The burden of road traffic injuries in developing countries: the 1st national injury survey of Pakistan

OBJECTIVES: To assess the burden of road traffic injuries in Pakistan-a developing country in South Asia. METHODS: A nationally representative household interview survey, to measure the burden of all injuries for all ages and in both genders using a three-month recall period. RESULTS: The overall incidence of injury events was 41 (CI: 39.2-43.8) per 1000 per year and for road traffic injuries 15 (CI: 13.7-16.5) per 1000 per year. The relative risk for road traffic injuries was found to be higher in males, those 16-45 years old, and those in the professional category of laborers and vendors. CONCLUSIONS: This first national survey reflects the growing impact of injuries, especially road traffic injuries in Pakistan and portends a challenge for the national health system.     

Road crashes: a modern plague on South Asia's poor

South Asian nations are at the crossroads of economic and political progress but still face severe problems of under-development. Available data illustrates that while some macroeconomic indicators have improved over the years, disparities between rich and poor have increased manifold. Although infectious diseases remain a formidable enemy, noncommunicable diseases and injuries are increasing the health challenges facing the countries of the region. While it is widely recognized and accepted that infectious diseases predominantly affect the poor, there is insufficient evidence documenting the burden of RTI on the lower socioeconomic groups in developing countries. Low educational level, poorly paid occupations and poverty have all been found to be risk factors for road traffic injuries. This paper reviews available data from South Asia to show that RTI disproportionately affect the poor in terms of mortality, morbidity and disability, and presents a persuasive argument to policy makers about the importance of road crashes as a public health problem in South Asia. It is hoped that this will provide further visibility to the increasing burden of RTI in South Asian countries and will attract more political and financial support from the national governments and the donor community to further scale up prevention and control.     

Molecular characterisation of macrolide resistance mechanisms of Streptococcus pneumoniae and Streptococcus pyogenes isolated in Germany, 2002-2003

In the present study, a real-time PCR protocol was developed for the detection of macrolide resistance determinants and was validated in a nationwide study in Germany covering a total of 236 Streptococcus pyogenes and 241 Streptococcus pneumoniae strains collected from children < or = 16 years of age with community-acquired infections. Macrolide resistance was observed in 19.9% of pneumococcal strains and 14% of S. pyogenes isolates. Of the erythromycin A-resistant S. pyogenes strains, 93.9% showed the efflux type mef(A); 62.5% of the S. pneumoniae strains were mef(A)- and 37.5% erm(B)-positive. The correlation of the results of real-time PCR assay genotyping in the present study compared with those of conventional PCR genotyping and resistance phenotyping was 100%. Macrolide resistance is of growing concern in Germany. This highly sensitive and specific PCR assay to detect macrolide resistance has the potential to provide sufficiently rapid results to improve antibiotic treatment of streptococcal infections.     

Opportunities for disease state management in prostate cancer.

In this paper, we examine how the management of prostate cancer lends itself to a disease state management (DSM)-based approach, and propose a framework that emphasizes the patient-provider-caregiver triad in managing the long-term implications of the condition. There is often no clearly superior approach to the management of patients with prostate cancer (eg, watchful waiting and hormonal therapy), and each option entails different trade-offs in quality of life. Ideally, the physician and patient discuss the options, issues, and patient preferences for treatment through the shared decision-making process. A family caregiver such as the spouse of the patient is often involved in the treatment decision and in the long-term management of the cancer experience. In order to develop a DSM program supporting both patient and caregiver, educational, psychosocial, and health care system support needs should be tailored to each phase of cancer treatment/management. To embrace the unique aspects of prostate cancer management, the proposed framework emphasizes communication among the patient-caregiver-provider triad, inclusion of family caregivers in the program, cancer phase-specific support, and psychosocial services as a basis for implementation and evaluation of a DSM program in prostate cancer.     

Should interventional cardiologists treat ischemic strokes? A global perspective

Stroke is the third leading cause of death and the leading cause of severe neurological disability in our nation. The stroke death rate has the potential to reach epidemic proportions as the elderly segment of the population continues to rise. There is an insufficient number of trained physicians to supply the care for this patient population. The logical source for qualified physicians to care for these patients is the interventional cardiologist. We review the recent intraarterial therapy trials and detail the training necessary to allow interventional cardiologists to treat ischemic strokes.