Journal club articles, by date with most recent first
Africans die in pain because of fears of opiate addiction
published 06-10-2007
Views : 467
Times marked as favorite : 64
Extract
"Attempts to improve palliative care services in Africa are being hampered by the fear that many African professionals have of using morphine therapeutically and by poor access to the drug, a conference was told last month.
"Many countries in Africa have no access to morphine so that palliative care is reduced to the level of supportive care without pain relief, delegates from 35 countries heard. They were attending the second palliative care conference for Africa, in Nairobi.
"While the world's 20 richest countries consume 86% of global therapeutic morphine, countries such as Rwanda use just 0.039 mg per capita, one of three lowest users in the world."
Abstract
"Global concerns about an impending influenza pandemic escalated when highly pathogenic influenza A subtype H5N1 appeared in Nigeria in January 2006. The potential devastation from emergence of a pandemic strain in Africa has led to a sudden shift of public health focus to pandemic preparedness.
Preparedness and control activities must work within the already strained capacity of health infrastructure in Africa to respond to immense existing public health problems.
Massive attention and resources directed toward influenza could distort priorities and damage critical public health programs.
Responses to concerns about pandemic influenza should strengthen human and veterinary surveillance and laboratory capacity to help address a variety of health threats.
Experiences in Asia should provide bases for reassessing strategies for Africa and elsewhere.
Fowl depopulation strategies will need to be adapted for Africa.
Additionally, the role of avian vaccines [i.e., vaccines for the fowl] should be comprehensively evaluated and clearly defined."
This is a rather curious article, or perhaps just poorly titled, and would be a good one to use for a journal club discussion of research technique. Basically, the researchers interviewed people who had been treated with ivermectin as part of an onchocerciasis control program, asking them what benefits they got from the drug.
The results were that minorities of 5% to 25% reported benefits such as disappearance of nodules, deworming, improved vision, improved libido in males, improved appetite, reversal of secondary amenorrhea, and disappearance of head lice.
As far as I can tell, there was no control group, no pre- and post-test comparison, no longitudinal data, ... simply asking people what results they had seen. Hence, a better title would be, "Perceived benefits of ivermectin..."
While ivermectin does, according to research cited in the article, have various benefits, the study itself does little to demonstrate those benefits; placebo treatment might have been seen as just as beneficial. Or did I miss something ...?
Psychiatry tends to be a neglected area in the developing world, perhaps because of the priority of ensuring physical survival. Whatever the causes, this study shows that in the "happiest country in the world" depression is still a significant problem, at least in the elderly (over 65). Of special note, "there was a mean delay of 5 years from onset of depression to receipt of first treatment." That probably surprises no one, but it certainly shows a glaring gap that needs addressing. ... read more
Control of Neglected Tropical Diseases (NEJM)
published 14-09-2007
Views : 2977
Times marked as favorite : 66
Discusses a list of 13 "neglected tropical diseases", particularly the seven most common,* which together are responsible not so much for mortality but for much morbidity and poverty in the developing world. The article discusses what is currently being done, what treatments are available, and what new efforts are needed to bring these diseases under control.
*ascariasis, trichuriasis, hookworm infection, schistosomiasis, lymphatic filariasis, trachoma, and onchocerciasis
Putting Typhoid Vaccination on the Global Health Agenda (NEJM)
published 14-09-2007
Views : 511
Times marked as favorite : 63
Enteric fever or typhoid cases have increased significantly at our hospital in the past 2 years, both in children and adults, with many cases of intestinal perforation and not a few deaths. This editorial discusses the reasons why typhoid has been relatively neglected in recent years, and why it may be time to begin immunization programs in some endemic areas.
Psychiatry tends to be a neglected area in the developing world, perhaps because of the priority of ensuring physical survival. Whatever the causes, this study shows that in the "happiest country in the world" depression is still a significant problem, at least in the elderly (over 65). Of special note, "there was a mean delay of 5 years from onset of depression to receipt of first treatment." That probably surprises no one, but it certainly shows a glaring gap that needs addressing. ... read more