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  • Public health debates in resource limited settings are all

    2019-04-28

    Public-health debates in resource-limited settings are all too often focused on pitting one approach against another. For example, the history of epidemic infectious diseases is littered with examples of prevention pitted against treatment, from HIV infection to Ebola virus disease. These debates can be attributed to governments and implementing organisations being socialised for scarcity, compelled by long experience to ration the meagre resources at their disposal by arguing for one approach at the expense of the other, when the real problem is the need for more resources to ensure equitable access to basic human needs for the world\'s poor. The fact that 650 million people in the world do not have access to safe water means that we have much work to do to change the status quo. A cholera vaccine will never provide the broad social and health benefits of universal access to clean water. However, in the short term, we must use all of the available tools, including vaccines, to protect lives from cholera, while accelerating progress towards the long-term goal of universal WASH.
    In the past year, ap5 to Europe from Africa and the Middle East has reached unprecedented levels. In 2016, 181 405 migrants reached the shores of Italy and more than 5000 died trying to reach the southern coasts of Europe. Many migrants seek to escape war, poverty, persecution, or ill treatment in their countries of origin. However, migrants are often victims of torture and sexual violence during their journey or time in Libyan prisons. Several studies and international organisations have highlighted that migrants from sub-Saharan Africa are at a high risk of sexual victimisation and that many women are forced to pay for their migration through prostitution or are subject to brutal sexual exploitation and torture along the journey.
    Numerous guidelines frame the proper conduct and reporting of medical research. The Helsinki Declaration exists to safeguard the health, safety, autonomy, and privacy of research participants. Other guidelines define how research should be reported in scientific journals. However, these norms are not applied equally to other forms of scientific reporting, such as conference presentations. Particularly worrying is an increasing trend in the use of photographic images that we believe violate patients\' trust and privacy. At a recent, major international conference, for example, we witnessed gratuitous use of photographs of refugees and patients affected by Ebola or Zika in purportedly scientific presentations. Most of these photographic images were not directly relevant to the scientific content of the presentation, but appeared to be aimed at eliciting an emotional response or connecting with the audience. In no instance was it clear whether the photographs were taken and used with the subjects\' consent.
    The use of teleradiology in war zones dates back to the wars of Afghanistan and Iraq. However, the practice of teleradiology during the Syrian crisis presents a new challenge to the international medical community given the repeated attacks on medical personnel and health-care facilities. The Teleradiology Relief Group consists of several radiologists located across the globe, who communicate with health-care providers in Syria via the internet and social media to deliver the best care possible ap5 to Syrian patients. Use of a traditional teleradiology programme is not possible in Syria because of the absence of picture archiving and communication systems (PACS), even before the crisis. Instead, social media is used to share digital imaging and communications in medicine (DICOM) images and other image formats. Image uploading is often not possible because of the unreliable and interrupted internet service that mainly depends on satellite providers. Emails and social-media applications such as WhatsApp (WhatsApp, Mountain View, CA, USA) and Facebook (Facebook, Menlo Park, CA, USA) facilitate instant sharing of important images, including screen shots, analogue films captured on mobile phones (), and video recordings of ultrasonography.
    Cerebral palsy, a syndrome of motor impairment resulting from a lesion in the developing brain, has a worldwide prevalence of 1·0–3·5 per 1000 livebirths. A life-course perspective needs to be adopted as more children live into their adolescence and adulthood. Individuals\' participation in life and availability of family-centred services are very important and differ between countries. In low-income countries, most treatments are provided by families and multidisciplinary assessment is done in rural clinics.
    Introduction Since 2000, coverage levels for several reproductive, maternal, newborn, and child health interventions increased in many low-income and middle-income countries. However, there is growing recognition that national levels and trends could hide important inequalities that need to be tackled to achieve universal coverage. Whereas some countries managed to increase national-level coverage at the same time as reducing disparities among different socioeconomic groups, in other countries the magnitude of inequalities remained unchanged.