ABSTRACT
In 1976, the Croatian-Austrian philosopher, historian and Catholic priest, Ivan Illich, later to be defrocked for his radical views, shocked the medical world with his publication Medical nemesis: The expropriation of health. Illich argued that modern medicine was one of the greatest dangers to health, pointing to ever-increasing rates of iatrogenesis, that is, illness, disease or death due to medical treatment. His dire forebodings were prophetic. As Stegenga reveals “a recent study estimated the number of preventable hospital-caused deaths in the United States to be over 400,000 per year (p 180). It is well known that iatrogenesis is one of the ten leading causes of death in the US.
ABSTRACT
Background: An important factor to effectiveness of ART is good adherence to treatment. This study aims to investigate the adherence levels to ART among people living with HIV (PLHIV) attending a Government ART centre in Anakapalli, Andhra Pradesh, India.Methods: A cross sectional study was done among 1000 adult PLHIV receiving ART. Out of nearly 4500 patients on ART we selected 1000 patients by simple random sampling technique. The average of adherence for a period of 2 years and socio demographic details were taken from the patients treatment card. Chi square test was performed to find out significant difference between the socio-demographic variables and adherence level < 95%.Results: Out of 1000 patients, 53.9% were male. 42.2% were in age group 31 to 40 years. 50.1 % had adherence >95%. Major factors influencing poor adherence were: decrease in weight (OR=18.65, p=0.000); decrease in CD4 counts (OR=20.12, p=0.000), presence of opportunistic infections (OR=12.67, p=0.000), WHO stage 3 and 4 illness (OR=6.50, p=0.000), travel distance to ART >50 kilometres (OR=1.94, p=0.000), smoker (OR=1.82, p=0.000),being illiterate (OR=1.72, p=0.000), and alcohol consumption (OR=1.58, p=0.001).Conclusions: Careful monitoring of weight, CD4 counts and opportunistic infections can help to identify poor adherence early.
ABSTRACT
I would like to thank the organisers of this conference for their truly inspiring need to be in touch with the ideas and ethics of Health For All, with a tribute to Dr Amit Sengupta. I feel honoured to have been asked to be here. The storm of tributes to Amit from all over the world punctures one conceit of mine: that Amit was my special friend. I realise he was not just my special friend, but a special friend, mentor, hand-holder to many people, of all ages. He taught us all public health, but also organising, reaching out across political divides, across movements.
ABSTRACT
In July 2011 Nature carried a Comment titled “Grand Challenges to Global Mental Health”announcing research priorities to benefit people with mental illness around the world. The essay called for urgent action and investment. However, many professionals, academics, and service user advocate organisations were concerned about the assumptions embedded in the approaches advocated and the potential for the project to do more harm than good as a result. Nature refused to print a letter (sent on 20th August 2011) protesting against the issue, citing ‘lack of space’ as the reason. This letter is an effort to critique the initiative through wide participation and consensus
ABSTRACT
The Census of 2001 brings the heartening news that the secular decline in the sex ratio of file population has come to a halt: The sex ratio in the population has increased from 927 females per thousand males to 933 females per thousand males in 2001. However it also brings disturbing figures of the continuing decline in the sex ratio in the 0-6 years age group. Partly due to higher female mortality in this age group, demographers had agreed that it is also due to female foeticide, the sex-selective abortion of female foetuses. The figure for the number of females per 1000 males has come down from 945 in 1991 to 927 in 2001. Some states in the country, Himachal Pradesh, with a decline of 54, Punjab of 82, Haryana of 59, and Delhi and Gujarat of 50 each, have shown more precipitous declines. Indeed the sex ratio at birth, based on the SRS, points to an increasing masculinisation from 109.5 males per 100 females in 1990 to 111.0 males per 100 females in 1998. As a consequence there has been a great deal of official concern, the Indian Medical Association initiated a campaign to sensitise the public, the Supreme Court has instructed states to implement the Prenatal Diagnostic Techniques (PNDA) Act, and so-called religious leaders have too entered the fray. The situation is complex: Prenatal sex diagnostic tests are increasingly available, prospective parents apparently want it. A section of the medical profession, which supplies these services, argues that they reflect the values of society and are merely meeting the demands of women. It is in this context that Amin Malouf's excellent novel 'The Century after Beatrice' should perhaps be made essential reading for medical students, indeed all medical professionals.