Losing the battle of the bulge: causes and consequences of increasing obesity.

Increasing proportions of Australians are overweight or obese, a problem shared by all developed and, increasingly, developing nations. Now as many people in the world are overweight as underweight. Increasing obesity is a serious public health as well as economic problem. Its associated greater risks of high blood pressure, heart disease, osteoarthritis, type 2 diabetes, some cancers and other health problems consume considerable proportions of healthcare budgets. Health inequalities often reflect social inequalities, but with overweight there is also a male-female difference in the relationship between overweight and socioeconomic status. Health promotion campaigns are underestimating the social determinants of health, and "risk fatigue" is affecting attitudes to complying with healthy lifestyle standards. Proposals to reverse the obesity trend, such as taxing or restricting the advertising of unhealthy foods, raise contentious issues of choice and regulation.     

On-Site Investigation of the Early Phase of Bhutan Health Telematics Project

Telemedicine is valuable to many developing countries. International use of telemedicine is widespread. Telemedicine can improve health care in the developing countries by removing time and distance barrier, and optimize the use of limited health services in developing countries. The purpose of this paper is to investigate the current situation of healthcare services and telecommunications infrastructure in Bhutan. It summarizes the experience gained from a previous telemedicine pilot project initiated and implemented by the Telecommunication Development Bureau, International Telecommunication Union (BDT/ITU). It also introduces the priorities of telemedicine development set out by the local health authorities as well as the international organizations. By analyzing the common and most urgent problems in the country, which could be alleviated by using telemedicine, it formulates several recommendations concerning the future development strategy of telemedicine in Bhutan.     

What is managed care? A conceptual primer

Managed care is a new concept for many health policymakers. Developed in the USA as a response to increasing healthcare costs, it is being exported across the world, and many countries are incorporating elements of managed care into their health systems. In the absence of a basic understanding of managed care, reality may not meet expectations. This article explains what managed care is, traces its development in the context of the American healthcare system, discusses its achievements (or lack thereof) to date and considers its relevance to healthcare delivery in India.     

Adding insult to injury: the healthcare brain drain

Recent reports published by the United Nations and the World Health Organization suggest that the brain drain of healthcare professionals from the developing to the developed world is decimating the provision of healthcare in poor countries. The migration of these key workers is driven by a combination of economic inequalities and the recruitment policies of governments in the rich world. This article assesses the impact of the healthcare brain drain and argues that wealthy countries have a moral obligation to reduce the flow of healthcare workers from the developing to the developed world.     

Design and Implementation of a Telecare Information Platform

For the aging population and for people with dominant chronic diseases, countries all over the world are promoting an "Aging in Place" program with its primary focus on the implementation of telecare. In 2009, Taiwan held a "Health Care Value-Added Platinum Program" with the goal of promoting the development of "Telecare" services by integrating medical treatment, healthcare, information communication, medical equipment and materials and by linking related cross-discipline professions to enable people to familiarize themselves with preventive healthcare services offered in their household and community environments. In addition, this program can be utilized to effectively provide diversified healthcare service benefitting society as a whole. This study aims to promote a diversified telecare service network in Taiwan's household and community environments, establish telecare information platforms, build an internal network of various healthcare service modes, standardize externally interfacing telecare information networks, effectively utilize related healthcare service resources, and complete reasonable service resource links forming an up-to-date health information exchange network. To this end, the telecare information platform based on service oriented architecture (SOA) is designed to promote an open telecare information interface and sharing environment to assist in such tasks as developing healthcare information exchange services, integrating service resources among various different healthcare service modes, accessing externally complex community affairs information, supporting remote physiological information transmissions, and providing diversified remote innovative services. Information system architecture and system monitoring indices of various types of healthcare service modes are used for system integrations for future development and/or expansions.     

Diarrheal diseases in the history of public health

While the public health threat of HIV/AIDS in developing countries has drawn increasing attention from the international community for more than two decades, other health problems such as diarrheal diseases continue to contribute to higher morbidity and mortality rates in much of the developing world. This literature review is an account of both the history and current risks associated with diarrheal diseases.     

Public-private partnerships and global health equity: prospects and challlenges

Health equity remains a major challenge to policymakers despite the resurgence of interest to promote it. In developing countries, especially, the sheer inadequacy of financial and human resources for health and the progressive undermining of state capacity in many under-resourced settings have made it extremely difficult to promote and achieve significant improvements in equity in health and access to healthcare. In the last decade, public-private partnerships have been explored as a mechanism to mobilise additional resources and support for health activities, notably in resource-poor countries. While public-private partnerships are conceptually appealing, many concerns have been raised regarding their impact on global health equity. This paper examines the viability of public-private partnerships for improving global health equity and highlights some key prospects and challenges. The focus is on global health partnerships and excludes domestic public-private mechanisms such as the state contracting out publicly-financed health delivery or management responsibilities to private partners. The paper is intended to stimulate further debate on the implications of public-private partnerships for global health equity.     

A Roadmap for Designing a Personalized Search Tool for Individual Healthcare Providers

Each year, a large percentage of people change their physicians and other individual healthcare providers (IHPs). Many of these people have difficulty identifying a replacement they like. To help people find satisfactory IHPs who are likely to be good at managing their health issues and serve their needs well, in a previous paper we proposed a high-level framework for building a personalized search tool for IHPs. There are many issues regarding designing a personalized search tool for IHPs, of which only a small portion are mentioned in our previous paper. This paper surveys various such issues that are not covered in our previous paper. We include some preliminary thoughts on how to address these issues with the hope to stimulate future research work on the new topic of personalized search for IHPs.     

国际视野下的医院认证现状与发展趋势

自1951年美国联合委员会在美国国内开展医院认证以来,国际社会不少国家和地区均先后开展了医院认证项目,极大地提升了医疗质量与患者安全水平。本文主要立足国际视野角度,分析当前国际医院认证的普遍现状与共同点,对国际医疗服务体系的变革进行观察,由此分析医院认证在未来变革浪潮中的发展趋势。     

The North Carolina Healthcare Safety Net, 2005: fragments of a lifeline serving the uninsured

North Carolina is in the midst of a quiet, but growing healthcare crisis. The number of uninsured residents is rising at an alarming rate--and a faster rate than in most other states. Almost one of every five (20%) non-elderly North Carolinians have no health insurance, which means a sizeable portion of our population has unmet healthcare needs. As healthcare costs continue to increase, North Carolina is likely to continue seeing increased numbers of uninsured. Until we can dramatically reduce the volume of the uninsured, there will be a continuing and growing need for governmental, private sector, and voluntary healthcare providers to serve this population. In this issue of the Journal, we have attempted to draw attention to the volume and variety of services, programs, and organizations involved in meeting this important healthcare need among our state's most vulnerable populations. The organizations involved in rendering these services, and the private physicians and other healthcare professionals who give of their time and talents to meet these needs, are stretched to their limits in most communities. The Task Force has recommended several concrete steps that would shore up safety net organizations' and individual providers' capacity/ability to meet these needs. Some of these steps will require rather straightforward changes in regulations and laws governing the provision of healthcare services. Others will require appropriation of funds to augment the public, private, and voluntary support now given through these safety net provider organizations in support of their efforts to serve the uninsured. While some effort needs to be made to bring these issues to the attention of the state's Congressional delegation in Washington, DC, many of these problems should not have to wait for federal action. The needs are great, and the demands for service are increasing among those organizations and professionals who have assumed these responsibilities in counties and communities across our state. For those with healthcare insurance, these problems and their administrative complexities may seem of remote interest and concern. But, for the people who depend on the safety net services, these problems can mean the difference between health, work, and opportunity, or between disease, disability, or death. There is a genuine collective benefit to meeting the healthcare needs of the uninsured, for the health and wellbeing of a fifth of our state's population affects the health of all of us. Depending on a stop-gap, safety net to maintain the health of such a large segment of our population is a societal risk we all must confront. Failure of any part of the healthcare safety net could be detrimental to the stability of the larger healthcare system on which we all depend.     

Tremendous benefits

In this essay, a physician describes the personal and professional satisfaction he gained from his volunteer work with Doctors Without Borders (DWB). The account begins with an explanation of why the physician chose a career in medicine and how his interest in international public health was enhanced during a year of volunteer work in a children's hospital in the West Indies. This and later volunteer work with Boston's Health Care for the Homeless Program caused him to realize that volunteers gain far more from their experiences than they can possibly contribute. DWB, which sponsors more than 2000 international volunteers working in approximately 80 countries, is the largest private, nonprofit, nongovernmental, volunteer aid organization in the world. When the physician was given the chance to manage a malaria control project for DWB in Myanmar, he was given a first-hand opportunity to see the interrelationship between human rights and public health that had been stressed by his mentor, the late Dr. Jonathan Mann. While the physician found only a limited opportunity to improve on the human rights situation, some progress was made in controlling the malaria. The physician ends by noting that, while US physicians are experiencing increasing frustration because their practices are increasingly dictated by business concerns, DWB volunteers can make an important difference in the lives of many people and can practice medicine without unnecessary distractions.     

Is there an Aboriginal bioethic?

It is well recognised that medicine manifests social and cultural values and that the institution of healthcare cannot be structurally disengaged from the sociopolitical processes that create such values. As with many other indigenous peoples, Aboriginal Australians have a lower heath status than the rest of the community and frequently experience the effects of prejudice and racism in many aspects of their lives. In this paper the authors highlight values and ethical convictions that may be held by Aboriginal peoples in order to explore how health practitioners can engage Aboriginal patients in a manner that is more appropriate. In doing so the authors consider how the ethics, values, and beliefs of the dominant white Australian culture have framed the treatment and delivery of services that Aboriginal people receive, and whether sufficient effort has been made to understand or acknowledge the different ethical predispositions that form the traditions and identity of Aboriginal Australia(ns).     

Towards the Systematic Development of Medical Networking Technology

Currently, there is a disparity in the availability of doctors between urban and rural areas of developing countries. Most experienced doctors and specialists, as well as advanced diagnostic technologies, are available in urban areas. People living in rural areas have less or sometimes even no access to affordable healthcare facilities. Increasing the number of doctors and charitable medical hospitals or deploying advanced medical technologies in these areas might not be economically feasible, especially in developing countries. We need to mobilize science and technology to master this complex, large scale problem in an objective, logical, and professional way. This can only be achieved with a collaborative effort where a team of experts works on both technical and non-technical aspects of this health care divide. In this paper we use a systems engineering framework to discuss hospital networks which might be solution for the problem. We argue that with the advancement in communication and networking technologies, economically middle class people and even some rural poor have access to internet and mobile communication systems. Thus, Hospital Digital Networking Technologies (HDNT), such as telemedicine, can be developed to utilize internet, mobile and satellite communication systems to connect primitive rural healthcare centers to well advanced modern urban setups and thereby provide better consultation and diagnostic care to the needy people. This paper describes requirements and limitations of the HDNTs. It also presents the features of telemedicine, the implementation issues and the application of wireless technologies in the field of medical networking.     

全球卫生教学机构现状研究

目的通过对世界全球卫生教学机构设置情况的研究,了解全球卫生教学现状,为我国开展相应的教学提供参考。方法对Web of Science数据库文献进行计量学分析,同时结合机构网页检索和专家访谈,了解目前主要的教学机构及其研究方向。结果 目前,世界上以“全球卫生”或“国际卫生”为名设立的教学机构将近百所,其中大部分位于北美和欧洲,分别占所有教学机构数量的52％和29％。主要采用设在单一学院下、作为独立学院、跨学院及合作中心等设置方式。主要教学和研究方向包括生物和流行病学、国际关系与外交、社会学和伦理学等。结论全球卫生教学机构的设置方式和研究方向多种多样,我国在设立相应机构和确立研究方向时应当结合自身优势,加以综合考虑。     

Cloud Based Emergency Health Care Information Service in India

A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the past years. We have developed two services for health care. 1. Cloud based Palm vein recognition system 2. Distributed Medical image processing tools for medical practitioners.     

The care of children from developing countries in Australia.

Many children from developing countries enter Australia yearly either with their family or alone. Many such immigrants establish themselves in Sydney of Melbourne. Due to infectious, malnutrition, and poverty, the children come with a high risk of death, disease, and disability. these risks continue in Australia due to unemployment, poverty, and social obstacles. The government provides health screenings to protect Australians from infectious diseases such as tuberculosis and syphilis. Health services should also tend to the growth, development, and personal health needs of these immigrant children. Few health practitioners have received training in identifying and intervening in their health problems, however. A clinic has organized a service for immigrant children including those who had experienced war, threat, or disaster. An integrated health service which can address unique needs must be available to children from developing countries. In south Western Sydney, such a system exists. A community health nurse works with school age refugees to match them up with appropriate health services. The Service Director of the Department of Community Paediatrics in South Western sydney proposed an even more comprehensive health service for all children from developing countries which would encourage self-reliance and independence. Trained community nurses would actually g into their homes and schools to assist them in finding appropriate practitioners. This system of individual attention would round out the public health screenings. All health practitioners should familiarize themselves with the unique health needs of these children and the different cultural contexts from which they derive. Only then can these children reach the full development potential as Australian-born children.     

我国基层卫生人力资源现状与发展研究综述

基层卫生人力在卫生事业发展中有着决定性的作用,所以基层卫生人力资源的研究在世界各国都受到广泛关注。本文对近年来反映我国基层卫生人力资源现状与发展的20篇相关文章进行研究,描述了我国卫生人力资源的数量、质量、结构、分布,分析了影响卫生人力发展的经济、社会、政策等方面的因素,阐述了发展基层卫生人才的策略,即通过大力加强对农村人才的培养,调整医学教育的专业结构,实施优惠政策来吸引和稳定卫生人才三个方面来实施。     

Meeting of minds in Moscow

Smith reports on the annual congress of the International Physicians for the Prevention of Nuclear War (IPPNW), held June 1987 in Moscow. The IPPNW declared its support for the total abolition of nuclear weapons, a theme addressed by many of the speakers to the assembly of delegates. While much attention was directed toward relations between the superpowers, the impact of the arms race on expenditures for health in developing countries was also emphasized. The congress closed with discussions of ways to encourage peaceful international cooperation and the use of satellite communication technology to promote world health.     

Medical students, medical schools and international health

Over the past decade, student participation in international health has moved beyond individual elective terms in developing countries to collective responses led by student international health organisations. There are now at least 10 such organisations, with more than 500 medical students participating at a local or national level each year. Student international health organisations can deliver short- and long-term benefits to developing countries, while equipping students with skills such as leadership, teamwork and cultural sensitivity. Activities include delivery of medical equipment, fundraising, educating university communities, and acting as advocates for social justice. We believe Australian medical schools must formally incorporate international health into their curricula, drawing upon the experiences of schools in Europe and North America.     

Nutrition-related disorders in Indigenous Australians: how things have changed

Awareness of a serious Indigenous health problem in Australia did not emerge until the 1960s and 1970s. Much attention was focused at the time on poor pregnancy outcomes, high infant and young child mortality rates, and childhood malnutrition and impaired growth, often associated with high infectious disease burdens. Although that situation has improved somewhat, Indigenous infant and child health is still poor compared with that of other Australian children. Over recent decades, there has been a rapid rise among Indigenous people of nutrition-related "lifestyle" disorders such as obesity, cardiovascular disease, type 2 diabetes mellitus and chronic renal disease and their complications. This epidemic of disabling and often fatal chronic diseases in Indigenous Australians is also occurring in disadvantaged groups in many other countries. Control of this potentially disastrous epidemic must become a much higher priority in Indigenous health programs. Governments must commit to this task in cooperation and collaboration with Indigenous organisations and communities.