The Director of the Panamerican Health Organization gives us a message about the 50th anniversary of WHO, emphasizing its origin and characteristics, the successes of its programmes and policies to the sound management of health programmes in its member countries, through the strategy of primary health care and health for all programmes.

History, 20th Century↗

PubMed1996

Measles elimination in the Americas. Evolving strategies.

The strategy currently used to control measles in most countries has been to immunize each successive birth cohort through the routine health services delivery system. While measles vaccine coverage has increased markedly, significant measles outbreaks have continued to recur. During the past 5 years, experience in the Americas suggests that measles transmission has been interrupted in a number of countries (Cuba, Chile, and countries in the English-speaking Caribbean and successfully controlled in all remaining countries. Since 1991 these countries have implemented one-time "catch-up" vaccination campaigns (conducted during a short period, usually 1 week to 1 month, and targeting all children 9 months through 14 years of age, regardless of previous vaccination status or measles disease history). These campaigns have been followed by improvements in routine vaccination services and in surveillance systems, so that the progress of the measles elimination efforts can be sustained and monitored. Follow-up mass vaccination campaigns for children younger than 5 years are planned to take place every 3 to 5 years.

Americas↗

PubMed1996

Information for health and human development.

Information is one of the most powerful instruments of change known to man. It can be used to relieve much pain and suffering, because the basic infrastructure of any successful enterprise is based not only on the management of the physical, financial, and human resources but also on information resources. This paper describes the relationship between health and human development and outlines the roles health sciences librarians might consider in managing information to ensure health, to assist not only medical scientists but also the powerful members of the community. No persons should be hampered in their ability to make decisions about health matters because they did not have access to information librarians have at their disposal.

Developing Countries↗

PubMed1993

Use by visitors of the services of the Queen Elizabeth Hospital, Barbados, W.I.

This paper analyses data for 1990 culled from the medical records of the Queen Elizabeth Hospital, Barbados and examines the use of inpatient and emergency services by visitors to Barbados. The 473 visitors admitted represented 2.1% of all admissions. The records of 425 contained information on country of origin: 145 were from non-Caribbean and 280 from Caribbean countries. The distribution by country of non-Caribbean visitors was the same as that of regular tourist arrivals--the majority came from the USA. Canada and the UK. Caribbean visitors represented 14.4% of the tourists, but accounted for 65.9% of visitor admissions. Non-Caribbean visitors were 85.6% of tourists, but 34.1% of admissions. Young patients predominated among Caribbean, and older patients among non-Caribbean. Accidents, cardiovascular disease, alcohol-related illnesses and near drowning were commoner in the non-Caribbean visitors, while cancer and obstetrical/gynaecological problems were commoner in Caribbean visitors. Seven per cent of visitor admissions went to the Intensive Care Unit as against 0.15% of other patients. The average hospital stay of visitors was 11.7 days compared with 7.0 days for Barbadians. There were 898 visitors treated in the Accident and Emergency Department and the commonest problems were lacerations, abrasions and infections. The UK provided most of these patients. These data show that there is appreciable visitor use of the public health services. Non-Caribbean visitors use them because they fall ill on holiday, but many Caribbean visitors may come specifically for health care. The cost to the Barbadian health service is not insignificant: at the 1990 estimated bed-day cost of Bds$250, it represents a cost of Bds$1.1 million per annum to the Government for inpatient services alone, or 2% of total hospital costs.

Adolescent↗

PubMed1991

Variations in the kinetic response of several different phosphate-dependent glutaminase isozymes during acute metabolic acidosis.

We describe the kinetic modifications to mitochondrial-membrane-bound phosphate-dependent glutaminase in various types of rat tissue brought about by acute metabolic acidosis. The activity response of phosphate-dependent glutaminase to glutamine was sigmoidal, showing positive co-operativity, the Hill coefficients always being higher than 2. The enzyme from acidotic rats showed increased activity at subsaturating concentrations of glutamine in kidney tubules, as might be expected, but not in brain, intestine or liver tissues. Nevertheless, when brain and intestine from control rats were incubated in plasma from acutely acidotic rats enzyme activity increased at 1 mM glutamine in the same way as in kidney cortex. The enzyme from liver tissue remained unaltered. S0.5 and nH values decreased significantly in kidney tubules, enterocytes and brain slices preincubated in plasma from acidotic rats. The sigmoidal curves of phosphate-dependent glutaminase shifted to the left without any significant changes in Vmax. The similar response of phosphate-dependent glutaminase to acute acidosis in the kidney, brain and intestine confirms the fact that enzymes from these tissues are kinetically identical and reaffirms the presence of an ammoniagenic factor in plasma, either produced or concentrated in the kidneys of rats with acute acidosis.

Acidosis↗

PubMed1991

Toward a taxonomy of technical cooperation in health.

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Budgets↗

PubMed1990

Influence of acute metabolic acidosis on the monomer and polymer forms of renal phosphate-dependent glutaminase.

Phosphate-dependent glutaminase (PDG) was measured in kidney cortex homogenates and mitochondria from control and acutely acidotic rats. The effect of plasma from acutely acidotic rats on PDG activity in homogenates from normal rats was also studied. Acidosis or incubation in acidotic plasma enhanced enzyme activity when measured at 1.0 mM but not at 20.0 mM glutamine. This effect was not due to increased mitochondrial permeability since similar results were obtained after solubilization of the enzyme with Triton X-100. Increased enzyme activity was observed with either the Tris (monomer) form or the borate (polymer) form of the enzyme, indicating that enhanced activity is not due to polymerization but probably to a conformational change in the enzyme such that the Km for glutamine is lowered.

Acidosis↗

PubMed1990

Health and tourism in the Caribbean.

Health and tourism impact on each other in the Caribbean, so it is both appropriate and necessary that those concerned with tourism in the region should consider health issues. The health and environment of the Caribbean can have good or bad effects upon the health of visitors, and tourism has health consequences for local residents. Tourism for health purposes also needs to be considered. This article points out the major issues related to these interactions, indicates where more data are needed, and suggests lines of future action.

Conservation of Natural Resources↗

PubMed1987

Renal disease in Africa and the Caribbean: an overview.

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Adolescent↗

PubMed1985

Membranous glomerulonephropathy with crescents in systemic lupus erythematosus.

Over a 2-year period percutaneous renal biopsies were carried out on 23 patients with systemic lupus nephritis. When classified by immunofluorescence, and light and electron microscopy, 4 patients had mesangial disease, 1 had focal and segmental proliferation, 5 had diffuse proliferation and 5 had membranous changes. 3 biopsies were unclassifiable with end-stage changes and 5 showed an unusual combination of pure membranous changes in association with significant crescent formation. The outcome of the latter group of patients was uniformly poor. We think that this group represents a distinct histological entity with a poor prognosis.

Adolescent↗

PubMed1984

Renal ammoniagenesis in rats made acutely acidotic by swimming.

Rats develop metabolic acidosis acutely after exercise by swimming. Renal cortical slices from exercised rats show an increase in both ammoniagenesis and gluconeogenesis from glutamine. In addition, plasma from the exercised rats also stimulates ammoniagenesis in renal cortical slices from normal rats. In exercised rats renal phosphate dependent glutaminase shows a 200% activation when the enzyme activity is measured at subsaturating concentration of glutamine (1 mM) while only an increase of 12% in Vmax is observed. When kidney slices from normal rats are incubated in plasma from exercised rats an activation of phosphate dependent glutaminase is obtained with a 1.0 mM (100%) but not with 20 mM glutamine as substrate. This activation of phosphate dependent glutaminase at subsaturating levels of substrate may indicate a conformational change in PDG effected by a factor present in the plasma of exercised acidotic rats.

Acidosis↗

PubMed1984

Comparison of the effectiveness of a beta blocker (atenolol) and a diuretic (chlorthalidone) in black hypertensive patients.

A double-blind crossover trial of atenolol and chlorthalidone was done in black Jamaican hypertensive patients. After an initial four weeks of single drug therapy, the beta blocker and thiazide diuretic were used in combination. Chlorthalidone at a daily dose of 25 mg produced a significant (P less than .05) fall in the mean systolic and diastolic pressures (19.4 mm Hg and 12.2 mm Hg, respectively); atenolol produced a significant fall in the diastolic blood pressure (6.5 mm Hg); and combination therapy produced a reduction in systolic and diastolic blood pressures (27.8 mm Hg and 17.8 mm Hg, respectively). The study showed that combination therapy using a low dose of thiazide diuretic and a beta blocker was synergetic, but that a thiazide was more effective than a beta blocker in lowering the blood pressure in black hypertensive patients.

Adult↗