A scoping review of unintended harm associated with public health interventions: towards a typology and an understanding of underlying factors.

OBJECTIVES: Unintended harm theory as related to public health interventions (PHI) is under developed, with harm evaluation and reporting often absent or incomplete. This review presents a typology for, and underlying factors linked to, PHI-associated unintended harm. METHODS: This scoping review was conducted electronically and includes articles from 1992 to June of 2013. Out of 2,490 originally identified titles, 26 full-text articles were included that discussed unintended harm associated with PHI. An iterative data analysis process was utilized to identify both a typology and underlying factors associated with unintended harm. RESULTS: A typology of PHI-associated unintended harm was identified: (1) physical; (2) psychosocial; (3) economic; (4) cultural and (5) environmental. Five underlying factors associated with PHI unintended harm emerged: (1) limited and/or poor quality evidence; (2) prevention of one extreme leads to another (boomerang effects); (3) lack of community engagement; (4) ignoring root causes; and (5) higher-income country PHI implementation in a lower- or middle-income country. CONCLUSIONS: PHI planning and evaluation frameworks may benefit from the consideration and potential incorporation of the unintended harm typology and underlying factors.

Transdisciplinary research for complex One Health issues: a scoping review of key concepts.

In order to address the complexity inherent in researching One Health (OH) issues, we support the concept that researchers must transcend individual disciplinary and non-disciplinary boundaries, and move into the realm of transdisciplinary (TD) research approaches. For the purposes of this paper we use the term OH and the concept that OH research is conducted to solve complex health challenges at the animal-human--human-ecosystem interface. TD goes beyond interdisciplinary research to engages disciplines and communities through a unified conceptual framework. In this scoping review we investigated key concepts, definitions and themes in OH and TD based on the peer reviewed literature. We identified nine emerging themes in TD research: (1) education, (2) conflict amongst disciplines, (3) effective communication, (4) shared conceptual framework, (5) leadership, (6) perceived power differentials, (7) community-based methodologies, (8) support for TD research and (9) time and effort. This review provides a synthesized knowledge base that describes the nature, extent of evidence and challenges of engaging in TD initiatives. This knowledge base further provides a foundation for those interested in developing improved strategies for TD collaborative and cross-sectoral research in OH.

Aerial contamination of fruit through wet deposition and particulate dry deposition.

The current state of knowledge concerning the processes and pathways which lead to the contamination of fruit crops by non-gaseous airborne contaminants is reviewed. Given the wide range of fruit canopies which occur, it is necessary to look for generic factors which affect the contribution of each of these processes and pathways to distribution through the canopy, losses from the canopy back to the atmosphere, and the fate of particle-bound substances once attached to the canopy. This latter stage represents perhaps the greatest source of uncertainty in determining levels of contamination. For wet deposition, the controlling factors appear to be the ability of the canopy surface to store precipitated water, and the interaction of the contaminant species with the leaf cuticle, which appears to act as an ion exchange medium, selectively accumulating certain ionic species. Where possible, models and parameterisations are provided for these stages. A summary is given of current data requirements for those cases where this is not possible.

Quinolone antibiotics in the treatment of Salmonella infections.

The 4-fluoroquinolones are a new class of antimicrobial agents that possess broad in vitro antibacterial activity, including efficacy against enteric pathogens such as Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio species. These drugs are clinically effective against both drug-sensitive and multiresistant strains of Salmonella typhi and Salmonella paratyphi that cause enteric fever. In salmonella enterocolitis, the quinolones--unlike older antimicrobial agents that may have little impact on the duration of symptomatic illness and can in fact prolong fecal carriage of salmonellae--actually shorten the course of clinical disease and terminate excretion of these organisms in the stool. Similarly, for chronic carriers of both typhoidal and nontyphoidal Salmonella strains, the quinolones are effective in eradicating biliary and fecal reservoirs of infection. Immunosuppressed persons with salmonellosis, such as those with AIDS, may benefit from both short-term treatment and prolonged prophylaxis with a quinolone antibiotic. The optimal agent, dose, and duration of quinolone therapy for all salmonella syndromes remain to be determined by larger controlled trials.

Respiration and osmoregulation of the estuarine crab, Rhithropanopeus harrisii (Gould): effects of the herbicide, alachlor.

1. The effects of a sudden decrease in salinity and exposure to sublethal concentrations of the herbicide, alachlor, on osmoregulation and respiration of the crab, Rithropanopeus harrisii, were studied. 2. Crabs were hyperosmotic regulators at salinities below 24 ppt and became hypoosmotic at higher salinities. Upon a salinity decrease from 20 to 1 ppt, crabs adjusted their haemolymph osmolality to a stable hyperosmotic level in 8 hr. Alachlor concentrations to 50 ppm did not affect this adjustment. 3. A salinity decrease from 10 to 0 ppt elevated VO2 and the critical oxygen tension. This response was unaffected by alachlor concentrations as high as 25 ppm.

The relationship between prior clerkship experience and student performance in medicine clerkships. Implications for grading.

The purpose of this study was to examine the relationships between prior clerkship experience and student performance in a third-year medicine clerkship. Trend analysis was used to determine if there was a linear relationship between amount of prior clerkship experience and scores on the following performance measures: subjective preceptor ratings; locally developed examinations; and the National Board of Medical Examiners (NBME) Special Examination in Medicine. Results indicated a positive linear relationship between amount of prior experience and the NBME Special Examination in Medicine, but no trends were found for the other performance measures. The effect was found to be a short-term phenomenon, in that no sequencing effect was evident from 1 to 2 years later, as indicated by scores on the Medicine subtest of NBME II. Implications for grading are discussed.

The effectiveness of progressive relaxation in chronic hemodialysis patients.

An experimental group of 38 patients on chronic hemodialysis were presented a 30-min, self-instructional, color videotape on progressive relaxation (PR) exercises; and a control group of 23 patients viewed a neutral videotape. Both groups were given the State-Trait Anxiety Inventory while on the dialysis machine, before and after the actual viewing. The experimental group significantly reduced its state anxiety level while the control group remained the same. Patients who reported higher levels of state anxiety and experienced tension more frequently tended to achieve the greater benefit from the program. It is postulated that PR can be a useful resource to overcome the sometimes severe anxiety related to the stresses of chronic hemodialysis.

Impact of a colposcopy satellite clinic.

A community educational program and the introduction of a colposcope in Decatur, Alabama, led to a dramatic decrease in the relative percent of patients evaluated by conization after a positive Pap smear, and a corresponding increase in the relative percent of colposcopic evaluations. The percent of negative or dysplastic tissue diagnoses from conization was reduced from 78% before the colposcopy program to 61% after the program. It was estimated that the colposcopy program resulted in an 81% reduction in the number of conizations and that colposcopy used in lieu of conization resulted in a substantial reduction in both morbidity and cost.

The effects of commercial coaching or the NBME Part I Examination.

A total of 55 second-year medical students from the University of Alabama in Birmingham utilized the services of a commercial test-coaching company to assist them in preparations for the June 1977, 1978, and 1979 National Board of Medical Examiners Part I examination. These students scored significantly higher on the examination than students with comparable basic science grade-point averages. Students were surveyed to determine the nature of the course and to identify the salient points which they believed contributed to higher Part I scores. The study raises questions concerning the impact of commercial coaching on the licensure process for both domestic students and students of foreign medical schools entering the U.S. medical profession.

Attitude change in a human sexuality course that de-emphasizes small group activities.

The attitudes of second-year medical students were measured to determine if positive attitude changes could be obtained in a human sexuality course that de-emphasized small group activities. Students were given a semantic differential instrument and were asked to rate four concepts related to human sexuality: (a) my sexuality, (b) masturbation, (c) homosexuality, and (d) my role in understanding sexual problems. Significant changes in student attitudes were reported at the 0x05 level for the concept, my sexuality; at the 0x01 level for the concept, my role in understanding sexual problems; and at the 0x001 level for the concepts, homosexuality and masturbation. Females had more positive attitudes (P < 0x001), pre and post, towards homosexuality than did males. No significant differences were found between married and single students.

An evaluation of the effectiveness of audio cassettes for CME.

Medical teachers and practising doctors were surveyed by questionnaire and given pre- and post-tests to determine the efficiency and effectiveness of Practical Reviews in Cancer Management, a cassette tape programme of continuing medical education (CME). Doctors indicated a high degree of satisfaction with this approach; in particular the idea of keeping abreast of the current literature while commuting in their cars was appealing. The programme's effectiveness was measured by pre- and post-tests, and the data were analysed by the non-directional t-test for dependent groups. These tests indicated a significant (P less than 0.001) increase in knowledge from the pre- to post-tests.