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PubMed2006

Will availability of inhaled human insulin (Exubera) improve management of type 2 diabetes? The design of the Real World trial.

BACKGROUND: Common deterrents to insulin therapy for both physicians and patients are the complexity and burden of daily injections. In January 2006, the first inhaled human insulin (INH, Exubera (insulinhuman [rDNA origin])InhalationPowder) was approved for use in adult patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) in the United States and European Union. Results from the INH clinical trial program have shown comparable efficacy of INH to subcutaneous (s.c.) insulin and superior efficacy versus oral antidiabetic agents; thus providing effective glycemic control in adult patients with T2DM without the requirement for preprandial injections. However, because subjects in those trials were randomized to either INH or an alternative, the studies could not estimate the effect of INH on patient acceptance of insulin therapy. Therefore, traditional study designs cannot provide answers to important and practical questions regarding real world effectiveness, which is influenced by psychological and other access barriers. METHODS: To overcome these limitations, the Real World Trial was designed to estimate the effect of the availability of INH as a treatment option for glycemic control. A total of approximately 700 patients from Canada, France, Germany, Italy, Spain, United Kingdom, and the United States with T2DM poorly controlled by oral agent therapy will be randomized to two different treatment settings. Patients and clinicians in both groups (A & B) may choose from all licensed therapies for diabetes including SC insulin delivered by pens; INH will be an additional treatment option only available in Group A. The Real World Trial (Protocol A2171018) has been registered with ClincalTrials.gov, registration id NCT00134147. RESULTS: The primary outcome for the trial will be the difference in mean glycosylated hemoglobin (HbA1c) at 6 months between groups. The design was based on a preceding feasibility study examining the theoretical effects of inhaled insulin availability on treatment choice in 779 patients. In that study, patients were three times more likely to choose insulin therapy when inhaled insulin was available. CONCLUSION: Innovations in study designs may provide an opportunity to reveal unbiased answers to important treatment questions that are more relevant to prescribers, funding agencies, and healthcare policymakers.

Journal Article↗
PubMed2004

Correlation of nuclear morphometric features with animal and human World Health Organization International Histological Classifications of canine spontaneous seminomas.

The aim of this study was to correlate nuclear morphometric features with animal and human World Health Organization International Histological Classifications in canine seminomas. Twenty-three canine seminomas were classified, according to Animal World Health Organization International Histological Classification as intratubular, intratubular with signs of invasion, or diffuse and according to Human World Health Organization International Histological Classification criteria as spermatocytic and typical. The morphonuclear characteristics of tumors were quantitatively evaluated by means of digital cell image analyses of hematoxylin and eosin-stained nuclei. In particular, the mean nuclear area, mean nuclear perimeter, mean nuclear form factor, and their respective standard deviations were calculated. The relationship between the different variables and the tumor histologic types was assessed. On the basis of animal and human classification systems, statistically significant differences were observed only between intratubular seminomas with signs of invasion and the other two types and between spermatocytic and typical seminomas, respectively. In humans, it is well known that typical seminomas are more common and aggressive than spermatocytic ones. In our study, the canine seminomas classified as typical showed significantly larger and more variable nuclear area and perimeter than spermatocytic seminomas. These results support the opinion that most canine seminomas correspond to human spermatocytic seminomas and could explain the benign behavior of canine seminomas, which derive from a more differentiated type of germ cell.

Animals↗
PubMed1999

Foreign aid, international organizations, and the world's children.

Recent improvement in child mortality has taken place in all regions of the world. In developing countries, major remaining causes are neonatal problems, diarrheal diseases, vaccine-preventable diseases, and respiratory diseases. Foreign aid has come in many forms, among them individual persons, nongovernmental organizations, national governments, and international agencies. Governmental involvement in health activities abroad can advance foreign policy interests as well as help protect a country's citizens against existing and potential disease foci. Intergovernmental health agencies, regional and worldwide, have been in existence only in this century; the World Health Organization is barely 50 years old and suffers from US delinquency in paying its dues. Child labor has health aspects in industrialized as well as in developing countries. The United Nations Convention on the Rights of the Child has significant implications for health. Despite broad support, including that of the American Academy of Pediatrics, the United States has not ratified the convention, the only nation in the world beside Somalia not to do so.

Child↗
PubMed2003

Cutaneous drug reaction case reports: from the world literature.

Skin disorders are the most common adverse reactions attributed to drugs. Any skin disorder can be imitated, induced or aggravated by drugs. To help you keep up-to-date with the very latest skin reactions occurring with both new and established drugs, this section of the journal brings you information selected from the adverse drug reaction alerting service Reactions Weekly. The following case reports are selected from the very latest to be published in the world dermatology literature. Any claim of a first report has been verified by a search of AdisBase (a proprietary database of Adis International) and Medline. In addition, the World Health Organization (WHO) Adverse Drug Reactions database is also searched. This database, maintained by the Uppsala Monitoring Centre in Sweden, is the largest and most comprehensive adverse drug reaction source in the world, with information obtained from National Centers of 70 affiliate countries. Each case report is assessed for seriousness using the FDA MedWatch definition of serious (patient outcome is: death; life-threatening; hospitalization; disability; congenital anomaly; or requires intervention to prevent permanent impairment or damage).

Adolescent↗
PubMed2004

The world health situation.

This article, based on a speech given at the Sixth IUHP European Conference on Health Promotion and Education, describes the consequences of the concentration of economic, political, and cultural power in the world today (in the countries of both North and South) for the health and well-being of the world population. The author stresses that the current world disorder is based on a set of alliances between the dominant classes (and economic and financial groups) of the North and the dominant classes (and groups) of the South against redistributional policies that would adversely affect their interests. This situation hurts the health and well-being of the dominated classes and other social groups of both North and South.

Culture↗
PubMed2006

Use of the veterans history project to assess World War II veterans' perceptions of military experiences and health.

OBJECTIVE: This qualitative research study evaluated the attitudes, perceptions, and opinions of World War II veterans regarding the health impact of their military service. METHODS: The study design involved adding relevant health questions to the interview format developed by the ongoing Veterans History Project, a military oral history depository directed and maintained by the U.S. Library of Congress. Audiotaped interviews conducted with individuals and a focus group were coded and evaluated. Key informants provided background information. RESULTS: Findings included a general consensus among participants that military service during World War II was beneficial to their health. Preventive health practices were instilled as lifelong habits, as were feelings of self-confidence and independence. The Veterans Administration was viewed positively by respondents but was not used to any great extent. CONCLUSIONS: Current good health and feelings of patriotism, duty, and selflessness may underlie expressed positive attitudes about the health impact of service during World War II.

Aged↗
PubMed2000

[BCG vaccination in the world].

BCG vaccination programme and BCG vaccination coverage in the world were summarized mainly based on the published informations from official organizations, such as World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Centers for Disease Control and Prevention (CDC). From this review, we can see how widely BCG has been used for the prevention of tuberculosis in the world. In most of the developing countries, especially in Africa, the Americas, and Pacific Region, BCG vaccination is carried out to newborn babies soon after birth by intradermal injection according to the recommendations from WHO, but some of the developing countries in Asia and Europe have their own modified BCG vaccination programmes. In economically developed countries, BCG vaccination programme has been established according to the tuberculosis status of each countries. Some countries have general vaccination policy, and other countries have selected vaccination policy, but there is no country where BCG vaccination is not carried out at all. Among G8 contries, as representatives of the economically developed countries, Japan, United Kingdom, France and Russian Federation have BCG general vaccination policy for the specified age group. In these 4 countries revaccination (s) of BCG are still carried out. In Germany, some provinces have general vaccination policy and some others have selected vaccination policy. In the United States of America, BCG vaccination is recommended to selected high risk infants and health care workers by CDC. There are many debates as for the efficacy and safety of BCG vaccination, and the development of new vaccine better than BCG has been actively discussed and some encouraging results in animal models have been reported from several laboratories. But, there is almost no possibility to be able to use a new vaccine in the routine practice within a couple of years. From the practical point of view, therefore, the operational researches for the better and more appropriate usage of BCG are equally important and more practical than the researches for the development of new vaccines.

BCG Vaccine↗
PubMed2000

The greying world: a challenge for the twenty-first century.

As we approach the next millennium, an unprecedented rapid increase of total and relative numbers of older persons in both the developed and the developing world is being observed. The total aged population (aged more than 60 years) world-wide will rise from 605 million in the year 2000 to 1.2 billion in 2025. Population ageing is due to two factors: increased life expectancy and decreasing fertility rates. Public health interventions are major contributor to both. A significant consequence of ageing is the shift from communicable to non-communicable diseases. The World Health Organization (WHO) is addressing the multiple challenges posed by population ageing through integrated activities that include consolidation of databases, capacity building (research and training), advocacy and policy development. These are all approached through WHO perspectives on ageing and health: life-course, health promotion, socio-economic, community based, intergenerational, cultural, gender and ethical.

Aged↗
PubMed2001

[The present state of blindness in the world].

PURPOSE: To investigate the present state of blindness around the world. METHODS: The article reviews significant studies by WHO and literature on the topic. RESULTS: Current global estimates indicate that blindness affects close to 45 million people, with nine out of ten blind people living in developing countries. Two-thirds or more of all blindness is avoidable, in that the causes are preventable or treatable. Cataract is the major cause of blindness in the world and the number of cases is increasing. The second cause is glaucoma, and the third is trachoma. The extent of disability of blindness itself is very high compared to that of other illnesses. Also, in terms of the burden of diseases in society, blindness is a relatively huge problem in the developing world. CONCLUSIONS: Intervention should be focused on the factors that have the higheat possibility of change. Manpower development is the most important countermeasure. The aid required to support developing countries is what can make them stand on their own in long term ophthalmic care.

Blindness↗
PubMed1995

[Neuropsychiatry in the Islamic world of the Middle Ages].

The distinction between neurology and psychiatry, which represents a prevailing tendency in contemporary medicine, did not exist in the medieval Moslim world. Moslim doctors, linking their research to the Hippocratic and Galenic heritage, thought of the brain as the origin of psychic and neurological diseases. The article analyzes the history of neuropsychiatry in the Moslim medioeval world and its fundamental contribution in a dark age for the western world, through texts written by famous doctors and scientists. Special attention is devoted to pharmacology and therapeutics: many simple and composed drugs were used to cure mental diseases, together with medical rules for a correct way of life.

Arab World↗
PubMed1995

[The integration of Greek pharmacology into Arabic world].

The paper is a first study of the assimilation of ancient Greek pharmacology in the Arabic world. In a first part, it inventories the Greek works in the field, with their relative importance (tables 1 & 1). The second part is a study of the translations of these treatises, with, first, an inventory of their various Syriac and Arabic versions and, second, a reconstruction of the dynamic of this enterprise (table 3). The third part studies more specifically the integration of the most important work in that field, the De materia medica of Dioscorides. From the methodological point of view, the study is conducted on the Arabic sector, as well on the Greek one, with a special attention to the various aspects of the phenomenon, pharmacological, textual, artistic and others. The conclusion is that the integration of Greek pharmacology in the Arabic world reproduced the general tendencies of the Byzantine world, with an association of both Dioscorides' and Galen's works in the field.

Arab World↗
PubMed1994

Expert fears doom if world population hits 12-15 billion.

Earth's land, water and cropland are disappearing so rapidly that the world population must be slashed to 2 billion or less by 2100 to provide prosperity for all in that year, says a study released yesterday. The alternative, if current trends continue, is a population of 12 billion to 15 billion people and an apocalyptic worldwide scene of "absolute misery, poverty, disease and starvation," said the study's author, David Pimentel, an ecologist at Cornell University. In the US, the population would climb to 500 million and the standard of living would decline to slightly better than in present-day China. Mr. Pimentel said at the annual meeting of the American Association for the Advancement of Science. Even now, the world population of 6 billion is at least 3 times what the Earth's battered natural resources and depleted energy reserves would be able to comfortably support in 2100, Mr. Pimentel said. Mr. Pimentel defines "comfortably support" as providing something close to the current American standard of living, but with wiser use of energy and natural resources. Although a decline to 1 billion or 2 billion people over the next century sounds nearly impossible, it could be done by limiting families around the world to an average of 1.5 children, Mr. Pimentel said. Currently, US women have an average of 2.1 children, while the average in Rwanda is 8.5.

Conservation of Natural Resources↗
PubMed1992

Making the World Health Organization work: a legal framework for universal access to the conditions for health.

Improving global health conditions has been one of the most important and difficult challenges for the world community. Despite concerted efforts by international organizations, like the World Health Organization, great disparities in health conditions remain between developed and developing countries, as well as within those countries. The World Health Organization has achieved some successes through its Health for All strategy; however, it can and should encourage member nations to enact national and international laws to protect and promote the health status of their populations. A comparison to the lawmaking efforts in other areas by international organizations indicates that WHO may have the authority and the means to institutionalize efforts to improve global health conditions.

Forecasting↗
PubMed1992

Evaluation of the World Health Organisation pathfinder methodology for oral health surveys in industrialised countries.

The aim of this study was to carry out a survey using the pathfinder methodology developed by the World Health Organisation for international surveys and to compare the results (DMFT, DT, MT, FT) with those obtained from a national survey in France. The statistically significant difference observed between the results of the DMFT and DT indices obtained by using the two methods does not affect the classification of France at the 'moderate' level on the World Health Organisation scale for caries prevalence at the age of 12 years. The observed DMFT difference is an argument in favour of using the World Health Organisation pathfinder methodology, as it provides a satisfactory degree of precision on the oral health status of a population for planning purposes.

Child↗
PubMed2004

[Control and prevention of cardiovascular disease around the world].

The situation regarding cardiovascular disease in different parts of the world is presented, and the prevalence and trends in main risk factors based on Omran's epidemiological transition model are reported. A World Heart Federation survey documenting the limited human and technical resources in some developing countries and inadequate use of these resources in others is discussed. This survey also shows that few countries have guidelines for the management of cardiovascular disease and its risk factors, and reveals a lack of relationship between the percentage of countries with guidelines and the importance of a given disease or risk factor. Because economic resources for health in highly populated developing countries are limited, preventive measures for cardiovascular disease and its risk factors must be combined with those for all other chronic diseases. We recommend the following actions: a). improve the use of facilities for the dissemination of information; b). create suitable conditions for the development of research in developing countries; c). incorporate into primary care the innovations proposed by the WHO in 2002 to control chronic diseases, and d). assist in the development of the program proposed by the World Heart Federation.

Cardiovascular Diseases↗
PubMed2004

Ethical and programmatic challenges in antiretroviral scaling-up in Malawi: challenges in meeting the World Health Organization's "Treating 3 million by 2005" initiative goals.

The Fifty-seventh World Health Assembly's (WHA's) resolution on the "scaling up of treatment and care within a coordinated and comprehensive response to HIV/AIDS' is welcomed globally, and even more so in Sub-Saharan Africa, where the majority of the people currently in need of antiretroviral therapy do not have access to it. The WHA identified, among others, the following areas which should be pursued by member states and the World Health Organization (WHO): trained human resources, equity in access to treatment, development of health systems, and the integration of nutrition into the comprehensive response to HIV/AIDS. The WHO Director-General was requested to "provide a progress report on the implementation of this resolution to the Fifty-eighth World Health Assembly.' Much of what happens between now and that time depends on the actions of the WHO and the member states and also on the contribution of the international community to the fight against HIV/AIDS. Much of what is to be done will be based on what is available now in terms of practice, human resources, and programs. This paper explores the WHA's resolution, especially regarding the scaling up of antiretroviral therapy, taking Malawi as the case study, to identify the challenges that a Southern African country may be facing which will eventually influence whether the initiative to "Treat 3 Million by 2005' ("3 by 5') will be achieved or not. The challenges southern countries may be facing are presented in this paper not in order to undermine the initiative but to create an awareness of these factors and initiate the appropriate action which would surmount the challenges and achieve the goals set.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Influence of World War II on high medical school education in the US].

Modern medical education was gradually established in the US since Flexner's report was published in 1910. Medical education had developed rapidly before World War II. The outbreak of World War II had become an important factor influencing the development of medical education in history. By analyzing the influence of World War II in medical education and analyzing and summarizing the American medical education before and after this War, we hope that it can offer some useful experiences to the development of medical education in our country.

Education, Medical↗
PubMed1991

Views and reflections on anti-malaria programmes in the world.

The certification of achieved malaria eradication from Taiwan in 1965, and the maintenance of malaria-free status of the country for 25 years, do prove the soundness of the malaria eradication adopted in 1955 by the World Health Assembly, but only when this policy is well understood and well implemented. Certain unique features of Taiwan eradication programme that ultimately lead to its success are cited. The worsening of the malaria situation in the world, and the dismantling of the vertical malaria structures in many countries were highlighted in an article entitled "Malaria Programme from Euphoria to Anarchy" in the WHO forum of 1980. Since then another decade of indifference to the rising tide of malaria, brought about an alarming situation that elicited the 1989 World Health Assembly's resolution on Malaria Control. The underlying causes of this indifference by governments and international bodies concerned with health and socioeconomic development are presented to apprise governments of malarious countries of certain imperative facts that have to be accepted when seriously considering malaria control schemes in their health plans. The need for training future generations of seasoned malariologists is stressed, as well as the need to develop new curricula comprising the experience gained in this field since the dawn of this century. A stress is made on the importance of promoting research, not only on technical problems but also on the social behaviour of rural communities in relation to the acceptance and participation in malaria control programmes. The role of Tropical Diseases Institutes and Research Centres in promoting basic and practical research in the field of malaria is underlined.

Humans↗