Cooperation between health professionals from the United States and the Union of Soviet Socialist Republics. Conclusions from a trip to the Soviet Union.

The United States has long made its academic medical resources available to foreign medical graduates. Conspicuously absent from the number of foreign nationals, however, have been physicians, scientists, and educators from the Soviet Union. Under the new conditions of perestroika, Soviet medical professionals are seeking ways in which to open up broad collaboration with their American counterparts. Agreements are being sought between national organizations, between academic medical institutions, and for the exchange of individual scholars. Cooperation in the area of medical education is one of the distinctive bridges on the path to mutual understanding that will represent a strong link in the public diplomacy of the two superpowers. We recently had the opportunity to discuss in Moscow some of the issues with the U.S.S.R. Minister of Health and with the Pro-rector for International Programs of the Central Institute for Advanced Medical Studies, as well as with faculty members, young medical scientists, and medical students of the Moscow Medical Institutes. We describe briefly many of the similarities and some of the dissonances between our two health systems and set forth ideas for an exchange program in medical education.

Clinical and public health consequences of population ageing.

Those providing primary health care and referral services for the adult population should have the knowledge and positive attitudes that encourage persons, as they age, to maintain function and wellbeing. The WHO programme on Health of the Elderly is oriented to maintain wellbeing as men (and increasingly women) transit through the lifespan in increasing numbers. The key question, for clinical medicine and public health, is to identify the determinants of healthy ageing. The epidemiological thrust of the programme is designed to provide a rational basis for policy and programme development. For the countries of Asia, there is a "green field" situation with regard to knowledge about ageing. A major tool for identifying measures to prevent and control age-related disorders is the prospective, longitudinal study, although none has been conducted in ageing populations outside of industrialized countries. The top quality of evidence for assessing the efficacy of interventions directed at improving the health of the elderly is the randomized controlled trial: few such trials have been conducted outside Europe and North America. Teaching on ageing applicable to the Asian situation is just beginning, and self-health care guidance for the general public is beginning to appear in the popular press. There are moves to establish a better balance of care between hospital and community services and guides are available for assessing the quality of long term care services. The two pillars of the WHO programme on Health of the Elderly are prevention and development of alternatives to institutional care.

Introduction to world health statistics quarterly special issue on public health implications of aging.

The health services in most of the World Health Organization's Member States are directed at improving the wellbeing of families through improved maternal and child health, the control of poverty-related diseases and fertility regulation. Indeed, for the least developed countries, these are all-absorbing concerns. However many developing countries have shaken free from the legacy of shortened life expectancy and have begun to achieve declines in fertility. As a consequence, aging persons who previously were barely visible as a group, now feature more prominently in families, neighborhoods and communities. In effect, we are seeing the emergence of a sizeable human group-persons aged 60 and above-which, almost everywhere in the world, is the fastest growing age group of all. Increasing longevity is a subject of concern in the industrialized world also, where the attention of demographers is beginning to focus on shifts in mortality at advanced age, in view of the consequences to health and social policies of increasing survival.

Bacteriological measures for the detection of cases of pulmonary tuberculosis.

There is a need for more detailed information on the relative merits of the culture and direct sputum smear examination methods, separately and in various combinations, using one or more sputum specimens. The efficiency and relative cost of different bacteriological measures for the detection of cases of pulmonary tuberculosis, in the conditions of the Singapore tuberculosis control programme, are demonstrated. The findings provide guidance for deciding how, and in what order, these bacteriological measures should be used, and may assist planners and executives of national tuberculosis control programmes in the rational commissioning of laboratory facilities that already exist or are to be established.

Urine testing for isoniazid in the supervision of out-patient oral chemotherapy for pulmonary tuberculosis. The failure of a routine service.

Testing urine specimens obtained at surprise visits to the home or at routine clinic attendance is an established procedure in the supervision of patients receiving ambulatory chemotherapy for pulmonary tuberculosis. A urine test service was set up in 9 East African centres, involving 37 staff members (most with limited training) who conducted a simple paper test for isoniazid. Analysis of the results obtained yielded an unbelievably high proportion of positive results, indicating that the testing system, as organized, had been a failure. Special investigations were therefore carried out into the reasons for this.Over-reading of test results, incorrect performance of the test, and, in 1 centre, dishonest recording were found as explanations. Discussing the implications of their findings, the authors stress the importance of close supervision at all stages of tuberculosis-control procedures in the field, no matter how simple; and they point out with reference to urine testing that, even if a centralized testing system, involving a sensitive test method and quality control, were to be set up in regional laboratories, adequate supervision at all stages would be essential.