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PubMedDate not supplied

SatelLife: pioneering the path for electronic communication and health information in the developing world.

Information poverty is one of the most significant obstacles to better health in the developing world. To address this problem, SatelLife, a Boston-based nonprofit organization has created HealthNet, a computer-based network linking healthworkers throughout the world to facilitate the exchange of health-related information. Using low-cost, sustainable technologies, SatelLife provides both electronic mail communications services and a variety of information services including electronic publications, electronic access to remote databases, and ongoing electronic conferences on topics of special relevance to health in the developing world. The article cautions that simply bringing high-speed Internet access to the developing world will not solve problems of information poverty, because such technology will be prohibitively expensive for all but the elite private sector and because of the need to provide targeted, high-quality information, not simply access to the vast, disorganized universe of information available on the Internet.

Boston↗
PubMed1999

Current concepts in dyspepsia: a world perspective.

The meaning and definition of dyspepsia continues to challenge clinical investigators and has led to the setting up of several international working teams. However, confusion continues to reign around this term. The effort to classify patients with dyspepsia into subgroups according to their most predominant symptoms has failed to provide clues to the underlying disease, or even to discriminate between functional and organic dyspepsia. With these limitations in mind, the question arises: is there any reason for putting further effort into developing a world-wide definition of dyspepsia when, in addition to the aforementioned shortcomings, further variables such as geographical region, ethnic background, culture and sanitary resources come into play? The answer is that only by establishing a reproducible methodology for individual symptom assessment using a well-defined protocol will comparisons of the prevalence of dyspepsia and the impact of different therapeutic interventions become possible around the world. The data on dyspepsia prevalence, nearly all arising from studies in a few developed geographical areas and countries, are of the order of 1-4% of all consultations in all primary care medicine. However, estimates of adults affected by dyspepsia are as high as 20-40%. The magnitude of these statistics underlines the necessity for further work on the concept of dyspepsia and its major functional subgroups, following the exclusion of any organic causes. Issues such as 'investigate dyspepsia before starting with any kind of treatment or treat dyspepsia before further investigation' or the debate about whether to 'eradicate or ignore Helicobacter pylori in functional dyspepsia' will remain unresolved unless studies performed throughout the world use widely comparable and acceptable definitions and criteria for these conditions. Since the first international working party report in 1988, definitions of dyspepsia have included the description of 'upper abdominal pain or discomfort' and, more recently, have specified 'pain or discomfort centered in the upper abdomen' in order to emphasise further the site of origin as the upper alimentary tract (stomach-duodenum). However, a major change was evident in the more recent Rome I and Rome II reports, in which the symptoms heartburn, acid regurgitation, and belching were excluded from the definition of dyspepsia because of their relation to gastroesophageal reflux disease (GERD) and aerophagia. The intention to define a set of symptoms for dyspepsia is good, but we continue to be faced with overlaps. How should the patient with epigastric pain and heartburn after endoscopic exclusion of duodenal ulcer and reflux esophagitis be classified: dyspepsia or GERD? In cases of abnormal gastroesophageal reflux, 24-h pH monitoring could help to resolve this dilemma, but what if this investigation turns out to be normal? In this field, we need to perform careful studies. In addition, we need to consider the lifestyle and cultural habits of people around the world when translating upper gastrointestinal symptoms into dyspepsia. A step forward in the definition of dyspepsia was attempted by the recent working party for the Rome II consensus on functional gastrointestinal disorders (N. Talley et al.). In this project, the symptoms of dyspepsia were individually described not by a single term, but by painting a 'word picture', to make it easier for patients to express their symptoms, and give doctors and clinical investigators a better understanding of the 'dyspeptic problem' of each individual. It is advisable to follow this approach, since a clear picture of a patient's symptoms, including their duration and intensity, in association with the modern technical approaches that allow investigation beyond organic causes of dyspepsia, will lead to progress in our understanding and better communication about this problem within the medical community, and ultimately to better treatment.

Adult↗
PubMed2001

The impact of stroke on world leaders.

PURPOSE: Earlier studies by our unit documented frequent disability in world leaders resulting from stroke but did not quantify the incidence of cerebrovascular accidents. We sought to identify the frequency and impact of strokes in world leaders. METHODS: Using various sources, we identified world leaders who had sustained strokes while in office from 1970 to 1999 and tabulated information on symptoms and subsequent ability to lead. RESULTS: Twenty leaders were identified who had sustained strokes during the study period, for an incidence of 0.444 strokes/100 leaders/year. Half of the affected leaders lost their political power within the year; most had persistent disabilities, which included motor, speech, cognitive, and emotional deficits. CONCLUSION: Strokes in world leaders may be slightly less common than expected based on studies of Western populations of similar age, but they are often devastating to a political career. Nonetheless, loss of political power is not inevitable.

Age Distribution↗
PubMed2001

Sentinel monitoring of general community health during the 1998 World Football Cup.

BACKGROUND: Present knowledge of the consequences of mass gatherings for the health of the community is scant. Our objective was to determine the impact of the 1998 World Football Cup on general community health. METHODS: We set up an electronic sentinel disease surveillance, before, during and after the World Football Cup tournament held in France from June 10 to July 12, 1998. Medical activity, and the daily number of cases of communicable, environmental, and societal diseases relating to mass gatherings were surveyed. The incidence of the pathologies surveyed in real time during and after the World Cup versus the pre-Cup reference period was the main outcome measure. Five sentinel networks participated, comprising 553 general practitioners, 60 hospital adult emergency departments, 19 private emergency community services, 4 community health centres, and the medical centre of the Paris airports. RESULTS: Throughout the 66-day study period, physicians reported 558,829 medical encounters via 21,532 connections to the computer. Compared to the reference period, the level of medical activity reflected by the pathological items surveyed remained stable during the study period. CONCLUSION: The 1998 World Football Cup had no epidemiological impact on general community health, as observed by sentinel networks located downstream of the specific health services provided by the French authorities to ensure high standards of safety.

Adult↗
PubMed2001

Towards a tobacco-free world.

Many barriers must be tackled for controlling the tobacco epidemic responsible for completely preventable mortality. Tobacco addiction is presently considered as the central element in smoking. The mechanisms of action of drugs of abuse (including nicotine) and the current techniques for their study in animals and in humans are briefly reviewed. Cigarettes are manipulated by the tobacco industry to increase the level of dependence. The transnational tobacco companies use a global tactic to expand their sales, particularly in the third world, so that the mean world cigarette consumption per adult remains unchanged at approximately 1500 per year. Nevertheless, it is hoped that control of the epidemic will be gained in the 21st century, since the awareness of tobacco risks and costs is increasing, an antismoking climate is developing and the tobacco lobby has lost its credibility. On the other hand, improved behavioural and pharmacological methods increase the cessation rate. Health professionals are progressively more involved in the smoking cessation problems, while international control measures are applied by the European Commission. The World Health Organization is preparing a "Framework Convention on Tobacco Control" with binding mechanisms for governments. A larger involvement of the community is needed to promote an international policy based on health values, rather than on trade considerations, and addressing the specific problems of the third world. Nevertheless, since a latency of approximately 30 yrs exists between the increase in tobacco consumption in a population and the rise in tobacco mortality, past trends in consumption will continue to influence health status during the next 30 yrs. Present, urgently needed, radical health measures are expected to have their major impact only after that period.

Humans↗
PubMedDate not supplied

[Bodies and souls of Maxence van der Meersch. The gaze of a writer on medicine in France on the eve of the Second World War].

Maxence Van der Meersch, got the Prix Goncourt in 1937. He was an important writer between the two world wars, by his inspiration and his realism he was related to the naturalism school. His works reflect his life, from 1937, after having discovered the christian faith, he devoted his live to it and militated through his writing for his convictions. "Corps et âmes", published in 1943 is a painting of the medicine in France at the end of the thirties. When he was published the book raised up a sharp polemic, badly accepted by medical world because of its realism without concession, on another hand it was welcome by general public and litterary critics. In an university town the author stages physicians, students, nurses, administrators, politicians and many other characters to paint a vast fresco of medical world and society, during this time. In whole he gives a greater share to mental pathology with the advent of new therapeutics and to tuberculosis wich had a great medico-social importance. Taking a fancy for doctor Carton's neo hippocratics theories, he fully bound himself in his book to broadcast that he thinks to be a new medical truth and then was led to contest scientific medicine which had, for him, lost his humanity. Suffering of lung tuberculosis, holding fast to his convictions he rejected any therapeutics except his diets and died January the 13th 1951. Beside his spiritual and bound features, "Corps et âmes" the quality of documentation and the accuracy of descriptions remains a testimony about physicians and medicine at second world war eve.

France↗
PubMed1975

World-wide environmental problems.

Man and the physical and natural resources necessary to support him in a civilized society are on a collision course. It is simple to say that man cannot continue to grow in number at an ever-increasing rate without a destructive effect upon the environment. Positive scientific proof for this impending calamity is not now available, yet many indications--sometimes physical and sometimes natural--point towards major world-wide environmental troubles in the near future. A number of environmental problems are described, particularly as they relate to the total world system. A computer model simulating future world-wide environmental trends from 1900 to 2100 A.D. is evaluated and suggested as a major tool for data-gathering purposes to determine the extent of world-wide environmental problems. It is suggested that scientists take an active role in the study of the environment, particularly in relation to man's future on earth. The problems for the future are so potentially dangerous that we must not wait for a global catastrophe and then rely on science to rescue us. The article is about human survival.

Air Pollution↗
PubMed2002

Research-tool patents: issues for health in the developing world.

The patent system is now reaching into the tools of medical research, including gene sequences themselves. Many of the new patents can potentially preempt large areas of medical research and lay down legal barriers to the development of a broad category of products. Researchers must therefore consider redesigning their research to avoid use of patented techniques, or expending the effort to obtain licences from those who hold the patents. Even if total licence fees can be kept low, there are enormous negotiation costs, and one "hold-out" may be enough to lead to project cancellation. This is making it more difficult to conduct research within the developed world, and poses important questions for the future of medical research for the benefit of the developing world. Probably the most important implication for health in the developing world is the possible general slowing down and complication of medical research. To the extent that these patents do slow down research, they weaken the contribution of the global research community to the creation and application of medical technology for the benefit of developing nations. The patents may also complicate the granting of concessional prices to developing nations - for pharmaceutical firms that seek to offer a concessional price may have to negotiate arrangements with research-tool firms, which may lose royalties as a result. Three kinds of response are plausible. One is to develop a broad or global licence to permit the patented technologies to be used for important applications in the developing world. The second is to change technical patent law doctrines. Such changes could be implemented in developed and developing nations and could be quite helpful while remaining consistent with TRIPS. The third is to negotiate specific licence arrangements, under which specific research tools are used on an agreed basis for specific applications. These negotiations are difficult and expensive, requiring both scientific and legal skills. But they will be an unavoidable part of international medical research.

Developing Countries↗
PubMed2002

High tech. High touch. John Naisbett's world view.

History will record that 20 years ago, a man named John Naisbett made a contribution which literally changed the world, with his book Megatrends. It changed the way that we think about the world. It changed the way that we think about ourselves. A distinguished scholar, John Naisbett has worked in many different settings, including at the White House under Lyndon B. Johnson. He spent many years at Harvard University, and is best known for introducing a quantitative analysis of the major trends affecting America. One of those, of course, was demographics. Another was the aging of the planet. Another was technology. He recently authored a new book, High Tech, High Touch. Home care has "high touch" down to a science: that's the kind of care for which home care is famous. It is also important, however, that we introduce technology. As technology changes and offers the ability to provide new and more efficient ways of providing care, we need to embrace that opportunity. History will record that 20 years ago, a man named John Naisbett made a contribution which literally changed the world, with his book Megatrends. It changed the way that we think about the world. It changed the way that we think about ourselves. He delivered the following speech at the 2001 National Association for Home Care Annual Meeting.

Biotechnology↗
PubMed1994

World Population Day to focus on ICPD themes.

The eighth annual World Population Day will be celebrated world-wide on 11 July 1994. Last year, activities marking the occasion took place in more than 110 countries. According to Dr. Nafis Sadik, Executive Director of the United Nations Population Fund (UNFPA) and Secretary-General of ICPD, this year's celebration will help draw attention to the upcoming Cairo Conference and to its themes of "choices and responsibilities"--the basic right and responsibility of couples and individuals to make informed choices about child-bearing, and the responsibility of societies to help them in achieving their reproductive goals. To promote World Population Day, UNFPA's Information and External Relations Division has produced a colorful poster, a 15-minute video (available in English, French and Spanish) emphasizing maternal health, and a special pamphlet and a new edition of the Population Issues Briefing Kit (both in English, French, Spanish and Arabic). The kit outlines the major issues to be addressed at ICPD. UNFPA is also sponsoring a 5-15 July exhibit at UN headquarters, featuring photos and text from Material World: A Global Family Portrait, a book to be published in October. The book, by Peter Menzel, will document an extraordinary project in which 16 prominent photographers travelled to 30 countries to photograph typical families surrounded by all their possessions--in some cases a few jars and jugs, in others an abundance of electronic gadgetry.

Advertising↗
PubMed2002

Serving the world's poor, profitably.

By stimulating commerce and development at the bottom of the economic pyramid, multi-nationals could radically improve the lives of billions of people and help create a more stable, less dangerous world. Achieving this goal does not require MNCs to spearhead global social-development initiatives for charitable purposes. They need only act in their own self-interest. How? The authors lay out the business case for entering the world's poorest markets. Fully 65% of the world's population earns less than $2,000 per year--that's 4 billion people. But despite the vastness of this market, it remains largely untapped. The reluctance to invest is easy to understand, but it is, by and large, based on outdated assumptions of the developing world. While individual incomes may be low, the aggregate buying power of poor communities is actually quite large, representing a substantial market in many countries for what some might consider luxury goods like satellite television and phone services. Prices, and margins, are often much higher in poor neighborhoods than in their middle-class counterparts. And new technologies are already steadily reducing the effects of corruption, illiteracy, inadequate infrastructure, and other such barriers. Because these markets are in the earliest stages of economic development, revenue growth for multi-nationals entering them can be extremely rapid. MNCs can also lower costs, not only through low-cost labor but by transferring operating efficiencies and innovations developed to serve their existing operations. Certainly, succeeding in such markets requires MNCs to think creatively. The biggest change, though, has to come from executives: Unless business leaders confront their own preconceptions--particularly about the value of high-volume, low-margin businesses--companies are unlikely to master the challenges or reap the rewards of these developing markets.

Developing Countries↗
PubMedDate not supplied

[Nurses in the first times of World War one].

The First World War originated in new and huge problems for both military authorities and military health service. The modern war which begun in 1914 overflowed this Service reformed in 1912. Famous journalists and political men such as Barrès and Clémenceau took part against dramatic conditions encountered by wounded soldiers. The First World War saw the introduction of many new technologies to the art of killing one's enemy among them the machine gun and the heavy use of artillery. It resulted in massive amount of wounded and ill soldiers which overflowed the military health service and every evacuation mean to the rear front. From August 2nd, 1914 to December 31st, 1914, 798. 833 French wounded soldiers and 322.672 ill soldiers were treated by the French Army 7th direction, in charge of the military health service. In such circumstances, a voluntary, parallel and the efficient sanitary organisation took an importance unknown until yet. This organisation, the Red Cross, associated the Société française de secours aux blessés militaires (French society for help to the wounded soldiers), the Union des Femmes de France (French Women Union) and the Association des Dames françaises (French Ladies Association). These three organisations, associated to many religious ones, brought a real sanitary structure so necessary in the troubled period as the beginning of the First World War. Everywhere in France, health service structures such as the hôpital temporaire no. 103 (Temporary Hospital number 103) in Paris, model hospital from the Union des Femmes de France, associated volunteers civilian doctors and surgeons. To increase the professional value of the paramedical staffs, a very specific effort was done for the formation of nurses in number, as correctly and as quickly as possible. During the first year of the First World War, nurses will be estimated since they had been able by their action to balance the disorder of the very first time of the conflict.

France↗
PubMed2003

Mortality and postcombat disorders: U.K. veterans of the Boer War and World War I.

This study seeks to investigate the mortality rates of U.K. servicemen with postcombat syndromes following the Boer War and World War I. Random samples of veterans awarded war pensions for either disordered action of the heart (DAH) or neurasthenia/shellshock were compared with gunshot wounded ex-servicemen as controls. The destruction of pension records has led to reliance on groups of the longest lived veterans, which diminishes their representative qualities. Study groups were matched by rank and level of disability. With the exception of DAH cases in World War I, no statistically significant difference in mortality rates was found using Cox proportional hazards. The same DAH subjects were then compared with gunshot wound controls whose disability had been assessed 20% higher, and no statistically significant difference was seen. The reason why World War I veterans with DAH had a reduced life expectancy remains unclear, although it is possible that physician bias in assessment and the termination by the Ministry of Pensions of awards granted to healthy cases may have been factors. Postcombat disorders suffered by U.K. servicemen after the Boer War and World War I were not generally associated with an increased mortality.

Europe↗
PubMed2003

The role of teaching and research hospitals in improving global health (in a globalized world).

Globalization is impacting on Hong Kong and Australia in different ways, but the experience of the public healthcare systems in both jurisdictions suggests a need for teaching and research hospitals to refocus from the management of international patients to better meet the needs for global health. Traditional globalization suggests a stockpiling of capital--a focus on improving global health suggests dismantling the stockpiles and sharing access to the necessary data, information, knowledge and discoveries to further develop local health expertise. Consistent with its position as a leading healthcare provider, the University Health Network (UHN) has been reflecting on the impact of increasing globalization on hospitals. The goals of the UHN paper on globalization are threefold--to suggest how the external and internal environments of hospitals will change as a result of globalization; to suggest a role for hospitals in a globalized world; and to stimulate discussion and debate. Given our perspective, from the other side of the world, we are pleased to contribute to the discussion and debate but will limit our comments to the future role of teaching and research hospitals based on some of the experiences of Australia and Hong Kong. The citizens of Hong Kong have been acutely aware of the issue of globalization--the excellent deep-water harbour has ensured the position of Hong Kong as a major trading hub. Hong Kong has also had a continually evolving role as a financial centre and gateway to China, and with China's accession to the World Trade Organization the impact of globalization will be even greater. On the other hand, the citizens of Australia have lived with geographic isolation, relatively limited natural resources and a small population, all of which have limited their role in global trade and financial markets. However, both Hong Kong and Australia have seen recent benefits from the increasing speed of communication and information transfer and exchange. While it may still take close to a month for Australian practitioners to receive the hard copy of the journal in the mail, a electronic transfer is instantaneous. The globalization of knowledge and practice is one of the largest impacts of the Internet. With one of the most connected populations in the world, Hong Kong is very active in the sharing of knowledge with international experts.

Academic Medical Centers↗
PubMedDate not supplied

World report on violence and health.

Violence is not an intractable social problem or an inevitable part of the human condition. We can do much to address and prevent it. The world has not yet fully measured the size of the task and does not yet have all the tools to carry it out. But the global knowledge base is growing and much useful experience has already been gained. The World Report on Violence and Health attempts to contribute to that knowledge base. It is hoped that the report will inspire and facilitate increased cooperation, innovation and commitment to preventing violence around the world. These are the recommendations of the World Report on Violence and Health: Create, implement and monitor a national action plan for violence prevention. Enhance capacity for collecting data on violence. Define priorities for, and support research on the causes, consequences, costs and prevention of violence. Promote primary prevention responses. Strengthen responses for victims of violence. Integrate violence prevention into social and educational policies, and thereby promote gender and social equality. Increase collaboration and exchange of information on violence prevention. Promote and monitor adherence to international treaties, laws and other mechanisms to protect human rights. Seek practical, internationally-agreed responses to the global drugs trade and the global arms trade.

Global Health↗
PubMed1992

How the door opened: the peopling of the New World.

The timing, pathways, and number of migrations involved in the early peopling of the New World are examined from a variety of perspectives. Ultimately, the occupation of the Western Hemisphere was a direct result of boreal cultural adaptations in the Old World. Here, we discuss (1) the dates of appearance of these boreal cultural adaptations and their relevance to the peopling of America, (2) archeological and linguistic evidence bearing on the earliest peopling of the New World, (3) ecological and linguistic evidence on two alternative routes into the New World, and (4) the assumptions present in various migration models. The relative strengths of opposing hypotheses are analyzed by observing whether different approaches point to the same answers.

Anthropology, Cultural↗
PubMed2005

[Understanding the world as experienced by HIV-positive pregnant women].

This study aims at understanding how a HIV-infected pregnant woman perceives her corporeality in being-in-the-world bearing another being corroborating with the concepts of body and corporeality. It is a qualitative study with a phenomenological approach. HIV-positive pregnant women under pre-natal follow-up took part in the study. Semi-structured interview was carried out to collect the information. The hermeneutic approach was chosen to interpret the collected information. The discourses gave rise to two themes: being in the world while infected with the virus and the concepts of body in the world of HIV-positive pregnant women's concepts of body-in-the-world.

Adaptation, Psychological↗
PubMed2005

The motion sensitivity screening test in clinical practice in abuja, Nigeria: affordable automated perimetry for the third world?

Perimetry is essential in the clinical management and evaluation of glaucoma patients and other patients with diseases impacting on visual fields, but automated equipment may be too expensive for many practitioners in the developing world. I have used the Wu-Jones automated motion sensitivity system in a medium sized practice in Nigeria, a developing country, and hereby present an audit of our experience with it. The Wu-Jones Motion Sensitivity screening test is a lap-top computer based test which integrates a number of components including a test program and reporting facility, a self organizing neural network, a database management mechanism, and a menu-mouse-windowing user interface. The test is available on the public domain and is small enough (194 mb) to fit into a diskette. This test has been used at the Rachel Eye Center in Abuja since 1998, and has been applied to 339 individuals, 298 of whom are included in this analysis. Patients tested fell into four main groups: those with clinical glaucoma (intraocular pressure > 20 mmHg on at least one occasion and optic cup/disc ratio of 0.5 or more), glaucoma suspects, (i.e. ocular hypertensives >20 mmHg or c/d ratio of 0.5 or more and first degree relatives of glaucoma patients) patients undergoing routine tests for pre-employment ('normals'), and 'others'. These 'normals' were used as controls. Records are available for 531 eyes. It took an average of two minutes to complete the test. Significant field defects (Motion sensitivity less than 50%) were detected overall in 15.6% of tested eyes, 7.2% of normals but in 32.6% of glaucoma eyes. Using the 'normals' as controls, the sensitivity of the test in our hands varied from 33% to 72% and specificity from 57% to 93% at motion sensitivity cut off points from 50% to 97%. At the 83% cut off point, positive and negative predictive values were 86.0% and 47.5% respectively. Reliability averaged 70%. I find the test easy to administer and understand by patients. Results can be recalled without difficulty, facilitating the longitudinal follow up process. This test will be of value to practices in the third world unable to afford more expensive equipment in the third world. The main investment would be in form of a laptop computer and a diskette. It can also be a useful adjunct for office practice in the western world.

Case-Control Studies↗