to improve case management skills of health workers through training with locally adapted guidelines such as the use of clinical algorithms to detect the most common causes of childhood illnesses. In addition, the strategy was designed to improve the health system of the region, including the provision of essential drugs. A final component of the program seeks to optimize family and community practices in relation to child health, particularly care seeking behavior. Overall, the benefits include more rational drug use, increased attendance, improved provider morale, and improved perceptions of quality of care by mothers. Although its initial effects are rather small, it should be recognized that the proper implementation of IMCI should contribute to a steady reduction in childhood mortality in Africa.^ieng

Evaluation team assesses China IP.

PIP: JOICFP has implemented the Integrated Project (IP) in Qionghai City of Hainan Province and Dali County of Shaanxi Province, promoting integrated family planning (FP) and reproductive health activities with health education services. Baseline surveys were conducted in the 1st year and an evaluation survey in the 5th year. In the evaluation survey, the team observed the project activities at the city/county, town/township, and village levels such as FP service stations, primary schools, village clinics and farmers' houses. After observing the IP, the team found that sanitation and women's and children's health had greatly improved through health education and services, by using parasite control activities as a springboard for the promotion of various health activities. Furthermore, birth rates had greatly decreased. Most people in project areas revealed that they felt friendlier to FP workers, and had received benefits for their health and life by IP activities. The team recommended that the project should continue in the project areas and spread to other areas with sustainable development by their own self-efforts without external assistance, by means of appropriate fee-charging systems.^ieng

Impact of technology on women: strategies for non-formal education.

PIP: This article focuses on the impact of technology on women and its implications for nonformal education in developing countries. It describes how poverty and illiteracy created a distinctive gender bias in terms of women's participation in the labor force and health. Compared to men, women have lower levels of literacy, are poorer, and have more limited access to nontraditional skills. Moreover, illiteracy is associated with socioeconomic exploitation and deprivation suffered by women. It is therefore essential to identify how functional nonformal education (NFE) can help change the lives of women. To define, NFE is an integrated approach to education and training outside the formal system. It includes literacy, skills development, collaborative group activities, information, and training on issues of everyday life and work for improved health, status, and sustainable economic development. Following a discussion of the external factors that influence technology, the paper will focus on access to use of technology in two areas, namely, health and work opportunities, with emphasis on environment in both areas. It also outlines the role and responsibilities of NFE actors, the necessary infrastructures, and the barriers faced by women. Finally, the paper sets out the objectives of NFE programs, factors that determine the use of technology, strategies for NFE, and the challenges ahead.^ieng

China IP expanding with self-sufficiency.

PIP: This article reports the proceedings of the two National Workshops on the Integrated Project (IP), held in two cities in China. These workshops were organized by the National Steering Committee (NSC) of the Integrated Family Planning Project in China. About 70 representatives, project personnel from the first to the fourth cycle project areas, attended the Taicang workshop, while about 60 representatives from the fifth and sixth cycle project areas attended the Pingyao workshop. Workshop agendas included reports from the NSC, lectures by experts on new developments of reproductive health, summary report of the evaluation for the fifth cycle project, and presentation and discussion on selected project areas. The participants from each workshop took part in field trips to Taicang and Pingyao followed by discussions summarizing the trips. Overall, it is noted that pilot IP projects must not be conducted only within the pilot county, but also outside, as a model projects with appropriate directions and strategies.^ieng

Treatment in Kenyan rural health facilities: projected drug costs using the WHO-UNICEF integrated management of childhood illness (IMCI) guidelines.

Guidelines for the integrated management of childhood illness (IMCI) in peripheral health facilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death. To evaluate the impact of the guidelines on treatment costs, we compared the cost of drugs actually prescribed to a sample of 747 sick children aged 2-59 months in rural health facilities in western Kenya with the cost of drugs had the children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$). Antibiotics were the most costly component, with phenoxymethylpenicillin syrup accounting for 59% of the cost of all the drugs prescribed. Of the 295 prescriptions for phenoxymethylpenicillin syrup, 223 (76%) were for treatment of colds or cough. The cost of drugs that would have been prescribed had the same children been managed with the IMCI guidelines ranged from US$ 0.16 per patient (based on a formulary of larger-dose tablets and a home remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Kenyan or in the IMCI guidelines. Compliance with existing treatment guidelines for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to treat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used.

PIP: This study evaluated the impact of the integrated management guidelines of childhood illness (IMCI) developed by the WHO and UN Children's Fund on the treatment cost in Kenya. To determine the impact of the guidelines, a comparison was made of the cost of drugs actually prescribed to 747 sick children aged 2-59 months in rural facilities with the treatment cost had the children been managed following the IMCI guidelines. The study found that the estimated cost of drugs required to treat children following the IMCI guidelines was lower than the cost of the drugs actually prescribed in ill children. The average cost of drugs actually prescribed for every sick child was US$0.44. Antibiotics were the most expensive component, with phenoxymethylpenicillin syrup responsible for 59% of the total cost of prescribed drugs. The cost of medications that would have been prescribed had the children been treated using the guidelines ranges from US$0.16 to US$0.39 per patient. Managing cough and colds with antibiotics is not recommended in the IMCI guidelines, thus, compliance to guidelines would have reduced the treatment cost to one half the cost of drugs actually prescribed.

Child health promotion in developing countries: the case for integration of environmental and social interventions?

In spite of improving epidemiological knowledge in relation to child health, the challenge of promoting the survival and quality of life of infants and children in most parts of the developing world remains an abiding public health problem, for both the countries and the international agencies involved. Current infant and child health programmes largely reflect western style medical care, with emphasis placed on reducing mortality, and the preventive aspects confined mainly to immunisation, improved nutrition, provision of micronutrients, promotion of breast-feeding and birth spacing. In contrast, environmental and social factors which underpin the proliferation of disease agents are receiving minimal attention. This paper presents a critical review of current strategies for promoting child health in developing countries, and examines the environmental, social, and political factors that influence child health. Presenting a specific example of infant and childhood diarrhoea, the authors argue that in order for a real reduction in mortality, and improvements in quality of life to be sustained, attention needs to be focused equally on the environmental and social factors that underlie much of the childhood diseases in the developing world. This will involve the adoption of a broader strategy aimed at reducing childhood diarrhoea, using the hazard analysis critical control point (HACCP) system in combination with other methods.

PIP: Promoting the survival and quality of life of infants and children in most parts of the developing world is a public health problem, for both the countries and the international agencies involved. Current infant and child health programs largely reflect western style medical care, with emphasis given to reducing mortality. Programs' preventive aspects are largely limited to immunization, improved nutrition, the provision of micronutrients, and the promotion of breast-feeding and birth spacing. Environmental and social factors which facilitate the spread of disease agents receive only little attention. The authors review current strategies for promoting child health in developing countries, examining the environmental, social, and political factors which influence child health. Citing the specific example of infant and childhood diarrhea, the authors argue that in order for any real reduction in mortality and quality of life to be sustained, attention needs to be focused equally upon the environmental and social factors which underlie much of the childhood diseases in the developing world.

The Women and Infants Demonstration Project: an integrated approach to AIDS prevention and research.

The Women and Infants Demonstration Project is a multisite, behavioral intervention research effort funded by the Centers for Disease Control. The project is evaluating a theory-based, integrated intervention model to increase the use of condoms for prevention of both sexually transmitted diseases (STDs) and unintended pregnancy among women and their partners at risk of infection with HIV. The importance of utilizing carefully targeted, credible and persistent risk reduction interventions to effect lasting behavior change has become evident over the last ten years of the AIDS epidemic. The theory-based intervention components being evaluated in this intervention study involve one-on-one stage-tailored outreach; the development and distribution of community-tailored HIV prevention materials, called role-model stories; and the development of organizational and peer networking, all within a community mobilization framework. This article describes each of the intervention components being evaluated during this 5-year study. Such an intervention effort represents an important contribution in the design of community-level AIDS prevention intervention efforts which support individual-level behavioral changes by women at risk for HIV and other sexually transmitted infections.

PIP: The Women and Infants Demonstration Project is a multi-site, behavioral intervention research effort currently being funded by the US Centers for Disease Control. The project is evaluating a theory-based, integrated intervention model to increase condom use for the prevention of sexually transmitted diseases (STD) and unintended pregnancy among women and their partners at risk of infection with HIV. The theory-based intervention components being evaluated in the study involve one-on-one stage-tailored outreach; the development and distribution of community-tailored HIV prevention materials, known as role model stories; and the development of organizational and peer networking, all within a community mobilization framework. Each of the intervention components being evaluated is described.

Community, cooperation and sustainability in Ghana.

PIP: This article describes the activities and content of the 4th National Conference on the Integrated Project (IP) held in Ghana in 1999. The Conference was sponsored by the Japan International Cooperation Agency (JICA) and JOICFP's International Planned Parenthood Federation. The participants included 40 persons who were managers and field workers from Central and Eastern Regions, local and regional government representatives, nongovernmental organization (NGO) representatives, and JICA and JOICFP staff. Conference participants discussed government and NGO partnerships, reviewed projects, exchanged information and expertise, and made a field trip to the Central Region's IPs. Phase II in the Eastern Region replicated the IP in the Central Region. It was funded by JICA. Experiences were exchanged between the Eastern and Central Regions on how to improve services. It was recommended that the program concentrate on improving community involvement. Support for community involvement must come from local managers and local government. Local government should also provide technical and moral support and resources. Successful programs should also include inter-collaboration between agencies. Planning at the onset of programs should account for sustainability and include government funding and fee charging. During the field trip, participants met and talked with community clinic health staff, field workers, and supervisors of community-based distributors.^ieng

Community-operated RH, the JOICFP approach.

PIP: The JOICFP approach concerning "Community Operated Reproductive Health," is to improve the quality of life of people at the grassroots in the developing countries through the promotion of human-centered reproductive health and family planning (RH/FP). One of the most significant aspects of the program is project sustainability that helps maintain community commitment to and ownership of the RH/FP projects. To ensure the quality of care, data is collected and discussed among community members and the projects are adjusted accordingly. Accessibility, availability, acceptability and affordability of services are emphasized as well as the provision of appropriate information and professional standards of care.^ieng

Guatemala -- strength is NGO cooperation.

PIP: In early 1999, representations of the UN Population Fund, JOICFP, and APROFAM met in Guatemala to monitor progress of an integrated program promoting reproductive health (RH) and family planning (FP) among Mayans in the Department of Solola. The team observed field activities, such as training, and assessed information, education, and communication (IEC) promotion; service delivery; institutional coordination; and adolescent health programs. The program is training traditional birth attendants (TBAs) to provide RH/FP and general medical services. At one site, a TBA acquires counseling for her clients from a physician via the telephone. This activity will be facilitated with the addition of radio receivers. Resources have been maximized by increasing collaboration among the project, the government, and local nongovernmental organizations. Referrals are being facilitated with improved communication tools and provision of a boat and ambulance for transporting clients. Cooperative efforts are also being made to promote community health and development, health education, and adolescent health.^ieng

Chinese IP expands with self-reliance.

PIP: In 1999, program officers from JOICFP visited five of 10 projects where JOICFP has provided direct assistance during 1993-95 to enhance health education in China's integrated family planning, maternal-child health programs. The JOICFP team and three members of the Chinese National Steering Committee of the Integrated Projects visited project areas in remote and mountainous areas that are characterized by underdevelopment, low income rates, low rates of hospital deliveries, and high rates of parasitic infection. The monitoring team found that all project areas continued the projects after completion of the 3-year period and even expanded efforts to cover other areas. By 1998, more than a million people had been served, which is quadruple the initial target number. The team found that the program could benefit from additional assistance in training new staff to interact with the public and to use IEC (information, education, communication) materials appropriately. One project area, Shaowu City, opened a new Family Health Service Center in August 1998 with a grant from the Japanese Grant Assistance for Grassroots Projects and assistance from its provincial and local government. This Center serves women and children and adolescents on a fee-charged basis and hopes to expand its service area.^ieng

Integrated sexual health services: the views of medical professionals.

PIP: This paper describes the findings of the in-depth semi-structured interview of medical professionals on their views on integrated sexual health services. Health professionals working in genitourinary medicine, family planning, and generic sexual health services in UK were selected to represent the views of the clinical staffs in different residential areas and levels of integration. Findings showed that many sexual health professionals had strong positive views of integrating family planning, and genitourinary medicine services. They reported that integration was seen as benefiting clients as well as the staffs in terms of increased opportunities for career development. However, there were reservations expressed concerning the issues relating to professional status, career development, and adequacy of expertise; for example, as in the two specialties of family planning and genitourinary medicine, wherein family planning tends to be preventive and community-based, while the latter is more curative and hospital-based. Negative views are important in signaling perceived obstacles to integration, which should not be construed. Rather, it would allow the move towards integrated services to be guided by and to take account of all the factors likely to influence effectiveness.^ieng