The Economics of Global Health
Political and economic concerns have often guided global health interventions. As mentioned previously, early efforts to control yellow fever were tied to the completion of the Panama Canal. However, the precise nature of the link between economics and health remains a matter for debate. Some economists and demographers argue that economic development is the key to improving the health status of populations, while others maintain that ill health is the chief barrier to development in poor countries.
With this edition of Biomedical Ethics Reviews we commence
a somewhat new focus for the series. Building on its solid
tradition of exploring and debating pressing bioethical issues of
the day, this series will now also examine the real-life implications
of these issues for patients and the health care system in
which care is delivered. With each topic, attention will be focused
not only on the theoretical and policy aspects of ethical
dilemmas, but also on the clinical dimensions of these challenges,
and effects on the patient–physician relationship....
Limited success in scaling-up ITN coverage reflects the inadequately acknowledged economic barriers that prevent the destitute sick from accessing critical preventive technologies. Despite proven efficacy and what are considered "reasonable costs," the 2003 RBM report reveals disappointing levels of ITN coverage. In 28 African countries surveyed, only 1.3% (range, 0.2–4.9%) of households owned at least one ITN, and
Health Systems and the "Brain Drain"
A significant and oft-invoked barrier to effective health care in resourcepoor settings is the lack of medical personnel. In what is termed the brain drain, many physicians and nurses emigrate from their home countries to pursue opportunities abroad, leaving behind health systems that are understaffed and illequipped to deal with the epidemic diseases that ravage local populations.
Interactions between astrocytes and blood vessels are essential for the for-mation and maintenance of the blood–neural barrier (BNB). Astrocyte-derived A-kinase anchor protein 12 (AKAP12) influences BNB formation,
but the mechanism of regulation of BNB functions by AKAP12 is not fully
Each year, $100 billion is spent on pain care, yet 40% of Americans experience daily pain, including 50
million people with chronic pain and 25 million people with acute pain. The prevalence of pain has a
tremendous impact on business, with an estimated annual cost of $60 billion plus in lost productivity.
Despite advances in the treatment of pain, the quality of pain care remains far below the potential for
optimal care, and ineffective pain treatment continues to be a growing problem in the United States.
Clinical Implications of Drug Distribution Digoxin accesses its cardiac site of action slowly, over a distribution phase of several hours. Thus, after an intravenous dose, plasma levels fall, but those at the site of action increase over hours. Only when distribution is near-complete does the concentration of digoxin in plasma reflect pharmacologic effect. For this reason, there should be a 6–8 h wait after administration before plasma levels of digoxin are measured as a guide to therapy.
It is important to note, however, that no matter how or if they change,
UN agencies and other global entities can only be as useful as individual
governments allow them to be. The agencies serve the governments,
which have ultimate responsibility for overseeing service provision for
their citizens. Global partners can and should offer extensive support to
governments that show a clear interest in developing realistic policies and
programmes to reduce vertical transmission.
Table 116-4 Standards for Immunization Practice
Child and Adolescent Immunization Practice
1. Immunization services are readily available.
2. Vaccinations are coordinated with other health care services and provided in a "medical home" when possible.
3. Barriers to vaccination are identified and minimized.
4. Patient's costs are minimized.
5. Health care professionals review the vaccination and health status of
patients at every encounter to determine which vaccines are indicated.
6. Health care professionals assess for and follow only medically accepted contraindications.
Harrison's Internal Medicine Chapter 55. Immunologically Mediated Skin Diseases
Immunologically Mediated Skin Diseases: Introduction
A number of immunologically mediated skin diseases and immunologically mediated systemic disorders with cutaneous manifestations are now recognized as distinct entities with consistent clinical, histologic, and immunopathologic findings. Many of these disorders are due to autoimmune mechanisms.
Site of Infection
The location of the infected site may play a major role in the choice and dose of antimicrobial drug. Patients with suspected meningitis should receive drugs that can cross the blood-CSF barrier; in addition, because of the relative paucity of phagocytes and opsonins at the site of infection, the agents should be bactericidal. Chloramphenicol, an older drug but occasionally useful in the treatment of meningitis, is bactericidal for common organisms causing meningitis (i.e.
For the purposes of excluding pregnancy, the CEU would advise that hormonal, intrauterine
and barrier methods can be considered reliable providing they have been used consistently
and correctly on every incidence of intercourse. This should be assessed on an individual
Quick starting may also mean starting a method immediately after the administration of
emergency contraception (EC). In this situation there is a possibility of EC failure and
pregnancy, therefore such practice would always be outside the licence of hormonal
The first task of any aspiring professional is to become acquainted with the
terminology of the chosen subject. When the need arises to understand and
discuss problems in another professional field, it is, inevitably, the new
terminology that forms the largest barrier to communication and which may
lead to misunderstanding.
Claims of negligence against the professions have been increasing over the
last few years. Lawyers increasingly have to deal with the subject of dental
surgery in its widest sense.
Mucositis Irritation and inflammation of the mucous membranes particularly afflicting the oral and anal mucosa, but potentially involving the gastrointestinal tract, may accompany cytotoxic chemotherapy. Mucositis is due to damage to the proliferating cells at the base of the mucosal squamous epithelia or in the intestinal crypts. Topical therapies, including anesthetics and barrier-creating preparations, may provide symptomatic relief in mild cases.
Harrison's Internal Medicine Chapter 121. Intraabdominal Infections and Abscesses
Intraabdominal Infections and Abscesses: Introduction
Intraperitoneal infections generally arise because a normal anatomic barrier is disrupted. This disruption may occur when the appendix, a diverticulum, or an ulcer ruptures; when the bowel wall is weakened by ischemia, tumor, or inflammation (e.g.
The retail sector spearheaded the evolution of Turkey’s commercial
property market. Within a few years, domestic retailers expanded
and consolidated to form regional and national chains. Cross-border
retailers entered the market, benefiting from the country’s strong
economic growth, limited legal barriers to entry and attracted by high
Despite significant accomplishments to date, kidney transplantation is a relatively young field in medicine. Due to the armamentarium of agents available to effectively suppress the immune system, the past decade has seen a shift in focus from prevention of rejection to a focus on extending the life of the allograft and novel strategies to increase the organ donor pool. This book covers basic concepts in kidney transplantation while also addressing ways to manage kidney transplant recipients in order to maximize patient and graft survival.
In this paper we review the fiscal evolution of China and Russia, asking how the process of creating a
separate, tax-financed public sector in the two countries differed. We observe that the size of China's
budget sector was consistently smaller than in Russia and that budget decentralization was consistently
greater. We see both pros and cons in China's decentralization. Local governments that were allowed to
keep marginal increases in local tax revenue had incentives to pursue growth-supporting policies,
including support for foreign investment and export-oriented production.
The normal glomerular endothelial cell forms a barrier composed of pores of ~100 nm that hold back blood cells but offer little impediment to passage of most proteins. The glomerular basement membrane traps most large proteins (100 kDa), while the foot processes of epithelial cells (podocytes) cover the urinary side of the glomerular basement membrane and produce a series of narrow channels (slit diaphragms) to normally allow molecular passage of small solutes and water but not proteins.
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Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study