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Background: Over the last two decades, video-assisted surgery has become the preferential access route for many procedures. Despite cholecystectomy being the laparoscopic procedure most frequently performed in Brazilian public hospitals from 2008 to 2012, the lack of population-based studies led us to conduct a survey on the prevalence of video-assisted surgery in the treatment of patients using the Sistema Único de Saúde (SUS) (Unified Health System), which is the universal, free, and public healthcare system of Brazil. Methods: By analyzing the DATASUS (national public health registry database), the prevalence of laparoscopic cholecystectomy and open cholecystectomy (OC) was calculated in the period from January to December in 2008, 2010 and 2012, taking into consideration their geographic distribution throughout Brazil. Results: At the end of the study period, an increase in the number of laparoscopic cholecystectomies was observed, with a variation of 125.7 %. However, OC was more prevalent despite an increase in the use of video-assisted surgery over the 5-year study period, increasing from 12 to 25 % in 2012. Conclusions: In spite of a trend toward increased use of video-assisted surgery for treating SUS patients during the period under study, the data from 2012 are still far from being ideal. For this population, OC via laparotomy is still the most prevalent option in all regions. This information must encourage the Brazilian surgical societies to push for an improvement in the supply of the treatment provided by the public health system. [ABSTRACT FROM AUTHOR]

Introduction Volunteer community health workers (CHWs) are one approach to addressing the health workforce shortage in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in using female volunteer CHWs as core workers in its successful health programmes. After 25 years of implementing the CHW model in rural areas, BRAC is now using CHWs in urban slums of Dhaka through Manoshi, a community-based maternal and child health project. However, high dropout rates among CHWs in the slums suggested a need to better understand factors associated with their retention, and consequently recommend strategies for increasing their retention.Methods This mixed-method study included a case-control design to assess factors relating to the retention of volunteer CHWs, and focus group discussions (FGDs) to explore solutions to problems. In total, 542 current and 146 dropout CHWs participated in the survey. Six FGDs were held with groups of current and groups of dropout CHWs.Results Financial incentives were the main factor linked to CHW retention. CHWs who joined with the expectation of income were almost twice as likely to remain as CHWs. This finding was reinforced by the inverse association between wealth quintile of the CHWs and retention; the poorest CHWs were significantly more likely to stay in the programme than the richest. However, social prestige, community approval and household responsibilities were important non-financial factors associated with CHW retention. Restructuring and expansion of existing financial incentives to better compensate CHWs were recommended by CHWs to improve their retention.Conclusions Factors found to be important in this study are similar to those from earlier studies in rural areas. While the data indicate that financial incentives are the most commonly discussed factor regarding CHW retention in urban slums, the results also suggest other avenues that could be strengthened to improve their retention. [ABSTRACT FROM PUBLISHER]

In a previous issue of Zygon (Carvalho 2007), I explored the role of scientists—especially those engaging the science-religion dialogue—within the arena of global equity health, world poverty, and human rights. I contended that experimental biologists, who might have reduced agency because of their professional workload or lack of individual resources, can still unite into collective forces with other scientists as well as human rights organizations, medical doctors, and political and civic leaders to foster progressive change in our world. In this article, I present some recent findings from research on three emerging viruses—HIV, dengue, and rotavirus—to explore the factors that lead to the geographical expansion of these viruses and the increase in frequency of the infectious diseases they cause. I show how these viruses are generating problems for geopolitical stability, human rights, and equity health care for developing nations that are already experiencing a growing poverty crisis. I suggest some avenues of future research for the scientific community for the movement toward resolution of these problems and indicate where the science-religion field can be of additional aid. [ABSTRACT FROM AUTHOR]

The rise of non-communicable diseases and their impact in low- and middle-income countries has gained increased attention in recent years. However, the explanation for this rise is mostly an extrapolation from the history of high-income countries whose experience differed from the development processes affecting today’s low- and middle-income countries. This review appraises these differences in context to gain a better understanding of the epidemic of non-communicable diseases in low- and middle-income countries. Theories of developmental and degenerative determinants of non-communicable diseases are discussed to provide strong evidence for a causally informed approach to prevention. Health policies for non-communicable diseases are considered in terms of interventions to reduce population risk and individual susceptibility and the research needs for low- and middle-income countries are discussed. Finally, the need for health system reform to strengthen primary care is highlighted as a major policy to reduce the toll of this rising epidemic. [ABSTRACT FROM AUTHOR]

The authors reflect on global access which is available to vaccines. They suggest that barriers to the distribution of life saving vaccines in low income countries can be overcome. They argue that the public health community should better regulate intellectual property so that new vaccines can reach the people in low income countries who need them.

Public health in Brazil achieved remarkable development at the turn of the 20th century thanks in part to physicians and social thinkers who made it central to their proposals for "modernizing" the country. Public health was more than a set of medical and technical measures; it was fundamental to the project of nation building [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To evaluate alternative strategies for improving the uptake of benefits of a community based health insurance scheme by its poorest members. Design Prospective cluster randomised controlled trial. Setting Self Employed Women's Association (SEWA) community based health insurance scheme in rural India. Participants 713 claimants at 'baseline (2003) and 1440 claimants two years later among scheme members in 16 rural sub-districts. Interventions After sales service with supportive supervision, prospective reimbursement, both packages, and neither package, randomised by sub-district. Main outcome measures The primary outcome was socioeconomic status of claimants relative to members living in the same sub-district. Secondary outcomes were enrolment rates in SEWA Insurance, mean socioeconomic status of the insured population relative to the general rural population, and rate of claim submission. Results Between 2003 and 2005, the mean socioeconomic status of SEWA Insurance members (relative to the rural population of Gujarat) increased significantly. Rates of claims also increased significantly, on average by 21.6 per 1000 members (P<0.001). However, differences between the intervention groups and the standard scheme were not significant. No systematic effect of time or interventions on the socioeconomic status of claimants relative to members in the same sub-district was found. ¦ Conclusions Neither intervention was sufficient to ensure that the poorer members in each sub-district were able to enjoy the greater share of the scheme benefits. Claim submission increased as a result of interventions that seem to have strengthened awareness of and trust in a community based health insurance scheme. Trial registration Clinical trials NCT00421629. [ABSTRACT FROM AUTHOR]

I conducted case studies on the level of political priority given to maternal mortality reduction in 5 countries: Guatemala, Honduras, India, Indonesia, and Nigeria. Among the factors that shaped political priority were international agency efforts to establish a global norm about the unacceptability of maternal death; those agencies' provision of financial and technical resources; the degree of cohesion among national safe motherhood policy communities; the presence of national political champions to promote the cause; the deployment of credible evidence to show policymakers a problem existed; the generation of clear policy alternatives to demonstrate the problem was surmountable; and the organization of attention-generating events to create national visibility for the issue. The experiences of these 5 countries offer guidance on how political priority can be generated for other health causes in developing countries. [ABSTRACT FROM AUTHOR]

Commercial realities have drastically reduced private investment in the development of new public health tools, but increased awareness of this situation has resulted in the emergence of a variety of research-based, nonprofit organizations. We reviewed current vaccine developments and developed a framework for efficient research and development investments in this area. We have identified several key "push" and "pull" forces within the vaccine research and product development environment and have examined their impacts on the process. These forces affect the global vaccine pipeline, which is composed of all individual vaccine initiatives and global partnerships (i.e., stakeholders). All of these research and development stakeholders must work together to establish and promote a global, sustainable research and development pipeline that delivers optimal vaccines and immunization technologies. (Am J Public Health. 2006;96:1554-1559. doi:10.2105/AJPH.2005. 074583) [ABSTRACT FROM AUTHOR]

Increased support from the global HIV/AIDS community is driving advances in HIV treatment and vaccine development in the developing world. Care of patients with AIDS includes many biomedical, nutritional, psychosocial, and behavioural interventions. In resource-poor settings, antiretroviral drugs should be given with use of standardised treatment regimens and streamlined algorithms for monitoring use. A safe and effective HIV vaccine will supplement prevention efforts to protect uninfected people against infection, or might possibly be able to modify the course of HIV infection. Advances have been made in understanding the immune response and immunisation to HIV, and new ideas for candidate vaccines have been developed, including several based on HIV-1 strains prevalent in Africa. HIV vaccine efficacy trials are needed in Africa to determine whether these advances can be translated into clinical and public health benefits. In this review, we discuss the prospects for use of treatment and vaccines in resource-poor settings. [ABSTRACT FROM AUTHOR]

Poverty not only excludes people from the benefits of health-care systems but also restricts them from participating in decisions that affect their health. The resulting health inequalities are well documented, and the search for greater equity attracts many concerned players and initiatives. Fundamental to the success of these efforts, however, is the need for people to be able to negotiate their own inclusion into health systems and demand adequate health care. This calls for a restatement of the centrality of people in public health and its practice. New forms of communication and cooperation are required at all levels of society, nationally, and internationally, to ensure equitable exchange of views and knowledge to formulate appropriate action to redress inequalities and improve people's health and wellbeing. [ABSTRACT FROM AUTHOR]

Provides information on the public health development in Cuba. Impact of economic condition in Cuba's health system; Health problems addressed by the Ministry of Health in Cuba; Role of National Institute for Workers Health; Significance of the Center for Genetic Engineering and Biotechnology.

Discusses the health information needs of developing countries. Disparities between rich and poor nations; Brief statistics from the Oxfam and World Bank organizations; Information about poverty in developing countries; Impact of limited fiscal resources; Medical curricula offering little training in informatics; The key public health issue of cardiovascular disease in developing countries.

The article discusses the World Health Organization's (WHO) Stop TB Partnership Second Global Plan to Stop TB. According to the author, each of the partnership's three Implementation Working Groups (DOTS Expansion, MDR-TB, and TB-HIV) now have the opportunity to allocate human and financial resources to tuberculosis treatment. The six actions steps developed by the WHO's tuberculosis initiative are analyzed. The plan includes establishing a profile of poor and vulnerable groups and an assessment of poverty-related barriers to accessing of tuberculosis services.

Introduces a study on the effect of hand-hygiene promotion on childhood infectious disease conducted by Stephen Luby and colleagues, published in the July 16, 2005 edition of "The Lancet." Review of how nearly thirty-thousand children under the age of five-years die each day from preventable infections, such as pneumonia and diarrhoeal disease, in countries with limited resources; Statistics related to a decrease in disease prevalence following soap use and education programs.

Focuses on market influences on public health in less-developed countries. The 1994 World Trade Agreements; Access to HIV treatment in Thailand; Generic drugs in Thailand; United States pressure to change patent law in Thailand; The role of World Health Organization; Role of non-governmental organizations in defending the rights of less-developed countries.

The authors describe a plan for international burn prevention and care. They note statistics indicating the prevalence of burn injuries and deaths in low- and middle-income countries (LMIC). It notes age-related biases in burn injuries in LMICs. It emphasizes that even in the U.S., a relationship exists between burn injuries and socioeconomic status. It cites the importance of burn prevention in LMICs. It notes social, psychological, and economic problems that burned children and adults face after healing.

The authors reflect on the use of early vaccination to prevent measles in developing countries. They suggest that early vaccination may improve the control of measles but that it cannot replace doses which are given to children between the ages of nine and fifteen months. They argue that additional research is needed to assess the efficacy of early vaccination strategies.

The article presents an overview of the role antimicrobial resistance plays in the mortality of children in developing countries. A discussion of some of the major causes of death of approximately ten million children under the age of five which is seen annually across the globe is presented. The role limited laboratory facilities and a lack of population based disease surveillance systems plays in the acquisition of information about antimicrobial resistance and the mortality of children in developing countries is discussed.

The author reflects on the use of anesthesia in developing countries. He argues that while the safety of surgery and obstetric care owes much to improvements in anesthesia, the safety of anesthesia is not seen in many developing countries. He argues that to solve that problem support for good quality training for non-physician anesthetists and the recruitment of more physician anesthetists in developing countries is vital.

Measles is still an important public health concern in most developing countries. Nonimmune or single-dose vaccinees traveling to high-endemic countries should be advised on the risk of acquiring the infection. We describe two cases of imported measles in Spanish travelers. [ABSTRACT FROM AUTHOR]

The article focuses on new efforts being made to decrease the amount of newborn deaths in developing countries. According to the author, funding and programs aimed at providing better access to care have been lacking, despite the fact that most newborn deaths can be prevented by simple measures. Statistics related to the number of infant deaths in Africa are reviewed. Comments from Christopher Elias, president of the Program for Appropriate Technology in Health, are included. The author reviews how the Gates Foundation recently announced that it was issuing more than $84 million in grants to two organizations that are spearheading such efforts, including Save the Children's Saving Newborn Lives initiative.

The author reflects on the need for vaccines against the human papillomaviruses which exists in developing countries across the globe. He suggests that in developed countries the introduction of vaccines for the viruses has gone smoothly, but in developing countries the introduction has been limited because of cost. He argues that cheaper vaccines for the human papillomaviruses are needed in developing countries.

The article reports on a literary tool kit on palliative care for healthcare professionals in poor countries that see large degrees of human suffering that was developed by Vicky Lavy, a doctor at Helen and Douglas House Hospice in Oxford, England, and Charlie Bond, a consultant in palliative medicine at Severn Hospice in Shrewsbury, England. An overview of public health problems which both doctors have seen in developing countries, and of solutions for the problems which they have proposed in their tool kit, is presented.

The author reflects on whether knowledge concerning public sanitation collected in the 19th century in England could be used to help improve water quality and sanitation in developing countries. He argues that improvements in basic sanitation in the countries which may lead to improved health conditions, can only be accomplished with finance, political will, and demand for change by local populations. An overview of how the knowledge led to changes in sanitation practices in England is offered.

Looks at a recent reports published by the World Health Organization stating that many of the world's poorer countries will not meet the health millennium development goals without concerted effort. Review of the goals, which were established in the 1990s by nearly two hundred participating countries, and aim to reduce infant mortality, improve maternal health and combat infectious disease; Discussion of how no region of the developing world is currently on track to meet the child mortality goal; Analysis of child mortality data; Importance of the retention of health care professionals in Africa in successfully meeting the millennium development goals.

Presents an editorial on the global shortage of blood and blood donors for transfusions. Reports that fewer than thirty percent of the countries in the World Heath Assembly (WHA) have nationwide systems in place for blood donations and that many of them still pay donors for the blood, a practice known to jeopardize blood safety; Lack of proper disease screening of donated blood in developing countries; Increasing demand for healthy blood world wide; Need for better blood donation safety measures and more blood donors.

Offers a look at the rise of cardiovascular disease as a public health problem in developing countries. Effects of cardiovascular disease on society and on the workforce; Mortality from cardiovascular disease among working age people; Measures needed for the prevention of cardiovascular disease including a reduction in tobacco production and consumption, improved nutrition, and educational strategies.

A silent crisis in cancer treatment exists in developing countries and is intensifying every year, said Mohamed El Baradei, the International Atomic Energy Agency (IAEA) Director General. 85 percent of the world's population live in developing countries, which have about 2200 radiotherapy machines compared with 4500 machines in the developed world. IAEA says that $2.5 billion will be needed to provide adequate facilities in developing countries: half to buy machines and half to train physicians and physicists. Ethiopia's situation illustrates the problems faced by a country with few cancer treatment facilities--it has one radiotherapy machine per one million people--and a growing rate of cancer. For women in Ethiopia, cervical cancer is one of the most common cancers. In western nations with routine surveillance, such as Pap smears, such cancers would be caught early. But without early detection Ethiopian women are four times more likely to have cervical cancer compared with women living in a developed nation. Another country faced with a growing cancer burden is Sri Lanka. According to the World Health Organization, 43 percent of cancer cases worldwide are caused by diet, tobacco, and infection.