Articles: health.
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Despite the fundamental transformations occurring in health care, academic medicine can maintain, and actually enhance, its value to society. But to do so will require a shared vision of where academic medicine should go. The author offers his own vision, one that includes (1) establishing true partnerships between medical schools and the communities they serve; (2) elevating prevention and health maintenance to equal status with diagnosis and treatment; (3) addressing pressing social problems, such as drug abuse, teenage pregnancy, and domestic violence; (4) assuming a leadership role in containing health care costs; (5) harnessing information technology to develop, disseminate, and implement comprehensive clinical information systems, and to provide the public with reliable medical information; (6) fostering racial, ethnic, and gender parity in medicine; (7) carrying out appropriate downsizing and restructuring of the academic medicine enterprise; (8) addressing forcefully the workforce needs for physicians and medical scientists; (9) improving the education of medical students and residents and fostering the conduct of clinical research by creative use of the integrated academic health care systems that teaching hospitals are becoming; (10) developing regional educational consortia to guide important aspects of medical students' and residents' education; (11) building a learning network so that meaningful cross-talk and dissemination of lessons learned can occur among all segments of the academic medicine community; and (12) creating a permanent planning process to guide academic medicine's future. The author concludes that if academic medicine adheres to its tradition of public service and professionalism, its future can be as glorious as its past.
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Tidsskr. Nor. Laegeforen. · Jan 1996
[Increasing use of cesarean section, even in developing countries].
At Kaziba hospital in rural Zaire, the frequency of deliveries by Caesarean section rose from 6.2% in 1971 to 12% in 1992, and the fraction of repeated sections rose from 17% to 49%. During the same period, the overall maternal mortality decreased from 0.3% to 0.12%, and deaths connected with Caesarean section from 3.2% to 0.7%, but still the risk of dying remained 13 times higher for births by Caesarean section compared with vaginal deliveries. The frequency of vacuum deliveries was halved during the period, and mean birth weight decreased by about 100 g. ⋯ Operations carried out by persons other than physicians were complicated by wound infections at a higher rate (20.8%) than those carried out by experienced doctors (11.2%). In areas with a poorly developed health system, a high rate of Caesarean section represents a hazard to maternal health. The need for knowledge about alternative methods like vaginal extraction, symphyseotomy and active management of labour is underlined.
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Am. J. Trop. Med. Hyg. · Jan 1996
Developing effective strategies for malaria prevention programs for pregnant African women.
The control of malaria in pregnant African women, one of several child survival strategies applied through antenatal care, has been particularly challenging. Prevention and control recommendations for typical areas of high Plasmodium falciparum transmission have promoted the use of antimalarial chemoprophylaxis to prevent placental infection. ⋯ The principle findings of the MMRP include: 1) populations at risk of the adverse consequences of malaria in pregnancy include women with low parity, women infected with human immunodeficiency virus, pregnancy during the high malaria transmission season, and the use of a malaria drug that is suboptimally efficacious; 2) the estimated maximum benefits of an antimalarial intervention that clears placental and umbilical cord parasitemia are a 5-12% reduction of low birth weight (LBW), an approximately 35% reduction in the risk of LBW for risks that are actually preventable once a woman has become pregnant (e.g., risks such as infectious disease or poor nutrition during gestation), and a 3-5% reduction in the rate of infant mortality; 3) the intervention must be capable of rendering the woman malaria parasite free, including clearance of parasites from the placental vascular space and umbilical cord blood; 4) other diseases adversely affect pregnancy outcome and, while the control of malaria in pregnancy may not warrant independent programming, if coupled with prevention programs to provide a range of antenatal services, the incremental costs of malaria control may prove to be highly cost-effective; and 5) the choice of a regimen must balance intervention efficacy with safety, availability, affordability, and simplicity of delivery, and several antimalarials may meet these criteria. The Malawi Ministry of Health has modified its malaria prevention in pregnancy recommendations and now faces the challenge of effective programming to improve child survival.
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About 50 studies based on the 1988 National Survey of Family Growth (NSFG) and a telephone reinterview conducted with the same women two years later provide continuing information about the fertility and health of American women. Among the findings of these studies are that black women have almost twice as many pregnancies as do white women (5.1 vs. 2.8), with nearly all of the difference being unintended pregnancies. Unwanted births increased between 1982 and 1988, particularly among less-educated, poor and minority women. ⋯ Rates of teenage pregnancy were fairly stable during the period 1980-1988, as increases in the proportion of teenagers having intercourse were offset by increases in condom use. Rates of infertility did not change significantly in the 1980s, but because of delayed childbearing and the aging of the baby-boom cohort, the number of older childless women increased substantially. The 1995 NSFG was redesigned in a number of ways in order to answer a new generation of questions about fertility and women's health in the United States.