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Health o Meter Physician Balance Beam Scale

pbr_201 — Wed, 10 Mar 2010 23:35:17 +0000

Scale is just like the one you’d find in your doctor’s office
Heavy gauge steel base and platform for professional accuracy
Silent slide height rod measures from 30-78 inches
Rotating poise bars for dual reading in pounds and kilograms
Accurately measures up to 450 pounds in 0.25-pound increments

Product Description
The 402KL/402KLSB Physician Balance Beam Scale with built in height rod features a large heavy-duty steel 1/4 lb platform with raised balance beam for increased foot room. With accurate readout and easy weight reading, the weight capacity of the 402KL is 350 lbs with an optional counter weight that can be added to bump it to 450 lbs. The 402KL Physician Balance Beam Scale also features easy to read double beams with slide poises and a 30″-78″ measuring rod to help m… More >>

Health o Meter Physician Balance Beam Scale

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Florida Health Insurance Rate Hikes and Quotes

pbr_201 — Wed, 10 Mar 2010 11:19:03 +0000

Florida Health Insurance Rate Hike

Florida Health insurance premiums have touched new heights! Every Floridian has the common knowledge that most annual health insurance contracts will endure a rate increase at the end of the year. This trend is not new and should be expected. Every time this issue pops up it seems as though the blame game starts. Floridians blame Health insurance companies; Health insurance companies blame Hospitals, Doctors and other medical care providers, Medical care providers blame inflation and politicians, well, we really don’t know what they do to help the issue… No one seems to be interested in finding the real cause of the health insurance premium rate increase. Most individuals, self employed, and small business owners have taken Florida Health Insurance Rate Hikes as the inevitable evil.

Hard Facts

What are various reports telling us? Why do Health insurance premium have annual rate increases?

Rate of inflation and heath insurance premium rate increase.

America’s health expenditure in the year 2004 has increased dramatically, it has increased more than three time the inflation rate. In this year the inflation rate was around 2.5% while the national health expenses were around 7.9%. The employer health insurance or group health insurance premium had increased approximately 7.8% in the year 2006, which is almost double the rate of inflation. In short, last year in 2006, the annual premiums of group health plan sponsored by an employer was around $4,250 for a single premium plan, while the average family premium was around $ 11,250 per year. This indicates that in the year 2006 the employer sponsored health insurance premium increased 7.7 percent. Taking the biggest hit were small businesses that had 0-24 employees. There health insurance premiums increased by nearly 10.4%

Employees are also not spared, in the year 2006 the employee also had to pay around $ 3,000 more in their contribution to employer’s sponsored health insurance plan in comparison to the previous year, 2005. Rate hikes have been in existence since the “Florida Health Insurance” plan started. In covering an entire family of four, a person will experience an increase in premium rate at every annual renewal. If they would have kept the record of their health insurance premium payments they will find that they are now paying around $ 1,100 more than they paid in the year 2000 for the same coverage and with the same company. The same item was found by the Health Research Educational Trust and the Kaiser Family Foundation in their survey report of the year 2000. They found out that the premiums of health insurance that is sponsored by the employer increases by around 4 times than the employee’s salary. This report also stated that since 2000 the contribution of employees in group health insurance sponsored by employer was increased by more than 143 percent.

One business man predicts that if nothing is done and the Health insurance premiums keep increasing that in the year 2008, the amount of health premium contribution to employer will surpass their profit. Professionals within and outside the field of Florida health insurance, think that the reason for increase in Florida health insurance premium rates are due to many factors, such as high administration expenditure, inflation, poor or bad management, increase in the cost of medical care, waste etc.

Florida health insurance rate hikes affect whom?

Rising rates of Florida health insurance generally affects most of the Floridians who live in our beautiful state. The highest affected individudals are the minimum wage and low wage workers. Recent drops in the renewal of health insurance are mostly from this low income group. They just can’t afford the high premiums of Florida health insurance. They are in the situation where they can not afford the medical care and they can not afford the medical insurance premiums that are assosiated with adequate coverage. Almost half of all Americans are of the opinion that they are more worried about the high health insurance rate and high cost of health care, over any other bill they have on a monthly basis. A survey also finds that around 42% of Americans can not afford the high cost of health care services. There is one very interesting study conducted by Harvard University researchers. They found out that 68% of people who filed bankruptcy covered themselves and their family by health insurance. Average out-of-pocket deductibles for people filed bankruptcy were around $ 12,000 per year. They also found some co-relation between medical expenditure and bankruptcy. A national survey also reports that main reason for people not to take health insurance is the high premium rate of health insurance.

How to reduce Florida’s high health insurance cost? Nobody knows for sure. There are different opinions and experts are not agreeing with each other. Health professionals believe that if we can raise the number of healthy people by improving the lifestyle and regular exercise, good diets etc. than naturally they will need less medical care services which decreases the demands of health care and hence the cost.( This year in Florida the smoking rate has increased by 21.7 percent) One Floridian sarcastically suggested that there are ‘highs’ and ‘lows’ in health care that are needed to reversed. That the state of Florida is to ‘high’ in cost of medical care compare to other States and ‘low’ in the quality of health care.

Florida Health insurance rate hike has attracted many frauds. These frauds float many bogus insurance companies and offer cheap health insurance rate which attract many people to them. These companies usually through assosiations that are based in other states.

Meanwhile reputable Florida health insurance companies provide different types of health insurance like employer sponsored group health insurance, small business health insurance, individual health insurance etc. to vast number of employees and their families. Still there are many people in Florida that lack any health coverage. Today the employer also has found it challenging to decide how to offer employer sponsored group health insurance to their employees, so that both of them arrive at some point of agreement.

For Floridians it is very important to shop around for a quality health insurance program that doesn’t break the bank.

You need to find an agent or web portal like Florida Health Insurance Web, www.FloridaHealthInsuranceWeb.com that offers a variety of products. There you will most likely be able to get quotes, compare plans, and apply online.

Florida Health Insurance Consultants can help you!

Morgan Q. Moran is a licensed insurance agent in the state of Florida and is the managing partner of The Moran Financial Group http://www.floridahealthinsuranceweb.com. His strong background in financial management includes: insurance, annuities, and asset management. He has proven methodologies to help his client with all aspects of financial risk management. Morgan holds a B.S. degree from the University of Vermont in Business Administration with concentrations in both marketing and finance.

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At White House Health Care Summit, Republicans Make It Clear They’re the Party of Ideas

pbr_201 — Wed, 10 Mar 2010 08:04:34 +0000

Republicans laid out their health care reform ideas at the White House Health Care Summit last week, emphasizing the need to abandon comprehensive legislation which Congress doesn’t do very well and instead move step-by-step in the right direction toward lowering health care costs without driving the country ever deeper into debt.

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At White House Health Care Summit, Republicans Make It Clear They’re the Party of Ideas

pbr_201 — Wed, 10 Mar 2010 08:04:34 +0000

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At White House Health Care Summit, Republicans Make It Clear They’re the Party of Ideas

pbr_201 — Wed, 10 Mar 2010 08:04:34 +0000

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Beliefs and Practices in Women Health

pbr_201 — Tue, 09 Mar 2010 23:20:54 +0000

Beliefs and Practices in Women Health

• Ramaiah Bheenaveni *

Rural women’s health is an infinitely broad topic. Many Indian women have come from circumstances in which women have limited access to healthcare. Traditionally, there has been discrimination towards women in decision-making; access to resources such as food, education and health care; job opportunities; and in child-rearing and parenting. However, women’s health in rural areas affects everything in their environment from their families to their economies and vice versa. A woman’s health, especially among the poor and illiterate, is often neglected not just by her family but by the woman herself. She is taught not to complain and if she does then she is directed either to use condiments in the kitchen or try faith healing.

Man is unique in that he has a distinct cultural environment of his own. This includes all the conditions in which men are born, brought up, live, work, procreate and perish. Culture as an environment is deeply related to the health of humans. It includes patterns of social organizations designed to regulate a particular society; one can understand the behaviour of people belonging to various sections and predict how an individual of a particular section will react in a given situation. With our knowledge of health, the treatment of diseases among ignorant peoples appears to be strange since they frequently follow practices of praying, wearing of amulets or consulting an exorcist who recites certain verbal formula. Hence, we can say that beliefs and cultural practices are predominately playing significant roles in the human health more peculiarly in the health of women.

Many rural people did not know about the services set up for them at sub-centres and PHC by the government because they did not see any evidence of these services being provided for them. As a part of the awareness programmes, the health workers (ANM) have been organizing to several exposure trips at the villages. It was there that the women were informed about the specifics of various services supposed to be made available to them. This encouraged some of them to ask questions and report on the situation in their PHC. They explained that though a nurse did visit their village it was not a daily visit, nor did she go beyond a certain point in the village, and certainly did not take a round of the village. They made a show of doing their duty by providing nominal services.

A variety of factors, including an older population, a limited supply of health care providers, and further distances from health care resources may contribute to special health concerns for people in non-metropolitan areas. Access to health care and social services are critical issues for rural women.

Belief is the psychological state in which an individual is convinced of the truth of a proposition. Like the related concepts truth, knowledge, and wisdom, there is no precise definition of belief on which scholars agree, but rather numerous theories and continued debate about the nature of belief 1.

The cultural phenomenon of social organization, according to Giger and Davidhizar (2004), includes groups in the social environment that influence cultural development and identification. The family, an important aspect of the social organization phenomenon, strongly influences cultural behavior through a process of socialization or enculturation of children and group members (Giger & Davidhizar; Niska, 1999). These learned cultural behaviors guide individuals through life situations, events and health practices. Understanding family from a cultural perspective is a significant element in providing nursing care to Mexican-Americans since Giger and Davidhizar identify the family as being most values in this culture.

Environmental control is defined by Giger and Davidhizar (2004) as the ability of persons within a particular cultural heritage to plan activities that control their environment as well as their perception of one’s ability to direct factors in the environment. Kuipers’ (1999) discussion of this model, in relation to Mexican-American culture, emphasized the construct of environmental control with a focus on locus-of-control, health beliefs, and folk medicine. Locus-of-control explains the way in which individuals, within their cultural environment, perceive their ability to control what happens to them and to their health. Health may be viewed as being dependent on outside forces or their own actions (Bundek et al., 1993). Beliefs about health and illness, which are components of environmental control, affect health practices, use of health resources, and a person’s response to experiences of both health and illness (Giger & Davidhizer, 2004; Northam, 1996). A third component of environmental control, folk medicine, includes alternative therapies such as using herbs and teas or visiting a cultural folk healer.

Objectives:

1. Exploration of women beliefs on health, risk and their relationship to lifestyles;

2. Elicitation of their views across a range of health-related behaviours and practices, especially puberty, menstruation, pregnancy and child rearing, and assessment of the potential for the positive promotion of women health in these and other areas of her sexual health.

3. Identification of the sources of information and influences on the development of health beliefs amongst women, particularly with respect to common elements in attitudes to risk-taking across a number of health beliefs and practices.

4. To focus on what women themselves know and want to know, including the salience of health, and the relevance of health-related knowledge in their lives

Hypothesis:

1. There is a positive relationship between social beliefs and cultural practices of a given society

2. Positive relationship may be observed among the social beliefs and cultural practices and various other factors such as caste, religion, social and traditional customs in society

3. The explanation for the persistence of belief systems is that people remain committed to them, but for this commitment to last long, the belief system must be validated

Research Design:

A quantitative and qualitative study, building on our previous work in this area, concerning the knowledge, attitudes, beliefs and practices of female children and young women to health, risk and lifestyles. A guiding methodological principle underpinning the study was the development of a sensitive research design for rather than on women: a study grounded not simply in what women know or need to know, but also in what they want to know and feel to be important in the context of their everyday lives. The methods enabling these principles to be taken forward are described below.

a) Area of the Study:

The Telangana region of Andhra Pradesh consists of ten districts namely Hyderabad, Ranagareddy, Mahabubnagar, Medak, Adilabad, Nizamabad, Karimnagar, Warangal, Nalgonda, and Khammam. From this region, the village Ramchandrapur in Koheda Mandal of Karimnagar district has been randomly selected as an area of the study.

b) Universe & Sampling:

According to 2001 census, the village Ramchandrapur has an approximate population of 1840 who from nearly 550 families. This village has a primary health centre (PHC), but lacks a major hospital within a range of 35 kms. And this village has been selected as universe for this study.

So for this study, the researcher adopted stratified-proportionate random method of sampling based on caste composition of the villagers and selected the respondents from the families mentioned in the habitation list of Ramchandrapur. This village population data was collected from Supraja Seva Samithi, a voluntary organization, which is working in the region for the last 10 years in the fields of health, education and environmental protection. The list consists of various caste grouping and from which proportionate stratified samples were selected. Then a list of about 181 respondents was prepared for data collection. Therefore, it is obvious that an attempt has been made to present a general picture of community data and on the basis of which, views and attitudes of the respondents were taken into consideration.

C) Tools of Data Collection:

As the research is qualitative and quantitative, non-participant observation and interview schedule was adopted for the collection of primary data. The aspects that will cover in the interview schedule were defined under two parts, one is for socio-economic and cultural status of respondents such as name, sex, age, social status, education, religion, income, nature and type of the house, etc. and the other for socio-cultural beliefs and practice patterns in health and the related treatment of the villagers.

D) Analysis and interpretation of data:

After arranging the collected data through tabulation and classification, they were analyzed and interpreted in the socio-cultural context so as to give a scientific basis to the study. Although statistical methods like frequencies, percentages, means, standard deviations, t-test, chi-squire and ANOVA have been used in the study, they were applied in a relevant way.

Findings:

Socio-Economic Profile:

During the field work, observed that 22 castes were appeared and most of the respondent belongs to the BC castes like Yadava, Gouda, Munnuru Kapu, Vishwa Brahmin, Mudiraj and a insignificant number of people belongs to services caste like Mangali, Chakali, Mera and so on. A considerable amount of people belongs to SC community i.e. Mala and Madigas. Only a few respondents belong to ST (Erukala) community. Out of the 181 respondents, 55 percent are male and 45 percent female,. This research is carried out with almost all the equal four fold age groups of respondents. Thus, it is noted that age group is scattered in this study. More number of respondents i.e. 91% belongs to Hindu religion and 5% are Muslim. Nearly 4% of the respondents belong to Christianity. It is also proved that common phenomena of religion composition in India.

In this village, a majority of the respondents i.e. 82 (45%) are illiterates. The next more number of respondents have studied up to primary and secondary level i.e. 24 (13%). There are 21 (12%) of the respondents can read and write. A significant number of respondents i.e. 18 (10%) claimed to have studied up to college level while the small number of people who have studied up to professional level, technical level and others stands at 7 (4%), 3 (2%) and 2 (1%) respectively. The findings reveal that more number of the respondents i.e. 55 (30.4%) are labourers and one-fourths of the respondents i.e. 45 (24.9%) are engaging in the farming. On the whole 38(21%) are continuing their caste occupation while 20 (11%) and 17 (9.4%) respondents are doing other occupation and brought up into the service sector respectively. Only a few of the respondents i.e. 6 (3.3%) are carrying out business.

It is also noted that a majority of the respondents i.e. 84.21% are living under the tiled houses and a significant number of the respondents i.e. 15.79% posses R.C.C houses. A substantial number of the BC community respondents i.e. 75% owned the tiled house and rest of them i.e. 14.29% have R.C.C. houses and 8.04% own asbestos roofed houses. Most of the SC respondents i.e. 91.49% are residing under the tiled houses while only 8.51% consist R.C.C. houses. Among the ST respondents, 33.33% have R.C.C., tiled house and thatched house equally. Regarding the income, less than 24% of the respondents earn Rs. 1501 – 2000 per month. Almost equal number i.e. 22.7 and 21.5 % of the respondents earn below Rs. 500 and between Rs. 1001 and 1500 respectively. A significant number of respondents i.e. 20 % obtaining monthly income is in the range of Rs. 501 – 1000 while only 12.7% claimed their income was over Rs. 2000.

This village consist very good fertile lands, There is just below half of the respondents i.e. 84 (46.4%) have not possess any land on their own. There are 35 (19.3%) of the respondents possess land between 1- 2.19 acres. A significant number of respondents i.e. 28 (15.5%) and 20 (11.04%) are having land between 2.20 – 4.39 acres and 5 – 9.39 acres respectively. A considerable number of respondents i.e. 14 (7.7%) are owned land 10 and above acres.

Social Dogmatism on Menstruation

Patriarchal societies have tended to control women by first announcing menarche (the onset of menstrual cycle in a young girl) to the world in an apparently celebratory fashion while thereafter attempting to control the implied fertility and sexual power by monthly rites of pollution, restriction and isolation of the menstruating woman.

The various names for menstruation or ‘periods’ point to its polluting quality. For instance in Telugu, it is called samurta or peddamanshi meaning attaining maturity. Menstrual blood is believed to be polluting. There are varying restrictions put on a girl due to this belief such as not touching people or hanging washed clothes out to dry; not touching certain flowering plants lest they die or not fruit; sleeping on a jute bag or woollen blanket away from others. A woman cannot touch her child during menstruation. If she has to, the child must first be unclothed completely or made to wear silken clothes. Visiting or touching images of gods, temples, religious scriptures is also prohibited. A fear is inculcated in the adolescent that she will sin if she breaks these taboos. Restrictions are also placed on diet. These pollution taboos result in many women getting an enforced rest for at least these three days of the month since they are barred from carrying out their normal activities.

Not only is menstrual blood supposed to be dirty, but evil too. A menstruating girl should not let her shadow fall on a child with measles lest the child turn blind. The used menstrual cloth also possesses an evil quality. If men see the cloth, dry or otherwise, they could go blind. If a cow were to swallow the cloth she would curse the girl with infertility. In villages in A.P., women do not throw their menstrual cloth-they either burn it or bury it.

There seem to be some similarities between Hindus and Muslims regarding the practice of some of these rituals. Among Muslims, the menstruating woman should not touch holy books lest they become impure. Converted Christians follow, although to a lesser degree, the rituals of their original castes. The taboos and rituals clearly devalue. Women’s reproductive powers. The notion of women being polluted and unclean can be ascribed to patriarchal control of women’s reproductive powers. While the woman fulfils a vital social role of giving birth to progeny through her biological reproductive capacity, she is, at the same time, isolated during menstruation.

Cultural Practices of Puberty

Most women do not know about the physiology of menstruation and therefore the first experience of menstruation is filled with fear, shame and disgust. In some areas such as in rural areas of A.P. the girl is sometimes told to dub three or four dots of menstrual blood or mustard oil on the wall and draw a line between the second and third or third and fourth; it is believed that she will finish her menstruation within two and a half or three and a half days in all subsequent periods.

Elaborate rituals are performed in south Indian states-as well as in many parts of north India-at the onset of menstruation. The onset of puberty is traditionally viewed in terms of the girl’s emergent sexuality and prospective motherhood. The pubescent girl is given an elaborate ritual bath, after a massage with turmeric and vermillion. The Mudiraj communities in A.P. isolate the pubescent girl for 21 days within the house, away from the male gaze. The room in which she is secluded is separated with an iron rod and a fire is kept constantly burning during this period. Fire signifies purity and also keeps away daiyyam or witches and evil spirits. The girl is polluted and hence prohibited from touching people and other people are not allowed to touch her. In case of default, a bath is essential for ritual purification.

The Impact of the Food Habits on Women Health:

Although women are more or less marginalized and neglected in relation to the quality and quantity of food, certain occasions in a woman’s life are celebrated with the offering of a variety of nutritious foods specially prepared for her. Almost every community has the practice of feeding a girl on her first menstruation with delicious and nutritive foods, with the time of seclusion for the period ranging between nine to 21 days. In parts of A.P., sweets made of jaggery, groundnuts, sesame, fenugreek, wheat flour and sorgum are given to the girl. Menstruation for the first time in the house of one’s in-laws is also considered very auspicious in all regions of A.P. and is celebrated with gaiety.. The idea seems to be to give the girl ‘rich’, that is, strength-giving foods as well as both ‘hot’ and ‘cold’ foods.

Certain ‘hot’ foods (like jaggery) and ‘cold’ foods (like tamarind and lemons) are taboo as it is believed that the girl will suffer from menstrual pain. ‘Hot’ foods may cause heavy bleeding and ‘cold’ foods may cause severe menstrual pain. Special foods are understood to compensate for the loss of blood, regularise the menstrual cycle and flow, strengthen her reproductive organs and generally contribute to her fertility.

Work Prohibition of Pregnant Women:

It is also observed during the fieldwork that almost all the respondents have revealed that prohibition of work is compulsory while a women pregnancy but this notion is varies to one community to another. The higher social status communities are not allowed to perform the works even domestic works also from the early months to after late months of maternity. Whereas weaker section women perform the daily domestic actives some of them perform field activates but it is only in the early months. They should also take rest in the late months of pregnancy and early months of maternity.

Encourage and Disencourage Food Items During the Pregnancy of Women:

During pregnancy and lactation, many traditional communities across the country restrict a woman’s food intake. It is believed that if a pregnant woman eats too much, the foetus will not have room to move. The abdomen is supposed to contain both the food and the foetus and the latter’s space needs should be given greater priority. Another reason for controlling a pregnant woman’s food consumption is perhaps that excess weight would reduce the productivity of her work in the fields and around the house. A widely prevalent practice all over India is shrimanta. In the seventh month of pregnancy special rituals are performed and different types of sweets are prepared and given to the parents-to-be. The purpose is to give moral support and encouragement to the pregnant woman and celebrate her achievement of having reached near full-term. The sweets are generally made of wheat flour, jaggery, ghee, fenugreek and dry fruits. In the final stages of pregnancy, the pregnant woman is supposed to cat these foods custom every day. This is a good custom because it provides the calories and protein needed for the rapidly growing foetus in the last trimester of pregnancy.

Food Items Encourage % Disencourage %

1.Milk 173 95.5 8 4.4

2.Green leafs 148 81.7 33 18.2

3.Toddy 80 44.1 101 55.8

4.Non-Veg 132 72.9 49 27

5.Papaya — — 181 100

6.Potato 49 27 132 72.9

7.Brinjal 50 27.6 131 72.3

The above table explains the villager’s perceptions on encourage and disencourage food items during the pregnancy of women. The data shows that there are 173 (95.5%) of the respondents have stated that they are encouraging milk and its related food items and only insignificant number of respondents i.e.8 (4.4%) are not encouraging the food items of milk. As many as 148 (81.7%) of them revealed that they are encouraging green leafs and rest of the significant number of respondents i.e. 33 (18.2%) are not interested to give the green leafs to the pregnants. Interestingly the data depicts that more than half of the respondents i.e. 101 (55.8%) have said that they are encouraging toddy and 80 (44.1%) of them are not giving taking toddy. A substantial number of the respondents i.e. 132 (72.9%) have expressed that they are encouraging the consummation of non-vegetarian foods like mutton, chicken and egg. The total number of respondents is practicing the prohibition of papaya consummation during the pregnancy. All most all equal number of respondents i.e. 49 (27%) and 50 (27.6%) have revealed that Potato and Brinjal are encouraged food items and as similar 132 (72.9%) and 131 (72.3%) of them are not encouraging the food items of Potato and Brinjal.

The data regarding Caring of Pregnant Women among the Villagers clarifies the pursuance of the opinion of several communities respondents such as Yadava 14 (7.7%), Gouda 3 (1.7%), Munurukapu 11 (6.1%), Oddera 6 (3.3%), Vishwa Brahmin 5 (2.8%), Mala 25 (13.8%), Madiga 21 (11.6%), Padmashali 7 (3.9%), each 3 (1.7%) of Mangali, Dudekula and Erukala, Kumari 2 (1.1%) and each 1 (0.6%) of Pusala, Mera, Chindi and Dakkali have stated that family and their kins are taking care of their pregnant women. In this category the total numbers of SC and ST communities are appeared because of less financial status and peer group pressure. A majority number of working caste like Yadava, Munnurukapu, Oddera, Padmashali, Dudekula and Kummari are appeared. However, these communities’ people are visiting either government or private hospital for check up their health conditions during early pregnant hood as well as before delivery. One more interesting thing that the caste Mangali itself is traditional birth attendant community in this village so we may consider them in response to this query that they are taking care about pregnant as a traditional birth attendant and as a family. On the whole 3 (1.7 %) of Yadava, 2 (1.1 %) Gouda, 1 (0.6 %) of Munnurukapu and Kummari, 8 (4.4 %) of Chakali, 5 (2.7%) of Dudekula and the total number of Mudiraj 7 (4%) community respondent have expressed that traditional birth attendant are taking care about pregnant of their communities. It is important to note that previous these caste people took care about pregnant but at presently they are seeking the help of traditional birth attendant by reason of saving of time. These kind of villagers always busy in their routine work if they involve in the caring process they should be lost more time in order to money also. The data also describes that all most all the respondents of Deshmukh 3 (1.6%), Vysya 4 (2.2%) and Vaisnava 5 (2.7%) communities have revealed that health workers or ANMs are looking after the pregnant women. It may due to the higher awareness regarding health and personal bias or prejudices of health workers or ANMs who are interested to associate with the higher social status communities.

On account of preferable birthplace; the responses of majority respondents i.e. 112 (62%) is that birth at the traditional birth attendant is more preferable. As many as number of respondent i.e. 36 (20%) have revealed that they prepared birthplace is Government Hospitals and the reaming respondents i.e. 32 (18%) have expressed their perception that Private Hospital are preferable to give the birth. The cluster analysis of data also provides the social status wise explanation that there are 7 (4%) of OC respondents, 19 (10.5%) of BCs and 10 (5.5%) of SCs are interested to go to the government hospitals. There are 10 (5.5%) of OCs and 23 (12.7%) of BCs were interested on Privates hospitals. Among the reaming of categories, the more number of BC respondents i.e. 70 (38.5%), 37 (20.5%) and the total number of ST community respondents i.e. 3 (1.7%) and only few {2(1.1%)} of OC respondent are still interested to give birth under the observation or treatment of traditional birth attendant.

Practices after Delivery:

Women underfed themselves during pregnancy and strove for a small baby to ensure easy delivery. Babies were not to be breast fed on first three days and baby-clothes were not used till a ceremony (purudu/Naming) on 9th day to 21st day. Mothers could not leave the delivery room till that day. To minimize the toilet needs, they severely restricted their intake of fluids and food during first week after delivery. Mothers did not wash hands properly; their clothes and linen were often dirty. Newborn babies, even if sick, were not moved out of home. The usual explanations for the sicknesses in neonates were ‘evil eye’, ‘witch craft’, or ill effects of foods eaten by mother.

The practice of breast-feeding female children for shorter periods of time reflects the strong desire for sons. If women are particularly anxious to have a male child, they may deliberately try to become pregnant again as soon as possible after a female is born. Conversely, women may consciously seek to avoid another pregnancy after the birth of a male child in order to give maximum attention to the new son

Summary and Conclusions:

Due to the orthodoxical and traditional dogma, majority numbers of respondent are not possess proper notion on Women’s health. In addition to supernatural beliefs about what brings on disease, women also have some beliefs about the non-physical causes of ill-health. The most commonly found syndrome was ‘weakness’ which consists of fatigue, body ache, ghabrahat (a generic term used for anxiety, fear, restlessness, trepidation, etc.), pallor, low backache and burning of palms and feet. Thus poverty, illiteracy and social backwardness complete the subordination of women. In reality, therefore, most women carry a tremendous degree of mental anguish and agony due to the improper beliefs and practices.

However, practices existed to over come or to tune with the problems, which may be physical, psychological, cultural and environmental. Subsequently practices are to be strengthen in order to persisting as the beliefs. Once, belief is to be got its own identity; the existence of practice should automatically come by the deeds of the victims or followers. Sometimes belief might be deteriorate due to the business, cost effective and the rationalism should also vanish the irrational beliefs so that we can eventually conclude beliefs exist by the practices which may takes place to over come the problems or to adjust with the nature.

References:

1. http://en.wikipedia.org/wiki/Belief

2. Giger, J.N., & Davidhizar, R. E. (2004): “Transcultural nursing: Assessment and intervention” (4th ed.). St. Louis: Mosby publication.

3. Spector, R. E. (2004): “Cultural diversity in health & illness” (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall Health publication..

4. Bundek, N. I., Marks, G., & Richardson, J. I. (1993): “Role of health locus of control beliefs in cancer screening of elderly Hispanic women”. Health Psychology, 12(3), 193-1999.

5. Pachter, L. M. (1994) “Culture and clinical care: Folk illness beliefs and behaviors and their implications for health care delivery”. Journal of the American Medical Association, 271(9), 690-694.

6. Roberson, M. H. (1987): “Folk health beliefs of health professional”. Western Journal of Nursing Research, 9(2), 257-263.

7. Treistman, J. (1988): “Health beliefs in socio-cultural perspective”. In G. Caliandro & B. L. Judkins (Ed.), Primary nursing practice (pp. 119-133). Glenview, IL: Scott, Foresman and Company.

http;//www.ramaiahbheenaveni.com

New York Health Insurance

pbr_201 — Tue, 09 Mar 2010 10:32:46 +0000

New York Health Insurance

Health insurance is insurance that pays for all or part of a person’s health care bills. A health insurance policy is an annually renewable contract between an insurance company and an individual. With health insurance claims, the individual policy-holder pays a deductible plus co-payment (for instance, a hospital stay might require the first 1000 dollar of fees to be paid by the policy-holder plus 100 dollar per night stayed in hospital). Usually there is a maximum out-of-pocket payment for any single year, and there can be a lifetime maximum.

The purpose of health insurance is to help people cover their health care costs which usually include doctor visits, hospital stays, surgery, procedures, tests, home care, and other treatments and services.

According to the latest United States Census Bureau figures, around 85% of citizens have health insurance. 59.5% of these people receive their health insurance coverage through an employer, and about 9% purchase it directly from the market. Government sources cover 27.3% of the population. Those without health insurance coverage are expected to pay privately for medical services.

Types of New York Health Insurance (http://new-york.ixs.net/General/New-York-Health-Insurance/index.aspx ) The types of health insurance in New York are group health plans, individual plans, and government health plans such as Medicare and Medicaid. In the United States, government-funded Medicare programs help to insure the elderly and end stage renal disease patients.

Group Health Plans

A group health plan offers health care coverage for employers, student organizations, professional associations, religious organizations, and other groups. The employer may pay for part or all of the insurance cost (premium).

Individual and Family Health Insurance

Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. These types of health care plans are sold directly to individuals. For those of you who are unemployed or self-employed, an individual health insurance policy is always an option. Unfortunately rates for these policies are high and the coverage is usually less comprehensive than a managed care plan. The good news is that, in many cases, your insurance premium will be tax deductible. Of course, if you’re married, you can always try to catch a ride on your spouse’s group health insurance benefits plan.

Health insurance can be further classified into fee-for-service or indemnity (traditional insurance) and managed care. Both group and individual insurance plans can be either fee-for-service or managed care plans.

Managed Care Health Insurance

These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan.

There are three main types of managed care plans:

• Health Maintenance Organizations (HMO)

• Point-of-Service (POS)

• Preferred Provider Organizations (PPO)

All of these plans offer substantial health insurance benefits to members and their families. If you’re fortunate enough to have a choice of plan, consider the advantages, and disadvantages, of each. Compare the cost of care, the difference in premiums, deductible amounts and your freedom to choose a doctor outside the plan. There are numerous other coverages to compare as well — from prescription drugs to dental to alternative therapies. Be sure you understand the fine points of each.

Indemnity or Fee-For-Service Plan

Normally it covers the same expenses as managed care. The difference is your doctor is paid for each visit with the claim filed by either the patient or the medical provider. A big advantage– unlike some managed care plans, Fee-for-Service allows the patient a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork.

However, you’ll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.

Short-Term Health Insurance

Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care. It covers for a limited period of time, and may be an ideal solution for those between jobs or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA (Health Insurance Portability and Accountability Act) Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise.

Medical Savings Account (MSA)

Medical savings account (MSA) is the most recent development in the area of health insurance. The principle behind the MSA is to take the bulk of the financial risk, and premium payments, away from the managed care and indemnity insurers, and allow individuals to save money, tax free, in a savings account for use for medical expenses. Individuals or their employers purchase major-medical policies, medical insurance policies with no coverage for medical expenses until the amount paid by the patient exceeds a predetermined maximum amount, such as 2500 dollar per year. These policies have extremely high deductibles and correspondingly low monthly premiums and the participants take the money that they would have spent on higher premiums and deposit it in an MSA. This money accrues through monthly deposits and also earns interest, and can be spent only to pay for medical care

What’s The Best Health Insurance Plan?

There is no one “best” plan for everyone. The best match for you and your family may be different than the best match for someone else. In order to help you answer this question, here are a few things to consider:

1. Are you going to need long-term coverage or just something for the short-term?

If you’re between jobs for 1-6 months, you may want to go for short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.

2. Are you looking for basic coverage or more comprehensive coverage?

Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness. Other insurance plans that offer more comprehensive coverage may include benefits such as preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.

3. Would you pay for your services before you use them or when you use them?

If you choose a health insurance plan with a low monthly premium, you’re likely to have a higher co-payment or deductible. If you don’t anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.

4. How important to you is easy access to specialists?

Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. So, if you prefer easier access to specialists, you may wish to consider a different type of plan.

5. Do you have a specific doctor or hospital that you would like to visit for healthcare?

Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.

6. What is the most you could pay out in case of a serious illness or injury?

Health insurance plans typically place limits on how much a member is required to pay out per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you’ve contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. If you’re concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you’re considering.

No matter what insurance plan you may choose, educate yourself and understand all the basics of the health insurance before finalizing anything.

For more information about New York Health Insurance visit: http://new-york.ixs.net

Maria hosts http://events.ixs.net and expresses her passion for events through writing and discussion. She works for Less Corporation at http://www.ticketnest.com Copyright Heidi Grumm

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Imbalance of Ecosystems and Its Effect on Public and Livestock Health

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Imbalance of Ecosystems and Its effect on Public and Livestock health

Dr.Kedar Karki M.V.St. (Preventive veterinary Medicine)

Central Veterinary Laboratory Tripureshwor

The health of humans, like all living organisms, is dependent on an ecosystem that sustains life. Healthy ecosystems are the sine qua non for healthy organisms. Yet there is abundant evidence that many life-support systems are far from healthy, placing an increased burden on human health. In some areas of the world, gains in life expectancy and quality of life made during the twentieth century are at risk of being reversed in the twenty-first century. The consequences of ecosystem degradation to human health are numerous, and include health risks from unsafe drinking water, polluted air, climate change, emerging new diseases, and the resurgence of old diseases owing to ecological imbalances. Reversing this damage is possible in some cases, but not in others. Prevention of ecological damage is by far the most efficient strategy.

DEFINING ECOSYSTEMS

An ecological system may be defined as a community of plants and animals interacting with each other and their abiotic, or natural, environment. Typically, ecosystems are differentiated on the basis of dominant vegetation, topography, climate, or some other criteria. Boreal forests, for example, are characterized by the predominance of coniferous trees; prairies are characterized by the predominance of grasses; the Arctic tundra is determined partly by the harsh climatic zone. In most areas of the world, the human community is an important and often dominant component of the ecosystem. Ecosystems include not only natural areas (e.g., forests, lakes, marine coastal systems) but also human-constructed systems (e.g., urban ecosystems, agro-ecosystems, impoundments). Human populations are increasingly concentrated in urban ecosystems, and it is estimated that, by the year 2010, 50 percent of the world’s population will be living in urban areas.

A landscape comprises a mosaic of ecosystems, including towns, rivers, lakes, agricultural systems, and so on. Precise boundaries between ecosystems are often difficult to establish. Often regions slide into one another gradually, over a protracted “transition” zone, as for example between the boreal forest and the Taiga regions of Canada.

ECOSYSTEM HEALTH

It is important to recognize the inherent difficulties in defining “health,” whether at the level of the individual, population, or ecosystem. The concept of health is somewhat of an enigma, being easier to define in its absence (sickness) than in its presence. Perhaps partially for that reason, ecologists have resisted applying the notion of “health” to ecosystems. Yet, ecosystems can become dysfunctional, particularly under chronic stress from human activity.Example for this can be cited the discharge of nutrients from sewage, industrial waste, or agricultural runoff into lakes or rivers affects the normal functioning of the ecosystem, and can result in severe impairment. Excessive nutrient inputs from human activity was one of the major factors that severely compromised the health of the lower Laurentian Great Lakes (Lake Erie and Lake Ontario) and regions of the upper Great Lakes (Lake Michigan). Unfortunately, degraded ecosystems are becoming more the rule than the exception.

The study of the features of degraded systems, and comparisons with systems that have not been altered by human activity, makes it possible to identify the characteristics of healthy ecosystems. Healthy ecosystems may be characterized not only by the absence of signs of pathology, but also by signs of health, including measures of vigor (productivity), organization, and resilience.

Vigor can be assessed in terms of the metabolism (activity and productivity) of the system. Ecosystems differ greatly in their normal ranges of productivity. Estuaries are far more productive than open oceans, and marshes have higher productivity than deserts. Health is not evaluated by applying one standard to all systems. Organization can be assessed by the structure of the biotic community that forms an ecosystem and by the nature of the interactions between the species (both plants and animals). Invariably, healthy ecosystems have more diversity of biota than ecologically compromised systems. Resilience is the capacity of an ecosystem to maintain its structure and functions in the face of natural disturbances. Systems with a history of chronic stress are less likely to recover from normal perturbations such as drought than those systems that have been relatively less stressed.

Healthy ecosystems can also be characterized in economic, social, and human health terms. Healthy ecosystems support a certain level of economic activity. This is not to say that the ecosystem is necessarily self-sufficient, but rather that it supports economic productivity to enable the human community to meet reasonable needs. Inevitably, ecosystem degradation impinges on the long-term sustainability of the human economy that is associated with it, although in the short-term this may not be evident, as natural capital (e.g., soils, renewable resources) may be overexploited and temporarily enhance economic returns. Similarly, with respect to social well-being, healthy ecosystems provide a basis for and encourage community integration. Historically, for example, native Hawaiian groups managed their ecosystem through a well-developed social cohesiveness that provided a high degree of cooperation in fishing and farming activity.

Another reflection of ecosystem health lies directly in the public health domain. In spring 2000, a deadly strain of the bacterium E-coli (0157:H7) entered the public water supply in Walkerton, Ontario, Canada, causing seven deaths and making thousands sick. This small town, with a population of five thousand, is in a farming community. Inadequate manure management from cattle operations was the likely source of this tragedy.

HOW HEALTHY ECOSYSTEMS BECOME PATHOLOGICAL

Stress from human activity is a major factor in transforming healthy ecosystems to sick ecosystems. Chronic stress from human activity differs from natural disturbances. Natural disturbances (fires, floods, periodic insect infestations) are part of the dynamics of most ecosystems. These processes help to “reset” ecosystems by recycling nutrients and clearing space for recolonization by biota that may be better adapted to changing environments. Thus, natural perturbations help keep ecosystems healthy. In contrast, chronic and acute stress on ecosystems resulting from human activity (e.g., construction of large dams, release of nutrients and toxic substances into the air, water, and land) generally results in long-term ecological dysfunction.

Five major sources of human-induced (anthropogenic) stresses have been identified by D. J. Rapport and A. M. Friend (1979): physical restructuring, overharvesting, waste residuals, introduction of exotic species, and global change.

Physical Restructuring. Activities such as wetland drainage, removal of shoals in lakes, damming of rivers, and road construction fragment the landscape and alter and damage critical habitat. These activities also disrupt nutrient cycling, and cause the loss of biodiversity.

Overharvesting. Overexploitation is commonplace when it comes to harvesting of wildlife, fisheries, and forests. Over long periods of time, stocks of preferred species are reduced. For example, the giant redwoods that once thrived along the California coast now exist only in remnant patches because of overharvesting. When dominant species like the giant redwoods (arguably the world’s tallest tree—one specimen was recorded at 110 meters tall with a circumference of 13.4 meters) are lost, the entire ecosystem becomes transformed. Overharvesting often results in reduced biodiversity of endemic species, while facilitating the invasion of opportunistic species.

Waste Residuals. Discharges from municipal, industrial, and agricultural sources into the air, water, and land have severely compromised many of the earth’s ecosystems. The effects are particularly apparent in aquatic ecosystems. In some lakes that lack a natural buffering capacity, acid precipitation has eliminated most of the fish and other organisms. While the visual effect appears beneficial (water clarity goes up) the impact on ecosystem health is devastating. Systems that once contained a variety of organisms and were highly productive (biologically) become devoid of most lifeforms except for a few acid-tolerant bacteria and sediment-dwelling organisms.

Introduction of Exotic Species. The spread of exotics has become a problem in almost every ecosystem of the world. Transporting species from their native habitat to entirely new ecosystems can wreck havoc, as the new environments are often without natural checks and balances for the new species. In the Great Lakes Basin, the accidental introduction of two small pelagic fishes, the alewife and the rainbow smelt, combined with the simultaneous overharvesting of natural predators, such as the lake trout, led to a significant decline in native fish species. The introduction of the sea lamprey, an eel-like predacious fish that attacks larger fish, into Lake Erie and the upper Great Lakes further destabilized the native fish community. The sea lamprey contributed to the demise of the deepwater benthic fish community by preying on lake trout, whitefish, and burbot. This contributed to a shift in the fish community from one that had been dominated by large benthics to one dominated by small pelagics (fish found in the upper layers of the lake profile). This shift from bottom-dwelling fish (benthic) to surface-dwelling fish (pelagic) has now been partially reversed by yet another accidental introduction of an exotic: the zebra mussel. As the zebra mussel is a highly efficient filter of both phtyoplankton and zooplankton, its presence has reduced the available food in the surface waters for pelagic fish. However, while the benthic fish community has gained back its dominance, the preferred benthic fish species have not yet recovered owing to the degree of initial degradation. Overall, the increasing dominance by exotics not only altered the ecology, but also reduced significantly the commercial value of the fisheries.

Global Change. Rapid climate change (or climate warming) is an emerging potential global stress on all of the earth’s ecosystems. In evolutionary time, there have of course been large fluctuations in climate. However, for the most part these fluctuations have occurred gradually over long periods of time. Rapid climate change is an entirely different matter. By altering both averages and extremes in precipitation, temperature, and storm events, and by destabilizing the El Niño Southern Oscillation (ENSO), which controls weather patterns over much of the southern Pacific region, many ecosystem processes can become significantly altered. Excessive periods of drought or unusually heavy rains and flooding will exceed the tolerance for many species, thus changing the biotic composition. Flooding and unusually high winds contribute to soil erosion, and at the same time add to nutrient load in rivers and coastal waters.

These anthropogenic stresses have compromised ecosystem function in most regions of the world, resulting in ecosystem distress syndrome (EDS). EDS is characterized by a group of signs, including abnormalities in nutrient cycling, productivity, species diversity and richness, biotic structure, disease prevalence, soil fertility, and so on. The consequences of these changes for human health are not inconsiderable. Impoverished biotic communities are natural harbors for pathogens that affect humans and other species.

ECOSYSTEM HEALTH AND HUMAN HEALTH

An important aspect of ecosystem degradation is the associated increased risk to human health. Traditionally, the concern has been with contaminants, particularly industrial chemicals that can have adverse impacts on human development, neurological functions, reproductive functions, and that appear to be causative agents in a variety of carcinomas. In addition to these serious environmental concerns (where the remedies are often technological, including engineering solutions to reduce the release of contaminants), there are a large number of other risks to human health stemming from ecological imbalance.

Ecosystem distress syndrome results in the loss of valued ecosystem services, including flood control, water quality, air quality, fish and wildlife diversity, and recreation. One of the major signs of EDS is increased disease incidence, both in humans and other species. Human population health should thus be viewed within an ecological context as an expression of the integrity and health of the life-supporting capacity of the environment.

Ecological imbalances triggered by global climate change and other causes are responsible for increased human health risks.

Climate Change and Vector-Borne Diseases. The global infectious disease burden is on the order of several hundred million cases per year. Many vector-borne diseases are climate sensitive. Malaria, dengue fever, hantavirus pulmonary syndrome, and various forms of viral encephalitis are all in this category. All these diseases are the result of arthropod-borne viruses (arboviruses) which are transmitted to humans as a result of bites from blood-sucking arthropods.

Global climate change—particularly as it impacts both temperatures and precipitation—is highly correlated with the prevalence of vector-borne diseases. For example, viruses carried by mosquitoes, ticks, and other blood-sucking arthropods generally have increased transmission rates with rising temperatures. St. Louis encephalitis (SLE) serves as an example. The mosquito Culex tarsalis carries this virus. The percentage of bites that results in transmission of SLE is dependent on temperature, with greater transmission at higher temperatures.

The temperature dependence of vector-borne diseases is also well illustrated with malaria. Malaria is endemic throughout the tropics, with a high prevalence in Africa, the Indian subcontinent, Southeast Asia, and parts of South and Central America and Mexico. Approximately 2.4 billion people live in areas of risk, with some 350 million new infections occurring annually, resulting in approximately 2 million deaths, predominantly in young children. Untreated malaria can become a life-long affliction—general symptoms include fever, headache, and malaise.

The climate sensitivity of malaria arises owing to the nature of the interactions of parasites, vectors, and hosts, all of which impact the ultimate transmission rates to humans. The gestation time required for the parasite to become fully developed within the mosquito host (a process termed sporogony) is from eight to thirty-five days. When temperatures are in the range of 20°C to 27°C, the gestation time is reduced. Rainfall and humidity also have an influence. Both drought and heavy rains tend to reduce the population of mosquitoes that serve as vectors for malaria. In drier regions of the tropics, low rainfall and humidity restricts the survival of mosquitoes. Severe flooding can result in scouring of rivers and destruction of the breeding habitats for the mosquito vector, while intermediate rainfall enhances vector production.

Ecological Imbalances. Cholera is a serious and potentially fatal disease that is caused by the bacterium Vibrio cholerae. While not nearly so prevalent as malaria, cases are nonetheless numerous. In 1993, there were 296,206 new cases of cholera reported in South America; 9,280 cases were reported in Mexico; 62,964 cases in Africa; and 64,599 cases in Asia. Most outbreaks in Asia, Africa, and South America have originated in coastal areas. Symptoms of cholera include explosive watery diarrhea, vomiting, and abdominal pain. The most recent pandemic of cholera involved more regions than at any previous time in the twentieth century. The disease remains endemic in India, Bangladesh, and Africa. Vibrio cholerae has also been found in the United States—in the Gulf Coast region of Texas, Louisiana, and Florida; the Chesapeake Bay area; and the California coast.

The increase in prevalence of V. cholerae has been strongly linked to degraded coastal marine environments. Nutrient-enriched warmer coastal waters, resulting from a combination of climate change and the use of fertilizers, provides an ideal environment for reproduction and dissemination of V. cholerae. Recent outbreaks of cholera in Bangladesh, for example, are closely correlated with higher sea surface temperatures. V. cholerae attach to the surface of both freshwater and marine copepods (crustaceans), as well as to roots and exposed surfaces of macrophytes (aquatic plants) such as the water hyacinth, the most abundant aquatic plant in Bangladesh. Nutrient enrichment and warmer temperatures give rise to algae blooms and an abundance of macrophytes. The algae blooms provide abundant food for copepods, and the increasing copepod and macrophyte populations provide V. cholerae with habitat. Subsequent dispersal of V. cholerae into estuaries and fresh water bodies allows contact with humans who use these waters for drinking and bathing. Global distribution of marine pathogens such as V. cholerae is further facilitated by ballast water discharged from vessels. Ballast water contains a virtual cocktail of pathogens, including V. cholerae.

Two other examples of how ecological imbalances lead to human health burdens concern the increased prevalence of Lyme disease and hantavirus pulmonary disease. Lyme disease, sonamed because it was first positively identified in Lyme, Connecticut, is a crippling arthritic-type disease that is transmitted by spirochete-infected Ixodes ticks (deer ticks). Ticks acquire the infection from rodents, and spend part of their life cycle on deer. Three factors have combined to increase the risk to humans of contracting Lyme disease, particularly in North America: (1) the elimination of natural deer predators, particularly wolves; (2) reforestation of abandoned farmland has created more favorable habitat for deer; and (3) the creation of suburban estates, which the deer find ideal habitat for browsing. The net result is a rising deer population, which increases the chances of humans coming into more contact with ticks.

By 1995, in the southwestern United States, hantavirus infection was confirmed in ninety-four persons in twenty states, with 48 percent mortality. Variants of the strain that causes hantavirus pulmonary syndrome have also been found in other areas of the country, as well as in Asia and Europe. The virus is apparently asymptomatic in rodents, and it is transmitted in their saliva and excreta. In humans it has a flu-like presentation, which is followed by acute respiratory distress syndrome. The primary reservoir in the Four Corners area of the southwestern United States is the deer mouse. Climatic disturbances, which in recent years are thought to be exacerbated by human activity (e.g., global warming), appear to set up conditions that trigger outbreaks. In the early 1990s, ENSO events initially caused drought conditions to develop in the southwestern United States. This led to a decline in plant and animal populations, including natural predators of the deer mouse. Heavy rains followed the drought in 1993, resulting in a bumper crop of piñon nuts, a major food supply for the deer mouse. Subsequently the deer mouse population greatly increased, bringing about increased contact with humans and triggering the outbreak of hantavirus.

Antibiotic Resistance and Agricultural Practice Antibiotic resistance is a growing threat to public health. Antibiotic resistant strains of Streptococcus pneumoniae, a common bacterial pathogen in humans and a leading cause of many infections, including chronic bronchitis, pneumonia, and meningitis, have greatly increased in prevalence since the mid-1970s. In some regions of the world, up to 70 percent of bacterial isolates taken from patients proved resistant to penicillin and other b-lactam antibiotics. The use of large quantities of antibiotics in agriculture and aquaculture appears to have been a key factor in the development of antibiotic resistance by pathogens in farm animals that subsequently may also infect humans. One of the most serious risks to human health from such practices is vancomycin-resistant enterococci. The use of avoparcin, an animal growth promoter, appears to have compromised the utility of vancomycin, the last antibiotic effective against multi-drug-resistant bacteria. In areas where avoparcin has been used, such as on farms in Denmark and Germany, vancomycin-resistant bacteria have been detected in meat sold in supermarkets. Avoparcin was subsequently banned by the European Union. Another example is the use of ofloxacin to protect chickens from infection and thereby enhance their growth. This drug is closely related to ciprofloxacin, one of the most widely used antibiotics in the year 2000. There have been cases of resistance to ciprofloxacin directly related to its veterinary use. In the United Kingdom, ciprofloxacin resistance developed in strains of campylobacter, a common cause of diarrhea. Multi-drug-resistant strains of salmonella have been traced to European egg production.

Food and Water Security. Agricultural practices are also responsible for a growing number of threats to public health. Some of these are related to inadequate waste management, which has resulted in parasites and bacteria entering water supplies. Others are of entirely different origins and involve apparent transfer across species of pathogens that affect both animals and humans. The most recent and spectacular example is mad cow disease, known as variant Creutzfeldt-Jakob disease in humans, a neuro-degenerative condition that, in humans, is ultimately fatal. The first case of Bovine Spongiform Encephalopathy (BSE), the animal form of the disease, was identified in Southern England in November 1981. By the fall of 2000, an outbreak had also occurred in France, and isolated cases appeared in Germany, Switzerland, and Spain. More than one hundred deaths in Europe were attributed to what has come to be commonly called mad cow disease.

Improper manure management was the likely source of the outbreak of E. coli 0157:H7 in Walkerton, Ontario, Canada. Other health risks associated with malfunctioning agroecosystems include periodic outbreaks of cryptosporidiosis, a parasitic disease that is spread by surface runoff contaminated by feces of infected cattle. This parasite causes fever and diarrhea in immunocompetent individuals and severe diarrhea and even death in immunocompromised individuals.

ECOSYSTEM RESTORATION

Ecosystem pathology in some cases can be reversed simply by removing the source of stress. In cases, for example, where ecosystem degradation is the result of point-source additions of nutrients or toxic chemicals, removal of these stresses may result in considerable recovery of ecosystem health. A classic case is Lake Washington (near Seattle, Washington). This lake had become highly anoxic (oxygen-depleted) owing to a sewage outfall entering the lake. Redirecting the sewage outfall away from the lake reversed many of the signs of pathology.

In cases where it is not feasible to remove the source of stress, more innovative engineering solutions have been tried. For example, in the Kyrönjoki and Lestijoki Rivers in western Finland, spring and fall runoff leads to sharp pulses of acidity. Spring runoff from snowmelt, which releases acid from tilled or dug soils, has been particularly damaging to fish, during the critical time of year for spawning. Fish reproduction is severely curtailed, if not all together eliminated in highly acidic water. Further there have been massive fish kills resulting from the highly acidic waters. One possible remedy is to replace the original drains which take runoff from the land to the rivers with new limed drains that can neutralize the acidity. This solution has been implemented on an experimental basis and appears to substantially reduce acidic runoff.

More radical treatments for damaged ecosystems involve “ecosystem surgery.” In some cases, invading exotic vegetation (such as mangroves in Hawaii) have been removed from regions, and native vegetation has been replanted. In areas of North America where wetlands have been severely depleted owing to farming, urbanization, and industrial activity, efforts have been made to establish new wetlands.

More often than not, however, reversing ecosystem pathology is not possible. Efforts to restore the indigenous grasslands in the Jornada Experimental Range in the southwestern United States provide an example. Overgrazing by cattle has severely degraded the landscape and has lead to replacement of the native grasses by largely inedible shrubs, dominated by mesquite. Erosion by wind and episodic heavy rains have left areas between shrubs largely bare, and subsequently underlying sands have developed in dune-like fashion over a large part of the area. The resulting mesquite dunes have proven highly resistant to efforts to restore the native grasslands, although almost every intervention has been tried, including highly toxic defoliants (Agent Orange), fire, and bulldozing.

Even where it has been possible to restore some of the ecological functions of degraded ecosystems, and thus improve ecosystem health, the restoration seldom results in reestablishment of the pristine biotic community. The best that can be achieved in most cases is reestablishment of the key ecological functions that provide the required ecosystem services, such as the regulation of water, primary and secondary productivity, nutrient cycling, and pollination. In all such efforts, key indicators of ecosystem health (vigor, productivity, and resilience) are essential to monitor progress. Standard ecological indicators can be used for this purpose (e.g., measures of productivity, species composition, nutrient flows, soil fertility) along with socioeconomic and human health indicators.

Experience in efforts to restore highly damaged ecosystems suggests that ecosystem-health prevention is far more effective than restoration. For marine ecosystems, setting aside protective zones that afford a sanctuary for fish and wildlife has considerable promise. Many countries are adopting policies to establish such areas with the prospect that these healthy regions can serve as a reservoir for biota that have become depleted in the unprotected areas. Yet this remedy is not without its limits. Restoring ecosystem health is not simply a matter of replenishing lost or damaged biota. It is also a matter of reestablishing the complex interactions among ecosystem lifeforms. Having a ready source of healthy biota that could potentially recolonize damaged ecosystems is important, but it is only part of the solution.

PREVENTION OF ECOSYSTEM DISRUPTIONS

Given the difficulties in reversing ecosystem degradation, and the many associated human health risks that arise with the loss of ecosystem health, the most effective approach is simply the prevention of ecosystem disruption. However, like many common-sense approaches, this is easier said than done. In both developed and developing countries there is a strong inclination to continue economic growth, even at the cost of severe environmental damage. Apart from selfish motivations, the argument is made that economic growth has many obvious health benefits, such as providing more efficient means of distributing food supplies, providing more plentiful food, and providing better health services and funding for research to improve standards of living. These are indeed benefits of economic development, and have led to substantial increases in health status worldwide.

However, at the dawn of the twenty-first century, the past is not necessarily the best guide to the future. The human population is at an all-time high, and associated pressures of human activity have led to increasing degradation of the earth’s ecosystems. As ultimately healthy ecosystems are essential for life of all biota, including humans, current global and regional trends are ominous. Under these circumstances, a tradeoff between immediate material gains and long-term sustainability of humans on the planet may be the only option. If so, the solution to sustaining human health and ecosystem health becomes one of devising a new politic that places sustaining life support systems as a precondition for betterment of the human condition.

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Senior Vet.Officer,Central Veterinary Laboratory Kathmandu Nepal M.V.St. Preventive Veterinary Mrdicine