Part I B

Swedish Family Medicine Residencies

Cherry Hill and First Hill Campuses

International Medicine Track- Reading Curriculum

This curriculum is designed to provide a sampling of pertinent and interesting articles covering important topics in international health. Some are reviews, others are case studies, and still others are focused on a specific disease, thus illustrating more general principles of how to approach health and disease in developing countries.

All of these readings are available online; they will also be printed and placed in a notebook in the Learning Center. Some of them are readily accessible online, while others will require the use of a computer which is equipped with a UW proxy server.

Click on one of the headings below to proceed to the readings.

A. Major global health issues and transitions

Worldwide demographics and burden of disease

Murray CJ, Mortality by cause for 8 regions of the world: global burden of disease study. Lancet 1997; 349:1269-1276.
http://pdf.thelancet.com/pdfdownload?uid=llan.349.9061.original_research.8645.1&x=x.pdf

This is the first of a series of four landmark articles in The Lancet describing "global burden of disease" methodology and its application to causes of mortality worldwide.

Macfarlane S, Public health in developing countries. Lancet 2000;356:841-846.
http://www.thelancet.com/journal/vol356/iss9232/full/llan.356.9232.editorial_and_review.10087.1

Inequalities in health and wealth demand new approaches to providing improved health to people in developing countries.

Dye C, Global burden of tuberculosis. JAMA 1999; 282:677-686.
http://jama.ama-assn.org/issues/v282n7/ffull/jst80025.html

This article uses "burden of disease" methodology to describe changing patterns and impacts of TB worldwide. For a more recent and thorough treatment of TB worldwide, see the following article:

Cegielski JP, The global tuberculosis situation. Infect Dis Clin N Amer 2002; 16:1-58.
http://home.mdconsult.com/das/journal/view/19448802/N/12347508?ja=282634&PAGE=1.html&ANCHOR=top&source=

· Pronyk PM, Whose priorities? A response to the issue of antiretrovirals in Africa. Trop Med Int Hlth 2001; 6:575-576.

This editorial asks whether the push to provide large scale HIV medications to African populations is a quick (and premature) fix to more systemic problems with health care in Africa. (This article is not available online, and is reprinted in the notebook in the Learning Center.)

Transitions in patterns of health and disease

· Murray C, Evidence-based health policy--lessons from the global burden of disease study. Science 1996; 274:740-743.
http://www.sciencemag.org/cgi/content/full/274/5288/740?ijkey=vd.vBXsmMcpok

Murray and Lopez from Harvard and WHO discuss projected shifts in the global pattern of disease prevalence over the next two decades.

· La Porte R, Epidemiological Transitions. Supercourse lecture.
http://www.pitt.edu/~super1/lecture/lec0022/index.htm

Dr. La Porte presents data on patterns of disease among the world's nations as they have evolved over the course of the nations' development and as they are likely to evolve in the coming years. (Note: This is an online lecture in the "Supercourse" series. Click "Start," then use the navigation arrows to move through the lecture.)

Interrelationship of health and socioeconomic factors

· Stanghellini A, The situation of sleeping sickness in Angola: a calamity. Trop Med Intl Health 2001; 6:330-334.
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-3156.2001.00724.x

Burri C, Editorial: Are there new approaches to roll back trypanosomiasis? Trop Med Intl Hlth. 2001; 6:327-329.
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-3156.2001.00730.x

The Stanghellini article and the accompanying editorial describe the tragic rise in prevalence of African trypanosomiasis in Angola, and its sources in the civil war.

· Sachs J, The economic and social burden of malaria. Nature 2002; 415:680-685.
http://www.nature.com/cgi-taf/DynaPage.taf?file=/nature/journal/v415/n6872/full/415680a_fs.html

Sachs and Malaney discuss the sweeping impact of malaria on the demographics, economic vitality, and overall health of a population.

· Sheik-Mohamed A, Where health care has no access: the nomadic populations of sub-Saharan Africa. Trop Med Intl Hlth 1999; 4:695-707.
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-3156.1999.00473.x&prevSearch=%2Ballfield%3Arefugee+%2Ballfield%3Ahealth

The health problems of, and the challenges of providing health care to, some 100 million nomadic people in the developing world.

Family Medicine in the Developing World

· (to be inserted)

B. Important disease topics in the developing world

Maternal and child health in the developing world

· UNICEF, Birth and broken promises. From State of the world's children 2002, UNICEF, 2002.
http://www.unicef.org/sowc02/pdf/sowc2002-eng-p7-31.pdf

This is Part I of the 2002 UNICEF State of the World's Children report. It reviews progress on several important goals set a decade earlier at the World Summit for Children

· Stoll BJ, Children can't wait: improving the future for the world's poorest infants. J Pediatr 2001; 139:729-733.
http://home.mdconsult.com/das/journal/view/19349996/N/12137304?ja=258504&PAGE=1.html&sid=107211275&source=MI

This article discusses the etiology and prevention of neonatal mortality, within the context of efforts to reduce maternal mortality and improve child survival.

Nutrition and malnutrition in the developing world

· UNICEF, The silent emergency. From State of the world's chldren 1998, 1998.
http://www.unicef.org/sowc98/

This report highlights the "silent" epidemic of malnutrition that plagues mothers and children worldwide. The next section, "Answers that Work," describes interventions that have succeeded.

· Newman RD, A longitudinal study of Giardia lamblia infection in north-east Brazilian children. Trop Med Intl Hlth 2001; 6:624-634.
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-3156.2001.00757.x&prevSearch=%2Ballfield%3Amalnutrition

Giardiasis is highly prevalent in some populations, and has an adverse impact on nutritional status, especially in children.

· Beaudry M, Nutrition and Global Health. Supercourse lecture.
http://www.pitt.edu/~super1/lecture/lec0141/index.htm

Dr. Beaudry discusses the major world nutrition problems, and malnutrition as a factor not only in health but in the social and economic development of societies. She then posits affordable solutions and how they might be accomplished. (Note: This is an online lecture in the "Supercourse" series. Click "Start," then use the navigation arrows to move through the lecture.)

Significant tropical diseases

· Davis JR, Emerging infectious diseases from the global to the local perspective. Institute of Medicine, 2001.
http://books.nap.edu/books/0309071844/html/index.html

Choose a chapter covering one world region (or more) from this excellent summary of emerging infectious diseases, and read about patterns of those diseases in that region and what the future might hold.

· Piot P, The global impact of HIV/AIDS. Nature 2001; 410:968-973.
http://www.nature.com/cgi-taf/DynaPage.taf?file=/nature/journal/v410/n6831/full/410968a0_fs.html

"The scale of the human immunodeficiency virus epidemic has exceeded all expectations since its identification 20 years ago. Nothing less than a sustained social mobilization is necessary to combat one of the most serious crises facing human development."

· White NJ, The treatment of malaria. NEJM 1996; 335:800-806.
http://content.nejm.org/cgi/content/full/335/11/800

A practical review of the treatment of the most important tropical disease.

· Herwaldt BL, Leishmaniasis. Lancet 1999; 354:1191-1199.
http://www.thelancet.com/journal/vol354/iss9185/full/llan.354.9185.editorial_and_review.3049.1

A very helpful review of this disease, which is "endemic in areas of the tropics, subtropics, and southern Europe, in settings ranging from rain forests in the Americas to deserts in western Asia, and from rural to periurban areas."

· Zumla A, Science, medicine, and the future: tuberculosis. BMJ 1998; 316:1962-1964.
http://bmj.com/cgi/content/full/316/7149/1962?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=zumla&searchid=1022788994517_14462&stored_search=&FIRSTINDEX=0&fdate=1/1/1998&tdate=11/30/1998&resourcetype=1,2,3,4,10

"Among thoseaged over 5 years, tuberculosis kills more people than AIDS, malaria,diarrhoea, leprosy, and all other tropical diseases combined." The authors discuss new approaches to TB control.

· Ross AJP, Schistosomiasis. NEJM 2002; 346:1212-1220.
http://content.nejm.org/cgi/content/full/346/16/1212

A current review of this parasite, which currently infects over 200 million people in the developing world.

C. Preparation for an effective overseas rotation

Cross-cultural issues and practical anthropology

· Yahoo! Cultural directory
Home > Society and Culture > Cultures and Groups > Cultures

The Yahoo! Directory lists many third-world cultures, and links to informative websites regarding those cultures.

Travel medicine

· CDC Travelers' Health
http://www.cdc.gov/travel/

The CDC has a number of country-specific and disease-specific resources for the traveler.

· Freedman DO, Emerging infectious diseases and risk to the traveler. Med Clin N Amer 1999; 83:865-83.
http://home.mdconsult.com/das/journal/view/19448802/N/10861866?ja=148508&PAGE=1.html&sid=108015021&source=MI

With the troubling resurgence and emergence of a variety of infectious diseases, the CDC has targeted travelers as a population warranting special attention by health authorities.

· Kitchen LW, Case studies in international travelers. Amer Fam Phys 1999; 60:471-474.
http://home.mdconsult.com/das/journal/view/19349996/N/10912895?sid=107207976&source=MI

Three interesting case studies of travelers who presented to their physicians with illnesses acquired overseas.

· Ansdell VE, Prevention and empiric treatment of traveler's diarrhea. Med Clin N Amer 2000; 14:945-973.
http://home.mdconsult.com/das/journal/view/19349996/N/10861870?ja=148512&PAGE=1.html&ANCHOR=top&source=MI

This is an excellent, thorough review of various pathogens that can afflict travelers. It includes a practical guide for self-treatment by the traveler.

· Suh KN, Evaluation of fever in the returned traveler. Med Clin N Amer 1999; 83:997-1017.
http://home.mdconsult.com/das/journal/view/19349996/N/10861872?ja=148514&PAGE=1.html&ANCHOR=top&source=MI

A very good review of how to evaluate a patient with a febrile, travel-related illness.

Refugee medicine

· Kitchen LW, Case studies in international medicine. Amer Fam Phys 1999; 59:3040-3044.
http://home.mdconsult.com/das/journal/view/19349996/N/10843980?ja=219195&PAGE=1.html&sid=107207976&source=MI

Five interesting case studies of immigrants harboring tropical diseases from their host countries.

· Halimi KM, Afghan refugees: the ugly truth. Ann Emerg Med 2002; 39:200-202.
http://home.mdconsult.com/das/journal/view/19370410/N/12076962?ja=264793&PAGE=1.html&sid=107387838&source=MI

A first-hand account by a US medical resident who returned to his homeland on two occasions, helping with a free clinic for Afghans living in a refugee camp.

Preparing for the rotation

            · The IHMEC Guidebook: Advising Medical Students and Residents for International Health Experiences
            International Health Medical Education Consortium

· International Health: A Manual for Advisors and Students
The Society of Teachers of Family Medicine

· Bringing International Health Home: A Guide to Applying International Health Principles to Underserved Communities at Home

· The Medical Student's Guide to Essential International Health and Development
http://www.ihmec.ucl.ac.uk/ssc/electivepack.pdf

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