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PubMed1995

Different approaches and cultural considerations in third world prosthetics.

The major objective of prosthetics the world over is the same, i.e. to restore the amputee to as functional a capacity as possible in his cultural environment, whilst attaining as good a cosmetic result as can be achieved. At first glance it would seem that this would mean there would be very little difference in approach to the subject in western and in third world countries. Availability of materials, resources and skilled personnel, together with a variety of cultural differences, however, make third world prosthetics a subject in itself. This paper reviews the literature available on the subject, examines some different approaches to prosthetics in the third world, gives an overview of some materials and designs used and considers adaptations for cultural differences. It concludes that, whilst direct transfer of western prosthetics technology is useful in the short term, for long term benefit to the poorer amputees in the third world, culture-specific designs and materials are more appropriate.

Attitude to Health↗

PubMed1996

Rationalizing health care in a changing world: the need to know.

The World Development Report 1993 announced that global life expectancy was then 65. Experience in the developed world suggests that the World Health Organization's dictum, "health is a state of complete physical, mental and social well-being', is simply not attainable for the foreseeable future. As physical health has improved, mental problems have become more prominent and a sense of well-being has declined. Furthermore, as the population ages and medical technology improves, the cost of health care grows almost exponentially. Since the population of the developed world is continuing to age and aging is spreading rapidly throughout the developing world, knowledge is the principal way of dealing with this seemingly intractable problem: we must know, quantitatively, the age-specific causes of ill health, and we must know which means of prevention and treatment are effective. Finally, we must apply that knowledge rationally.

Aging↗

PubMed1990

[Does rheumatoid polyarthritis come from the New World?].

While rheumatoid arthritis apparently did not exist in the Old World prior to the eighteenth century, a symmetrical erosive arthritis, indistinguishable from contemporary rheumatoid arthritis is clearly documented in the 1,000 year before present Fort Ancient-Anderson Village site. As lesions compatible with a diagnosis of rheumatoid arthritis have not been noted in the Old World prior to 1785, observation of 35 pre-Columbian cases of compatible lesions, suggests the likelihood that rheumatoid arthritis is a New World disease that subsequently spread to the Old World. Study of the geographical patterns and timing of distribution of rheumatoid arthritis and of New World organic items may provide an opportunity to identify the responsible pathogens or allergens.

Arthritis↗

PubMed1995

The risks and benefits of estrogen replacement therapy: Leisure World.

A women spends about one-third of her life in her postmenopausal years. Some women supplement this period of decreased estrogen production with estrogen replacement therapy (ERT). Many epidemiologic studies have examined the long-term effect of postmenopausal estrogen deprivation and of ERT. Since the 1970s, we have evaluated the risks and benefits of ERT in one population of older women in the California retirement community of Leisure World. ERT is the most effective method for preventing osteoporotic bone loss and fractures in postmenopausal women. In Leisure World, ERT reduced the risk of hip fractures by about 50%. The effect is greatest in longterm users, but may be lost after discontinuation. Postmenopausal osteoporosis affects the bones of the jaws as well as other skeletal bones. Bone loss in the jaws may result in tooth loss. In Leisure World, estrogen users have retained more natural teeth than nonusers. Cardiovascular disease is the leading cause of hospitalization and death in women. In Leisure World, ERT reduced the risk of fatal and nonfatal myocardial infarction, ischemic heart disease, other heart disease, and stroke by 20-40%. The reduction is greatest in long-term and/or current users. ERT is effective in women with and without cardiovascular disease risk factors. One of the most feared aspects of aging is Alzheimer's disease. In Leisure World, women who had used ERT had a reduced risk of Alzheimer's disease. Risk decreased with increasing duration of use. Estrogen use, however, is not without risk. Unopposed estrogen increases risk of endometrial cancer. Risk increases with increasing years of use and remains high after discontinuation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Body mass index defines the risk of seasonal energy stress in the Third World.

A method has been devised to quantify the effect of seasonal environmental stress on nutritional well-being and to estimate the proportion of Third World populations at risk of functional deterioration. An Index of Agro-Climatic Seasonality, IACS--a measure of potential agricultural biomass availability--has been developed from agro-climatic data. IACS was found to be highly correlated with the seasonal weight loss of adults in rural Third World communities. This relationship was then used to predict the existence and severity of seasonal energy stress incurred by the adult population of Third World countries at any given body mass index (BMI). The average weight loss recorded in all seasonality studies was calculated; this value was used to specify, in combination with BMI, a condition of moderate seasonal energy stress. This grade of energy stress involved a loss of about 2% fat-free mass. The risk of greater energy stress, with larger losses of lean tissue, was specified as severe when predicted weight changes exceeded the maximum losses of weight recorded--at any given BMI--in Third World rural communities. The global dimensions of seasonality were then calculated by enumerating the individuals who--by the combined criteria of the BMI and the IACS of the habitat--fell into the categories of moderate and severe seasonality risk. On this basis, 65% of the rural adult population in the Third World run the risk of at least moderate seasonal energy stress, while 45% fall into the severe stress category. Of these 25% qualify as true seasonal 'casualties' because their body weight loss shifts their BMI from the normal range of nutritional status into the category of chronic energy deficiency.

Agriculture↗

PubMedDate not supplied

Interrelation between Western type cancers and non-Western type cancers as regards their risk variations in time and space. VI. Chronological transition of various cancer risks of the world from 1975 to 1985.

We comparatively investigated the age-adjusted incidence rates (AAIRs) of overall cancers of the world between 1975 and 1985 to see whether or not any consistent change is in progress in the risk for cancer in general on a world scale. Results obtained are summarized as follows: 1) the total male population of the world, but not the total female population, experienced a significant rise in AAIR for cancers of all sites during the above 10 years. 2) In the comparison study of geographical subgroups, the above integral cancer risk significantly increased with time in the male population of Canada, USA-White, USA-Black, European continent (EC)-West, EC-others and Great Britain, and also in the female populations of both USA-Black and Great Britain. In other geographical subgroups the cancer risks for 1985 were also higher than those for 1975, but the differences were not statistically significant. 3) The above increase of cancer risk in general was accounted for by a surplus in weight of the increasing contribution of Western-type cancers over the decreasing contribution of non-Western type cancers to the integral cancer risk of a population. 4) Japan was found to be an exceptional case in that the risk for liver cancer (a non-Western type cancer) increased 3 to 8 fold from 1975 to 1985 in both male and female populations of Japan. Evidence was presented to suggest that the above increase of liver cancer incidence could be related to the persistence of social tension following the first oil crisis in 1973. In summary, the chronological transition patterns of cancer risk in Japan as well as in other parts of the world support our interpretation that social tension linked to the economic recession plays a crucial role in the production of recent changes of cancer risk in the world.

Age Factors↗

PubMed1993

[Interaction of the world of dreams and wakefulness].

While we are dreaming the dream is the world. This reality is extinguished when we wake up. At the same time we recognize parts of the world of wakefulness in the things we dreamed about. Both worlds merge, and each in doing so interprets the other. Interpreting dreams is like drawing out these perspectives. This is shown here with examples from a series of dreams. They are woven into the biography of the dreamer and continually transform the traces of his world. The illustrations serve to visualize the elements of the world of wakefulness and of history, which reappear in a changed form in the dream.

Dreams↗

PubMedDate not supplied

Finding an appropriate ethic in a world of moral acquaintances.

This paper discusses the possibility of finding an ethic of at least partial and perhaps ever-growing content in a world not that of moral strangers (where we have nothing except our desire to live freely to unite us) and one of moral friends (in which values, goals and ways of doing things are held in common). I argue that both the world of moral strangers which Engelhardt's world view would support, as the world of moral friends which is the one Pellegrino seeks both are untenable and that furthermore both can lead to a similar state of affairs. I suggest a dynamic world of moral acquaintances in which different belief systems and ways of doing things can come to some broad agreements about some essential thing. This is made possible because although we do not share the intimate framework Pellegrino might suggest, yet we are united by a much broader framework than the one moral strangers share.

Altruism↗

PubMed1997

Searching for information on the Internet using the UMLS and Medical World Search.

Medical World Search is a search engine for medical information on the Internet that distinguishes itself from other search engines by its built-in knowledge of medical terminology through its use of the National Library of Medicine's UMLS and its carefully selected but large database of medical sites. After discussing some of the previous uses of the UMLS for medical information retrieval, we describe the Medical World Search system. In October 1996, Medical World Search became operational on the World Wide Web at http:@www.mwsearch.poly.edu. It has been operating uninterrupted since then. We review our experiences with creating a search engine for medical information on the Internet and using the UMLS in this application. The UMLS has some clear advantages in this application. Some aspects of the UMLS also decrease its usefulness in information retrieval. Medical World Search's usage by medical information seekers is summarized. future directions for research are outlined.

Computer Communication Networks↗

PubMed1998

World Health Day is a day for safer motherhood.

Every year, April 7 is kept as World Health Day. This year [1998] marks the 50th anniversary of the foundation of WHO. However, the day has a double significance because the theme of this year's World Health Day is safe motherhood. All around the world people will mark this day and remind communities and leaders that there is still much work to be done to make pregnancy and childbirth safer. World leaders in Washington will be doing their part on this day, for without high-level political commitment it is hard to get things done. However, this effort is not just for a day. The whole year is dedicated to the theme of safe motherhood. Please let us know about the initiatives taking place in your country, and do send photographs] We can all do something this year to make things better for women and their newborns. Please send your stories and photos to the Editor, Safe Motherhood (address on back page). As well as the 10 action messages that were developed at the technical consultation to mark the 10th anniversary of the Safe Motherhood Initiative, fact sheets and slides are also available either by writing to WHO or on the Internet.

Health↗

PubMed1994

Re-thinking skilled international labour migration: world cities and banking organisations.

"Highly skilled professional and managerial labour migration has become an important facet of the contemporary world economy. The operations of transnational corporations have created more opportunities for skilled migrants to work abroad.... There is a growing interest amongst economic geographers to examine this form of migration through an appreciation of global economic restructuring, labour market change and world cities. Consequently, this paper introduces a new conceptual framework...[which] is based on the rationale that world cities, and the patterns of labour market demand that exist within them, are of paramount importance in influencing highly skilled professional and managerial labour migration within the world economy. The author uses an example of highly skilled labour migration within the transnational banking sector [in London] to illustrate this new conceptual framework."

Demography↗

PubMed1991

Activities of the International Federation of Pharmaceutical Manufacturers Associations in world health.

The IFPMA represents 51 member associations of national pharmaceutical manufacturers throughout the world. It has developed several programs to interface and communicate with the World Health Organisation (WHO) programmes especially in regard to its activities in developing countries. Examples of collaboration with WHO are the IFPMA Training Scheme in Quality Control run jointly with the Pharmaceuticals Unit of the WHO. The IFPMA has developed a Code of Pharmaceutical Marketing Practices. It contributes to the health of both the developed and developing world through industry research, development and production of new and improved medicines. IFPMA publications provide important technical information for the global pharmaceutical industry and deal with the important issues of rational drug use in the developing world.

Drug Industry↗

PubMed2001

Cancer: a reality in the emerging world.

World societies have changed significantly in the last decades. The main characteristics of these changes are reciprocal connections and interdependencies. It has been thus realized that a major part of the world population still lives in poverty. Due to specific health care interventions and consequent demographic changes, it is expected that the population in general, and of the older people in particular, will increase significantly in the future. The annual number of new cases of cancer is expected to double from 10 million at present to 20 million in the next 20 years. Considering the increases in life expectancy and in tobacco abuse worldwide, and the existence of viral diseases leading to cancer in less developed countries besides other factors, the majority of new cases will probably occur in the emerging world. The number of new cases of cancer could in the future be reduced with the enhancement of education on vertical and horizontal levels in less developed countries. On the vertical arm, the education would concentrate on physicians, nurses, and other health care workers, while on the horizontal arm, it would be provided to government officials, politicians, and other decision-makers. It should be accepted that the world is one and that the problems associated with cancer in less developed countries are global problems. Semin Oncol 28:210-216.

Cost of Illness↗

PubMedDate not supplied

Trichophytobezoar duodenal obstruction in New World camelids.

OBJECTIVE: To describe clinical findings, surgical treatment, and outcome associated with trichophytobezoar duodenal obstruction in New World camelids. STUDY DESIGN: Retrospective study. ANIMALS: Alpacas (7) and 1 llama. METHODS: Historical and clinical data were obtained from the medical records of New World camelids with a diagnosis of trichophytobezoar duodenal obstruction confirmed by surgical exploration or necropsy. RESULTS: Seven camelids were <1 year old. Abnormal clinical findings included anorexia, reduced fecal output, recumbency, colic, abdominal distension, regurgitation, decreased serum chloride concentration, increased serum bicarbonate concentration, and/or elevated first gastric compartment chloride concentration. Survey abdominal radiographs obtained (4 animals) revealed gastric distension (4) and/or visualization of the obstruction (2). Diagnosis was confirmed at necropsy (1) or surgery (7). Right paracostal celiotomy was performed on all animals and duodenotomy (3) or retropulsion of the trichophytobezoar combined with third compartment gastrotomy (4) was used to remove the obstruction. Six animals survived to discharge and 5 were healthy at follow-up, 8-20 months later. The remaining discharged alpaca was healthy at 12 months but subsequently died of unrelated causes. CONCLUSIONS: Diagnosis of trichophytobezoar duodenal obstruction should be considered in juvenile New World camelids with abdominal distension and hypochloremic metabolic alkalosis. Right paracostal celiotomy can be used for access to the descending duodenum and third gastric compartment for surgical relief of obstruction. CLINICAL RELEVANCE: Duodenal obstruction from bezoars should be considered in New World camelids <1year of age with abdominal distension and hypochloremic metabolic alkalosis. Surgical relief of the obstruction by right paracostal celiotomy has a good prognosis.

Animals↗

PubMed2006

Risk management in a polio-free world.

Inherent in the decision to launch the Global Polio Eradication Initiative in 1988 was the expectation for many people that immunization against poliomyelitis would eventually simply stop, as had been the case with smallpox following its eradication in 1977. However, the strategies for managing the risks associated with a "polio-free" world must be continuously refined to reflect new developments, particularly in our understanding of the live polioviruses in the oral poliovirus vaccine (OPV) and in the international approach to managing potential biohazards. The most important of these developments has been the confirmation in 2000 that vaccine-derived polioviruses (VDPVs) can circulate and cause polio outbreaks, making the use of OPV after interruption of wild poliovirus transmission incompatible with a polio-free world. A comprehensive strategy has been developed to minimize the risks associated with eventual OPV cessation, centered on appropriate long-term biocontainment of poliovirus stocks (whether for vaccine production, diagnosis, or research), the controlled reintroduction of any live poliovirus vaccine (i.e., from an OPV stockpile), and appropriate use of the inactivated poliovirus vaccine (IPV). Although some aspects of this risk management strategy are still debated, there is wide agreement that no strategy would entirely eliminate the potential risks to a polio-free world. The current strategy for risk management in a polio-free world will continue to evolve with better characterization of these risks and the development of more effective approaches both to reduce those risks and to limit their consequences should they occur.

Disease Outbreaks↗

PubMedDate not supplied

Health research in the developing world: a gastroenterological view from Bangladesh.

Ill health is a serious impediment to progress in most poor countries, yet health is not a high priority on foreign aid agendas. Health research, which provides the essential base for sustainable progressive health programs, is barely visible in developing countries. For example, in Bangladesh, one finds unacceptably high morbidity and mortality rates among infants and children, health programs that are struggling and a rudimentary health research establishment; for the huge foreign donor community in that country, health programs and research do not appear to warrant major investments. Diarrheal diseases are at the top of the list of killers in many poor nations including Bangladesh. Recent advances in our understanding of diarrhea suggest that when prevention may not be possible soon, improved active treatment can evolve from an aggressive research effort centered in a developing country and linked to appropriate international partners. Global agencies such as the World Health Organization have demonstrated a declining interest in health research, as reflected in the policies of their Diarrhoeal Disease Control Programme. Major donors to the developing world, the Canadian International Development Agency for example, have had a relatively minor involvement in health and little commitment to health research. University links with the west, private enterprises and specially targeted programs are involved in developing world health research but they have not been able to foster and leave behind sustainable, high quality research programs. The problem should be attacked directly by supporting focused, relevant health research centres in regions of the world where the burden of disease continues to impede progress and where the environment is conducive to high quality research that is well integrated with care delivery programs. An instructive model of this approach is the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh.

Bangladesh↗

PubMed1990

Convergence in world urbanization? A quantitative assessment.

"Cross-national data are used to explore the question of whether world urban patterns and processes are converging or diverging. We compare tabular data on overall percent urban, urban primacy, overurbanization, and urban bias across world-system strata and global regions. The evidence suggests continuing differences and little evidence for convergence. To determine whether world-system effects have causal efficacy, we conclude with a regression analysis. These results provide strong evidence for a world-system explanation of continuing differences in overall level of urbanization and urban primacy, and a developmentalist approach seems to explain persisting divergence in levels of urban bias."

Demography↗

PubMed2006

The WHO World Alliance for Patient Safety: towards the years of living less dangerously.

Improving the safety of patient care is now a global issue. In 2004, the World Health Assembly supported the creation of the World Alliance for Patient Safety to coordinate, spread and accelerate improvements in patient safety internationally. Australia has been at the forefront of international work on patient safety and is working closely with the World Alliance. The World Alliance is taking forward work in six main action areas: Patients for Patient Safety; Reporting and Learning; Taxonomy; Solutions; Research; and Global Patient Safety Challenge. Despite differences in context, there are many common challenges for countries seeking to establish patient safety programs and initiatives. Looking forward, long-term action on patient safety must be built and sustained with the commitment of policy makers and the active engagement of health care professionals.

Communication↗