Attacks on Medical Education : Document

“…..The aim of this report is to explore an impact of violence on medical education, with its specific components, such as education facilities, teaching hospitals, libraries, professors, medical students and all other directly related components…..”

“….Venezuealan Case Studies:

Threats / intimidation of medical personnel of the Central Hospital of San Cristóbal during protests: During the month of April and May several threats were reported against the personnel of the Central Hospital of San Cristóbal, Táchira state, because the National Guards forbade treating the wounded during social protests, intimidating some doctors who attended these wounded youth, despite the multiple protests that took place in the hospital, this intimidation did not stop.

Tear gas pumps near the Del Valle maternal and child hospital on 04/20/2017: The use of tear gas bombs by the Bolivarian National Police and the Bolivarian National Guard in Longaray and the Intercomunal Avenue of El Valle affected the patients of El Valle Children’s Maternity Hospital. Gases seeped into hospital facilities affecting workers, mothers and newborns17.

Detention of the professor of medical school of the Universidad Central de Venezuela, MD Óscar Noya, on 04/20/2017: Oscar Noya is a doctor and professor at the Central University of Venezuela (UCV). He works continuously for the population that lives in the upper Orinoco. Through the Twitter social network it was possible to know that in the afternoon of Thursday, April 20, Dr. Oscar Noya was arrested, when participated in the protest. Moya was helping people affected by tear gas in Santa Monica, Caracas…..”

DUKE

“…..Crowdsourcing. They would survey motorcyclists about road traffic “hotspots”—areas of high-density crash locations—in the region. They hypothesized that the people who spend their days traversing across town would have valuable insights that could help inform future road safety interventions. It turns out they were right.  Staton, Vissoci, Østbye and Luciano Andrade, a post-doctoral researcher working with Staton, initially tested this method in Kigali, Rwanda, and Galle, Sri Lanka, in collaboration with Stephen Rulisa in Rwanda and Vijitha Da Silva in Sri Lanka. They asked moto drivers in Rwanda and tuk-tuk (three-wheel) drivers in Sri Lanka to identify dangerous locations in the region and label the severity of danger of each location. Then, the researchers compared police data to the information the drivers provided.

The study not only showed that data from these “high road utilizers” aligned well with police data, but also identified potential additional hotspots. The research team also found that this crowdsourcing approach is less costly than collecting police data and is easily reproducible, adaptable and interpretable. They were able to replicate the study in Moshi, Tanzania, a year later in collaboration with KCMC researcher Mark Mvungi and got similar results…..

The next step….is to formulate targeted, cost-effective interventions to minimize the risk in these traffic hotspots. These interventions might include measures such as adding speed bumps; improving road pavement conditions, visibility and signage; and promoting helmet use……”

NY Times

“…..In the study — known as the Mordor trial and published in the New England Journal of Medicine — 190,238 children under age 5 in 1,500 villages in Malawi, Niger and Tanzania were given one dose of azithromycin or a placebo every six months for two years.

Overall, there were 14 percent fewer deaths among children getting the antibiotic; the reduction was strongest in Niger, where infant mortality is highest.

The protection appeared to be greatest for infants aged 1 month to 5 months; the antibiotic prevented one in four deaths in this group…..”

ABC

NursingNow

Uganda, where the Government has joined with nursing, health and academic organisations to set out a Nursing Now road map for developing nursing and midwifery. This work is laying the groundwork for Nursing Now Africa.

Hopkins/Bloomberg Public Health

“….Yet while supplements work wonders—UNICEF estimates that if every child who needed supplements received them, as many as 1 million lives could be saved each year—even massive distribution campaigns can’t reach everyone who requires them. And industrially fortifying foods does not always work in developing countries, where it can be difficult to identify a commonly eaten food that can be centrally—and reliably—processed. Several Central American countries, for example, have successfully reduced vitamin A deficiency by fortifying sugar with vitamin A; but….attempts to do so in Zambia failed due to flawed fortification processes.….

Biofortification  would allow vulnerable populations to grow and eat their own nutritionally enhanced crops, sidestepping many of the obstacles to supplementation and industrial fortification.”

 

NY Times

“….Until the late 1980s, malnutrition was widespread among poor Chileans, especially children. Today, three-quarters of adults are overweight or obese, according to the country’s health ministry. Officials have been particularly alarmed by childhood obesity rates that are among the world’s highest, with over half of 6-year-old children overweight or obese.

In 2016, the medical costs of obesity reached $800 million, or 2.4 percent of all health care spending, a figure that analysts say will reach nearly 4 percent in 2030…..”

WHO

Violence

NY Times

“…..The health care plan, part of the government’s 2018-19 budget presented on Thursday, would offer 100 million families up to 500,000 rupees, or about $7,860, of coverage each year. That sum, while small by Western standards, would be enough to cover the equivalent of five heart surgeries in India…..”

 

NY Times

WHO

Obesity and overweight

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Key facts

• Worldwide obesity has nearly tripled since 1975.
• In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
• 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
• Most of the world’s population live in countries where overweight and obesity kills more people than underweight.
• 41 million children under the age of 5 were overweight or obese in 2016.
• Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
• Obesity is preventable.

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What are overweight and obesity?

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.

Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m²).

Adults

For adults, WHO defines overweight and obesity as follows:

• overweight is a BMI greater than or equal to 25; and
• obesity is a BMI greater than or equal to 30.

BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.

For children, age needs to be considered when defining overweight and obesity.

Children under 5 years of age

For children under 5 years of age:

• overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth Standards median; and
• obesity is weight-for-height greater than 3 standard deviations above the WHO Child Growth Standards median.

• Charts and tables: WHO child growth standards for children aged under 5 years

Children aged between 5–19 years

Overweight and obesity are defined as follows for children aged between 5–19 years:

• overweight is BMI-for-age greater than 1 standard deviation above the WHO Growth Reference median; and
• obesity is greater than 2 standard deviations above the WHO Growth Reference median.

• Charts and tables: WHO growth reference for children aged between 5–19 years

Facts about overweight and obesity

Some recent WHO global estimates follow.

• In 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these over 650 million adults were obese.
• In 2016, 39% of adults aged 18 years and over (39% of men and 40% of women) were overweight.
• Overall, about 13% of the world’s adult population (11% of men and 15% of women) were obese in 2016.
• The worldwide prevalence of obesity nearly tripled between 1975 and 2016.

In 2016, an estimated 41 million children under the age of 5 years were overweight or obese. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. In Africa, the number of overweight children under 5 has increased by nearly 50 per cent since 2000. Nearly half of the children under 5 who were overweight or obese in 2016 lived in Asia.

Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.

The prevalence of overweight and obesity among children and adolescents aged 5-19 has risen dramatically from just 4% in 1975 to just over 18% in 2016. The rise has occurred similarly among both boys and girls: in 2016 18% of girls and 19% of boys were overweight.

While just under 1% of children and adolescents aged 5-19 were obese in 1975, more 124 million children and adolescents (6% of girls and 8% of boys) were obese in 2016.

Overweight and obesity are linked to more deaths worldwide than underweight. Globally there are more people who are obese than underweight – this occurs in every region except parts of sub-Saharan Africa and Asia.

What causes obesity and overweight?

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

• an increased intake of energy-dense foods that are high in fat; and
• an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.

Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education.

What are common health consequences of overweight and obesity?

Raised BMI is a major risk factor for noncommunicable diseases such as:

• cardiovascular diseases (mainly heart disease and stroke), which were the leading cause of death in 2012;
• diabetes;
• musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative disease of the joints);
• some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon).

The risk for these noncommunicable diseases increases, with increases in BMI.

Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.

Facing a double burden of disease

Many low- and middle-income countries are now facing a “double burden” of disease.

• While these countries continue to deal with the problems of infectious diseases and undernutrition, they are also experiencing a rapid upsurge in noncommunicable disease risk factors such as obesity and overweight, particularly in urban settings.
• It is not uncommon to find undernutrition and obesity co-existing within the same country, the same community and the same household.

Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant, and young child nutrition. At the same time, these children are exposed to high-fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which tend to be lower in cost but also lower in nutrient quality. These dietary patterns, in conjunction with lower levels of physical activity, result in sharp increases in childhood obesity while undernutrition issues remain unsolved.

How can overweight and obesity be reduced?

Overweight and obesity, as well as their related noncommunicable diseases, are largely preventable. Supportive environments and communities are fundamental in shaping people’s choices, by making the choice of healthier foods and regular physical activity the easiest choice (the choice that is the most accessible, available and affordable), and therefore preventing overweight and obesity.

At the individual level, people can:

• limit energy intake from total fats and sugars;
• increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts; and
• engage in regular physical activity (60 minutes a day for children and 150 minutes spread through the week for adults).

Individual responsibility can only have its full effect where people have access to a healthy lifestyle. Therefore, at the societal level it is important to support individuals in following the recommendations above, through sustained implementation of evidence based and population based policies that make regular physical activity and healthier dietary choices available, affordable and easily accessible to everyone, particularly to the poorest individuals. An example of such a policy is a tax on sugar sweetened beverages.

The food industry can play a significant role in promoting healthy diets by:

• reducing the fat, sugar and salt content of processed foods;
• ensuring that healthy and nutritious choices are available and affordable to all consumers;
• restricting marketing of foods high in sugars, salt and fats, especially those foods aimed at children and teenagers; and
• ensuring the availability of healthy food choices and supporting regular physical activity practice in the workplace.

WHO response

Adopted by the World Health Assembly in 2004, the “WHO Global Strategy on Diet, Physical Activity and Health” describes the actions needed to support healthy diets and regular physical activity. The Strategy calls upon all stakeholders to take action at global, regional and local levels to improve diets and physical activity patterns at the population level.

The Political Declaration of the High Level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable Diseases of September 2011, recognizes the critical importance of reducing unhealthy diet and physical inactivity. The political declaration commits to advancing the implementation of the “WHO Global Strategy on Diet, Physical Activity and Health“, including, where appropriate, through the introduction of policies and actions aimed at promoting healthy diets and increasing physical activity in the entire population.

WHO has also developed the “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020” which aims to achieve the commitments of the UN Political Declaration on Noncommunicable diseases (NCDs) which was endorsed by Heads of State and Government in September 2011. The “Global Action Plan” will contribute to progress on 9 global NCD targets to be attained by 2025, including a 25% relative reduction in premature mortality from NCDs by 2025 and a halt in the rise of global obesity to match the rates of 2010.

The World Health Assembly welcomed the report of the Commission on Ending Childhood Obesity (2016) and its 6 recommendations to address the obesogenic environment and critical periods in the life course to tackle childhood obesity. The implementation plan to guide countries in taking action to implement the recommendations of the Commission was welcomed by the World Health Assembly in 2017.