Developing an on-line course in health economics: if I had known then what I know now..

Health economics is an important component of professional education in health services administration, public health, and related fields. This article describes the development of an on-line course in health economics for web-based programs in health services administration and pharmacy. The on-line environment offered solutions for some of the problems often encountered in teaching this subject, but raised a set of new issues. The author explains 13 lessons learned in the process of course development and course revision. The course remains a work-in-progress, with some issues, especially in student assessment and course evaluation, yet to be resolved.     

Preventing suicide in young people: what is known and what is needed

In the UK the suicide rate for male adolescents has nearly doubled since 1975. With a similar increase reported from other countries it is not surprising that preventing suicide in young people has become a priority for many health professionals and policy makers. Unfortunately despite advances in our understanding of suicide in young people there are still deficiencies and inconsistencies in our knowledge. There are also problems in transforming our knowledge of suicide and suicidal behaviour in young people and our understanding of theoretically possible approaches to prevention into effective suicide prevention strategies. To increase the chance of preventing suicide in young people we need to be aware of the problems of putting theory into practice and evaluate all interventions that are undertaken to determine their appropriateness and effectiveness.     

Clinical information in psychiatric practice: what do doctors know,what do they think is known and what do they record?

Deficiencies in recording clinical information are a widespread problem in both psychiatry and medicine. Previous studies have not established whether information not recorded in the notes is nonetheless known to clinicians. This study compared both the information known to individual clinicians and that recorded in the notes with previously established criteria. Overall, individual clinicians recalled more information than was recorded in the notes (median values: clinicians 47-63% of criteria; notes 42%) and when all this individual knowledge was pooled, 88% of the preset criteria were satisfied. Consultants, but not more junior staff, recalled significantly more about subsections of the history which they considered to be especially relevant to the management plan for a given patient. Only a third of data not known to clinicians, but thought by them to be recorded in the notes, was actually present. The implications of these findings for clinical audit and medical education are discussed.     

The burden of pneumococcal disease among adults in developed and developing countries: what is and is not known

The burden of pneumococcal disease among adults in developed countries is neither widely known nor appreciated. The incidence of pneumococcal pneumonia is uncertain because a precise diagnosis cannot be obtained for most patients. Population-based data on invasive pneumococcal disease (e.g., bacteraemia and meningitis) suggest an annual incidence in all developed countries of ≥15–20 cases per 100,000 persons of all ages and ≥50 cases per 100,000 elderly adults (≥65 years). In developing countries there are no population-based data on the burden of pneumococcal disease among adults. Studies of high risk groups, hospital-based studies, vaccine efficacy trials, extrapolations from surveillance of “native populations” in developed countries, and demographic studies in developing regions all suggest a high burden of disease. The broad variation in these estimates, however, indicates that better studies are needed. Increased use of pneumococcal vaccines among adults in all countries will depend on better scientific and public understanding of the burden of pneumococcal disease. In developing countries, intensive community-based studies of the impact of pneumococcal disease, or, alternatively, a “vaccine probe” approach, in which a population is vaccinated and the reduction in pneumonia is compared with that in a control population, could give more accurate estimates of the burden of disease and of the potential effectiveness of pneumococcal vaccination among adults.     

HIV and AIDS in South Africa: what is an appropriate public health response?

Ninety-eight cases of acquired immune deficiency syndrome (AIDS)were reported in the Republic of South Africa by the end of1987, and 166 by mid-December 1988. By 12 February 1990, 353cases of AIDS had been reported: 326 in South Africans and 27in people from either elsewhere in southern Africa or abroad.The South African patients comprised two main groups: whitemen with the pattern of infection typical of homosexual andbisexual men; and heterosexuals exhibiting the pattern commonin much of central and southern Africa. There have been a smallnumber of people with haemophilia affected with AIDS, but onlyone injecting drug user with AIDS to date. There is evidenceof considerable spread of the epidemic into the South Africanblack population; migrant labour, the high prevalence of sexuallytransmitted diseases and suspicion of government-directed familyplanning programmes have all contributed to this. Seropositivityrates in South African blacks are noted to be rising rapidlyand the doubling time is considered to be about 8.5 months.The government and some employers have adopted discriminatorymeasures to control the disease, including the screening ofmigrant workers and the repatriation of those found to be seropositive.Public health leadership from the state authorities has beeninappropriate. We argue for greater involvement of homosexual,worker, community and public health personnel in developingpolicies of control for human immunodeficiency virus (HIV) infectionin South Africa, if the response is to be ethical, non-discriminatory,sensitive, prevention-orientated and effective.