Women's health. The childbearing years and after.

Health and development planners have tended to see women primarily in context of their reproductive role. As a result, solutions to women''s health needs have been restricted to expanding and improving maternal and child health systems. There has recently been a major shift in direction, largely because of the influence of the world conference on population and development held in Cairo in 1994. Dr Guiseppe Benagiano, director of the special programme of research, development and research training in human reproduction based at the WHO, says, "We need to remind ourselves constantly that reproductive health is not simply a biomedical issue but one with serious implications for our general health and by extension, for all our efforts in human social and economic development." The 1993 world development report on health identified the lack of a clear strategy for engaging women in health care and suggested that child health services, prenatal care, treatment of sexually transmitted diseases, and family planning services should be provided jointly at convenient times. In an example of this, the Chilean Institute of Reproductive Medicine now offers integrated family planning services at the same time as child health services, and Thailand is experimenting with mobile health clinics to reach women in their homes. As the proportion of elderly women increases, old age is increasingly being seen as a female issue. With the impact of urbanisation and industrialisation, more of these women are living isolated lives, often suffering from chronic debilitating diseases. In his opening statement to the global commission on women''s health in April 1995 which focused on health conditions of women in old age, Dr Hiroshi Nakajima, the WHO''s director general, said: "Our goal should not be solely to extend lives in the physical sense, but to ensure that the added years are worth living."     

The World Health Organisation. WHO in Europe: does it have a role?

WHO is under pressure from all sides to justify its existence. Donors want to know what they are getting for their money, and health professionals question the relevance of the organisation''s work. The pressure to justify itself is perhaps strongest of all in Europe, where most member countries have fully fledged health infrastructures and high overall levels of health. Now there is the additional threat of encroachment into the field of public health by the European Union. The disintegration of the Soviet bloc has given WHO''s regional office in Europe a new sense of purpose and led to a major shift in resources towards the countries of central and eastern Europe. But WHO''s critics are calling for a different shift in the way its European office works: from its current concentration on broad based policy issues to the nitty-gritty of health care management and delivery.     

WHO at country level--a little impact,no strategy.

The acid test of WHO''s effect on the world''s health is its impact at country level. Unless it has an impact there, all of its declarations, its debates at the World Health Assembly, its conferences, its pamphlets, its political manouvering in Geneva and the regions, all of these come to nothing. Working as it does through national governments, WHO insists that it has no role in directly managing or delivering health care. Judging WHO''s impact in individual countries is therefore difficult--its approaches are largely indirect, and initiatives may take years to bear fruit. But from the meagre resources that WHO makes available at country level it is clear why its country operations are criticised as the weakest link in an already weak chain of influence from its headquarters in Geneva to the people in its member states. Poorly funded, undertrained, and with no clear strategy to follow, its staff at country level stand little chance of making an impact.     

WHO in crisis.

Media attention has been focused on the leadership of the World Health Organisation, rather than on the real factors that limit WHO''s effectiveness. These factors relate to the organisation''s structure and also to its current priorities, methods, and management. This article examines the objectives and strategy of WHO in view of financial constraints and donor countries'' demands; WHO''s stated goal of integrated primary health care; staff morale; and the growing dislocation between the regions and headquarters.     

WHO in retreat: is it losing its influence?

WHO says it has three main functions: to set normative standards; to provide technical advice and assistance on medical matters; and to advocate changes in health policy. During its 46 year history the first two functions have been a constant and uncontroversial backbone through which WHO has earned its reputation for scientific excellence. The third function, advocacy, came to the fore with the launch of Health for All in 1977, after which WHO took a key role in influencing international health policy. WHO''s friends and critics alike now say that the organisation is losing its influence and retreating into its technical and biomedical shell. This article maps the changes in WHO''s approach over the past 46 years and considers whether fears about its loss of influence are justified.     

WHO fellowships--what do they achieve?

Training health professionals is one of WHO''s major strategies for improving health care in the developing world. The aim, to strengthen a country''s own capacity rather than injecting expertise from outside, is in the best tradition of sustainable development. But how effective is this so called "capacity building in human resources"? Since it accounted for $43m of WHO''s budget in 1992-3 and is considered by WHO to be a major contribution to health in individual countries, it deserves detailed examination.     

Requests approaching 50,000 annually for emergency drug release program.

Health Canada''s Emergency Drug Release Program, which allows physicians to acquire nonmarketed drugs to treat people with HIV infection, AIDS and other illnesses, handles about 44 000 requests annually. The executive director of the Drugs Directorate says the program''s name is a misnomer, since few of the requests involve medical emergencies. Dr. Philip Berger, who uses the program for his AIDS patients, complains that the amount of paperwork required is oppressive. A government spokesperson says changes may be made to make the program less labour intensive.     

Tributes to Truman G. Yuncker and Ethel Claflin Yuncker

Editor’s note: This tribute was prepared by Barbara Yuncker from a recorded interview she had with Dr. Callejas during his six-week visit to the Garden’s Herbarium in September 1988 to study the Piperaceae specimens received from DePauw University.     

The World Health Organisation. The regions--too much power,too little effect.

WHO''s regional offices make it structurally one of the most decentralised of all United Nations agencies. But at what cost and to what effect? This article argues that too often the regions give only the illusion of decentralisation while wresting power from WHO''s governing body and prolonging the time taken for resources to reach the point of need.     

Health,humanitarian relief,and survival in former Yugoslavia.

Since the World Health Organisation''s effort in former Yugoslavia started in July 1992 it has been concerned with the public health policies of survival. It has provided advice to the United Nations High Commission for refugees, helped the voluntary agencies coordinate their work, assessed health needs, and provided practical help in the field to all parties to the conflict. Three features of the Bosnia war have particularly deplorable effects on health: ethnic cleansing, deliberate attacks on hospitals, and systematic rape. The WHO''s response has included initiatives in nutrition, winter survival, and medical supplies. This experience shows that the WHO can have a useful role complementary to that of other agencies in situations where the basic elements for survival of the population are seriously compromised by war.     

Comment on „designing EMF experiments: What is required to characterize ‘exposure’?”︁

Dr. Peter Valberg has written an excellent and clear paper describing our current understanding of the many facets of characterizing exposure to extremely-low-frequency (ELF) electric and magnetic fields. Dr. Valberg has directed his paper to the characterization of exposures used in laboratory experimentation. In this context, it seems to me that Valberg's program of exposure characterization can be accomplished with currently available instrumentation and with relatively modest effort. Thus, I have no fundamental problems with his recommendations and, really, have only a few minor comments to make. However, if one argues that Valberg's recommendations should be extended to the characterization of exposure in epidemio-logical research, I have serious reservations, which I will mention briefly at the end of this commentary. © 1995 Wiley-Liss, Inc.     

The “ethnographic surrealism” of Jean Rouch

Using James Clifford's notion of “ethnographic surrealism,” this paper focuses on the “surrealist” features of the film work of Jean Rouch. First, drawing extensively from an interview held with Rouch in May 1988, I outline the influence that the “ethnographic surrealism” of the 1930s had on Rouch. I then go on to discuss “surrealism” in Rouch's use of the camera, choice of subject matter, techniques of narration, and relationship to his subject. I conclude by demonstrating that Rouch's current work at the Cinémathèque Française and the Comité du Film Ethnographique offer excellent examples of his ability to cross disciplinary boundaries and thus extend the original spirit of “ethnographic surrealism” into the present.     

Dr. Max King: the sad life and early death of Mackenzie King's physician brother

While researching her best-selling biography, Mrs. King: The Life and Times of Isabel Mackenzie King, CMAJ contributing editor Charlotte Gray discovered a wealth of information about Dr. Dougal Macdougall (Max) King. Although he never became as famous as his older brother Mackenzie, Gray presents a convincing argument that Dr. Max King''s life and early death speak volumes about medicine and the medical profession at the turn of the century. She also argues that Mackenzie King''s own life would have been much different had his brother not died at the too young age of 42. Gray''s book was nominated for the Viacom Award, which honours the best nonfiction book published annually in Canada.     

McMaster's pioneer in evidence-based medicine now spreading his message in England.

Dr. David Sackett, formerly of McMaster University and now at Oxford University in England, is considered one of the pioneers of the evidence-based medicine movement. This article looks at his colleagues'' assessment of Sackett''s contributions to medicine and at Sackett''s own views on his lengthy career.     

Interview with Sydney Brenner. The world of genome projects

Dr Sydney Brenner has played a major, and unique, role in biology during the past 40 years. His contributions have ranged from key work on the structure of the genetic code and the existence of mRNA through the development of Caenorhabditis elegans as a key model system in developmental biology to genomic analysis and function in vertebrates. BioEssays went to interview Dr Brenner at his home in the cathedral city of Ely, England, on the significance of the genome projects for human biology, in particular, and for biology, in general.     

The role of hybridization in evolution: old wine in new skins

Perhaps no one has had a greater influence on the development of hybridization theory than Dr. Ledyard Stebbins. However, his contributions have not been restricted to his writings or lectures alone. Many of you have marveled at the great authority with which Dr. Stebbins identified the hybrid status, parentage, and ploidal level of plants in the field or on herbarium sheets. He didn't seem to need all the modern techniques that the current generation of botanists is both blessed and burdened with. For example, I remember a short field trip with Dr. Stebbins in the fall of 1984 to look at some sunflower hybrids near Davis. The plants were dead, only a few dried leaves, stalks, and floral heads remained, yet he confidently identified parental, hybrid, and backcrossed generations. Ironically, after 2 yr of careful molecular studies, I essentially confirmed his initial observations (Rieseberg, Soltis, and Palmer, 1988). Thus, I came to the conclusion that he was able to see things in plants that escaped less careful or less knowledgeable observers such as myself.     

Consensus finally achieved on resuscitative interventions.

A joint policy statement on the resuscitation of patients is published in this issue of CMAJ. Dr. John Williams, the CMA''s director of ethics and legal affairs, discusses how it differs from the joint statement published last year.     

A.M.A. Meeting

The following summary of actions of the House of Delegates at the American Medical Association''s Thirteenth Clinical Meeting, held December 1-4, 1959, in Dallas, is not intended as a detailed report on all actions taken. It has been composited from reports by Mr. Ed Clancy, director of public relations of the California Medical Association, and by Dr. F. J. L. Blasingame, executive vice-president of the American Medical Association.     

An appreciation of A.E. Malloch,MB, MD (1844-1919): a forgotten surgical pioneer

Dr. Archibald Edward Malloch was a surgeon whose life and work were greatly influenced by Joseph Lister and his revolutionary system of antiseptic surgery. This paper describes how a young Canadian medical man came to introduce Lister''s system to North America in 1869 and studies his career in the light of Lister''s surgical epoch.     

Dr. Haifan Lin. Interviewed by Han Lee and Rachel Rosenstein

Dr. Haifan Lin is professor of Cell Biology at Yale University, where he studies the mechanism of stem cell self-renewal in fruit flies, mice, and human cancer cells. Recently named director of the Yale Stem Cell Center, Dr. Lin has made seminal contributions to the stem cell field, most notably his demonstration of the stem cell niche theory using the fruit fly model, his discovery of the PIWI/AGO gene family that is essential for stem cell division in diverse organisms, and his recent finding of a group of small RNAs called PIWI-interacting, or piRNAs, which may play a crucial role in stem cell proliferation and germline development. Dr. Lin’s work on piRNAs was recognized by Science Magazine as a top scientific breakthrough of 2006. Recently, the Lin lab has begun exploring the role of these molecules in stem cell division and oncogenesis.