Saturday, April 30, 2005

Multiplicity in randomized trials I: Endpoints and treatments

The Lancet:
Kenneth F Schulz and David A Grimes
"Multiplicity problems emerge from investigators looking at many additional endpoints and treatment group comparisons. Thousands of potential comparisons can emanate from one trial. Investigators might only report the significant comparisons, an unscientific practice if unwitting, and fraudulent if intentional. Researchers must report all the endpoints analysed and treatments compared. Some statisticians propose statistical adjustments to account for multiplicity. Simply defined, they test for no effects in all the primary endpoints undertaken versus an effect in one or more of those endpoints. In general, statistical adjustments for multiplicity provide crude answers to an irrelevant question. However, investigators should use adjustments when the clinical decision-making argument rests solely on one or more of the primary endpoints being significant. In these cases, adjustments somewhat rescue scattershot analyses. Readers need to be aware of the potential for under-reporting of analyses."

Atlas of the Human Journey - The Genographic Project

Atlas of the Human Journey - The Genographic Project
Global Gene Project to Trace Humanity's Migrations
Hillary Mayell for National Geographic News
April 13, 2005

New DNA studies suggest that all humans descended from a single African ancestor who lived some 60,000 years ago. To uncover the paths that lead from him to every living human, the National Geographic Society today launched the Genographic Project at its Washington, D.C., headquarters.

The project is a five-year endeavor undertaken as a partnership between IBM and National Geographic. It will combine population genetics and molecular biology to trace the migration of humans from the time we first left Africa, 50,000 to 60,000 years ago, to the places where we live today.

Ten research centers around the world will receive funding from the Waitt Family Foundation to collect and analyze blood samples from indigenous populations (such as aboriginal groups), many in remote areas. The Genographic Project hopes to collect more than a hundred thousand DNA samples to create the largest gene bank in the world. Members of the public are also being invited to participate.

"Our DNA tells a fascinating story of the human journey: how we are all related and how our ancestors got to where we are today," said American geneticist and anthropologist Spencer Wells, the project leader. "This project will show us some of the routes early humans followed to populate the globe and paint a picture of the genetic tapestry that connects us all."

Wells, a National Geographic explorer-in-residence, feels a certain sense of urgency. Wars, environmental disasters, and increasing globalization are causing more people to move, and the world is gradually becoming less culturally and genetically diverse.

Readers guide to critical appraisal of cohort studies: 3. Analytical strategies to reduce confounding --

Readers guide to critical appraisal of cohort studies: 3. Analytical strategies to reduce confounding -- Normand et al. 330 (7498): 1021 -- BMJ: "The previous articles in this series1 2 argued that cohort studies are exposed to selection bias and confounding, and that critical appraisal requires a careful assessment of the study design and the identification of potential confounders. This article describes two analytical strategies—regression and stratification—that can be used to assess and reduce confounding. Some cohort studies match individual participants in the intervention and comparison groups on the basis of confounders, but because matching may be viewed as a special case of stratification we have not discussed it specifically and details are available elsewhere.3 4 Neither of these techniques can eliminate bias related to unmeasured or unknown confounders. Furthermore, both have their own assumptions, advantages, and limitations."

Friday, April 29, 2005

Making decisions in Public Health

E84884.pdf (application/pdf Object)
© World Health Organization, 2004
on behalf of the European Observatory on Health Systems and Policies This document may be freely reviewed or abstracted, but not for commercial
purposes. For rights of reproduction, in part or in whole, application should be made to the WHO Regional Offi ce for Europe, Scherfi gsvej 8, DK-2100 Copenhagen, Denmark [for translation: pubrights@euro.who.int.
For reproduction: permissions@euro.who.int]. The European Observatory on Health Systems and Policies welcomes such applications.
The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or its participating organizations concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. The names of countries or areas used in this document are those which obtained at the time the original language edition of the document was prepared.

Monday, April 25, 2005

Girl soldiers: the forgotten victims of war

News
Girls make up almost half of the 300,000 children involved in wars, according to a report which says they are abducted, raped and often used as currency among fighters.

Sunday, April 24, 2005

Epidemiology 3: likelihood ratios

The Journal : Current Issue: "Likelihood ratios can refine clinical diagnosis on the basis of signs and symptoms; however, they are underused for patients' care. A likelihood ratio is the percentage of ill people with a given test result divided by the percentage of well individuals with the same result. Ideally, abnormal test results should be much more typical in ill individuals than in those who are well (high likelihood ratio) and normal test results should be most frequent in well people than in sick people (low likelihood ratio). Likelihood ratios near unity have little effect on decision-making; by contrast, high or low ratios can greatly shift the clinician's estimate of the probability of disease. Likelihood ratios can be calculated not only for dichotomous (positive or negative) tests but also for tests with multiple levels of results, such as creatine kinase or ventilation-perfusion scans. When combined with an accurate clinical diagnosis, likelihood ratios from ancillary tests improve diagnostic accuracy in a synergistic manner.

Despite their usefulness in interpretation of clinical findings, laboratory tests, and imaging studies, likelihood ratios are little used. Most doctors are unfamiliar with such ratios, and few use them in practice. In a survey of 300 doctors in different specialties, only two (both internists) reported using likelihood ratios for test results.1 Since simple descriptions help clinicians to understand such ideas,2 we will try to make likelihood ratios both simple and clinically relevant.3 Our aim is to enhance clinicians' familiarity with and use of likelihood ratios."

Immunity. Historical Keywords

The Journal : Current Issue: "Immunity

From Latin immunitas (immunis, meaning exempt), immunity entered English as a legal term in the 14th century. But it was not until the late 19th century that, together with immune and immunisation, it became familiar in medical discourse. An awareness of the underlying concept had, however, existed for centuries, because of the observation that children who recovered from certain viral diseases rarely suffered again from the same disease. Immunology--defining the science concerned with responses to substances foreign to animal or human bodies--came into use in the early 20th century. Studies showed that Pasteur's initial observations of immunity, which had led to vaccines against chicken cholera, anthrax, swine erysipelas, and rabies in the 1880s and 1890s, were naive. The process was found to be far more complex and variable, giving rise to the doctrine of susceptibility or predisposition and to the differentiation of natural from acquired immunity.

In 1886, D E Salmon and T Smith found that birds inoculated with hog cholera bacilli killed by heat could withstand multiple doses of otherwise fatal live bacilli. Similar attempts to protect humans against cholera, plague, and typhoid fever followed with equal success. Earlier indications of the bactericidal powers of arterial blood were elaborated around the turn of the century when E Behring and S Kitasato's studies revealed the mechanisms of the capacity of cell-free serum to neutralise the toxins of tetanus and diphtheria infections. This work led to effective immunisation techniques to mobilise and stimulate the body's natural defences and to an understanding of specific types of immunity, such as passive, phagocytic, and toxin-antitoxin.

Another type of immune response, autoimmunity, deserves mention. At the end of the 19th century, Paul Ehrlich observed that the immune system required the body's ability to distinguish foreign from indigenous antigens. Understanding this issue became acute in the wake of World War II when the grafting of tissues and organs from one individual into another was found to be possible only among identical twins. In 1953, Peter Medawar discovered that grafts were not always rejected in mice if donor cells were injected into the prospective recipient while still in the womb or post-natally. This problem of immune intolerance has undermined the metaphoric simplicity of 'the body's defence system' in medical, if not popular, discourse.

Lise Wilkinson"

Diabetes UK Home page

Saturday, April 23, 2005

The Development Challenge for Brazil

brazildevchallenge.pdf (application/pdf Object)
Brazil is the 5th most populous country in the world and has the 9th largest economy1. It accounts for half or more of South American Gross National Income (GNI). In 2000 a total of US$30 billion of foreign capital was invested, making Brazil the number two recipient among developing countries

Brazil - The new challenge of adult health

multi_page.pdf (application/pdf Object)
Brazil - The new challenge of adult health
Document Type: Publication
Rapporteur: John Briscoe
The World Bank currently supports major Brazilian programs designed to improve maternal and child health and reduce infectious diseases and other basic health problems. This study focuses on the problems which the Brazilian health system will face in coming decades as the population gets older, and as chronic and degenerative diseases and AIDS increase. It concentrates on the causes of mortality. Although problems, such as cardiovascular diseases, cancers and injuries, have existed for centuries in Brazil, they have come into prominance as the epidemiologic and demographic transition is completed, and are referred to as " new " or " post-transition " problems in this report. This study concentrates on how the current health system operates, what new challenges it will face in the next few decades, and how it might deal with these challenges.

Friday, April 22, 2005

Hospitals Worldwide - Hospitals Search

Hospitals Worldwide - Hospitals Search
Search through our database of worldwide hospitals (currently 12,000 entries). Search by combination of country, alphabetical letter or keyword. Our hospital database will eventually contain the address and contact details of every hospital in the world.

Senate Committee Approves Bill To Establish Medical Error Reporting Database, USA

Senate Committee Approves Bill To Establish Medical Error Reporting Database, USA
(Recommended by Jorge Ossanai [jorge@ossanai.com])
.
The Senate Health, Education, Labor and Pension Committee on Wednesday approved by voice vote a bill (S 544) that would create a database to allow care providers to report medical errors, CQ Today reports. The database would be used to track medical errors, examine trends and prevent reoccurring mistakes, CQ Today reports. Information included in the database would not be used in medical malpractice lawsuits, according to CQ Today. Before the full Senate considers the measure, committee Chair Michael Enzi (R-Wyo.) and Sen. Edward Kennedy (D-Mass.) are expected to insert language to clarify that the bill would not affect information already available to attorneys for use in malpractice suits. The committee last year approved similar legislation, which was unanimously approved by the Senate. The House approved a separate version of the legislation, but the issue died after conference committee members were not appointed. The new bill is expected to pass the Senate. The House Energy and Commerce Committee has not yet scheduled a review of the bill (Schuler, CQ Today, 3/9).
"Reprinted with permission from kaisernetwork.org kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Will the next Lord Winston please stand up -- Fister 330 (7497): 971 -- BMJ

Will the next Lord Winston please stand up -- Fister 330 (7497): 971 -- BMJ
"I think all I did was pull strands of research together that hadn't previously been thought related," she later told the BMJ. "Also I think the topic appealed to non-scientists and gets people interested in what science can help us understand. I want to appeal to the non-scientist—people who aren't already interested," she said. "I feel that often science is communicated very patronisingly. This makes people switch off. My mission is to show that knowing about science doesn't have to be something that you have to do for any other reason than the excitement that can come from knowledge of the world around us. I want to be involved in science communication to allow it to enrich people's life like food, literature, or music can. We need to `re-trendify' science."

Reader's guide to critical appraisal of cohort studies: 2. Assessing potential for confounding -- Mamdani et al. 330 (7497): 960 -- BMJ

Reader's guide to critical appraisal of cohort studies: 2. Assessing potential for confounding -- Mamdani et al. 330 (7497): 960 -- BMJ
In cohort studies, who does or does not receive an intervention is determined by practice patterns, personal choice, or policy decisions. This raises the possibility that the intervention and comparison groups may differ in characteristics that affect the study outcome, a problem called selection bias. If these characteristics have independent effects on the observed outcome in each group, they will create differences in outcomes between the groups apart from those related to the interventions being assessed. This effect is known as confounding.1 In the first paper in the series we dealt with the design and use of cohort studies and how to identify selection bias.2 This paper focuses on the definition and assessment of confounders.

Germany sets up a system for reporting medical mistakes -- Tuffs 330 (7497): 922 -- BMJ

Germany sets up a system for reporting medical mistakes -- Tuffs 330 (7497): 922 -- BMJ: "Heidelberg Annette Tuffs

Germany has set up a critical incident reporting system on the internet so that GPs and specialists can anonymously report any mistakes that they have made or that they have seen being made by colleagues."

Statistical outlier? Retrospective analysis using routine hospital data to identify gynaecologists' performance -- Harley et al.

Was Rodney Ledward a statistical outlier? Retrospective analysis using routine hospital data to identify gynaecologists' performance -- Harley et al. 330 (7497): 929 -- BMJ
Useful methods for monitoring performance
Although scanning methods14 such as ours will never have complete diagnostic certainty, they could be used to reliably identify signals from noise,13 which need to be systematically and sensitively examined, perhaps confidentially, by peers.21 Although our methods urgently need to be evaluated prospectively, organisations engaged in this type of performance monitoring, including the National Patient Safety Agency, the Healthcare Commission, the General Medical Council, the NHS Litigation Authority, and the National Clinical Assessment Authority may find our methods of interest. Nevertheless, although the ability to identify poorly performing clinicians after the event has its uses, prevention is preferable; but this presents an altogether different challenge—one that seeks to engineer the safety of patients into the process of care by

Posted as supplied by author.

Appendix

Robust Multivariate Outlier Detection using the Mahalanobis Distance

We first undertook a robust principal component analysis, for each year (and all years together) which showed that the seven indicator variables were orthogonal (results not shown). We then carried out a robust multivariate outlier detection analysis, based on the computation of a robust Mahalanobis Distance (MD)[9] for each consultant in each year.

The MD is in essence a weighted (by the sample robust variance-covariance matrix) Euclidean distance. The MD is measured from the centroid of the indicator variable-space, so that a consultant with average values for each variable will have a MD of zero, and this represents the origin. Consultants who are furthest away from the centroid, irrespective of direction will have relatively larger MDs. We used the Stahel-Donoho robust multivariate estimator to compute our MDs (Maronna RA, Yohai VJ. The behaviour of the Stahel-Donoho robust multivariate estimator. J Am Stat Assoc 1995;90:330-41).

For each consultant, we derived approximate 95% intervals of uncertainty using simulation. Since each variable is based on its own sample size (n), which varies with each consultant, we attempted to account for this by taking repeated random samples from an underlying binomial distribution (based on n and p, for the six proportion based variables) and a normal distribution (for the mean length of stay variable). Exploratory analyses indicated that these were reasonable underlying sampling distributions. So for each consultant we produced 1000 randomly simulated values for each of seven variables, and then computed a robust MD in the manner described above from these simulated data sets. From these MDs, we used the 0.95 and 0.05 centiles to estimate the approximate 95% intervals of uncertainty around each consultant's MD.

The Ö MD distance is known to approximately follow a Ö χ2 distribution with k degrees of freedom (k being equal to the number of variables, 7 in our case)[9] with mean equal to Ö k.[9] Where a consultant's approximate 95% intervals of uncertainty were above the mean (Ö k=2.65), we deemed this consultant to be an outlier. In the presentation of results in Figure 1, we chose to express the Ö MD on the loge scale to aid visualization of the plots.

Multi-level modelling

We also investigated the change in MD over the five years, by taking the transformation loge(Ö MD) using a multi-level modeling approach with the repeated measurements (MD) nested within consultants. The reason for transforming the Ö MD to the loge scale was to avoid heteroscedasticity seen on visual examination of the residuals. The log likelihood of the model with Ö MD -857 versus -238 when using the transformed, loge(Ö MD). We used the standardised residual output from this model to identify outliers beyond +/- 2 standard deviations (Figure 2).

Who needs health care--the well or the sick? -- Heath 330 (7497): 954 -- BMJ

Who needs health care--the well or the sick? -- Heath 330 (7497): 954 -- BMJ
(Recommended by Maria Inês Reinert Azambuja)
Iona Heath, general practitioner. Caversham Group Practice, London NW5 2UP iona.heath@dsl.pipex.com

Shifting drug spending from the worried well in developed countries to those with treatable disease in poorer nations will benefit the health of everyone
Investment in health care, especially when it is driven by the interests of pharmaceutical companies, seems to produce a J curve. For most of the curve, the more money spent, the better the health outcomes, but after a certain point, the more spending and the more emphasis on health at the expense of other areas of human activity and achievement, the worse overall health becomes. Many poorer countries are trapped high on the long arm of the curve while richer countries seem intent on exploring the upper end of the short arm through the excessive self confidence of preventive medicine.1 The emphasis on preventive care damages patients in rich countries by tipping them towards misery. This process is built on a foundation of fear and is fanned by economic and political pressures.

Preventive medicine makes us miserable -- Godlee 330 (7497): 0 -- BMJ

Preventive medicine makes us miserable -- Godlee 330 (7497): 0 -- BMJ
(Recommended by Maria Inês Reinert Azambuja)
Because it is acted on healthy people, preventive medicine needs even stronger supporting evidence on benefits and harms than therapeutic interventions. And, for a new age, we need new adages. But will they have the same ring to them? Prevention may not be better than cure. A stitch in time may in some cases be unnecessary and even harmful. All better ideas to bmj.com.

Fiona Godlee, editor
(fgodlee@bmj.com)

Thursday, April 21, 2005

MyPyramid.gov - United States Department of Agriculture - Home

MyPyramid.gov - United States Department of Agriculture - Home:
(Referred by Berencie Goelzer)
"One size doesn't fit all. MyPyramid Plan can help you choose the foods and amounts that are right for you. For a quick estimate of what and how much you need to eat, enter your age, sex, and activity level in the MyPyramid Plan box.

For a detailed assessment of your food intake and physical activity level, click on MyPyramid Tracker.

Use the advice 'Inside MyPyramid' to help you

* Make smart choices from every food group,
* Find your balance between food and physical activity, and
* Get the most nutrition out of your calories."

Wednesday, April 20, 2005

JOHN PAUL II - WAS NOT A FRIEND OF THE POOR

-----Mensagem original-----
De: Social Determinants of Health [mailto:SDOH@YORKU.CA] Em nome de Vicente Navarro
Enviada em: quarta-feira, 20 de abril de 2005 10:01
Para: SDOH@YORKU.CA
Assunto: Setting the Record Straight (2) - JOHN PAUL II - WAS NOT A FRIEND OF THE POOR
Prioridade: Alta

Vincent Navarro

Dear Colleagues,

It is not customary for me to write on Church affairs. Most of my work is concerned with how to eliminate poverty and reduce social
inequalities in the world. But I am outraged by the way the U.S. media have portrayed the deceased Pope. I am enclosing an article I have
written recently published in Counterpunch which aims at setting the record straight. Needless to say, my influence is remarkably limited, since my access to the media is nil. I hope, however, that people involved in correcting health and social inequalities will help to correct the record.
April 8, 2005
John Paul II Was Not a Friend of the Poor
By VICENTE NAVARRO
The predominant perception of John Paul II, as extensively reproduced in most of the Western media, is that he was very conservative ("traditional" is the term widely used) in religious subjects but progressive in social matters, as evidenced by his defense of the poor and his concern for human and social rights. His key ideological role in the demise of the Soviet Union is put forward as further proof of his commitment to liberty and democracy. John Paul's support for the Polish trade union Solidarnosc, his numerous speeches in support of the poor and of those left behind by capitalism or globalization, and his frequent calls for human solidarity not to mention his opposition to the invasion of Iraq by U.S. forces all are presented as examples of his progressiveness in the social arena.
In this perception of Pope John Paul II, some critical elements are forgotten. Let's detail them. He was groomed for the Papacy, long before he was elected Pope, by the ultra-right-wing sect Opus Dei. This secret organization was founded by Monsignor Escrivá, a Spanish priest who was formerly a private confessor to General Franco, organizing spiritual meetings for the Spanish fascist leadership. Opus Dei chose John Paul as the candidate for Pope very early in his career, when he was bishop of Krakow. His conservatism and anti-communism were very attractive to this sect.
John Paul traveled extensively at that time on trips organized and funded by Opus Dei, developing a very close working relationship with the sect. Opus Dei was the organization that developed the strategy to make him the Pope, assisted by the bishop of Munich, Joseph Ratzinger; the U.S. cardinals close to Opus Dei, Joseph Krol and Patrick Cody; and a cardinal then close to Opus Dei, Cardinal Franz König from Vienna (who later distanced himself from Opus Dei and from the Pope). The center of operations for this campaign was Villa Tevere, the Opus Dei headquarters in Rome.
Immediately after his election as Pope, John Paul designated Opus Dei as a special order directly accountable to him, not to the bishops. He surrounded himself with members of the order, the most visible being Navarro-Valls, an Opus Dei journalist who had worked for Abc, an ultra-conservative Spanish paper that had been supportive of the Franco regime. Navarro-Valls is well-known for selecting journalists to cover the Pope's international visits who would report on them favorably. He constantly vetoed critical voices, such as that of Domenico del Rio of the Italian paper La Repubblica.
The Pope later named another Opus Dei member, Angelo Sodano, as Secretary of State of the Vatican. Sodano had been the Vatican's ambassador in Chile during the Pinochet dictatorship, becoming a close friend and advisor to the dictator. He was responsible for the Pope's visit to the Pinochet dictatorship in 1987. During this visit, the Pope never called publicly for liberty or democracy in Chile. By contrast, when John Paul visited Cuba he was publicly critical of the Cuban regime. But he remained silent when he visited Pinochet. Later, when Pinochet was detained in London (awaiting extradition to Spain at the request of the Spanish Judge Baltazar Garzon), the Vatican, under Sodano's influence, asked the British Government to let Pinochet return to Chile. This same Sodano had referred to liberation theologian Leonardo Boff one of the most popular priests in Latin America as "a traitor to the Church, the Judas of Christ." Under Pope John Paul II, the founder of Opus Dei was made a saint just twenty seven years after his death (one of the fastest such processes ever). Meanwhile, Pope John XXIII and Bishop Romero, assassinated in El Salvadore because of his support for the poor of that country, have been waiting in line for sainthood for a much longer time.
Opus Dei and its Pope were profoundly hostile to liberation theology. John Paul condemned it at the II Latin American Conference, presided over by Opus Dei member Monsignor Alfonso Lopez Trujillo, Secretary General and later president of that Conference. John Paul also was displeased with the Jesuits who had become increasingly concerned about identification of the Church with the strong oligarchical regimes of Latin America. He changed the leadership of the order, appointing very conservative priests as its new leadership. As reported by the ex-Jesuit Luis de Sebastian in the Spanish Daily El Periodico (5 April 2005), the Pope received periodical reports from U.S. CIA Director William Casey (a Roman Catholic) on the "distressing" Jesuit movements in Latin America.
John Paul's speeches on the poor were highly generic and sanctimonious, humanistic in character, without ever touching on the cause of poverty. As the Brazilian Bishop Helder Camara once said, "When I called for the role of the Church to be with the poor, I am called a saint; when I'm asked to do something about the causes of poverty, I am called a communist."
John Paul was profoundly political, always on the side of the powerful in Latin America and in Spain. He never touched on the political causes of poverty, he marginalized and ostracized the mass religious movements in Latin America that called for major social reforms in favor of the poor, and (with Cardinal Ratzinger, the guardian of the Church orthodoxy) he condemned such movements, ordering their leading figures Gustavo Gutierrez, Leonardo Boff, Jon Sobrino, and others to remain silent. Bishop Romero wrote in his personal notes that, when he denounced the brutal repression carried out by the fascist dictatorship in El Salvador, the Pope reprimanded him for not being sufficiently balanced in his criticisms of the Salvadorian dictatorship, whom John Paul referred to as the legitimate government of El Salvador.
In Spain, John Paul was political to an extreme. He was openly supportive of the post-Francoist party, the Popular Party (whose founder is Fraga Iribarne, ex-Minister of the Interior of the Franco fascist regime) and just a few months before his death he gave a speech against the Zapatero government that was actually written by the proPopular Party leadership of the Spanish Church. Although he opposed the invasion of Iraq and the bombing of the Iraqi population, he never condemned the Franco regime (which the Spanish Church supported), nor did he ever condemn the bombing of Spain's civilian population by the Franco Air Force, with the help of German Nazi bombers. When he was asked to condemn the bombing of Spanish cities by the Church-supported fascist forces of Spain, he declined to do so.
Rather than pushing a social agenda worldwide, Pope John Paul II became a major obstacle to such an agenda by making conservative issues (anti-abortion, anti-contraception, anti-homosexuality, and others) rather than social ones the center of political debate. The evolution of the U.S. political debate among Catholics is an example of this. In the past, Catholics in the U.S. voted Democrat more than Republican, but this is no longer the case. In the 2004 presidential election, more Catholics voted for Bush (52%) than for Kerry (47%), and they indicated that the primary reason they supported Bush was the "values" issue.
Based on all this evidence, it is remarkable that John Paul II, Opus Dei's Pope, can be considered a progressive icon.

Tuesday, April 19, 2005

UN Millennium Project - 2005 | Fast Facts

UN Millennium Project 2005 | Fast Facts

More than one billion people in the world live on less than one dollar a day. Another 2.7 billion struggle to survive on less than two dollars per day. Poverty in the developing world, however, goes far beyond income poverty. It means having to walk more than one mile everyday simply to collect water and firewood; it means suffering diseases that were eradicated from rich countries decades ago. Every year eleven million children die-most under the age of five and more than six million from completely preventable causes like malaria, diarrhea and pneumonia.

In some deeply impoverished nations less than half of the children are in primary school and under 20 percent go to secondary school. Around the world, a total of 114 million children do not get even a basic education and 584 million women are illiterate.

Following are basic facts outlining the roots and manifestations of the poverty affecting more than one third of our world.

Monday, April 18, 2005

AMNews: April 25, 2005. More efforts needed to reduce cancer mortality, report finds ... American Medical News

AMNews: April 25, 2005. More efforts needed to reduce cancer mortality, report finds ... American Medical News: "More efforts needed to reduce cancer mortality, report finds
Experts say primary care physicians should focus on proven interventions, such as smoking cessation, in guiding their patients toward a healthier way of life.

By Victoria Stagg Elliott, AMNews staff. April 25, 2005.

Of the estimated 500,000 deaths expected from cancer this year, more than half are preventable, according to a March report issued by the American Cancer Society.

And experts say that primary care physicians play a key role in helping patients make necessary lifestyle changes and urging them to undergo screening tests. Stepping up these efforts could make a significant impact on this number."

Ciência & Saúde Coletiva - Chronic non-communicable diseases in Brazil: the health care system and the social security sector

Ciência & Saúde Coletiva - Chronic non-communicable diseases in Brazil: the health care system and the social security sector
Aloyzio Achutti; Maria Inês Reinert Azambuja
A seguridade social envolve ações do poder público e da sociedade sobre direitos à previdência social, à assistência social e à própria saúde. Este artigo traça um esboço de cada um desses elementos. Muitas doenças crônicas não-transmissíveis têm fatores de risco comuns e demandam assistência continuada de serviços. Comparando-se nossa população com a dos EUA, vê-se que é praticamente do mesmo tamanho até a faixa dos 15 aos 24 anos. A americana é duas vezes maior dos 35 aos 44 anos e mais de quatro vezes maior acima dos 75 anos. Tais diferenças explicam porque o número de mortes por DCNT é muito mais baixo no Brasil: nossa população é mais jovem e morre antes. Na medida em que o processo de envelhecimento avance, especialmente, via redução da mortalidade precoce, aumentará a prevalência das DCNT e sua repercussão na seguridade social. Assim como a atenção à saúde, a previdência social e a assistência social sofrem pressões políticas, econômicas e culturais. Na tentativa de imaginar um cenário futuro possível para a seguridade social no Brasil discute-se a necessidade de reformular o orçamento do País, visando ao equilíbrio financeiro.

Sunday, April 17, 2005

Time and chance: the stochastic nature of disease causation

The Journal : Current Issue: "Time and chance: the stochastic nature of disease causation"
Conclusion

If our analysis is correct, it follows that for many, if not most, diseases we cannot reasonably expect to ever understand exactly why some people are affected and others are not. The best we can hope for is to identify causes that account for a substantial number of cases and that are amenable to preventive intervention. This conclusion applies whether the disorder is a stochastic outcome of unmeasurable subcellular events, or the combined effect of factors, both genetic and environmental, that are potentially measurable but too numerous to characterise fully.

The title of this essay is from the book of Ecclesiastes: "the race is not to the swift, nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favour to men of skill; but time and chance happeneth to them all".2 Pepys would certainly have been well acquainted with this text. Perhaps we too should keep it in mind.

Historical keywords: Pathology

The Journal : Current Issue: "Historical keywords: Pathology"
Pathology comes from the Greek pathos, suffering or distressed state. Galen used the term for a disturbance of vital processes. The changing use of the term pathology indicates changing ideas about the study of disease. Most doctors would have conceived of pathology as morbid anatomy until the end of the 19th century when laboratory studies gave it a dynamic aspect.

Jeffrey Sachs' "punk-rock" appeal to the Nobel committee

The Journal : Current Issue:
"The closing date for this year's Nobel prize nominations has now passed. Of particular interest to advocates for global health is whether Jeffrey Sachs will get the prize for economics. Sachs, Director of the Earth Institute at Columbia University in New York and special advisor to the UN on the Millennium Development Goals, has been touted as a likely prizewinner for several years, so far without success."

Improving diet and physical activity: 12 lessons from controlling tobacco smoking -- Yach et al. 330 (7496): 898 -- BMJ

Improving diet and physical activity: 12 lessons from controlling tobacco smoking -- Yach et al. 330 (7496): 898 -- BMJ: "On behalf of Oxford Vision 2020, a partnership dedicated to preventing the forecast worldwide growth of chronic diseases, the authors suggest that 12 lessons learnt from attempts to control tobacco smoking could be used to tackle the chronic disease epidemics evolving from unhealthy diets and a lack of physical activity

"

Reader's guide to critical appraisal of cohort studies: 1. Role and design -- Gurwitz et al. 330 (7496): 895 -- BMJ

Reader's guide to critical appraisal of cohort studies: 1. Role and design -- Gurwitz et al. 330 (7496): 895 -- BMJ:
"Valid evidence on the benefits and risks of healthcare interventions is essential to rational decision making. Randomised controlled trials are considered the best method for providing evidence on efficacy. However, they face important ethical and logistical constraints and have been criticised for focusing on highly selected populations and outcomes. Some of these problems can be overcome by cohort studies. Cohort studies can be thought of as natural experiments in which outcomes are measured in real world rather than experimental settings. They can evaluate large groups of diverse individuals, follow them for long periods, and provide information on a range of outcomes, including rare adverse events. However, the promise of cohort studies as a useful source of evidence needs to be balanced against concerns about the validity of that evidence.

In this three paper series we will provide an approach to the critical appraisal of cohort studies. This article describes the role and design of cohort studies and explains how selection bias can confound the relation between the intervention and the outcome. The second article will outline strategies for identification and assessment of the potential for confounding, and the third article describes statistical techniques that can be used to deal with confounding. Each paper defines a set of questions that, taken together, can provide readers with a systematic approach to critically assessing evidence from cohort studies.

Confronting an Ill Society: David Widgery, General Practice, Idealism and the Chase for Change -- Spence 330 (7496): 910 -- BMJ

The influence of big pharma -- Ferner 330 (7496): 855 -- BMJ

The influence of big pharma -- Ferner 330 (7496): 855 -- BMJ: "Wide ranging report identifies many areas of influence and distortion

...he would have us believe that his drug has been discovered by chemical research of alchemical profundity, and is produced by a process so costly and elaborate that it can only be sold at a very high price.1

A report published last week on 'the influence of the pharmaceutical industry' describes a strong United Kingdom pharmaceutical industry, whose net exports are worth over �3bn ($5.6bn; {euro}4.3bn) annually.2 The industry's declared goal is 'to bring patients life-enhancing medicines,' a goal 'not only necessary but noble.' The House of Commons health committee examined the means used to achieve this noble end. They found an industry that buys influence over doctors, charities, patient groups, journalists, and politicians, and whose regulation is sometimes weak or ambiguous. For example, the Department of Health, responsible for a national health service that spends �7.5bn on drugs annually, is also responsible for representing the interests of the pharmaceutical industry."

Molecular Immunology

Molecular Immunology
On the Defensive

Signs of our protracted struggle against pathogens show up in our genome--up to 10% of our genes may help build or operate body defenses. Learn more about the molecular and genetic underpinnings of the immune system in this primer written by medical student Daniele Focosi of the International Centre for Genetic Engineering and Biotechnology in Trieste, Italy. Packed with links and original pages, Molecular Immunology is an outline-style guide aimed at upper-division college students and above. Readers can start by touring our border defenses, learning about, say, the 20 varieties of gooey mucin molecules that trap pathogens trying to sneak in through the nose, mouth, and other entryways. Other topics include the origin of infection-fighting cells such as the T cell and the immune systems of fruit flies and other model organisms.

www.mi.interhealth.info

Chemical Genealogy Homepage

Chemical Genealogy Homepage: "Welcome to the Chemical Genealogy Database Hompage.
If you have any problems using the internal Adobe links, check to make sure that your browser is using an Adobe plugin, and is not simply linked to Adobe Acrobat Reader when a .pdf file is opened.

A professional genealogy (as opposed to a family genealogy) traces a person's intellectual line of descent via one's PhD advisor or mentor for one's highest non-honorary degree.

The starting points for this Database are usually chemists, so that this is a Chemical genealogy database; some scientists from other disciplines are included as the lines are traced.

The Database contains information about each person's birthdate, deathdate, highest non-honorary degree, degree date, degree place, degree advisor, scientific accomplishments, and references from which the information was compiled."

Chemical Genealogy Homepage

Chemical Genealogy Homepage: "Welcome to the Chemical Genealogy Database Hompage.
If you have any problems using the internal Adobe links, check to make sure that your browser is using an Adobe plugin, and is not simply linked to Adobe Acrobat Reader when a .pdf file is opened.

A professional genealogy (as opposed to a family genealogy) traces a person's intellectual line of descent via one's PhD advisor or mentor for one's highest non-honorary degree.

The starting points for this Database are usually chemists, so that this is a Chemical genealogy database; some scientists from other disciplines are included as the lines are traced.

The Database contains information about each person's birthdate, deathdate, highest non-honorary degree, degree date, degree place, degree advisor, scientific accomplishments, and references from which the information was compiled."

Unite For Sight, Inc. - International Medical Opportunities

Unite For Sight, Inc. - International Medical Opportunities
International Medical Opportunities
A picture of Andrew of Buduburam Refugee Camp, Ghana

"Jennifer, I write to show my gratitude to you for supporting such a worthy cause to give sight to the nearly blind who cannot afford even a daily meal. Your effort is immense to those of us who are in need. I am a direct beneficiary of your generous donations to assist people you don't even know. It is my prayer that God almighty bless you. The entire team did excellently well and were very kind to us all."
-Andrew, Unite For Sight Cataract Patient at Buduburam Refugee Camp, Ghana

A picture of Eye Technician at Cape Coast Christian Eye Centre

"May I use this opportunity to write and encourage you for doing a great job. Aficans are really proud of you for the number of people that are being operated and refracted by your expenses. As most of the patients come from Humjibre, a town in the Western region, though am not a native in that land, I will take this opportunity to thank you, for we have operated many cataract patients and many had been given glasses to regain their sight. I always stand by you to give help to Unite For Sight."
-Eye Technician at Cape Coast Christian Eye Centre

A picture of Clement Donkor of Humjibre, Ghana

"I wish to thank Unite For Sight for the wonderful job she has done. The outpour of gratitude, by people whose sight has been restored or can now read using reading glasses, makes me find satisfaction from service to humanity...There's a woman in a cottage along the path that leads to my farm. She looked so frail that I thought ill health prevented her from going to farm. I frequently said hello. But she was blind! Yes about 90% blind! Now her sight is restored."
-Clement Donkor of Humjibre, Ghana

A picture of volunteers and villagers of Henan, China

"When we were at the village, one woman followed us to the restaurant, and we conducted an on-the-spot vision screening and refraction. When she got her reading glasses, she got so excited because now she could see the wrinkles on her hand. She thanked us a thousand times, kept jumping around with glee, and brought her relatives and other villagers to the restaurant."
-Sally Ong, Unite For Sight Volunteer in Henan, China

A picture of Lutee, a cataract patient at Buduburam Refugee Camp

"I see the trees and the gate to the eye centre...I see the white gate, and I can tell you that it is open. Praise the Lord! His angels have heard my prayers and sent you to help me!"
-Lutee, Unite For Sight Cataract Patient at Buduburam Refugee Camp

A picture of Jeremiah, Buduburam Refugee Camp, Ghana

"Thanks for the great job that you are doing through Unite for Sight, especially so for the Buduburam Refugee Community in Ghana. The SHIFSD family is so appreciative of the SHIFSD-Unite for Sight Partnership. Thanks also for the Team of Unite for Sight Volunteers currently on the ground; indeed, it is an equivalent of a Dream Team. We love them!!!"
-Jeremiah, SHIFSD, Buduburam Refugee Camp, Ghana

A picture of Karrus, Buduburam Refugee Camp, Ghana

"I will like to take this time to thank you and the Unite For Sight Team here on the refugee camp in Ghana for your love and care you are showing to our people in this community. I love all of the team members they are loving and caring very much. I love Valda very much, and likewise the rest of the team like Silvia, Cathleen, and Grace. They are wonderful people. May God bless you all"
-Karrus, Buduburam Refugee Camp, Ghana

A picture of Max Madoro of Nyamuswa, Tanzania

"We are very much thankful to Jennifer and Unite For Sight for the brilliant work she does to provide eye care services to more than 200 people."
-Max Madoro of Nyamuswa, Tanzania

Africa, Asian, Eastern European, and Latin American Country Opportunities - Short and Long Term Volunteer Opportunities

Unite For Sight volunteers prescribe eyeglasses, screen for eye disease and coordinate and fund diagnosis, treatment, and surgery by doctors. Volunteers also implement Train the Trainer programs for teachers and educate children and adults about eye health and ways to prevent blindness.

All persons over the age of 18 are welcome to apply for these volunteer opportunities, including premedical students, medical students, public health professionals, doctors, corporate professionals, nurses, graduate students, retired professionals, and others.

If you are interested in the volunteer opportunities listed below, please contact JStaple@uniteforsight.org and consult Unite For Sight International Medical Opportunity Manuals and Applications:

Saturday, April 16, 2005

Embodiment: a conceptual glossary for epidemiology -- Krieger 59 (5): 350 -- Journal of Epidemiology and Community Health

Embodiment: a conceptual glossary for epidemiology -- Nancy Krieger 59 (5): 350 -- Journal of Epidemiology and Community Health
Embodiment. This construct and process are central to ecosocial theory and epidemiological inquiry. Recognising that we, as humans, are simultaneously social beings and biological organisms, the notion of ‘‘embodiment’’ advances three critical claims: (1) bodies tell stories about—and cannot be studied divorced from—the conditions of our existence; (2) bodies tell stories that often—but not always—match people’s stated accounts; and (3) bodies tell stories that people cannot or will not tell, either because they are unable, forbidden, or choose not to tell. Just as the proverbial ‘‘dead man’s bones’’ do in fact tell tales, via forensic pathology and historical anthropometry, so too do our living bodies tell stories about our lives, whether or not these are ever consciously expressed. This glossary sketches some key concepts, definitions, and hypotheses relevant for using the construct of ‘‘embodiment’’ in epidemiological research, so as to promote not only rigorous science but also social equity in health.

Wednesday, April 13, 2005

criticamedicina

criticamedicina
Dear colleages: Some Latinoamerican doctors are inaugurating a new and different web- space:Critica Medicina (Critical Medicine).
A free, democratic and latinoamerican place where you can found phylosofical and transgressing messages to help the building of the Social Medicine.
We 'll try to use dialectical and complex thoughts to improve our clinical practice to help our people and to build" Health for all the world": in better active mind, better bodies.
If you 'd like to send us your opinion o contibute with same issues, you' ll write us to: critica_medicina2005@yahoo.com.ar
Your opinion and your support are welcome!

Dr.Alejandro Wajner
Buenos Aires, Argentina

Tuesday, April 12, 2005

World Poverty and Human Rights

5109_eia19-1_pogge01.pdf (application/pdf Object)
Thomas Pogge
Despite a high and growing global average income, billions of human beings are still condemned to lifelong severe poverty, with all its attendant evils of low life expectancy, social exclusion, ill health, illiteracy, dependency, and effective enslavement.The annual death toll from poverty-related causes is around 18 million, or one-third of all human deaths, which adds up to approximately 270 million deaths since the end of the Cold War.

Monday, April 11, 2005

AMNews: April 18, 2005. Black box, black hole ... American Medical News

AMNews: April 18, 2005. Black box, black hole ... American Medical News
Although efforts are made to alert physicians to new drug risks, those warnings are often swallowed up in an overabundance of information.

By Susan J. Landers, AMNews staff. April 18, 2005.

More than three billion prescriptions are written per year, and each and every one of them comes with a complicated instruction manual known as a package insert.

"Package inserts were intended to inform physicians about the risks and benefits of a drug," AMA Trustee Cecil B. Wilson, MD, recently told a Senate panel investigating drug safety. "Unfortunately, today's package insert has become a long and complicated legal document rather than a useful resource for physicians."

AMNews: April 18, 2005. Diabetes compliance not as simple as A1c ... American Medical News

AMNews: April 18, 2005. Diabetes compliance not as simple as A1c ... American Medical News: Diabetes compliance not as simple as A1c
Information is important, but studies suggest it's not enough to prompt patients to change their behavior.

By Victoria Stagg Elliott, AMNews staff. April 18, 2005.

Saturday, April 09, 2005

Art Ludwig's Sound Page

Twilight for the Enlightenment? -- Kennedy 308 (5719): 165 -- Science

Historical Anatomies on the Web

Historical Anatomies on the Web
Historical Anatomies on the Web is a digital project designed to give Internet users access to high quality images from important anatomical atlases in the Library's collection. The project offers selected images from NLM's atlas collection, not the entire books, with an emphasis on images and not texts. Atlases and images are selected primarily for their historical and artistic significance, with priority placed upon the earliest and/or the best edition of a work in NLM's possession.

Friday, April 08, 2005

A good death, or a public one? -- Smith 330 (7495): 0 -- BMJ

A good death, or a public one? -- Smith 330 (7495): 0 -- BMJ
(Referred by Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
Many people might think that part of a good death is privacy—or at least having some say over how wide should be the circle of family and friends who come to talk and touch and give support. But these last two weeks have seen two very public deaths—with room to doubt that the victims would have wanted it that way.

Epidemiology 1: Sample size calculations in randomised trials: mandatory and mystical

The Journal : Current Issue
Kenneth F Schulz, David A Grimes
nvestigators should properly calculate sample sizes before the start of their randomised trials and adequately describe the details in their published report. In these a-priori calculations, determining the effect size to detect--eg, event rates in treatment and control groups--reflects inherently subjective clinical judgments. Furthermore, these judgments greatly affect sample size calculations. We question the branding of trials as unethical on the basis of an imprecise sample size calculation process. So-called underpowered trials might be acceptable if investigators use methodological rigor to eliminate bias, properly report to avoid misinterpretation, and always publish results to avert publication bias. Some shift of emphasis from a fixation on sample size to a focus on methodological quality would yield more trials with less bias. Unbiased trials with imprecise results trump no results at all. Clinicians and patients deserve guidance now.

Wednesday, April 06, 2005

Community Solutions to Health Disparities Database

National Public Health Week
Welcome to the Health Disparities Projects and Interventions database, sponsored by the American Public Health Association. This database contains projects and interventions provided by members of the public health community. Use the form below to search for projects and interventions to health disparity challenges in our communities.

Priority setting in health

285.pdf (application/pdf Object)
“…..Health interventions vary substantially in the degree of effort required to implement them. To some extent this is apparent in their financial cost, but the nature and availability of non-financial resources is often of similar importance. In particular, human resource requirements are frequently a major constraint. We propose a conceptual framework for the analysis of interventions according to their degree of technical complexity; this complements the notion of institutional capacity in considering the feasibility of implementing an intervention. Interventions are categorized into four dimensions: characteristics of the basic intervention; characteristics of delivery; requirements on government capacity; and usage characteristics.

The analysis of intervention complexity should lead to a better understanding of supply- and demand-side constraints to scaling up, indicate priorities for further research and development, and can point to potential areas for improvement of specific aspects of each intervention to close the gap between the complexity of an intervention and the capacity to implement it. The framework is illustrated using the examples of scaling up condom social marketing programmes, and the DOTS strategy for tuberculosis control in highly resource-constrained countries.

The framework could be used as a tool for policy-makers, planners and programme managers when considering the expansion of existing projects or the introduction of new interventions. Intervention complexity thus complements the considerations of burden of disease, cost-effectiveness, affordability and political feasibility in health policy decision-making. Reducing the technical complexity of interventions will be crucial to meeting the health-related Millennium Development Goals….”

WHO | The world health report

WHO | The world health report
The World Health Report 2005 – Make Every Mother and Child Count, says that this year almost 11 million children under five years of age will die from causes that are largely preventable. Among them are 4 million babies who will not survive the first month of life. At the same time, more than half a million women will die in pregnancy, childbirth or soon after. The report says that reducing this toll in line with the Millennium Development Goals depends largely on every mother and every child having the right to access to health care from pregnancy through childbirth, the neonatal period and childhood.

WHO | World Health Day 2005: Make every mother and child count

WHO | World Health Day 2005: Make every mother and child count
WHO is pleased to announce healthy mothers and children as the theme for World Health Day 2005. This is also the subject of the World Health Report 2005, which will be launched on World Health Day, on 7 April 2005.

The slogan for World Health Day 2005 is "Make every mother and child count", which reflects the reality that today, the health of women and children is not a high enough priority for many governments and the international community.

This web site will serve as the official web site for World Health Day 2005. Visit us regularly in the months ahead to find information about how to organize your World Health Day 2005 events, and related advocacy material. For more information please contact: whd2005@who.int

EU Advocate General Says Nay to EU Ban on Health Supplements -

EU Advocate General Says Nay to EU Ban on Health Supplements -
In 2002, the European Union governments approved a directive that would ban many of the most common nutritional supplements throughout Europe. This ban covered vitamins, mineral plant extracts, and other various natural health products. Under the terms of this directive, manufacturers of these products were to be given until July 12 of this year to provide evidence that their products contained ingredients that are considered safe. Once approval was received, the products would then be put on a “positive” list and could be sold.

Observatorio de Politicas Publicas y Salud

Observatorio de Politicas Publicas y Salud

El Observatorio de Políticas Públicas y Salud es un proyecto interuniversitario creado en el año 2000 desde dónde se realiza diferentes actividades de investigación, formación y asesoría en el ámbito de las políticas públicas y la salud.

Lo conforman la Universidad de Alicante (España), la Universidad de Antioquia (Colombia), la Universidad del Atlántico (Colombia), la Universidad de El Salvador (El Salvador) y la Facultad de Ciencias Médicas de Porto Alegre (Brazil). Cuenta además con el apoyo de organismos internacionales como la Organización Panamericana de la Salud (OPS)

Tuesday, April 05, 2005

Global Crises, Global Solutions


Copenhagen Consensus

Combating HIV/AIDS should be at the top of the world's priority list. That is the recommendation from the Copenhagen Consensus 2004 expert panel of world-leading economists.

About 28 million cases could be prevented by 2010. The cost would be $27 billion, with benefits almost forty times as high.

The results of Copenhagen Consensus 2004 are out - (the full list)

We are proud that the goal of Copenhagen Consensus has been achieved: a prioritized list of solutions to the world's great challenges.

The experts have used their knowledge and insight in a very positive and constructive way. It has been fantastic to witness their engagement in reaching concrete solutions.

Copenhagen Consensus has already started an important global debate on prioritizing resources. That debate will continue. I hope academics, politicians and citizens will each take part in this necessary discussion.

The Environmental Assessment Institute is grateful for the generous sponsors of Copenhagen Consensus: The Tuborg Foundation and the Carlsberg Bequest to the Memory of Brewer IC Jacobsen, the Ministry of the Environment, the Sasakawa Peace Foundation, the Sasakawa Peace Foundation USA, and The Economist.

The results of the Copenhagen Consensus Youth Forum, which shadowed the experts' panel, can be found here (Youth Forum results).

Problems and solutions will change over time, so we are looking forward already to Copenhagen Consensus 2008.

Environmental Assessment Institute

Monday, April 04, 2005

Global Health Summit

Welcome: Global Health Summit
Join U.S. Surgeon General Richard Carmona and an array of distinguished international leaders for the 2005 Global Health Summit, which will offer a unique opportunity for stakeholders to provide input on critical priorities in global health and potential collaborative strategies and approaches.

The Summit President will be Dr. Joxel Garcia, Deputy Director of the Pan American Health Organiation. Senator Daniel Inouye will read the Summit's closing Concord. Presenters will include Dr. Allen Jones, Secretary General of the World Federation of Public Health Associations; Dr. Andrew Sorensen, President of the University of South Carolina; Dr. David Brandling-Bennett, Senior Program Officer with the Bill and Melinda Gates Foundation; and Dr. Alfredo Solari of the Inter-American Development Bank. Other presenters during the day will include Dr. Stephen Blount, Director of the Office of Global Health at the Centers for Disease Control and Prevention, Dr. Rabia Mathai, Global Director of Programs for the Catholic Medical Mission Board and Dr. John Williams, Vice President for Health Affairs at George Washington University.

The Summit is planned as the venue for the anticipated release of the Surgeon General's Call to Action on Global Health.

The afternoon will feature breakout sessions in which attendees will have the opportunity to comment on specific crucial areas of global health. Key issues covered will include:

* International Safety
* Maternal and Child Health
* Chronic Disease
* Environmental Health
* Priority Health Problems and Disparities
* Health of Transient Populations
* Mental Health and Individual Behavior
* Infectious Disease
* Indigenous and Multi-Cultural Populations
* Self-Help Programs
* Social Equity
* Economic Impact of Global Health

The concluding event will be the reading of the Philadelphia Concord, a declaration of support for the Global Health Movement.

Saturday, April 02, 2005

Evaluation of Women’s Health Related Issues

documents\studyreports\apr114.pdf (application/pdf Object)
(Recommended by Marcelo Gustavo Colominas [mgcolominas@hotmail.com])
AllPoints Research, Inc. conducted a study among women over the age of 40 to explore attitudes and concerns regarding key health issues. Key sexual issues for women over the age of 40 were also investigated.

Friday, April 01, 2005

Epidemiology

The The lancet Journal : Current Issue
Derived from the Greek epidemia, "prevalence of disease", and embedded in the 5th/4th century BC title of a Hippocratic treatise (Epidemics), epidemiology conceals more than its dictionary definition reveals--the branch of medical science concerned with the incidence and distribution of disease. For inherent to the concept of an "epidemic" is a model of population and a pathologisation of social space. The point of statistics is to command authority on the basis of numerical "facts", yet the study of the statistics of disease is always shaped by larger political and ideological factors. Since the 19th century, the statistics of disease have served as powerful tools for state intervention, even if the practice of epidemiology was largely observational and aimed at solving disease outbreaks.

Disciplinary status was conferred on epidemiology when it became attached to bacteriology, which shifted the study of disease statistics away from environmental factors to an emphasis on monocausal vectors. Further redefinition came through developments in biometrics, pioneered in the UK by Francis Galton (1822-1911) and Karl Pearson (1857-1936) and made acceptable to the medical profession through the efforts of Major Greenwood (1880-1949), the first epidemiologist in the UK to hold an academic appointment. In the 1920s, epidemiology underwent another metamorphosis. For epidemics were now beginning to be conceived not simply in terms of bacteriological invasions but as disturbances to equilibriums within dynamic, multicausal, and holistic disease frameworks.

By the 1960s, medical statistics and social medicine combined to regenerate the field and redefine it away from its "pattern of disease" orientation. Social epidemiology looked beyond death and disease to disability, discomfort, and dissatisfaction. It also led to the study of the relations between disease and lifestyle, most famously in the work of Bradford Hill and Richard Doll on the carcinogenic effects of smoking. But if the discipline gained new lustre, it was not to the delight of all.

By the 21st century, some lambasted social epidemiology for blinding doctors to the individual experience of disease. However, there is little reason to doubt the continuance of epidemiology's rhetorical purchase in political discourse, and in the wake of AIDS, there are few immediate fears for its disciplinary status.

Lise Wilkinson

BMJ Series

Series
From this page, you can access most of the series we've published since 1994. It's a work in progress; if you see any series missing, or any article missing from a series, please contact us.

If you would like to suggest a topic for a series, click here.


* ABCs
* Other series (Statistics notes, Drug points...)
* Reviews (Books, films, websites...)
* Fillers (Endpieces, When I use a word...)

Can we avoid bias?

Can we avoid bias?

Colin P Bradley, professor of general practice1

1 University College Cork, Cork, Ireland c.bradley@ucc.ie

The cognitive processes we use in making diagnoses are characterised by heuristics and biases that are similar to those that underpin much human decision making.1 Although these processes are error prone, they have evolved as rapid and effective ways of making decisions in conditions of uncertainty and they are deeply ingrained in our psyche. Reducing such errors may be difficult and, indeed, some commentators are sceptical about whether such cognitive errors can be reduced at all.
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