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In the first half of the 20th century, improved living conditions, preventive measures, vaccines and antibiotics led to a marked reduction in morbidity and mortality from infectious diseases. It was predicted that the conquest of all infectious diseases was imminent. However, 50 years later, in 1999, they were still the major cause of disease worldwide, and caused nearly one third of all deaths (a total of 55.9 million). The eradication of smallpox in the 1970s and the approaching eradication of poliomyelitis represent major achievements. The prevalence of measles, pertussis and tetanus neonatorum is also markedly reduced, but still 1.5 million children in developing countries die each year because of lack of vaccines. Malaria and tuberculosis are re-emerging. Tuberculosis and HIV/AIDS are the diseases with known aetiology that cause most deaths, altogether 5 million each year. Respiratory and gastrointestinal infections cause 6.5 million deaths annually. Infections in the immunocompromised host have become a "trade mark" of today's advanced medicine. Almost every year, new diseases related to new micro-organisms are described; over the last 30 years, approximately 40 new diseases/micro-organisms have been diagnosed. Among the best known are HIV/AIDS, peptic ulcer caused by Helicobacter pylori, Legionnaires' disease, borreliosis (Lyme disease), hepatitis C, gastroenteritis caused by rotavirus, and Ebola haemorrhagic fever. Antimicrobial resistance development of micro-organisms has become one of the major health problems worldwide; a number of preventive measures are being introduced.
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PMID:[Microorganisms strike back--infectious diseases during the last 50 years]. 1180 14

The author has divided his work into parts. The first part entitled "Premature Death of Physicians" is dedicated to those who started their research, scientific works and fruitful medical practice but the premature death has stopped their lives and activities. Death causes are presented in ten chapters (groups of causes), i.e. Tuberculosis - Other Lung Diseases - Heart and Vessel Diseases - Septicaemiae - Infectious Diseases in Subgroups: Typhus, Plague, Cholera, Yellow Fever, Diphtheria, Influenza, Malaria, Smallpox, etc. - Encephalopathies and Mental Diseases - Malignant Neoplasms - Noninfectious Unit Diseases - Accidents - Manslaughters - Death Sentences - Suicides - Not Settled Causes of Death. There are in total 283 biographies in the first part. The second part "Longevity of Physicians" is much longer than the first one and contains 509 biographies of doctor, scientists, research workers and practitioners, meritorious in the history of medicine who attained at least 80 years of age. The biographies are arranged in 22 chapters, one for every year from 80 years of age assumed as the beginning of longevity up to 104 years in one of the cases. In each chapter the biographies are arranged in the alphabetical order. In the Epilogue the author presents shortly his conclusions and observations related to the first part and wider commentaries for the second part.
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PMID:[Premature death and longevity of physicians]. 1185 80

The Department of Health and Human Services (DHHS) has played a critical lead role over the past two years in fostering activities associated with the medical and public health response to bioterrorism. Based on a charge from Secretary Donna Shalala in 1998, the Centers for Disease Control and Prevention (CDC) is leading public health efforts to strengthen the nation's capacity to detect and respond to a bioterrorist event. As a result of our efforts, federal, state, and local communities are improving their public health capacities to respond to these types of emergencies. For many of us in public health, developing plans and capacities to respond to acts of bioterrorism is an extension of our long-standing roles and responsibilities. These are stated in the CDC Mission Statement: to promote health and quality of life by preventing and controlling disease, injury, and disability, and the Bioterrorism Mission: to lead the public health effort in enhancing readiness to detect and respond to bioterrorism. CDC's infectious diseases control efforts are summarized below: --Initially formed to address malaria control in 1946; --Established the epidemic Intelligence Service in 1951; --Participated in global smallpox eradication and other immunization programs; --Estimated 800-1,000 + field investigations/year since late 1990s; --New diseases: Legionnaire's Disease, toxic shock syndrome, Lyme disease, HIV, hantavirus pulmonary syndrome, West Nile, etc. -- Today: focus on emerging infections and bioterrorism. Over the past 50 years, CDC has seen a decline in the incidence of some infectious diseases and an increase in some, whereas others continue to present on a more unpredictable basis (i.e., hantavirus). Outbreak identification, investigation, and control have been an integral part of what we do for more than 50 years. We estimate that 800 to 1,000 field investigations have occurred every year since the late 1990s. Today, however, we have a new focus on emerging infectious diseases and bioterrorism.
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PMID:CDC's strategic plan for bioterrorism preparedness and response. 1188 Jun 62

The World Health Organization is the leading international agency in health. WHO's reputation reached a peak in the 1970s with the then director-general Halfdan Mahler's advocacy of Health for All by the Year 2000 and the successful worldwide eradication of smallpox. The 1980s and 1990s saw WHO lose much of its authority. Too easily, the blame was put on one man-Mahler's successor, Hiroshi Nakajima. In 1998, Gro Harlem Brundtland, Figure 1 a former Prime Minister of Norway, took office and WHO began a period of major strategic and structural reform. Almost 4 years into her first term as director-general, I visited WHO's headquarters in Geneva to learn about Dr Brundtland's successes and failures. Figure 2 The ground rules of my visit were that I could talk with anybody and attend almost any meeting (budget discussions were excluded). I interviewed Dr Brundtland, executive directors, members of the staff association, and directors and project managers of programmes such as StopTB, Roll Back Malaria, HIV-AIDS, violence prevention, polio eradication, essential drugs and medicines, and sustainable development. At senior levels, WHO is confident and clear about its purpose-in a way that matches Mahler's vision and goes beyond it in results. Brundtland told me that her most important achievements were to have "strengthened the credibility of WHO" and to have "raised the awareness of health on to the political and global development agendas". But there is a troubling schism between the aspirations of its leadership and the realities faced by the organisation on the ground. Rapid change during the past 4 years has reinvigorated WHO's mandate, but poor management has created new tensions that the organisation's leadership seems unwilling to address.
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PMID:WHO: the casualties and compromises of renewal. 1235 5

Potent and safe vaccinia virus vectors inducing cell-mediated immunity are needed for clinical use. Replicating vaccinia viruses generally induce strong cell-mediated immunity; however, they may have severe adverse effects. As a vector for clinical use, we assessed the defective vaccinia virus system, in which deletion of an essential gene blocks viral replication, resulting in an infectious virus that does not multiply in the host. The vaccinia virus Lister/Elstree strain, used during worldwide smallpox eradication, was chosen as the parental virus. The immunogenicity and safety of the defective vaccinia virus Lister were evaluated without and with the inserted human p53 gene as a model and compared to parallel constructs based on modified vaccinia virus Ankara (MVA), the present "gold standard" of recombinant vaccinia viruses in clinical development. The defective viruses induced an efficient Th1-type immune response. Antibody and cytotoxic-T-cell responses were comparable to those induced by MVA. Safety of the defective Lister constructs could be demonstrated in vitro in cell culture as well as in vivo in immunodeficient SCID mice. Similar to MVA, the defective viruses were tolerated at doses four orders of magnitude higher than those of the wild-type Lister strain. While current nonreplicating vectors are produced mainly in primary chicken cells, defective vaccinia virus is produced in a permanent safety-tested cell line. Vaccines based on this system have the additional advantage of enhanced product safety. Therefore, a vector system was made which promises to be a valuable tool not only for immunotherapy for diseases such as cancer, human immunodeficiency virus infection, or malaria but also as a basis for a safer smallpox vaccine.
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PMID:Immunogenicity and safety of defective vaccinia virus lister: comparison with modified vaccinia virus Ankara. 1209 85

This study in the Institute's intensive field practice demonstration area in India attempted to determine if male health workers at the rate of 1/5000 population can carry out the various activities now being carried out by unipurpose health workers employed by the national malaria, smallpox, family planning, leprosy, and tuberculosis programs. 2 patterns were tried: 1) the workers to carry out all the activities of the various programs simultaneously through house visits at the rate of 40 a day for 6 working days a week, and 2) to do all activities except smallpox vaccination and family planning for 4 days a week with 1 day reserved for smallpox vaccination and 1 day for family planning activities. 23 workers were employed and trained. 9 were assigned to Plan 1, covering 40% of the population of 120,000; 14 under Plan 2 covered the remaining 60%. Survey design is detailed along with job descriptions. In the 1st round the multipurpose workers discovered as many fever cases as the single-purpose malaria workers and in the 2nd round, their performance improved. Performance was slightly better under Plan 2. Smallpox vaccination coverage was slightly better under Plan 1 but the time spent per worker was about double that of Plan 2 and wastage of lymph was nearly 3 times as great as when a separate day was set aside for vaccination. Family planning performance was much better under Plan 1 with 44.5% of high priority couples contacted on round 1 and 33.3% on round 2 compared with 28.2% and 36.4% under Plan 2. It was found that the worker gained effectiveness after he had developed rapport through other health services. There was demand for treatment of side effects and complications resulting from contraceptive use and for treatment of minor ailments among other household members. Quantities of Nirodh condoms distributed was higher under Plan 2. The multipurpose workers were not as effective as single-purpose workers in detecting tuberculosis or leprosy but they can refer suspected cases. It was pointed out that under Plan 2 group meetings could be held and more couples reached but that people were shy about attending group discussions and treatment of minor ailments helped in talking about family planning.
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PMID:Report on the pilot study of multi-purpose health workers (male) in Athoor Block, Madurai District. 1225 31

According to this statement presented to the Committee on Population of the UN Economic and Social Commission for Asia and the Pacific, combined effects of continuing high fertility and declining mortality account for Nepal's current growth rate of 2.7%, which will produce a population of 25.4 million in the year 2000, up from 9.4 million in 1961 and 15 million in 1981. Children under 15 comprise over 40% of the population. The rapid expansion of public health facilities and successful efforts to control cholera, smallpox, and other communicable diseases account for an increase in life expectancy to an estimated 46 for males and 44 for females. There has been no significant decline in fertility, and the total fertility rate is 6.3. The infant mortality rate of 152/1000 live births is still very high. Population pressure in the mountains and hills has reduced the average size of individual family land holdings to less than .4 hectare, and average productivity of the land has fallen due to cultivation of marginal lands, landslides, loss of ground water, erosion, and nutritional deficiency of the soil. Wasteful forest cutting and soil erosion have occurred as the terai or plains have become more densely settled following the eradication of malaria and internal migration. Nepal adopted its 1st official population-related program in 1965 when the 3rd plan called for family planning to reduce the birth rate and help achieve balance between population and natural resources. During the 5th 5 year plan a multisectorial population policy aimed at managing spatial and temporal population distribution was adopted. The demographic target of the 6th plan was to reduce the total fertility rate to 5.8 by 1985. The population strategy recently formulated by the reconstituted National Commission on Population calls for reducing the growth rate from 2.6% to 1.2% in 15 years, integrating population and development programs in all sectors, increasing female literacy and employment rates, regulating immigration, and registering vital statistics. The family planning program is giving more emphasis to younger couples aged 20-30, who are offered a mix of temporary methods for child spacing. To combat the high drop out rate, all family planning programs will include IEC activities, and family planning service delivery programs have been extended. Maternal-child health programs, especially tetanus toxoid innoculation to prevent neonatal tetanus, are also receiving high priority.
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PMID:Nepal (country/area statements). 1226 50

For the past 15 years, the Fundac Esperanca, a private organization founded in Santarem by a North American Franciscan priest, has been working to provide the widely scattered rural residents in the mid-Amazon region of Brazil with effective health care. Early efforts focused on Esperanca's hospital boat, which traveled up and down the river to reach the remote settlements. During the 1st decade of operation, Esperanca vaccinated some 150,000 people and provided general medical and surgical services to countless others. Yet, by the late 1970s, the program's staff were beginning to question the longterm effectiveness of their efforts. In 1979, Esperanca decided it could have a longer lasting impact on health in the mid-Amazon region if it could mobilize rural communities to improve family diets and sanitary practices and carry out comprehensive vaccination campaigns. Supported by a grant from Private Agencies Collaborating Together (PACT), it launched its own primary health care program. This initiative began with a health survey of the region. The studies revealed that 1/3 of the children under age 6 were malnourished, 90% had untreated cavities, and 2/3 of the 10,000 people tested showed evidence of parasitosis. There were higher than normal incidences of malaria, anemia, tuberculosis, diphtheria, uterine cancer in women, smallpox, and visual problems. The social, cultural, and demographic characteristics of the region also were discouraging. Most people lived in widely scattered river villages and were illiterate, with little understanding of hygiene, nutrition, or public health. None of the settlements had formal health care systems. Esperanca chose to make the community paramedic the keystone of its program, stating clearly that the outreach worker is the conduit to clinical services in Santarem. In time, it was decided to phase out the hospital boat's activities. It had come to signal the wrong message, i.e., the doctors were coming and good health was on the way. Instead, Esperanca decided to help communities solve their own health problems. The relationship between the paramedic and the local health committee is the most obvious symbol of this new power to change the conditions of community life. Esperanca also has had a special project; it introduced wells, the benefits of clean water, in its 12 participating communities. Once they became available, the prospect of the wells started a minirevolution in the communities. After the wells were opened, parasitic diseases declined markedly. Esperanca's program continues to evolve. there are several hopeful signs of its success: the training program for paramedics is an ongoing effort; sensitization of medical professionals to the reality of rural health care and the need for alternative strategies; and the development of relationships with a whole range of public agencies.
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PMID:Making primary health care work: the case of Fundacao Esperanca. 1226 85

The implementation strategy for health for all (HFA) in China is presented as a targeted effort toward the rural population which makes up 900 million of the total 1160 million population. The WHO objective of HFA by 2000 was accepted by China in 1983 and 1986. Socioeconomic development has improved considerably since 1949. Targets were established 1) to double the 1980 gross national product (GNP) and guarantee food, clothing, and shelter between 1981 and 1990; 2) to quadruple the 1980 GNP between 1991 and 2000, and 3) to attain the average income per capita of medium-developed countries. The political system is the Communist Party of China (CPC). The Chinese People's Political Consultative Conference, which is comprised of members of the CPC and other individuals from democratic and other organizations, fills an advisory role. The National People's Congress is the highest organ of state power and serves to legislate, supervise, and make decisions in some matters including personnel. The Standing Committee exercises state power when the Congress is not in session. It is a 1-chamber system (state administration, judicial system, and chamber system) and members of the People's Congress do not resign. Since 1949, the health system has grown to 209,000 medical and health institutions, 2.6 million hospital beds, 4.9 million medical and health workers, an average life expectancy that has increased from 35 years to 69 years, an infant mortality rate that has declined from 20% to 5.1% from 20%, and a maternal mortality that has declined from 150/10,000 to 9.4/10,000. Diseases such as cholera and smallpox have been eliminated and other diseases such as malaria and goiter have been brought under control. A cooperative medical and health care system which was established in the 1960s was replaced with a fee system in the 1980s, which has led to medical care problems for the rural poor. At present there is a rural medical insurance system and a cooperative health system with 3 tiers (health clinic, township hospital, and county professional hospitals). In 1990, there were village clinics in 87% of the villages. In 1990, central government and local management are implementing the objectives stated in 1) Program Objectives of Global Goals for Health by 2000 in Rural Areas, 2) Management Procedures for Primary Health Care, and 3) Evaluation Standards of Health for All by 2000. Implementation began in 1989-90, and stage 2 is to begin in 1991-95, and stage 3 in 1996-2000. The problems that will be encountered are investment, population growth, and personnel training.
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PMID:The rural health care system in China. 1228 35

Reproductive changes were described in Xishuangbanna Autonomous Prefecture in China. Data from a retrospective sample survey conducted from 1986 to 1987 on birth cohorts in the early 1920s revealed for the ethnic minorities of Bulang, Jino, and Dai a fertility rate of 4 or more children. Bulang and Jino women had lower fertility. The birth rate was estimated during the early 1950s at 40%; other local survey data showed an average birth rate of 50.07% in 1953 and 1954. Early records indicated that the area was known for barbarism, tropical diseases, and malaria epidemics. During the 1950s malaria was estimated at over 50%. Small localized surveys revealed average annual mortality rates of 43.6% in 1953 and 1954. Measles and smallpox were also pernicious. There were shortages of food, poor health, and hardly any medical care during the decline of the feudal system. Beliefs in the "pipa ghosts" entering the bodies of malaria victims was believed to cause malaria. Sanitation and hygiene were not practiced, and hospitals catered to mainly local officials and headmen. Data on Cheli County, which is now part of Wuben District in Menghai County, in 1951 and 1983 showed the Dai population increased from 29,634 to 33,209 (12.06%) and the Jino population increased by 4% to 3000. In 1954 mortality ranged from 30.64% to 42.5%, the birth rate was 37.7%, and natural growth was 7.06%. Mortality was high due to lack of medical facilities and medicine. A study in 1981 of elderly women revealed that mortality could be 14 out of 18 children born. Between 1953 and 1991 population in Xishuangbanna increased to 796,352, a growth of 2.76 times. The birth rate declined in 3 periods and has remained around 20%. Dai fertility declined the most. Reproductive characteristics of the Xishuangbanna were high birth rates before 1970 and low birth rates after 1971; high mortality before 1956, a rapid drop during 1959-65, continued decline during 1966-70, and stabilization during 1971-91; and low growth before 1956, high growth during 1957-70, and low growth during 1971-91. Xishuangbanna completed its demographic transition. After liberation, educational advances and access to medical care played significant roles in lowering mortality.
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PMID:Social changes and the evolution of reproduction patterns in Xishuangbanna. 1228 76


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