Nilsson and his colleagues have assessed the hazards of tobacco
smoking among men and women in a Swedish cohort. The authors reported no
statistically significant gender differential in relative mortality rates
for any of the studied diseases [1].
I have deep concerns about gender differences of smoking-related risks for
Alzheimer and Parkinson’s diseases (the most frequent nuerodegenerative
diseases in...
Nilsson and his colleagues have assessed the hazards of tobacco
smoking among men and women in a Swedish cohort. The authors reported no
statistically significant gender differential in relative mortality rates
for any of the studied diseases [1].
I have deep concerns about gender differences of smoking-related risks for
Alzheimer and Parkinson’s diseases (the most frequent nuerodegenerative
diseases in the elderly for the time being). It was previously suggested
that smoking has protective effect against both diseases [2].
Recently, Sugita and his colleagues systematically reviewed the
association between smoking and Parkinson’s disease. Although the
summarised risk estimate for cohort studies was 0.43 (95% confidence
intervals = 0.27, 0.68), all included studies were restricted to men [3].
The observations of recent experimental studies show the essential role of
oestrogen in maintaining the integrity of the nigral dopamine system
involved in muscle control and higher brain functions [4,5].
I suggest to evaluate the hazards of tobacco smoking related mortalities
for these two neurodegenerative diseases among men and women, specially
that the Swedish cohort has long follow up and was large enough.
References
(1) Nilsson S, Carstensen JM, Pershagen G. Mortality among male and
female smokers in Sweden: a 33 year follow up. J Epidemiol Community
Health 2001;55:825-30.
(2) Fratiglioni L, Wang HX. Smoking and Parkinson's and Alzheimer's
disease: review of the epidemiological studies. Behav Brain Res 2000;113(1-2):117-20.
(3) Sugita M, Izuno T, Tatemichi M, Otahara Y. Meta-analysis for
Epidemiologic Studies on the Relationship between Smoking and Parkinson’s
Disease. J Epidemiol 2001;11(2): 87-94.
(4) Saunders-Pullman R, Gordon-Elliott J, Parides M, Fahn S, Saunders HR,
Bressman S. The effect of estrogen replacement on early Parkinson’s
disease. Neurology 1999;52(7):1417-21.
(5) Leranth C, Roth RH, Elswoth JD, Naftolin F, Horvath TL, Redmond DE Jr.
Estrogen is essential for maintaining nigrostriatal dopamine neurons in
primates: implications for Parkinson's disease and memory. J Neurosci
2000;20(23):8604-9.
Epidemiologists all over the world have been good enough to express their concerns and worries about how we, and other friends and colleagues in New York, fared in the terror provoked on September 11 2001. This annotation responds to the editor's invitation that we convey something from our vantage point. We welcomed his interest. The experience is, so far, unique in history. Our account is personal, that of fou...
Epidemiologists all over the world have been good enough to express their concerns and worries about how we, and other friends and colleagues in New York, fared in the terror provoked on September 11 2001. This annotation responds to the editor's invitation that we convey something from our vantage point. We welcomed his interest. The experience is, so far, unique in history. Our account is personal, that of four individuals, all related (Sally married to Ezra, and Ezra born to Mervyn and Zena). We share the same house. Also, atypically for any institution, all are of the Department of Epidemiology in the Mailman School of Public Health of Columbia University.
The themes we emphasize are common to many others among us in New York City. On the day of September 11 and after, much of what we saw and heard was televised, a source open to everyone else here and elsewhere. In some degree, then, much of the world was exposed to the New York experience. But in the Department of Epidemiology (the School and the Medical Center are on the Northwest outskirts of Manhattan) we were not only in propinquity to the events, we looked directly upon them from the south-facing windows of the 18th floor of our own dwarfed tower.
On the day of September 11, only Sally and Ezra were in the city. Zena and Mervyn were in South Africa. We tell the story as it unfolded in both situations. In New York, immediately the first plane hit the South Tower of the World Trade Center, many of us, alerted to what seemed a tragic accident, went to our south-looking windows. From there, horrified, we watched a second plane enter our view, veer toward and then disappear into the North Tower, becoming instantly enveloped, together with the upper levels of the tower, in a vast sheet of flame. At once, all understood the "accident" to be what it was - unimaginable evil. It was clear that twenty to thirty thousand people working in the Towers every day could be at risk, not counting even larger numbers visiting on business.
In shock or fright, first thoughts for many of us revolved around the fate of the friends or relatives whose work brought them there, and that of the children we knew to be in schools nearby. In the Medical Center, Ezra and many senior faculty and staff of the School of Public Health and all the other schools of the Health Sciences Faculty stood by for action, planning emergency care. They were not yet aware that from the Towers no route was open by which the casualties could reach the Medical Center. Nor could they yet know that in any case surviving casualties would be relatively few. Most were dead and turned to ash, obliterated by the 1500 degree (centigrade) flames ignited by exploded plane tanks filled with petroleum.
For the rest of us, thoughts about what a relief effort would require and about what our contributions might be were displaced by the urgency of other advice. Many like ourselves live outside Manhattan. We were told to get home and not place any unnecessary burden on the limited transport, food and relief supplies within the island. Yet little could go either in or out. Bridges and roads and subways were shut down, especially in Mid and South Manhattan.
When by late evening most of us did get home, we sat numbly through the hours of replays. Unforgettable moments are seared into memory. The succession of events and images insistently deepened horror and pain: first impact and explosion; then the collapse of the towers; then scared people fleeing a tsunami-like cloud of pulverized concrete and steel and charging on foot up the West Side Highway, their eyes on the lookout and turned to the sky.
We blanched as the battalion of firemen rushed into and up the burning tower, well aware of the imminent collapse of the towers and their own probable annihilation. Few returned. Other moments were empathetic projections of grief: we saw families leaving the Los Angeles airport on learning their children had boarded one of the three planes transmuted into death-dealing missiles. Survivors, witnesses and rescue teams recounted what ordinarily would have been merely our worst nightmares.
The seeming safety of life in the United States - neither invaded nor terrorized in the twentieth century - vanished in an instant. Like some other countries, we now are shadowed by the grief of a terrorist attack and by the expectation and fear of terrorist attacks to come. But on such a scale! Were the gigantic buildings - as symbols of business, government and the military - always to be targets, the more civilians killed the better - and airliners the lunatic weapons of mass destruction? Might some crazed fanatics - with the stakes raised on how great a destruction and disruption could be wreaked - mount a challenge to exceed that excess?
In the days after the strike, it often seemed that the destruction could not have been real. But each day our office windows framed the reality, the familiar towering landmark missing, and each evening the television screen replayed footage of those minutes of destruction as the second plane sliced into the middle of the North Tower. Periodically, we found tears could not be stanched in the face of recurring images: people hurling themselves out of the upper windows to escape the flames, their bodies falling and twisting like fragile kites and autumn leaves; and fifty floors, filled with people still very much alive, engulfed in flame. In one piece of footage, intact towers held people who chatted to each other, walked from one room to another, unsuspecting... people now crushed beneath piles of steel girders and concrete, no relic left but simply part of the rubble.
Slowly, as we began to hear from acquaintances throughout the region, we realized just how many people had offices in or near the World Trade Center. The vast numbers quoted by reporters were anonymous [In an effort to give all the victims an identity, the New York Times publishes each day a full page of photographs with details about victims. The intent is to report on all who can be traced, a memorial cross-section of a great city]. But almost everyone had some kind of personal encounter that made the event the more devastating. Our children told of happenings in the schools: a student whose father worked at the World Trade Center; hysterical at the news of its destruction the principal brought to the classrooms; a teacher, whose wife worked at the Center, on hearing the news, rushing straight out of the room in the middle of class. The man who delivers our newspaper, having lost his brother-in-law, was left worrying how he could fend for his sister and her four children.
Others were kept away from work in the Towers for various mundane reasons. One child cried all day before she learned that a doctor's appointment had kept her mother away and safe. One friend, a little late that morning and waiting for the elevator when the first plane struck, ran out and escaped the destruction. But many we know lived in the neighborhood of the World Trade Center and had to vacate their apartments and lodge wherever they could. Our teenage children were visibly distressed and anxious. At the School of Public Health and the Department of Psychiatry, faculty gave time and solace to those bereaved and in shock.
Meanwhile, Zena and Mervyn were still in Johannesburg, lingering with old friends at the tailend of an expedition to promote research and training in face of the emergent devastation of HIV/AIDS and resurgent tuberculosis. Due to leave for New York on Wednesday September 12th, they and thousands of others were forestalled by the destruction of Tuesday 11th.
It happened on that Tuesday afternoon (the time 6 hours ahead of New York), as they returned to the home of their Johannesburg friends, the housekeeper had the television turned on. Within a moment, they were faced with the unbelievable images of the second airliner exploding into the North Tower. Soon they learned that all New York airports were closed and all flights were cancelled. Benumbed, bemused and fragile in spirit, four days passed, spent between travelling from the city to the airport in a daily struggle at the booking desk to obtain a passage, and obsessively watching the mesmerizing television images and reportage. For some desperate hours, they tried to circumvent the constant thwarting of their every attempt to speak by telephone to the members of the families of their three offspring in the USA. They were at last rewarded by the news that they at least were all safe.
Still, they mourned the destruction. As the decades of their exiled lives had passed, they had grown to love the great city of New York for its rich intellectual and artistic life and its energy, diversity, and warmth. Among their friends of all races in Johannesburg, however, they relearned what they might have recalled from their own now ancient histories in radical opposition there: not all in South Africa would be empathetic or even sympathetic with the plight of New York City and the devastation brought upon imperial might.
Soon, however, Zena and Mervyn were back in New York and together we slowly restructured our perspectives on life and work. We all soon grasped that this malign and orchestrated tragedy opened a new chapter in history -- and in epidemiology. We began the business of facing and contending with that knowledge. In fact, we were soon immersed in the ensuing events.
Almost immediately we needed to come to terms with what we hoped was the metaphorical war on terrorism declared by the untried President. In grappling with the threat of chemical and bioterrorism, a central role falls naturally to the Department of Epidemiology in the School of Public Health. Weeks later, with bioterrorism upon us in the form of anthrax, we know for certain that the threat was no illusion. The world will not be the same again, a mantra often repeated in the aftermath of the destruction of the Towers. This latest biological attack confers truth on a cliché. Our Department - strong in psychiatric epidemiology - is also immersed in dealing with the impact of terror on the mental health of the affected population and preparing for mental health consequences of future attacks. At the same time, we believe it equally important, and perhaps even more daunting, for us to keep attention, our own and that of others, on the other great and persisting public health problems of today's world and, in particular, the catastrophe of HIV/AIDS in Africa.
Will this tragedy have any lasting impact on the discipline of epidemiology? We believe it will. The public has called epidemiologists into action and they are necessarily on center stage in these epic events. It is a call that cannot be ignored. We believe that the notion of separating epidemiology from public health action - popular in the U.S.A. in recent years - has collapsed along with the World Trade Center.
I spent six long years in the UK, and following a "Hospital Doctor"
report, requested the BMA to provide us with a list of the countries from
which the junior doctors who committed suicide between 1991 to 1995 came from. It is
felt that severe ill treatment of Indian/other overseas doctors by the
NHS, may have led to this. Why are the British Government, the British
Health Department, and the BMA...
I spent six long years in the UK, and following a "Hospital Doctor"
report, requested the BMA to provide us with a list of the countries from
which the junior doctors who committed suicide between 1991 to 1995 came from. It is
felt that severe ill treatment of Indian/other overseas doctors by the
NHS, may have led to this. Why are the British Government, the British
Health Department, and the BMA, witholding this information? Does Britain
profess to call itself a democratic country, and a member of the UN?
From a public health perspective, one of the major challenges post 11th September is whether we can build a more caring communitarian world. The signs are not good. Behind the media hype, what comes through is largely a lack of institutional caring. People as individuals still seem to care even if their voices are muted.
Markets and neo-liberal globalisation serve to create yet greater maldistributions not only of resources...
From a public health perspective, one of the major challenges post 11th September is whether we can build a more caring communitarian world. The signs are not good. Behind the media hype, what comes through is largely a lack of institutional caring. People as individuals still seem to care even if their voices are muted.
Markets and neo-liberal globalisation serve to create yet greater maldistributions not only of resources but also of power and influence. They reduce us too often to being consumers only when being citizens, especially world citizens, is increasingly important. When leadership is missing from the world stage, there remains no one but world citizens to adopt a world perspective.
Television pictures and the fact that this was the US filled the vacuum created by the absence of world leadership, capturing world minds more than for example Rwanda ever did. Leaders of Mandela's stature are needed. Despite having suffered so much for so long, he established the Truth and Reconciliation Commission on the basis of sentiments such as: 'You can't build a united nation [or a united world?] on the basis of revenge.' In comparison Bush's antics look like those of a very small man.
The calls for revenge against terrorism echo those against opponents of last century's British imperialism in Africa. Yet so often former 'terrorists' eventually sat down with representatives of the British government and successfully negotiated the independence of their countries.
The reopening of the US Stock Exchange was revealing. In advance, we heard that the "fundamentals" of the US economy remained strong. Fundamentalism was otherwise used in a pejorative sense about a major world religion. But maybe we are dealing here with two religions?
When the Stock Exchange did open, despite institutional voices calling for patriotism and for this great beast to act with compassion and commitment, there was a major initial fall and various falls since, and these despite almost certainly the US government pumping in billions of dollars. The major symbol of capitalism served up what it would be expected to serve up: greed and a lack of commitment to anything other than money making. It was not able to do otherwise even on the one day in the world's history when investors might have looked beyond the mighty dollar. We can now finally and assuredly reject the idea that there is anything or could be anything other than greed involved in capitalism. It lies exposed for what it is. The market has no heart. It does not - it cannot - care.
Whoever was responsible for the attacks should be brought to justice for these appalling crimes. While the inferno of racial and religious hatred that has followed is at least as appalling, other voices are beginning to be heard. The notion of the world being a village community has never been more explicit than on 11th September. Let the villagers use this to build bridges, mutuality, reciprocity, respect and love across national boundaries. The fact that the US is being forced back into the world community rather than seeing itself standing over it has to be a good thing. We villagers must develop institutions which more accurately reflect our world values but it would seem that nothing less than a major revision of modern capitalism is now needed to promote anew the health and happiness of the world community and especially those in developing countries. There remains the horrible feeling however, as the US prepares to wage war not to solve the problem of terrorism but to make themselves feel better by 'doing something', that it is already too late.
The tragedy of New York, Washington and Pittsburgh is both
immediate and long-term. Immediate in its violent loss and
bereavement; the anger, anguish and personal 'what ifs' that will devastate psychological well being over the next few weeks and months. What if she/he had missed the train, woke up late, been on a lower floor, not gone back to their desk, not taken that plane, had a few more seconds...? I breathed a huge...
The tragedy of New York, Washington and Pittsburgh is both
immediate and long-term. Immediate in its violent loss and
bereavement; the anger, anguish and personal 'what ifs' that will devastate psychological well being over the next few weeks and months. What if she/he had missed the train, woke up late, been on a lower floor, not gone back to their desk, not taken that plane, had a few more seconds...? I breathed a huge sigh of relief at news that my brother and his family who live in NY city were all safe. Not so for so many others.
The longer-term effects will be more subtle and harder to both express and manage. I am an American living abroad, was an early teenager during the Cuban Missile Crisis. In talking with my 13 year old son, I suddenly and very uncomfortably remembered what it felt like at 13 to be afraid of death. A death coming I knew not when nor where. It would come loudly and violently as a bomb. It might
hurt, I might not be with family or friends and may not be able to say goodbye. I had recurrent nightmares, lived with anxiety although at 13 I could not name what I felt. And now, he is doing the same.
In Afghanistan people live daily with an equal loss, though arguably less sudden and violent. Their children and family members die each day from starvation and disease. Which is worse and more damaging to watch and experience? How could one answer such a question? Their life expectancy is well below that of America. They unfortunately live all too frequently with anxiety of loss and war. It is human to feel envy and hatred of those that have when you have
not. In society people respond differently and so it is with the Middle Eastern societies where the perceived injustices have festered and grown and now spill over.
A public health consideration may need to step out of the comfort zone and challenge some of the prevailing national and party political issues. How do we encourage and develop good psychological health, particularly in our children and young people, if they live in fear and learn to respond to fear and anxiety with aggression? How do we also encourage good psychological health in nation states? The fear is
different, American and English children fearful of their overall safety, anxious about war, loss and death. Afghan children fearful of hunger, cold, repression, disease and death. Causes of fear may differ; outcomes are all too often similar. Is this a public health issue? I believe it is.
Having lived through the Cuban missile crisis I then spent my later teenager and early adult years living with the Vietnam war. My brother was 15, not much older than my son is and the same age as my nephew, at the time Americans began to fight in Vietnam; and 23 when he died there. I watched a bit of my mother die with him; and, a bit of my other brothers and me changed irrevocably. I vowed never to experience that; no son of mine would be sacrificed to war.
Now I have a son and my fear and anxiety are high; so are his. So presumably are many peoples in many countries.
I am angry with whoever actively or passively authorised the USA assault. They (individually and collectively) need to be confronted with the results of their actions. I want to shake them, shout at them, rant and rave at them. And I also want to ask them what has happened in their lives that has caused them to hate so much, that has led them to commit this act. I want to ask myself, as an American and I want America however painful to ask what could we have done differently? How might this have been avoided? And then we all need to act. I hope, at the moment seemingly against hope, that the action will not be about blanket aggression.
Is this selfishly motivated, a mother trying to look after her son, protect his future? Possibly. And my instinct tells me that I share this feeling with many Afghan, Palestinian, Israeli, Arab, American and English mothers. A
desire to grow physically and psychologically healthy children - to see them live in peace and well being. Surely this must be one of our most pressing international public health targets?
For the public health community, the terrorism wreaked on the United States is stunning, but not necessarily surprising. It was a shrieking reminder to us all that desperate and hopeless peoples will follow extremist minorities, that poverty and insecurity, compounded by smoldering pockets of war and the cautious engagement, if any, by the rich world breeds the destruction of September 11. That horror spread its message in nanos...
For the public health community, the terrorism wreaked on the United States is stunning, but not necessarily surprising. It was a shrieking reminder to us all that desperate and hopeless peoples will follow extremist minorities, that poverty and insecurity, compounded by smoldering pockets of war and the cautious engagement, if any, by the rich world breeds the destruction of September 11. That horror spread its message in nanoseconds across the world, evoking cries of alarm and sorrow, life-sacrificing rescues, and loud calls for vengeance and a "crusade" to counter the "jihad", expending more material and human resources for more death, disability, and damage to the lives and futures of thousands, perhaps millions.
Our commitment to the promotion of health and prevention of human and environmental damage calls us to join those whose voices are muffled in the mass media, those who claim another way, those who call for serious peace work and the conditions that can bring it about.
Clearly, the immediate priority in the terror for the public health community was and is to attend to survivors and their families and the protection of environments to avoid further injury and illness to rescuers, securing the necessary infrastructure-air, water, sewage and sanitation, transportation and communication.
Second, we must now-if we ever had doubts after decades of research and experience-work with renewed energy to prevent the anger and hopelessness that fosters extremism and finds solace in its crimes. But not, as many would lead the world, with terrorists' tactics. Rather let us use our own tested tools: working for policies and with organizations that will bring basic humane and healthful living conditions to communities-secure housing, safe environments, food security, education and health care-to those in our own rich countries who are deprived; let us lead, encourage, and support the same efforts in poor countries.
To reallocate national budgets in both rich and poor states, as we are doing, to wage a vaguely targeted war on terrorism will only confirm the claims of the "Great Satan" myth. A shift toward war in the U.S. will mean further reductions in already meager funds for social concerns (because the new money is not likely to be drawn from a repeal of recent tax cuts), diminishing the already threadbare hopes of 37 million Americans living in poverty, including one in five children, the 1 in 3 families facing housing hardship, the 44 million without health insurance. These are the grounds of anger and hopelessness.
Third on a public health agenda to eradicate the allure of terrorism is to use 21st century information technology to join the globalizing net of organizations which seek to humanize state policies and world markets, to end the rush to commodify everything from genes to environments. Locally and globally, we must raise the message persistently to publics, the media, and policymakers: that there can be no peace without social justice, the fair sharing of the goods and goodness that we have. Let us give leaders in communities and those in intergovernmental forums the political courage to dissent from a war regime and support social justice and criminal justice under law. Every move we can make, everywhere, toward a just society nourishes hope, calms rage, helps ensure a peaceable future for us all.
Nancy Milio
Professor of Nursing
Professor of Health Policy & Administration,
School of Public Health
The University of North Carolina at Chapel Hill
School of Nursing
Carrington Hall 7460
Chapel Hill, NC 27599, USA
It is a very short note but I feel the need to write it. It has been very interesting to read this new article written by Nancy Krieger. I have been following and reading all her articles. We at ALAMES (Asociación Latino Americana de Medicina Social) started following her papers when she first published the "The web of causation: has anyone seen the spider?". Many Latin American authors were writing about these c...
It is a very short note but I feel the need to write it. It has been very interesting to read this new article written by Nancy Krieger. I have been following and reading all her articles. We at ALAMES (Asociación Latino Americana de Medicina Social) started following her papers when she first published the "The web of causation: has anyone seen the spider?". Many Latin American authors were writing about these concepts and thoughts more than 20 years ago.
We were very happy to read that someone in the Northern hemisphere had similar thoughts and concept development. There are other authors like Asa Cristina Laurel, today the Secretary of Health of the State of México; María Urbaneja Ministry of Health of Venezuela; Jaime Breilh; and Edmundo Granda. Breilh has published many articles and books - some in conjunction with Granda - where he has done an exhaustive and brilliant review of the epistemology and politics of the epidemiology. He and his colleague both work together in the CEAS (Centro de Estudios y Asesoría en Salud, Quito Ecuador). jbreilh@ceas.med.ec.
He discusses the inherent social characteristic of epidemiology. Moreover, he suggests a new name for epidemiology to make it different of the classic causative- positivism based epidemiology. The new term/name is “Epidemilogía Crítica”/Critical Epidemiology. I suggest including this term in the glossary proposed by M. Krieger.
We thank Mr. Barnett for his interest in our article, even
though his comments suggest he has not read it. Following
there are some notes on Barnett’s comments:
We have never received funds from the beverage industry, either for this research or for any of the several studies we have done on the relationship between alcohol and health.
Contrary to Barnett’s comments, we finished our article
a...
We thank Mr. Barnett for his interest in our article, even
though his comments suggest he has not read it. Following
there are some notes on Barnett’s comments:
We have never received funds from the beverage industry, either for this research or for any of the several studies we have done on the relationship between alcohol and health.
Contrary to Barnett’s comments, we finished our article
alerting against undue use of our research findings. In
particular, we stated in the final paragraph of the
manuscript: "As to the study’s practical implications, the
negative association between alcohol and suboptimal
health should not be used to promote even the moderate
consumption of alcoholic beverages".
Clinical advice and public policy on alcohol consumption is
a complex topic, which should be based on scientific
evidence (of which our article is just one small piece),
resources, and values or preferences of the people. Posing
the debate in visceral rather than rational terms (those
that integrates the above components of decision
making), as Mr. Barnett does, is getting out of the way for
evidence-oriented public policy.
,
I trust peers in the fields of Epidemiology and
Community Health will have ample opportunity to
scrutinize the hapless "study" from Spain published in
your journal this week as reported on BBC News web site
and I wish to foreshadow their likely findings of the
so-called scientists whose study linked more and more
alcohol consumption with "feeling healthier" as
laughable and very unscientific.
,
I trust peers in the fields of Epidemiology and
Community Health will have ample opportunity to
scrutinize the hapless "study" from Spain published in
your journal this week as reported on BBC News web site
and I wish to foreshadow their likely findings of the
so-called scientists whose study linked more and more
alcohol consumption with "feeling healthier" as
laughable and very unscientific.
I feel it is a great disservice to the global
community as well as to the goal of health education,
the penultimate responsibility of the public health
professional, to propose that indiscriminate and over
indulgence in alcoholic beverages could ever possibly
be linked to "healthier" anything.
Every 5th grade student knows alcohol is a poison and
will damage cells and organs upon entering the body.
Detrimental effects on the brain and nervous system
are well established. The fact that the body can
recover and continue to tolerate intake of the poison
and that the physical & psychological effects of
depression are masked by temporary "good" feelings is
equally well known. However, to report a link of a healthier outcome to
alcohol consumption and an even healthier outcome to increased consumption
serves only the financial interest of the beverage industry and may lull
the demented drinkers into a further fantasy that their drinking habit is
not only not a detriment to their health, but may some how improve their
health.
Certainly any sober person can use empirical evidence
to discredit that notion. If simple facts of reality
are going to be leapfrogged over just to play in the
scientists’ sandbox of childish notions, certainly less
important and less worthy publications can be used in
this way to publish that nonsense rather than risk
tainting the reputation of this fine journal.
This article is a concise and comprehensive glossary in the basic concept of health care. It
is an asset to teaching classes of public health. However, in this developing country we are
curious about your term "Primary Care". We are all working in a two million population catchment area for our services; the "Service Area" of the Institute. We named these the "Teaching Districts" of BP Koirala Institute...
This article is a concise and comprehensive glossary in the basic concept of health care. It
is an asset to teaching classes of public health. However, in this developing country we are
curious about your term "Primary Care". We are all working in a two million population catchment area for our services; the "Service Area" of the Institute. We named these the "Teaching Districts" of BP Koirala Institute of Health Sciences. In the
last seven years as trained
doctors, practising in population medicine, we have realized that there is no grading of care. Care has no level, either primary or secondary or tertiary. It is confusing for those who never worked with a population but still define its term. For us, illness is a process that needs every level of care at all times. The political definition of health care as "Primary
Health care" Almaata 78
was so convenient to all. Some forms of compromised care or homeopathic medicine in modern medicine are termed primary care. Do we, as health
professionals, understand what primary care is when some one is sick?
Dear Editor
Nilsson and his colleagues have assessed the hazards of tobacco smoking among men and women in a Swedish cohort. The authors reported no statistically significant gender differential in relative mortality rates for any of the studied diseases [1]. I have deep concerns about gender differences of smoking-related risks for Alzheimer and Parkinson’s diseases (the most frequent nuerodegenerative diseases in...
Epidemiologists all over the world have been good enough to express their concerns and worries about how we, and other friends and colleagues in New York, fared in the terror provoked on September 11 2001. This annotation responds to the editor's invitation that we convey something from our vantage point. We welcomed his interest. The experience is, so far, unique in history. Our account is personal, that of fou...
Dear Editor,
I spent six long years in the UK, and following a "Hospital Doctor" report, requested the BMA to provide us with a list of the countries from which the junior doctors who committed suicide between 1991 to 1995 came from. It is felt that severe ill treatment of Indian/other overseas doctors by the NHS, may have led to this. Why are the British Government, the British Health Department, and the BMA...
Markets and neo-liberal globalisation serve to create yet greater maldistributions not only of resources...
The tragedy of New York, Washington and Pittsburgh is both immediate and long-term. Immediate in its violent loss and bereavement; the anger, anguish and personal 'what ifs' that will devastate psychological well being over the next few weeks and months. What if she/he had missed the train, woke up late, been on a lower floor, not gone back to their desk, not taken that plane, had a few more seconds...? I breathed a huge...
It is a very short note but I feel the need to write it. It has been very interesting to read this new article written by Nancy Krieger. I have been following and reading all her articles. We at ALAMES (Asociación Latino Americana de Medicina Social) started following her papers when she first published the "The web of causation: has anyone seen the spider?". Many Latin American authors were writing about these c...
We thank Mr. Barnett for his interest in our article, even though his comments suggest he has not read it. Following there are some notes on Barnett’s comments:
We have never received funds from the beverage industry, either for this research or for any of the several studies we have done on the relationship between alcohol and health.
Contrary to Barnett’s comments, we finished our article a...
Dear Editor
, I trust peers in the fields of Epidemiology and Community Health will have ample opportunity to scrutinize the hapless "study" from Spain published in your journal this week as reported on BBC News web site and I wish to foreshadow their likely findings of the so-called scientists whose study linked more and more alcohol consumption with "feeling healthier" as laughable and very unscientific.
...Dear Editor,
This article is a concise and comprehensive glossary in the basic concept of health care. It is an asset to teaching classes of public health. However, in this developing country we are curious about your term "Primary Care". We are all working in a two million population catchment area for our services; the "Service Area" of the Institute. We named these the "Teaching Districts" of BP Koirala Institute...
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