Health outcomes of crisis driven urban displacement: A conceptual framework
2015; 2 (2): 92-96
Microfinance: Untapped Potential for Global Health
JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED
2014; 25 (4): 1718-1722
The need for data in the world's most violent country
BULLETIN OF THE WORLD HEALTH ORGANIZATION
2014; 92 (10): 698-698
The high cost of diarrhoeal illness for urban slum households-a cost-recovery approach: a cohort study
2013; 3 (4)
Microfinance has recently come under criticism for not meeting its potential for poverty reduction and its exploitation by for-profit entities. Access to finance still remains limited for many of the world’s poor. This re-examination of microfinance should not impede its proliferation and development into a tool to improve health for the underserved. There are significant returns on microfinance investments in health at the household level. Microfinance that allows the consumption of goods and services that can improve health can also lead to increased savings and productivity making it a financially viable and powerful tool for both health improvement and development.
View details for Web of Science ID 000345732200019
View details for PubMedID 25418237
Rapid urbanization and the growing threat of violence and conflict: a 21st century crisis.
Prehospital and disaster medicine
2012; 27 (2): 194-197
Rapid urbanisation has often meant that public infrastructure has not kept pace with growth leading to urban slums with poor access to water and sanitation and high rates of diarrhoea with greater household costs due to illness. This study sought to determine the monetary cost of diarrhoea to urban slum households in Kaula Bandar slum in Mumbai, India. The study also tested the hypotheses that the cost of water and sanitation infrastructure may be surpassed by the cumulative costs of diarrhoea for households in an urban slum community.A cohort study using a baseline survey of a random sample followed by a systematic longitudinal household survey. The baseline survey was administered to a random sample of households. The systematic longitudinal survey was administered to every available household in the community with a case of diarrhoea for a period of 5 weeks.Every household in Kaula Bandar was approached for the longitudinal survey and all available and consenting adults were included.The direct cost of medical care for having at least one person in the household with diarrhoea was 205 rupees. Other direct costs brought total expenses to 291 rupees. Adding an average loss of 55 rupees per household from lost wages and monetising lost productivity from homemakers gave a total loss of 409 rupees per household. During the 5-week study period, this community lost an estimated 163 600 rupees or 3635 US dollars due to diarrhoeal illness.The lack of basic water and sanitation infrastructure is expensive for urban slum households in this community. Financing approaches that transfer that cost to infrastructure development to prevent illness may be feasible. These findings along with the myriad of unmeasured benefits of preventing diarrhoeal illness add to pressing arguments for investment in basic water and sanitation infrastructure.
View details for DOI 10.1136/bmjopen-2012-002251
View details for Web of Science ID 000329809200010
View details for PubMedID 23558731
Urbanization and Humanitarian Access Working Group: toward guidelines for humanitarian standards and operations in urban settings.
Prehospital and disaster medicine
2011; 26 (6): 464-469
Urbanization and Humanitarian Access Working Group: a blueprint for the development of prevention and preparedness indicators for urban humanitarian crises.
Prehospital and disaster medicine
2011; 26 (6): 460-463
The depressed patient and suicidal patient in the emergency department: evidence-based management and treatment strategies.
Emergency medicine practice
2011; 13 (9): 1-23
As the global population is concentrated into complex environments, rapid urbanization increases the threat of conflict and insecurity. Many fast-growing cities create conditions of significant disparities in standards of living, which set up a natural environment for conflict over resources. As urban slums become a haven for criminal elements, youth gangs, and the arms trade, they also create insecurity for much of the population. Specific populations, such as women, migrants, and refugees, bear the brunt of this lack of security, with significant impacts on their livelihoods, health, and access to basic services. This lack of security and violence also has great costs to the general population, both economic and social. Cities have increasingly become the battlefield of recent conflicts as they serve as the seats of power and gateways to resources. International agencies, non-governmental organizations, and policy-makers must act to stem this tide of growing urban insecurity. Protecting urban populations and preventing future conflict will require better urban planning, investment in livelihood programs for youth, cooperation with local communities, enhanced policing, and strengthening the capacity of judicial systems.
View details for DOI 10.1017/S1049023X12000568
View details for PubMedID 22591767
Human trafficking in the emergency department.
The western journal of emergency medicine
2010; 11 (5): 402-404
There are approximately 12 million emergency department (ED) visits related to mental health/substance abuse annually. Approximately 650,000 patients are evaluated annually for suicide attempts. Evidence to guide the management and treatment of depression and suicidal ideation in the ED is limited. A large variation exists in the quality of care provided due to the lack of standardized guidelines aiding emergency clinicians. Depression ften manifests as unexplained somatic complaints, adding to the challenge of making this diagnosis in the ED. Recognition of depression by emergency clinicians has proved poor. Suicide is associated with multiple risk factors, of which a prior history of suicide attempts is the single strongest predictor. A systematic approach is required in the ED to identify patients with or at risk of having depression, and screening tools may offer utility to identify high-risk patients.
View details for PubMedID 22164363
Improved health outcomes in urban slums through infrastructure upgrading
SOCIAL SCIENCE & MEDICINE
2010; 71 (5): 935-940
Human trafficking continues to persist, affecting up to 200 million people worldwide. As clinicians in emergency departments commonly encounter victims of intimate partner violence, some of these encounters will be with trafficking victims. These encounters provide a rare opportunity for healthcare providers to intervene and help. This case report of a human trafficking patient from a teaching hospital illustrates the complexity in identifying these victims. Clinicians can better identify potential trafficking cases by increasing their awareness of this phenomenon, using qualified interpreters, isolating potential victims by providing privacy and using simple clear reassuring statements ensuring security. A multidisciplinary approach can then be mobilized to help these patients.
View details for PubMedID 21293753
Urbanization--an emerging humanitarian disaster.
New England journal of medicine
2009; 361 (8): 741-743
The effects of ambulance diversion: A comprehensive review
ACADEMIC EMERGENCY MEDICINE
2006; 13 (11): 1220-1227
The world is rapidly urbanizing with over half the population now living in urban areas. As the urban population grows, so does the proportion of these persons living in slums where conditions are deplorable. These conditions concentrate health hazards leading to higher rates of morbidity and mortality. This growing problem creates a unique challenge for policymakers and public health practitioners. While the Millennium Development Goals (MDGs) aim to address these conditions and standards for water and sanitation as well as pertinent health outcomes, little evidence on interventions exists to guide policymakers. Upgrades in slum household water and sanitation systems have not yet been rigorously evaluated to demonstrate whether there is a direct link to improved health outcomes. This study aims to show that slum upgrading as carried out in Ahmedabad, India, led to a significant decline in waterborne illness incidence. We employ a quasi-experimental regression model using health insurance claims (for 2001-2008) as a proxy for passive surveillance of disease incidence. We found that slum upgrading reduced a claimant's likelihood of claiming for waterborne illness from 32% to 14% and from 25% to 10% excluding mosquito-related illnesses. This study shows that upgrades in slum household infrastructure can lead to improved health outcomes and help achieve the MDGs. It also provides guidance on how upgrading in this context using microfinance and a public-private partnership can provide an avenue to affect positive change.
View details for DOI 10.1016/j.socscimed.2010.05.037
View details for Web of Science ID 000280949400013
View details for PubMedID 20599311
Vasopressin-induced neurotrophism in cultured neurons of the cerebral cortex: Dependency on calcium signaling and protein kinase C activity
2000; 101 (1): 19-26
To review the current literature on the effects of ambulance diversion (AD).The authors performed a systematic review of AD and its effects. PubMed, EMBASE, the Cochrane database, societal meeting abstracts, and references from relevant articles were searched. All articles were screened for relevance to AD.The authors examined 600 citations and reviewed the 107 articles relevant to AD. AD is a common occurrence that is increasing in frequency. AD is associated with periods of emergency department (ED) crowding (Mondays, mid-afternoon to early evening, influenza season, and when hospitals are at capacity). Interventions that redesign the AD process or that provide additional hospital or ED resources reduce diversion frequency. AD is associated with increased patient transport times and time to thrombolytics but not with mortality. AD is associated with loss of estimated hospital revenues. Short of anecdotal or case reports, no studies measured the effect of AD on ED crowding, morbidity, patient and provider satisfaction, or EMS resource utilization.Despite its common use, there is a relative paucity of studies on the effects of AD. Further research into these effects should be performed so that we may understand the role of AD in the health system.
View details for DOI 10.1197/j.aem.2006.05.024
View details for Web of Science ID 000241978400026
View details for PubMedID 16946281
Neuronal process outgrowth has been postulated to be one of the fundamental steps involved in neuronal development. To test whether vasopressin can influence neuronal development by acting on the outgrowth of neuronal processes, we determined the neurotrophic action of the memory-enhancing peptide, vasopressin, in neurons derived from the cerebral cortex, a site of integrative cognitive function and long-term memory. Exposure to V(1) receptor agonist significantly increased multiple features of nerve cell morphology, including neurite length, number of branches, branch length, number of branch bifurcation points and number of microspikes. The dose-response profile of V(1) receptor agonist-induced neurotrophism exhibited a biphasic function, with lower concentrations inducing a significant increase while higher concentrations generally induced no significant effect. The neurotrophic effect of V(1) receptor activation did not require growth factors present in serum. Analysis of the regional selectivity of the vasopressin-induced neurotrophic effect revealed significant V(1) receptor agonist-induced neurotrophism in occipital and parietal neurons, whereas frontal and temporal neurons were unresponsive. Results of experiments to determine the mechanism of vasopressin-induced neurotrophism demonstrated that vasopressin-induced neurotrophism is dependent on V(1)a receptor activation, requires L-type calcium channel activation and activation of both pathways of the phosphatidylinositol signaling cascade, inositol trisphosphate and protein kinase C. These studies are the first to describe a functional cellular response for vasopressin in the cerebral cortex. The findings are discussed with respect to their implications for understanding the role of vasopressin-induced neurotrophism, the associated signaling pathways required for this response, and the ability of vasopressin to enhance memory function.
View details for Web of Science ID 000165265200004
View details for PubMedID 11068133