Mental health system in China: history, recent service reform and future challenges

This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.     

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.     

高校心理健康教育的问题及对策思考

当前,高校心理健康教育基本上已进入一个快速发展之后的平台期。虽然高校心理健康教育取得了显著的成绩,但还存在着一定的问题。其根源在于学生认同度不高、全员参与性不够、课堂渗透不多和师资队伍不强,这些使高校心理健康教育工作陷于困境,严重制约高校心理健康教育深入开展。本文提出了走出高校心理健康教育困境的四项对策。     

Challenges Facing the Adoption of Ecosystem Health as a Core Component in Professional Curricula

While there has been considerable success in introducing ecosystem health into professional curricula at a number of universities, there have been significant challenges to its introduction. There are difficulties relating to pervading attitudes within universities. Ecosystem health deals with uncertainty whereas most other disciplines cherish certainty. Ecosystem health is often considered a “soft science” lacking in specifics. The enormity and complexity of ecosystem health problems are often perceived as discouraging and impossible to solve. The university structure can present challenges in that transdisciplinary problem solving requires the participation of many different departments, with several levels of approval required. There are also challenges in the teaching of ecosystem health given its extremely broad focus, limited experience in ecosystem health curricula, and almost no experience in effective evaluation of a field that emphasizes attitudes as much as it does information. This article describes each of these challenges, draws on the experience of the conference, and provides potential solutions to overcoming these challenges.     

Benefits of coordinated action in PACS evaluation

PACS, a health care technology still in its developmental stage, aims to improve the management of diagnostic imaging investigations. As the technology has not been comprehensively assessed, data and facts to justify its clinical, economic and other benefits are to date insufficient. Through internationally coordinated action, it is expected to obtain a faster and more comprehensive technology assessment of PACS as well as recommendations for optimization of the system and guidelines for its rational use in various health care environments.     

Preparedness for SARS in the UK in 2003

Severe acute respiratory syndrome (SARS) has been described as the first major emerging infectious disease of the twenty-first century. Having initially emerged, almost unnoticed, in southern China, it rapidly spread across the globe. It severely tested national public health and health systems. However, it also resulted in rapid, intensive international collaboration, led by the World Health Organization, to elucidate its characteristics and cause and to contain its spread. The UK mounted a vigorous public health response. Some particular issues concerned: the practicalities of implementing exit screening had this been required; the likely efficacy of this and other control measures; the legal base for public health action; and the surge capacity in all systems should the disease have taken hold in the UK. We have used this experience of 2003 to inform our preparation of a framework for an integrated, escalating response to a future re-emergence of SARS according to the levels of disease activity worldwide. Recent cases confirm that SARS has not "gone away". We cannot be complacent about our contingency planning.     

Health Security and Risk Aversion

Health security has become a popular way of justifying efforts to control catastrophic threats to public health. Unfortunately, there has been little analysis of the concept of health security, nor the relationship between health security and other potential aims of public health policy. In this paper I develop an account of health security as an aversion to risky policy options. I explore three reasons for thinking risk avoidance is a distinctly worthwhile aim of public health policy: (i) that security is intrinsically valuable, (ii) that it is necessary for social planning and (iii) that it is an appropriate response to decision‐making in contexts of very limited information. Striking the right balance between securing and maximizing population health thus requires a substantive, and hitherto unrecognized, value judgment. Finally, I critically evaluate the current health security agenda in light of this new account of the concept and its relationship to the other aims of public health policy.     

Eicosapentaenoic and docosahexaenoic acids enriched polyunsaturated fatty acids from the coastal marine fish of Bay of Bengal and their therapeutic value

Eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) enriched polyunsaturated fatty acids (PUFA) significantly present in marine fish oil emerge as preventive agents for combating many health problems specially in chronic or metabolic disorders. The fish in the coastal area of Bay of Bengal has remained unexplored with respect to EPA/DHA enriched PUFA content in its oils, although it may be a potential source in harnessing the health benefit. In this study, seven varieties of the coastal fish were analysed for the content of EPA/DHA. The one locally known as lotte, (Harpadon nehereus) though has low content of total lipids, was found to have high EPA/DHA in its oil. The phospholipids rich fraction was extracted from the total fish oil. The EPA/DHA enriched PUFA was isolated to investigate the potential use for health benefits. EPA/DHA is found to act as protective agent against mercury poisoning studied in cell culture as well as in animal mode. It is found to be highly preventive in diabetes. The lotte is available in the coastal area of Bay of Bengal adjoining West Bengal, India in large scale and it is the first report showing EPA/DHA enriched PUFA in these fish oil that can be availed to harness in important health benefits.     

Health benefits of fucoxanthin in the prevention of chronic diseases

Fucoxanthin is a xanthophyll carotenoid abundant in macroalgae, such as brown seaweeds. When fucoxanthin is consumed, it can be esterified or hydrolyzed to fucoxanthinol in the gastrointestinal tract and further converted into amarouciaxanthin A in the liver. It has a unique chemical structure that confers its biological effects. Fucoxanthin has a strong antioxidant capacity by scavenging singlet molecular oxygen and free radicals. Also, it exerts an anti-inflammatory effect. Studies have demonstrated potential health benefits of fucoxanthin for the prevention of chronic diseases, such as cancer, obesity, diabetes mellitus, and liver disease. Animal studies have shown that fucoxanthin supplementation has no adverse effects. However, investigation of the safety of fucoxanthin consumption in humans is lacking. Clinical trials are required to assess the safety of fucoxanthin in conjunction with the study of mechanisms by which fucoxanthin exhibits its health benefits. This review focuses on current knowledge of metabolism and functions of fucoxanthin with its potential health benefits.This article is part of a Special Issue entitled Carotenoids recent advances in cell and molecular biology edited by Johannes von Lintig and Loredana Quadro.     

Squalene monooxygenase: a journey to the heart of cholesterol synthesis

Squalene monooxygenase (SM) is a vital sterol synthesis enzyme across eukaryotic life. In yeast, it is a therapeutic target for treating certain fungal infections, and in mammals it is a rate-limiting enzyme that represents a key control point in the cholesterol synthesis pathway. SM introduces an oxygen atom to squalene, which becomes the signature oxygen of the hydroxyl group in cholesterol. Our knowledge of SM has advanced tremendously since its initial cloning and characterization. Early research developed mammalian SM inhibitors to target SM for cholesterol-lowering purposes. The substrate squalene has gained considerable interest for its health benefits and in nanomedicine for delivery of drugs. More recently, SM has been implicated as a key dysregulated component in certain cancers. In this review, we summarize our present knowledge of SM, focusing on the regulation of SM and the gene encoding it, SQLE. Furthermore, we offer insights into the role of SM across different organisms and its significance in human health and disease.     

Trichinellosis: the zoonosis that won't go quietly

Trichinellosis, is normally not included among those regarded as emerging zoonoses because it has been a public health threat for more than 150 years. However, its dramatic re-emergence in many areas around the world over the past 10-20 years, inspite of a century of veterinary public health efforts to control and eradicate it, justifies it being included in this group. The reasons for this re-emergence are diverse, and include human pertubation and manipulation of ecosystems, war and political turmoil, rapidly changing food distribution and marketing systems, and even, surprisingly, rising affluence in developing countries. These influences, and their impact on the epidemiology of both domestic and sylvatic trichinellosis, are discussed, along with recommendations for confronting this altered status as a public health threat.     

Anthropology at the heart of medicine

Anthropology and medicine share many concerns, but have had trouble collaborating in the past. The anthropologist has had to plead both with his colleagues and physicians to move beyond a < culturalist > vision that would confine him to the study of traditional or alternative medicines and representations of populations and the sick. The anthropologist's approach perceived as intrusive has also raised fears in the medical world. These reciprocal misunderstandings and stereotypes need to be overcome by an anthropology that studies the practices and knowledge of modern medicine as they are elaborated daily. Anthropology will dialogue with medicine without judging it. In its turn, medicine will open its sites of healing and teaching to the anthropologist. Anthropology at the heart of medicine is organized around the idea that the paths and expectations of health professionals reflect the specicifities of the local system of health. The individual dimensions of practices cannot be divorced from the functioning of structures of health and decision. Finally, like any other kind of anthropology, medical anthropology must scrutinize its own methods and ethics in a critical way.     

Expectations and obligations: professionalism and medicine's social contract with society

As health care has become of great importance to both individual citizens and to society, it has become more important to understand medicine's relationship to the society it serves in order to have a basis for meaningful dialogue. During the past decade, individuals in the medical, legal, social sciences, and health policy fields have suggested that professionalism serves as the basis of medicine's relationship with society, and many have termed this relationship a social contract. However, the concept of medicine's social contract remains vague, and the implications of its existence have not been fully explored. This paper endorses the use of the term social contract, examines the origin of the concept and its relationship to professionalism, traces its evolution and application to medicine, describes the expectations of the various parties to the contract, and explores some of the implications of its use.     

Genetic Counseling—A Health Department Service to Physicians

Questions about inheritance in all kinds of diseases and defects are commonly asked of nearly all physicians. In attempting to answer these questions, however, the physician is often hampered by lack of formal instruction in clinical genetics.Since the health department, if it is to carry out its epidemiologic function, must be as concerned over the increasing identification of genetic agents in disease as it is and has been over environmental disease agents, it should come to represent a source of assistance not now generally available to the physician. In short, as it carries out those activities by which its store of general genetic information is increased, and until other sources of genetic consultation become reasonably available, the health department can be of real service to physicians as a resource to which they may turn for help when dealing with families wanting genetic information.Such a service has been provided experimentally for the last two years by the Contra Costa County Health Department.This program calls for the taking of family pedigrees by public health nurses on families with questions of a genetic nature who are health department clients and on families who are referred by their private physicians for this service. An interpretation of each pedigree is made by the department''s physician in charge of the program and submitted to the family''s physician for his use in counseling the family. Evidence to date suggests the process can be a highly useful service to the practitioner and his patient.     

Ecosystem Health in Professional Education: The Path Ahead

This supplement shows that ecosystem health has become a vital part of the curriculum in a small number of medical, veterinary, and public health schools. This limited, but important, experience provides the groundwork for further expansion into other professional schools and into other universities. Although ecosystem health has defined underlying principles, previous experience has shown that each professional faculty should define what ecosystem health means for the institution and for its students. Based on this definition, it is important that detailed learning objectives be defined for ecosystem health as it pertains to the profession. A model for further development is proposed in this editorial. This model focuses on developing the necessary skill sets for ecosystem health education, the expansion of ecosystem health into earlier and later stages of learning (high school through undergraduate, through postgraduate, and onto practicing professional levels), and raising the awareness of ecosystem health in the local community and at national and international levels. Once comprehensive, transdisciplinary, continuous ecosystem health programs become mainstream, one can expect a “sea change” in the attention given to the interrelationship between humans and their environments, and a more concerted effort to restore the health of our planetary ecosystems.     

The alluring myth of private medicine.

Canada''s medicare system has provided Canadians with high-quality health care for almost three decades. Now Canadian health care appears to be at risk of losing the single-payer system, which is the premise on which medicare is built. As medicare comes under increasing financial pressure, many are calling for the introduction of private care as a means of bolstering our health care system and maintaining its quality. Although it appears alluring to some politicians, physicians and commentators, privatization could very well lead to the demise of the principles and practices of the Canadian health care system as we know it, with little clear benefit to the public or physicians.     

Sodium Levels in Drinking Water As An Index to Human Health

As a consequence of the general lack of surface water in the Dalmatian region of Southern Croatia, health care institutions and water management authorities have become particularly interested in observing and monitoring water as well as preserv ing its quality. A relational database has been developed for carrying out chemical analyses (sodium), expressed by coefficients K₁ and K₂, because it is necessary from an informatical aspect to organize and integrate a large number of analytical and ecological health data. The database can serve as a methodological platform for the study of environmental factors influencing human health. The prototype database, consisting of data from investigations conducted by the Water Examination Depart ment of the Public Health Institute of Split Dalmatian County (Croatia), has been used for water quality control. The database currently contains more than 2,000 data.     

Concept, measurement and use of acculturation in health and disease risk studies

Acculturation, a concept with its root in social science and cultural anthropology, is a process intimately related to health behavior and health status of minority populations in a multicultural society. This paper provides a brief review of the subject of acculturation as it relates to health research, showing that this concept has a potential to identify risk factors that underlie increased prevalence of chronic diseases, particularly in immigrant populations. A proper understanding of this is helpful in designing intervention programs to reduce the burden of such diseases and to increase the quality of life in such populations. The concept is defined with an outline of its history showing its evolution over time. Criteria for measuring acculturation are described to illustrate the need of accommodating its multidimensional features. Drawing examples from health research in US Hispanics, the role of acculturation on health behavior is discussed to document that the discordant findings are at least partially due to either use of incomplete dimensions of the concept, or not accounting for the dynamic aspect of its process. Finally, with illustration of a finding from a study among overweight Mexican American women of South Texas, a model of acculturation study is proposed that may be used in other immigrant populations undergoing the acculturation process.     

Exploring the physiology and pathology of aging in the intestine of Drosophila melanogaster

The gastrointestinal tract, due to its role as a digestive organ and as a barrier between the exterior and interior milieus, is critically impacted by dietary, environmental, and inflammatory conditions that influence health and lifespan. Work in flies is now uncovering the multifaceted molecular mechanisms that control homeostasis in this tissue, and establishing its central role in health and lifespan of metazoans. The Drosophila intestine has thus emerged as a productive, genetically accessible model to study various aspects of the pathophysiology of aging. Studies in flies have characterized the maintenance of regenerative homeostasis, the development of immune senescence, the loss of epithelial barrier function, the decline in metabolic homeostasis, as well as the maintenance of epithelial diversity in this tissue. Due to its fundamental similarity to vertebrate intestines, it can be anticipated that findings obtained in this system will have important implications for our understanding of age-related changes in the human intestine. Here, I review recent studies exploring age-related changes in the fly intestine, and their insight into the regulation of health and lifespan of the animal.     

Oral Surgery: Present and Future

The history of the specialty of oral surgery is reviewed from the days of its origin, when it was essentially confined to exodontia, to its present status, in which it includes many and varied surgical operations relative to the human jaws and their associated structures. The scope and training pertinent to modern oral surgery are discussed. A three-year program on a graduate basis, required as partial fulfilment of the qualifications for accreditation and certification by the American Board of Oral Surgery, is described in detail. The need for mutual understanding by the medical and dental professions, as to what this specialty has to offer in terms of a total community health program, is emphasized.