Research in the fields of Preventive Medicine, Occupational/Environmental Medicine, Epidemiology and Public Health play an important role in the advancement of knowledge. In order to map the research production around the world we performed a bibliometric analysis in the above fields.All articles published by different world regions in the above mentioned scientific fields and cited in the Journal Citation Reports (JCR) database of the Institute for Scientific Information (ISI) during the period 1995 and 2003, were evaluated. The research production of different world regions was adjusted for: a) the gross domestic product in 1995 US dollars, and b) the population size of each region.A total of 48,861 articles were retrieved and categorized. The USA led the research production in all three subcategories. The percentage of articles published by USA researchers was 43%, 44% and 61% in the Preventive Medicine, Epidemiology, and Public Health subcategories, respectively. Canada and Western Europe shared the second position in the first two subcategories, while Oceania researchers ranked second in the field of Public Health.USA researchers maintain a leadership position in the production of scientific articles in the fields of Preventive Medicine, Occupational/Environmental Medicine and Epidemiology, at a level similar to other scientific disciplines, while USA contribution to science in the field of Public Health is by all means outstanding. Less developed regions would need to support their researchers in the above fields in order to improve scientific production and advancement of knowledge in their countries. The fields of Preventive Medicine, Occupational/Environmental Medicine, Epidemiology and Public Health constitute scientific fields, along with clinical medicine, which play an important role on people's health around the world -3. ReseaWhile, the academic community strives to identify the best approach to assess the quantity and quality of research production between different geographical boundaries, languages and scientific disciplines, most scientists agree on the utility of the impact factor as well as additional adjusted indicators for international comparisons . SeveralFor example, Gehanno JF et al has reported that 1.4% of journals in the field of Occupational Health  account for 27% of published articles in the field, while Navarro A et al have reported that one or more institutions in the United States contributed over 40% of articles in Occupational Health ,19. In aIn the current investigation, we sought to identify and quantify the research production of different world regions in the fields of Preventive Medicine, Occupational and Environmental Medicine, Epidemiology, and Public Health around the world.The methodology we used in our study parallels other bibliometric studies performed by our research group in order to evaluate research productivity in specific scientific disciplines -17.We searched for articles published between 1995 and 2003 and included in the category of the "Preventive and Occupational Medicine, Epidemiology and Public Health", of the Journal Citation Reports (JCR) database of the Institute for Scientific Information (ISI) and the PubMed database ,24. At tThe articles' origin was assigned by searching the address of the first author of each article, which is registered in the PubMed database. For each search in the PubMed database, a phrase consisting of four parts joined together by the so-called Boolean operators, i.e. AND, OR, and NOT was used in the search field. Moreover, each separate search was limited to a specific year. Publication types such as letters, editorials, and news reports were excluded from the analysis. The results of these searches  were summed up.Out of 89 journals included in the journal category investigated during the period 1999–2003, a total of 72 journals were included in our study. A further division of these journals into three subcategories was performed; the first subcategory included journals with main focus on Preventive, Occupational and Environmental Medicine , the second on Epidemiology , and the third on Public Health .For the purpose of our study, the world was divided into 9 regions; United States of America (USA), Canada, Western Europe, Japan, Oceania, Asia (excluding Japan), Eastern Europe, Latin America and the Caribbean, and Africa; a classification based on a combination of geographic, economic and scientific criteria.The sum of articles produced by all different world regions in a journal was compared to the actual total number of articles published in that journal for a specific year. This number was obtained again from PubMed by not using any address limits. In this way we were able to check for missed or unretrieved addresses. We considered a search result acceptable if less than 5% of the total articles of a specific journal during a year were missed by our methodology, otherwise we performed manual searches for the author's address. To strengthen the methodological validity of our study, two investigators independently performed data collection. In cases of disagreement between the two investigators the results were discussed in meetings of all investigators of our research group.The index of quantity of research productivity was the number of published articles. The quality of research productivity was estimated by the mean impact factor of the examined journals for each published article. Finally, the product of the number of articles published in a journal multiplied by the corresponding impact factor of its journal, for each year studied, was considered as an integrated index of the quantity and quality of research productivity. The sum of these products from all journals, for each world region within a year, was assigned as a "total research product" for each world region.In order to evaluate factors possibly associated with the research published in Preventive and Occupational/Environmental Medicine, Epidemiology, and Public Health journals, we used relevant "World Development Indicators" from the online databases of the World Bank . The resUsing the methodology described above, we managed to retrieve and categorize 48,681 out of 49,980 articles, (97.4%) from the implicated journals indexed in PubMed during the study period. In tables As shown in Table Similar rankings for USA, Canada, and Western Europe are seen in Table Finally, data from the 28 Public Health journals are presented in Table In all of the 3 subcategories examined, the annual number of published articles worldwide showed an increasing trend, a phenomenon that was more pronounced in the "Public Health" subcategory . Even after overall adjustment for gross domestic product and population size, USA continued to lead. However, Canada researchers ranked first when scientific production was adjusted for gross domestic product in the fields of Preventive Medicine, Occupational/Environmental Medicine and Epidemiology. Furthermore, we found that four regions of the world with more than 50% of the world's population have minimal contribution in the scientific fields studied.Our results support previous findings suggesting that the majority of research published in scientific journals is carried out in the developed world . It is aSeveral limitations of our current investigation have been cited previously and would also apply -17. MostIn summary, we found that the USA, Western Europe, Canada and Oceania are the leading regions in the research production in the fields of Preventive/Occupational/Environmental Medicine, Epidemiology and Public Health, with the USA being far ahead especially in the subcategory of Public Health. We believe that our findings clearly indicate the need to promote research in the above fields in less developed regions of the world. Promoting research in less developed areas such as Africa, Asia, Latin America and Eastern Europe, may involve but not limited to the development of infrastructure including research and academic institutes, the improvement of current collaborative partnerships with developed nations, increased sponsorship and support from world agencies such as the World Health Organization and the United Nations, and the implementation of programs including free access to online journals and translation services for scientific articles published in languages other than the English language. All of the above are likely to increase research and development in the less developed regions of the world and improve peoples' health through the diffusion of knowledge and the implementation of large-scale research projects.ISI – Institute for Scientific InformationGDP – Gross Domestic ProductJCR – Journal Citation ReportsThe author(s) declare that they have no competing interests.MEF had the idea for the study and developed the methodology in collaboration with ESS. Both authors supervised the data collection, analysis and interpretation. Also, both authors contributed to the writing of the manuscript and approved its final version.The authors would like to thank Ms. Paraskevi A. Papastamataki, RN, and Dr. Ioannis A. Bliziotis, MD, for their help in the collection and analysis of data.The pre-publication history for this paper can be accessed here:


A workshop of the Project on Evaluation of Screening Programmes of the International Union against Cancer (UICC) was held in Lyon, France. on November 20-22, 1984. The focus of the workshop was on screening for gynaecological cancer, especially for cancer of the cervix uteri. This report summarizes the presentations, conclusions and recommendations from the workshop.


A case-control study was undertaken to investigate the role of diet in women with breast cancer, and in two groups of women with benign breast disease: epithelial hyperplasia, and fibrocystic disease without hyperplasia. The study provides data which suggest that the consumption of red meat, savoury meals  and of starches is disadvantageous, while the consumption of chicken and fish, and of fruit, appears to be beneficial. These patterns were present for both the breast cancer patients and the patients with benign epithelial hyperplasia. One-third of breast cancer patients had changed their diet after their diagnosis, compared to only around 12% in controls and patients with benign breast disease. Overall, the women studied had changed their diet to reduce their intake of sugars, dairy products and meat, and increased their intake of poultry, fish, fruit and vegetables over the past decade; but the breast cancer group was less likely to have made this change.


Cancer mortality during 1970-85 of immigrants from East and West Africa and the Caribbean to England and Wales is described. Overall cancer mortality was raised in West African males , and non-significantly raised in West African females  compared to mortality in the England and Wales-born population. Much of the increased risk was due to very high rates of liver cancer in males , but rates were also raised for a wide range of other cancers in each sex. Only lung and brain cancer had significantly decreased mortality. In East Africans, overall cancer mortality was low in males , and in females . Mortality was significantly low for cancers of the stomach, pancreas and testis, and Hodgkin's disease in males, for cervical cancer in females, and for lung cancer and melanoma in both sexes. Cancer sites with significantly raised mortality included oropharyngeal cancer, leukaemia, and multiple myeloma in both sexes. In Caribbean immigrants overall cancer rates were significantly low in males  and in females . Mortality was significantly low for many cancers including colorectal, lung, testis and brain cancers. Mortality was significantly raised only for cancer of the prostate in males, of the placenta in females, and of the liver, non-Hodgkin's lymphoma and multiple myeloma in both sexes. Overall, mortality was high from prostatic cancer and liver cancer, and was low from brain cancer, in predominantly ethnic African immigrant groups. Both East and West African immigrants had raised rates of leukaemia. All of the migrant groups had high rates of multiple myeloma and low rates of testicular, ovarian and lung cancer. Genetic and environmental factors that may contribute to these patterns are discussed.


The article on influenza in tropical regions by Viboud and colleagues outlines an alarming global burden of influenza, with an estimated one million annual deaths worldwide . We woul2; population 23 million), officially known as the Republic of China, is located on the Tropic of Cancer. Taiwan lost its United Nation membership in 1971 to its rival, the People's Republic of China, but maintains official diplomatic relations with 25 countries and de facto relations with many nations. Taiwan has one of the highest levels of life expectancy in Asia, and it has eradicated infectious diseases such as the bubonic plague in 1948, smallpox in 1955, rabies in 1959, malaria in 1965, and polio in 2000. Taiwan became the first country in the world to implement a hepatitis B immunization program. Taiwan also initiated active vaccination programs against diptheria, pertussis, and tetanus in 1955, Japanese encephalitis in 1969, measles in 1978, hepatitis B in 1984, rubella in 1986, hepatitis A in 1995, and influenza in 1998. Valuable lessons may be learned from Taiwan's experience in public health and its response to disease outbreaks and crises.Taiwan . It has therefore been excluded from the Global Outbreak Alert and Response Network (GOARN). During the time of the enterovirus outbreak, Taiwan did not get any assistance from the WHO but managed to combat the outbreak. The avian flu scare of 1997 was controlled in Hong Kong because of timely action, aided by the WHO. If Taiwan is to respond effectively to similar outbreaks of global epidemics in the future, it will certainly need the cooperation of the WHO. Although the WHO is a non-political agency, because of pressure from the People's Republic of China, which considers Taiwan as a renegade province, Taiwan has been marginalized. Regardless of this, Taiwan has contributed over US$180 million since 1995 in medical and humanitarian aid to 95 countries, and it plans to make further donations. Therefore, excluding Taiwan from the WHO's GOARN is counterproductive from both medical and ethical standpoints.Taiwan, through its own efforts, has managed to improve public health remarkably, despite having no assistance from the WHO. It certainly has the potential to assist developing nations in the fight against emerging disease outbreaks, so other countries can seek Taiwan's expertise to fight against infectious diseases in the near future.


Medical data, disseminated in the Web or available in other digital forms, usually include clinical information obtained by the case history, signals related to bodily functions which are collected from in vivo diagnostic procedures, data acquired through in vitro diagnostic tests, images related to the morphology and the functions of the body and, finally, information related to various therapeutic interventions. Although these data, on the one hand, constitute cost-effective and practical means, augmenting equality in medical training, on the other, they result in a new type of fragmentation and compartmentalization of the patient's body and personality, thus endangering the interpersonal relation between him and the physician. Further, the use of the Web, combined with other traditional ways of distribution of medical data, such as published epidemiological studies and case-studies presentation in conferences and textbooks, intensifies the risk of eliminating the individual characteristics of the specific patient, in favor of the impersonal condition.The main challenge of a decision supporting system employing various educational means in web-sites or elsewhere, is the incorporation of social and ethical premises into the mode of the presentation of the medical inferences employed. This, however, necessitates the identification of the ethical issues which are involved in decisions made in a health care context and it requires the codification and the classification of the ethical problems. Additionally, this procedure should be employed in all sectors and the ensuing activities of the health-care providers, since problems are not identical nor do they carry the same weight in all real-world incidents.The authors argue, on the basis of a ten-year period of experience in the inter-disciplinary education of health-care professionals, that this goal can be reached only by the appropriate systematic instruction of all those -in the contemporary health-care system- involved in decision-making training. This means that the methods of reasoning employed in the inferences made in the various medical specialties should become common knowledge and that the acquaintance with the social and ethical issues, present in health care delivery, should be sine qua non.Such an educational process would contribute to the promotion of inter- disciplinary research and it would address, in an effective manner, the problem of intra-specialty communication in medicine. It would permit also the demonstration of the common characteristics of the reasoning models employed since the time Hippocrates.


For vaccines to reach the greatest number of people requires access, accelerated regional disease control, and the development of public health infrastructure. This is the second of two articles in the October 2005 issue on ways to create practical markets for vaccines.Thinking of ways to create practical markets for vaccines poses some interesting challenges, particularly in the context of introducing new and underutilized vaccines. In a complex, ever-changing world, making vaccines, whether they are new or old, available to children and families who need them most should be a top priority . Models Access to preventive and other health services covers several factors, including access to health units and hospitals, trained staff providing quality services, cost-effective technologies, the best use of available technologies, and information to improve the community's knowledge base and best practices.Inherently, improved access also addresses issues of equity. Equity is a critical cross-cutting concept that drives much of the work of PAHO and member countries. For vaccines, the challenge has always been, and will continue to be, to ensure that all communities benefit from the potential impact of these technologies .The initiative to eliminate rubella and congenital rubella syndrome in the Americas serves as an example of PAHO's member countries seizing the opportunity to ensure access, while promoting the ultimate goal of disease control , and the improvement of the public-health infrastructure . These ePublic-sector capacity development creates regional independence.In the Americas, targeting high-risk districts with low immunization coverage for special attention also promotes improved access and accelerated disease control. Efforts to strengthen leadership, management, and supervision of program activities have been essential for the success of this strategy. Districts that have less than 95% coverage are targeted for special training, outreach, and follow-up. This targeting helps ensure that even in middle-income countries the substantial disparities that exist in health are addressed. To that end, PAHO's member countries have conducted the annual Vaccination Week in the Americas, during which all countries attempt to reach and vaccinate marginalized, poor populations [In the context of access and equity, there is concern about global approaches to support only countries with average annual per capita income of less than $1,000, such as the approach taken by the Global Alliance for Vaccines and Immunization, thus limiting the scope of work and benefits that impoverished children and families could otherwise receive in the Americas. Currently, only six countries are eligible to receive support from the Global Alliance for Vaccines and Immunization: Bolivia, Cuba, Guyana, Haiti, Honduras, and Nicaragua—representing only 7% of the population of the Caribbean and Latin America. However, 11% of people in the Caribbean and Latin America live below the international poverty line  [In the Americas, efforts to control disease over the last 20 years have led to significant improvements in the public-health infrastructure, particularly in the area of program management, surveillance, and public-health laboratories. In some countries, such as Brazil, the development of public-sector capacity for vaccine production was also a top priority. Such public-sector capacity development creates regional independence, competition to reduce vaccine prices among private-sector producers, and dependable supply chains that are sustained and that contribute to intercountry cooperation . CurrentFuture approaches that attempt to enhance practical markets for vaccines and that enhance the introduction of new and underutilized vaccines should consider prioritizing the following: access and equity for as much of the population as is possible, well-implemented accelerated disease-control and prevention strategies, and development of a public-health infrastructure.The general approach also requires high-level political commitment, adequate attention to management, supervision, and logistics, and sound technical strategies. The opportunity to address widespread disparities in health that exist in low- and low-middle-income countries that otherwise do not benefit from Global Alliance for Vaccines and Immunization's marketing approaches will be a huge challenge for the future. PAHO will continue to make the support of immunization to member countries a priority.


A strong network of state, provincial, federal, and regional partner agencies and organizations populate the GLIN with essential information for use by policy makers and others with an interest in the region.The Great Lakes Information Network (GLIN) is a partnership of public and private organizations managed by the Great Lakes Commission, an eight-state compact agency. The GLIN website, located at The site’s homepage is divided into six different topic sections, plus a daily news page featuring current news articles, press releases, announcements, and links to information about lake conditions and weather forecasts. Visitors can sign up to receive daily news or to submit stories.The Great Lakes section of the site features an interactive map of the region. Clicking on different geographic areas brings up state-, province-, or lake-specific news as well as links to general resources , economic profiles, environmental information, and tourism sites.Science and the Environment Bulletin, and the Commission for Environmental Cooperation’s summary of environmental law in North America.The Environment section of the GLIN site groups information into five topics, each with several subtopics. The main topics are Air and Land, Water, Flora and Fauna, Pollution, and References. Subtopics include sustainable development, air toxics, human health, toxic contamination, and environmental justice, among many others. This section also provides an overview of the Great Lakes natural environment and general resources including an online atlas of the region published by the U.S. Environmental Protection Agency, back and current issues of Environment Canada’s Similarly, the Economy section includes information grouped under the main topics of Business Development, Business and Environment, and References, with agriculture, energy, economic development, and transportation among the subtopics.Aimed specifically for teachers, the Education portion of the site features free online “mini-lesson” modules for students in elementary through high school. Subjects covered in the lessons include the natural environment, geography, and pollution. The natural environment module features information on water diversion out of the region, invasive species, and protection of water quality. The causes and effects of Great Lakes pollution is the main focus of the pollution unit, which also includes a section on urban sprawl. An online glossary helps students with unfamiliar terms used throughout the modules.The Maps and GIS (geographic information systems) section of the site offers resources to help visitors customize their own Great Lakes map using GIS data , online mapping tools, and a gallery of free downloadable maps. The types of maps offered range from ecological assessment maps to satellite images.Finally, the Tourism section of the site, with its extensive list of local recreational, cultural, and historical offerings, provides one small hint of the richness of this magnificent natural resource we call the Great Lakes.


The endocrine system encompasses the thyroid gland, the hypothalamus, the pancreas, the adrenal cortex, the thyroid, the parathyroid, and the male and female reproductive glands. Two large and well-established societies, The Endocrine Society and the Society for Endocrinology, serve the practitioners of this field. Both groups have established websites to keep their members and the general public aware of newsworthy events and developments in the field, and to educate those laypeople wishing to learn more about the subject.http://www.endo-society.org/, features quick links so that information and materials can be pulled up by either subject or visitor’s role . Among the 16 subjects featured are cardiovascular function, diabetes/insulin, genetics/genomics, male reproduction, and female reproduction. Also gathered in one area of the homepage are quick links to the society’s five publications, membership information, a member directory, and a subscription page.The site of The Endocrine Society, The Endocrine Society’s homepage features two news sections, one of news in the general media, the other of updates within the society itself. Also available from the homepage is information on the society’s annual meeting, other society events, and related external events. Visitors can also select a quick link to The Hormone Foundation, the public education affiliate of the society, which offers basic information about the endocrine system, its function, and its associated diseases and disorders.The Endocrine Edge, a free monthly online newsletter geared toward the public with the latest news from the society and the field of endocrinology.In the Press Room portion of the site is information on the America Weighs In campaign. This program focuses on educating the media, policy makers, and the general public about the role that endocrinologists play in researching and treating obesity. The Press Room also features a link to http://www.endocrinology.org/, provides information about the Bristol, England–based organization and its programs. The society is affiliated with five journals, all accessible from a page on the website. The society also publishes a free quarterly newsletter, The Endocrinologist, which contains society news, general news, and feature articles.The Society for Endocrinology site, The website also offers listings of grants and fellowships, society conferences, training courses sponsored by the society, and a calendar of events. The society sponsors a number of travel grants and has five research grant programs. There is also a page on books of interest to those in the field, which includes ordering information and short descriptions.Endocrine Nursing News newsletter with reports from members and meeting notes. Past issues are available on the society website through the Endocrine Nurses link. Another subgroup are the Young Endocrinologists. Formed to support endocrinologists for up to six years after they receive their Ph.D., this group runs educational courses, provides career advice, and organizes special sessions at the Society of Endocrinology and British Endocrine Society meetings.In 1997, the Society for Endocrinology established a committee for endocrinology nurses. This committee organizes conferences and an annual training course, and publishes the quarterly


Cyberspace is a fast-changing, globally-networked, multicultural, and multilingual information environment with vast possibilities -9. It caThe Internet offers unprecedented power to provide users of healthcare information - patients, professionals, families, caregivers, educators, researchers, insurers, regulators, and policymakers - with data of unprecedented timeliness, accuracy, depth, and diversity. The very qualities that make the Internet such a rich marketplace of ideas - its decentralized structure, global reach, leveling of access to the tools of publication, immediacy of response, and ability to facilitate free-ranging interchange - also make it an exceptional channel for potential misinformation, unethical use, concealed bias, covert self-dealing, fraudulent practices, and evasion of legitimate regulation.There are many inadequacies concerning national and international controls and legislation, especially regarding the issue of jurisdiction; and urgent need for an internationally accepted policy framework that addresses basic rights and responsibilities of users and providers. Freedom of access to information and expression and the protection of users' data security and privacy are especially critical topics. Decisions and initiatives related to cyberspace law and ethics issues in health and healthcare must necessarily involve experts from a variety of knowledge domains involving civil and criminal law, medical ethics (bioethics), computing ethics, medical computing, and legal medicine.Given the sensitive nature of health care information, and the high degree of dependence of health professionals on reliable records, the issues of integrity, security, privacy, and confidentiality are of particular significance and must be clearly and effectively addressed by health and health-related organizations and professionals. Two factors make the matter a subject of preeminent significance: the intrinsically sensitive nature of patient data; and the growing use of network computing, particularly the Internet, for healthcare information processing. The growth of off-site processing and storage of electronic health records by application services providers (ASPs) adds a new dimension to those issues.Maintaining and safeguarding the integrity and physical protection of data and systems, privacy and confidentiality of individual health information, quality of content, and the protection of consumers and online health industry commercial interests against unethical practices, are the areas of greatest concern in the implementation and use of Internet and other interactive applications in health and healthcare.Privacy involves many aspects -18, and Electronic transactions involve important regulatory and legal issues not yet fully addressed. Vigilance in the maintenance of legal and ethical standards in the advertising, promotion, and sale of medical products through the Internet is required. Those standards include: approval of products, devices, and drugs by regulatory agencies at the site where the purchaser resides; the determination where the transaction occurred - in the purchaser's or the vendor's jurisdiction; and which courts and law will govern any disputes .Although there is a general agreement among conscientious professionals that all health websites should be held to the same standard and that the introduction of some form of "seal of approval" is an interesting proposition, enforcement is still a nebulous area. Particularly in the international setting there are complex issues of jurisdiction not yet addressed by laws or agreements.A number of organizations, government agencies, and scientific publishers have been active in the establishment of standards and methods to measure and assure credibility of health websites. One of the first players is the Health on the Net Foundation, established in 1996 ,33. AnotAlthough security, privacy, and confidentiality are matters of concern in telecommunication-based clinical applications, and indeed major features of it, such applications raise new challenges regarding professional conduct and accountability, technical standards, licensure, and reimbursement ,48. LiabThe society and public authorities have the responsibility to make information considered as of "public good" universally available for educational, cultural, and social needs. The challenge is to define and implement concepts, such as public domain contents and universal access to networks and services; and to promote public welfare while encouraging private initiatives and protecting human dignity, personal rights, fair use, intellectual property rights, and rightful economic interests.Traditionally, local standards are considered the yardstick against which health practice is evaluated, and they determine the parameters for eventual litigation. Remote conduction of health interventions brings forth, however, a whole new range of issues and ethical aspects in the telecare patient-provider relationship. Those issues have been reviewed and recommendations regarding a code of practice proposed ,13. GuidLicensing and professional standards of care providers and regulation of e-commerce is done in many countries on a regional or state level. Validation of professional licensure, alternative and non-approved health practice, contending with fraudulent practice and misleading claims, regulation, and legal jurisdiction problems on a national and international basis are major regulatory and quality assurance problems in these circumstances.The health sector has not addressed information security in a comprehensive manner. Healthcare organizations face a great variety of security, privacy, and confidentiality risks and must be made fully responsible for maintaining all aspects of security and confidentiality of data and information. Eventual conflicts between data sharing, data security, and confidentiality must be addressed early in the process of systems procurement and development and after implementation. Some health organizations have implemented security features in their information systems, but most organizations do not have written rules or procedures for their employees who are authorized to access client's information, such as policies on disclosure of sensitive information, or personnel policies dictating the types of disciplinary actions that will be taken if staff violate policies. Nevertheless, regulations and technical standards for privacy assurance and maintenance of data integrity and access security must be reasonable, in terms of recognizing the realities of health care delivery, the variability of application environments, and the diversity of national ethical values and legal systems.Developing countries are particularly affected by the rapid expansion of interactive communication technologies - increasingly, governments, professional organizations, advocacy groups, and users in developing countries have expressed their concerns about the impact of such happenings. Particularly, there is great apprehension about the reliability of healthcare information, new forms of health practice, advertising and commercial processes, content appropriateness, and privacy, as they pertain to the Internet. Multilateral or international agencies and national technical cooperation agencies are promoting the deployment of IHC applications, but have mainly focused on technological infrastructure development; little has been done regarding contents, human resources, impact evaluation, and ethical and legal aspects ,8,50-53.Ethical and regulatory questions, and national and international legislation addressing the many issues related to quality of information in the Internet, e-commerce, and telemedicine are a matter of present concern of many international organizations. The United Nations, and particularly UNESCO, the International Telecommunications Union (ITU), the World Health Organization (WHO), the World Trade Organization (WTO), regional trade blocks , and multilateral agencies such as the World Bank and the Inter American Development Bank have been in the forefront of initiatives directed to the promotion of exchanges in this area.Those are urgent and controversial issues that must be addressed jointly and comprehensively by international organizations, national and international scientific and technical societies, service providers, industry organizations, and users' interest groups, and not only from the viewpoint of legal or commercial interests. The United Nations specialized agencies, government organizations, independent and nonaligned consensus groups ,36,54-56Roberto J. Rodrigues, Member, JMIR Editorial BoardRegional Advisor in Health Services Information Technology, Essential Drugs and Technology Program, Division of Health Systems and Services Development, Pan American Health Organization / World Health Organization, Washington, D.C., USA


As individuals take a larger role in managing their own healthcare, more consumers are independently seeking out health information via the Internet. Health professionals are also turning to the Internet to keep informed and interact with their patients. Given the vast amount of healthcare data available on the Internet, the Internet Healthcare Coalition was created to promote quality health resources online and to ensure that consumers and professionals are able to find reliable, quality information online.The Coalition is an international, non-partisan, non-profit organization dedicated to promoting quality healthcare resources on the Internet. Founded in 1997, the Coalition's membership represents every sector of the Internet health space, including consumers, patient advocates, commercial developers of health information, health professionals, medical librarians, government officials, and pharmaceutical manufacturers. The goal of the Coalition is to educate healthcare consumers, health professionals, and others about the evolving issues relating to the quality of Internet health resources and information.The Coalition is dedicated to:Educating healthcare consumers, professionals, educators, marketers, and both healthcare and mainstream media, as well as public policymakers on the full range of uses of the Internet - current and potential - to deliver high-quality healthcare information and services.Furnishing clear models, not only of good and bad sources of online healthcare information and services, but of the potentially disparate methods of evaluating disparate sources of information - from product- or disease-information sites developed by regulated manufacturers, to peer-reviewed electronic publications and patient support groups.Publicizing and promoting the use of currently available resources and developing new resources that exemplify ethical, innovative, and high-quality uses of the Internet to deliver healthcare information and services.Acting as a representative of our constituencies in areas of mutual concern before public policymakers and with the media.The Coalition consults with various government agencies including the World Health Organization (WHO), the US Food and Drug Administration (FDA), and the US Federal Trade Commission (FTC) on broader-based efforts to promote credible healthcare information and combat health fraud online. To that end the Coalition formed an Internet Health Fraud Resources Working Group which will work with the FTC to develop, coordinate, and promote a global online health-fraud reporting web site, which will link to authorities with jurisdiction over illegal or fraudulent online healthcare activities. Using this resource, consumers and healthcare professionals anywhere in the world can be sure that their complaints are transmitted to the appropriate authorities for action.The Coalition holds an annual conference, "Quality Healthcare Information on the Net," each year in October or November for key thought leaders in the healthcare industry and government representatives to exchange their thoughts and opinions about the problems associated with and solutions to healthcare and the Internet. In October 1999, responding to calls from within the Internet Health community, the Coalition launched its ongoing "eHealth Ethics Initiative" to provide a forum for the development of a universal set of ethical principles for health-related Web sites.http://www.ihealthcoalition.org            The Coalition can be found at


For more than a hundred years, the United States has operated a decentralized vital statistics system as an essential component of public health. Statistics based on births and deaths registered in the United States are a primary source of data used to track health status, to plan, implement, and evaluate health and social services, and to set health policy. The national vital statistics system provides nearly complete, continuous, and comparable federal, state, and local data. The system, however, is based on outmoded vital registration practices and structures, which raises concerns about data quality, timeliness, and the lack of real-time linkage capabilities. While many organizations are working together to address these issues and have made notable achievements, questions remain to be answered. Efforts to rejuvenate the nation's vital statistics system will need to expand dramatically to provide public health with a timely, high-quality, and flexible system to monitor vital health outcomes at the local, state, and national levels. For more than a hundred years, the United States has operated a decentralized vital statistics system as an essential component of public health. Statistics based on births and deaths registered in the United States are a primary source of data used to track the health status of the U.S. population, to plan, implement, and evaluate health and social services for children, families, and adults, and to set health policy at the national, state, and local levels. Data on access to prenatal care, maternal risk factors, infant mortality, disparities in health status, changes in the rankings of causes of death, life expectancy, years of potential life lost, and other pregnancy and mortality indicators provide the staples for public policy and programmatic debates about improving health and health services delivery. Unlike any other public health data system, the national vital statistics system provides nearly complete, continuous, and comparable federal, state, and local data to public health officials and programs. This strength enables population-based analysis and comparisons to be undertaken at the national, state, and local levels by age, race, ethnicity, and sex. For example, with more than two million deaths each year, disparities in the leading causes of death by race and age can be monitored and compared at the local, state, and national levels. Rare and emerging causes of death can be identified, and using both the underlying and contributing causes of death, the impact of such diseases as hypertension, diabetes, and atherosclerosis on mortality can be measured.Despite the importance of the nation's vital statistics system, it is based on outmoded vital registration practices and systems, a fact that raises concerns about data quality, timeliness, and the lack of real-time linkage capabilities for the more than six million annual vital events. To resolve these issues, vital registration requires more complete automation at the level of primary data collection and changes in the relationships among the providers of source records, the state registration offices, and the National Center for Health Statistics (NCHS). For example, for almost 20 years, states have been using electronic birth certificate systems. While this is a significant step forward, states continue to operate dual paper and electronic systems, with the paper record considered the official legal document. To compound these problems, the current electronic systems for vital registration at the state level have been difficult to modify, causing many states to delay implementation of the 2003 revisions to the U.S. standard certificates, which would provide a wealth of new information. Collection of death information continues to be primarily a paper-based process, unchanged at the local and state levels for the last half century. Funeral directors are responsible for collecting demographic information on the decedent from the next of kin, while attending physicians, medical examiners, or coroners provide and certify medical information on cause of death. Demographic and medical information are brought together manually by passing the paper certificate back and forth; the certificate data does not become computerized until reaching the state vital registration office, sometimes after considerable delay. The lack of automation at the source precludes timely follow-back to improve data quality and does not take advantage of existing internal systems of funeral directors and physicians. The Internet is not even used for electronic data transfer between data providers and state registration offices.To address these problems, the National Association of Public Health Statistics and Information Systems, NCHS, and the Social Security Administration have developed a partnership to improve the responsiveness of state vital registration and statistics systems. Their objective is to improve the timeliness, quality, and sustainability of these systems by adopting national, consensus-based standards and guidelines. It will be necessary to go beyond modifying existing registration systems. State processes and systems must dovetail with local data providers' processes and systems. Stand-alone systems and paper-based processes can no longer be considered adequate. An overarching consensus within this partnership is that business practices within state vital records offices and data providers must be documented and then updated to be more efficient and effective in light of today's technology and that these systems must be driven by national consensus-based standards and guidelines. The resulting reengineered state systems will use the 2003 version of the U.S. standard certificates of live birth, death, and fetal death. Reengineered systems will include efficient methods for capturing data, standard data-collection instruments, coding specifications, query guidelines, standardized definitions, and Health-Level-7–based standardized messaging. As the Public Health Information Network expands and is knitted together with a National Health Information Infrastructure, these reengineered vital statistics systems will need to be integrated with other health information systems, such as those for immunizations, newborn screening, and hearing screening, and with electronic systems used by data providers, including hospitals, physicians, and funeral homes.The national partnership and its consensus process have already had some notable accomplishments, including the development of functional requirements for reengineered birth and death registration. The consensus national requirements will serve as the foundation for the design, development, and implementation of reengineered, Internet-based vital records and statistics systems for states. The most daunting challenge still to be overcome is the funding of the development and implementation of new systems, especially the automated reporting of deaths by the thousands of funeral directors and physicians who now manually provide mortality data.Many questions are yet to be answered. What is the most effective way to retrieve quality medical information from the attending physician, coroner, or medical examiner? How can funeral directors and physicians be connected electronically and share with the state confidential information about the decedent in a secure environment? At what level of specificity do prompts and data edits for the medical information obtained from the physician become counterproductive? How can the state vital statistics systems take advantage of the data systems already in use by funeral directors and medical examiners? Efforts are currently underway to address these questions. Efforts to rejuvenate the nation's vital statistics system are encouraging, but they will need to expand dramatically to provide public health with a timely, high-quality, and flexible system to monitor vital health outcomes at the local, state, and national levels.


If compared with printed media, the prospect for the success of health-related WWW publications lies in the added value of motivation and efficacy, due to the multi-modal coding of contents, in the possibility to provide search facilities and the flexibility of interaction with the user. An important advantage over the off-line distribution of disks or CD-ROMs is the automated diffusion and update of the contents. Whereas more and more medical WWW sites are launched, their acceptance and utilisation, especially in medical education is still unsatisfactory. Obviously, one reason for this phenomenon is the lack of quality. Many authors, developers and software publishers ignore that the design of high-quality electronic publications is a cost-intensive process. As key qualifications we identify: domain competence, software engineering skills, media production proficiency, GUI design competence, and didactic qualifications. On behalf of the German Association of Medical Informatics, Biometry and Epidemiology (GMDS), the authors have co-ordinated the development of a catalogue of "Quality Criteria for Electronic Publications in Medicine". This catalogue defines as Electronic Publications in Medicine any software containing health-related generic knowledge, with WWW publications being an important group. The criteria catalogue is divided into the sections contents, technical aspects, coding of information, ergonomy, dialogue and didactics. According to these items, typical faults and deficiencies of medical electronic publications are elucidated and possible solutions are given. Our criteria are intended to support the formative evaluation during the development of electronic publications, and to provide a basis for the summative evaluation of medical WWW and offline publications. The catalogue of "Quality Criteria for Electronic Publications in Medicine" is available in German, English, Portuguese and Spanish, at: http://www.imbi.uni-freiburg.de/medinf/gmdsqc/.


In 1998, the unique and experimental "Looking over the horizon - An Internet-based International Course in Comparative Healthcare Management" started. The course is a component of the larger project on "Promoting International Co-operation and Understanding in Healthcare Management". It is funded by the Canada-European Community Program for Co-operation in Higher Education and Training - a joint initiative between the Canadian Government and the European Commission.The purpose of the course is to enable graduate students from participating countries - Canada, Germany, Finland, and Ireland - to become better healthcare managers by learning more about their own and each others' healthcare systems and management processes. The course is structured around an introductory module  and four theme modules: Financing and Funding, Healthcare Delivery Issues, Impact of Health System Reform, and Evidence-based Management. The technology used for the delivery of the course is WebCT, a web-based distance learning software developed at the University of British Colombia. WebCT provides a large number of functions both for students - e.g.,e-mail, bulletin boards, chat rooms, and calendar - and for instructors - e.g., student tracking, page tracking, chat room log files, and marking management. Instructors are able to design the whole course, receive students' assignments, and post their assessments, via the World Wide Web.From January to April 1999, 25 students participated in the second course (19 students in the first course in 1998). The tracking function of the WebCT system was used to get some data about the students' activities. In 15 weeks, the students read an average number of 585  contributions -- i.e. the sometimes very profound messages posted by students and instructors --, whereas they posted 26  own contributions. The high activity of students is a typical characteristic of this student-centred course. Students have the opportunity and responsibility to be both students and teachers for the others. The role of the instructor, however, changes from that of the source of knowledge to that of a supervisor. Therefore students themselves can significantly increase the quality of the course.So far, 44 students participated in the course. For all of them, it has been a valuable experience of learning, which both increased their knowledge of national and international management issues and improved their technical skills on the field of the new medium Internet. The possibility to provide international courses via the Internet gives a new dimension to world-wide medical education and should be used very intensively. For the part of "Looking over the Horizon", the course is planned to expand on more students and even more countries.


EHP address the application of toxicogenomics data in the risk assessment and regulatory processes. Also addressing these issues is the National Research Council/National Academy of Sciences Committee on Emerging Issues and Data on Environmental Contaminants. (http://dels.nas.edu/emergingissues/index.asp). This committee, formed at the request of the National Institute of Environmental Health Sciences (NIEHS), provides a public forum for discussing emerging issues in environmental toxicology.The two editorials in this issue of The committee comprises experts from academia, industry, and public interest groups whose specialties include toxicology, toxicogenomics, genetics, bioinformatics, risk assessment, medical ethics, epidemiology, communications, public health. In addition, a U.S. federal government liaison group has been created to work with the committee with representatives from the NIEHS, the Centers for Disease Control and Prevention, the Environmental Protection Agency, the Food and Drug Administration, the Department of Agriculture, the Department of Energy, the Occupational Safety and Health Administration, the Department of Defense, and the Department of Transportation.A subcommittee is being formed to write a “Consensus Report on the Applications of Toxicogenomic Technologies to Predictive Toxicology.” This report will highlight how the study of gene and protein activities and other biological processes can improve the characterization of toxic substances and their potential risks. Ultimately, this report should show how major new or anticipated uses of these technologies could improve the protection of public health and the environment.


Existence of doctors with high performance is one of the necessary conditions to provide high quality services. There are different motivations, which could affect their performance. Recognizing Factors which effect the performance of doctors as an effective force in health care centers is necessary. The aim of this article was evaluate the effective factors which influence on clinical performance of general surgery of Tehran University of Medical Sciences in 2015.This is a cross-sectional qualitative-quantitative study. This research conducted in 3 phases-phases I: (use of library studies and databases to collect data), phase II: localization of detected factors in first phase by using the Delphi technique and phase III: prioritizing the affecting factors on performance of doctors by using qualitative interviews.12 articles were analyzed from 300 abstracts during the evaluation process. The output of assessment identified 23 factors was sent to surgeons and their assistants for obtaining their opinions. Quantitative analysis of the findings showed that “work qualification” (86.1%) and “managers and supervisors style” (50%) have respectively the most and the least impact on the performance of doctors. Finally 18 effective factors were identified and prioritized in the performance of general surgeons.The results showed that motivation and performance is not a single operating parameter and it depends on several factors according to cultural background. Therefore it is necessary to design, implementation and monitoring based on key determinants of effective interventions due to cultural background. Human resources are intellectual and capable factors that can create powerful and dynamic organization by optimizing the use of other resources . ObviousThis cross-sectional quantity-quality study research was conducted in three phases. The first phase, research: In this phase, information on performance evaluation, motivational factors of improving performance, and factors affecting the performance of doctors was collected using databases including The National Library of Medicine, Pub Med, EMBASE, Science Direct, Scopus, Springer link, and Google Scholar.The second phase, indigenousness of the identified factors: In this step, using the results of the first stage, the Delphi technique was used to criticize and validate initial list, the identified factors affecting the operation of general surgeons were presented to participants  and their feedback was collected.The third phase, prioritizing the factors affecting the performance of physicians: In the final stage of the project, researchers discussed the factors affecting the performance of the doctors in focused group sessions and ranked these factors in order of their depth of effect.The findings are adjusted in four sectors including: the results of the comprehensive review of studies, quantitative analysis of questionnaires, qualitative analysis of interviews, and summarizing the findings of the study.The findings of the comprehensive review of studiesIn this phase of the study, the most important keywords and databases, including Google Scholar, Pub Med, Pro Quest, Cochran library, ISI web of knowledge, Scopus, and Embase (1990 to present) were studied.The study began with a literature review of 300 abstracts. After inspection, 154 abstracts were excluded because of remoteness from the subject and 146 articles were evaluated. The assessment output was 12 articles. The information of 12 articles were evaluated in “general information” and “specific information” aspects. General information included: title, first author, year of publication, the performer country, the country of field of study, the journal, and the aim; and specific information included: author, type of study, method of data collection, data analysis, and findings. After assessing and analyzing the articles, identified themes were extracted and factors affecting employees’ performance were listed case by case.The primary identified themes were divided into three categories: personal factors, job and its nature, and organizational factors and job environment. The output was provided to general surgeons as the table below.Analysis of demographic variablesIn the current study, 22% of the samples aged 30 to 39 years, 38.9% of them aged 40 to 49 years, 5.6% of them aged between 50 and 59 years, and 5.6% were over 60 years old. 33.3% of the participants were female, 66.7% were men. Minimum job experience was 2 years and maximum was 20 years. 25% of the samples had less than 5 years of job experience, 81% of them less than 10 years, 92% less than 15 years, and 100% of them less than 20 years.The output of the first stage of DelphiAfter the implementation of the first phase of Delphi, the results were determined as follows. Given that more than 50% had over 60% consensual opinions, the following consensus was achieved in the first phase of Delphi.Qualitative analysis of interviewsIn this study, with implementation of Delphi, an open question was asked from participants to complete and correct the identified factors. In this part, we analyzed the conducted interviews qualitatively. The conceptual framework in the process of qualitative analysis was corrected, if necessary, and some of the subgroups of concept changed in this process. Finally, 3 topics and 11 sub-topics were identified in examining the relationship between the insurer and hospitals.In the final phase of the study, the results of the implementation of the Delphi techniques and analysis of interviews led to identify factors affecting function of general surgeons. In this section, these factors are presented in a table.The health and treatment sector account for a large part of costs and doctors has a very significant role, so their performance is evident on health sequences of the country. The results of the current study showed the role of factors of competence, passion, experience, and knowledge of the person from the job and salary payment method on general surgeons’ performance.Competence to do the job, interest, and understanding of the job have been identified as the most influential factors on performance of physicians. Similar to the study of Method of payment ranked fourth, which was among factors with a score high. Muhdi and et al. also state that the payment method can potentially affect the performance . Marce aPersonal characteristics such as age, sex, and type of personality were the factors affecting physicians ‘motivation. Four factors, including factors affecting psychological condition, type of view, professional responsibility, and job conscientious, were the most important items reported by interviewees in this area. These factors have been emphasized in Heydari’s study  and the 2. One of the participants said in this regard: “I suppose, job security should be evident. As too much or too little of it can be both damaging and harmful” (Interview 12), which is similar to Heydari’s results, conducted on prioritization of stressors affecting job performance of staff of Uremia University of Medical Sciences, reported negative factors affecting the performance , organizational factors affecting the performance negatively . Special jobs induce boredom and disgust after a while and weakens the job motivation in individuals that can be overcome by diversifying jobs, promoting employment, and providing further education .In study of The findings show the effect of variable intrinsic factors on physicians’ performance and study Mathieu’s study and et al.  also conThe results showed that physicians’ motivation and function is not a single operating parameter and several factors play a role with regard to cultural background. Therefore, it is necessary to implement and monitor more effective interventions based on key determinants or cultural background design. The health authorities should pay more attention to the importance and role of factors affecting job motivation. Individual factors, such as the competence to do the job, interest in the job, person’s knowledge of the job and its importance, personality type, age, and work background (experience); and organizational factors, such as the tariff, payment method , possibility of development and scientific progress, job security (employment type), diversity in the job, professional responsibility, and job’s professional relationships are the most important effectors of performance. Thus, health authorities should pay attention to the role of these factors and plan long-term to improve motivation and consequently the performance of physicians and prevent them from leaving the system and the country.ContributorsFF contributed to the conception and design of the work, and the acquisition, analysis and interpretation of data, and drafted the paper. EM, JN, TY, SFandARFcontributed to the conception and design of the work, and the acquisition, analysis and interpretation of data. EM contributed to the conception and design of the work, and the acquisition and interpretation of data. All authors contributed to the revision of the paper and approved the final manuscript for publication. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


Bernard Zinman, Programme Committee Chair of the International Diabetes Federation (IDF) World Diabetes Congress 2015, talks about the scientific programme highlights, the experience of attending the Congress and his involvement in diabetes care and research. Bernard Zinman is Director of the Leadership Sinai Centre for Diabetes and holds the Sam and Judy Pencer Family Chair in Diabetes Research at Mount Sinai Hospital and the University of Toronto, Canada. He is Professor of Medicine at the University of Toronto and Senior Scientist at the Samuel Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Ontario, Canada. The International Diabetes Federation (IDF) World Diabetes Congress (WDC) 2015 will be held in an outstanding venue in Vancouver, Canada. The programme will comprise symposia, debates, workshops, meet-the-expert and poster discussion sessions, and will present recent advances in six distinct streams including: Basic and Clinical Science, Diabetes in Indigenous Peoples, Education and Integrated Care, Global Challenges in Health, Public Health and Epidemiology and Living with Diabetes.Members of broad-based multi-disciplinary diabetes health care teams, individuals active in diabetes organisations, people with diabetes, diabetes-related industries and health ministries of various government sectors will all benefit from the diverse programme.The uniqueness of the IDF WDC derives from its international flavour, the diverse background of its participants and the integration of cutting-edge research with education and clinical care. It truly is a unique event for people involved with every component of the diabetes community to meet and exchange ideas.My background in biochemistry and passion for research directed me to a career as a clinician scientist in endocrinology with a major focus in diabetes.To effectively address the epidemic of diabetes we need three approaches. First, we need to develop effective strategies to prevent diabetes with a focus on reversing the increasing rates of obesity and physical inactivity particularly as it relates to our children. Second, we need to develop and implement effective diabetes treatment regimens very early on in the course of the disease to prevent the devastating complications of diabetes. And finally, for those with diabetes and complications, we need to screen efficiently for these complications and apply effective treatment before they become disabling and affect the long-term outcomes and quality of life.


Andrija Štampar School of Public Health celebrates its 90th anniversary. The School was opened on October 3, 1927 as a result of professor Andrija Štampar’s vision and many years of work. At the beginning of its activity, the School of Public Health was a joint organization with the Hygienic Institute. At that time, the School’s task was to study circumstances that could adversely affect public health and to educate people about major health issues. State-of-the-art technology was used, including several film workshops, which produced quite a number of educational films regarding public health.This year In 1947, the School became part of the University of Zagreb School of Medicine. From its beginnings to the present day, the most important role of the School has been education of medical doctors at all levels in the range of fields, from outpatient health care to public health competencies. The School maintains postgraduate courses in hygiene and social medicine and primary health care. The first postgraduate study in public health took place in 1947.Specialization in general practice or family medicine at the School started in 1960. It was the first such program globally. Nowadays, at the Andrija Štampar School of Public Health medical students continuously gain public health knowledge and skills within different courses. Postgraduate specialist studies in family medicine, school and adolescent medicine, occupational health and sports medicine, public health medicine, epidemiology, and health management are also provided at the School. In addition, the School contributes to postgraduate doctoral studies “Biomedicine and Health” at the University of Zagreb School of Medicine.During its history, the inner structure of the School underwent changes several times. Departments and institutes were founded and closed, merged or separated. Today, within the School of Public Health, along with the Library “Andrija Štampar”, the Office of Educational Technology and the Secretariat, there are five departments of the School of Medicine including Department of Social Medicine and Health Care Organization, Department for Medical Statistics, Epidemiology and Medical Informatics, Department of Health Ecology, Occupational Health and Sports Medicine with the Laboratory for Water and Balneoclimatology Research, Department of Medical Sociology and Health Economics, and Department of Family Medicine.The social, epidemiological, technological, and political circumstances over the course of 90 years have changed constantly. Today, almost nothing is the same as it was at the time of the School’s foundation. Immediate goals and tasks are necessarily also different, but the strategy that leads to health for all remains unchanged. From its foundation to the present day, the School has been an exceptional and recognizable project that set high goals for national health policy and medical profession. Many of these goals have been realized in a magnificent way. The School has changed the destiny of a large number of people positively. It began with health projects in Turopolje and continued in neighboring and remote countries and continents. We have partnered in projects with colleagues from many countries including Japan, China, the Netherlands, the United Kingdom, the United States, and others. Today, the School is part of the European and global network of public health education and research institutions. It actively cooperates with the Association of Schools of Public Health in the European Region (ASPHER) and the World Health Organization (WHO). The School includes two WHO Collaborating Centers, the one for HIV strategic information and the one for Occupational Health.As long as illness and disease occur, as long as there are health problems in individuals and vulnerable population groups, our School of Public Health continues with its mission. Andrija Štampar, our founder, our great teacher and visionary, has set high educational goals for public health professionals. Previous goals of sanitation and fight against infectious diseases, malaria, and tuberculosis are today largely replaced by new challenges posed by cardiovascular diseases and addiction and mental health issues. Today, in the 21st century, the School’s task is to convey new insights through contemporary communication channels and technologies, supporting public health with best available scientific evidence and translational research, building the bridge between public health theory and practice. Working together, academic researchers and local communities bring us into a realistic world of needs and opportunities. By strengthening public health competency in local communities, we provide citizens with support in achieving better health. The translation circuit loop is closed by simultaneous application of accumulated knowledge, both in practice planning and management for health and in teaching at the graduate, specialist, and doctoral level.Our main aim in the years to come is to sensitize young researchers and promote their inclusion into public health science to ensure better understanding and functioning of the health care system as a whole.


Long-lasting insecticide-treated nets and/or indoor residual spraying, associated with case management, are key interventions in the control of malaria in Africa. The objective of this study is to comment on the role of social and behavior change communication as a potential key intervention in the control of malaria in Mozambique. Malaria is a major public health problem in the world, with approximately 207 million cases and 627,000 deaths per year. Most of the cases (80.0%) and deaths (90.0%) occur in AfricaMalaria is endemic in Mozambique and it represents 45.0% of all the cases observed in outpatient appointments and 56.0% of the admissions in pediatric wards,,The use of long-lasting insecticide-treated nets (henceforth referred as “insecticide-treated nets”) and/or indoor residual spraying (henceforth “IRS”) can reduce malaria morbidity and mortality, especially in children and pregnant womenThere are three determinants of malaria distribution: i) the epidemiological triad: mosquito, parasite, and human; II) environmental factors; and, III) global factorsanopheles gambiae s.s. and anopheles funestus, has a leading role as vector in sub-Saharan Africa and in Mozambique. It is responsible for the sporogonic cycle of the parasite.The mosquito, particularly plasmodium falciparum, the most deadly of all the species in sub-Saharan Africa and in Mozambique, and the human being complete the epidemiological triad of the occurrence of the disease,The parasite, in particular ,Among the environmental factors, we highlight: temperature, relative humidity, and rainfall, which promote or inhibit the development of the vector in certain parametersThere is a strong negative correlation between the Human Development Index (HDI) and the prevalence of malaria in Mozambique by province, with Pearson coefficient of -0.8 and coefficient of determination of 64.3% .,36,,,Studies and the World Health Organization suggest that insecticide-treated nets and/or IRS associated with case management are key interventions in the fight against malariaRo of malaria is directly proportional to the vector capacity (C) that is the potential number of secondary cases originating from a primary case, in one day. The term refers to the combination of the components that determine the effectiveness of a local population of mosquitoes in transmitting malaria. Although the human host is the beginning and end of the sequence, the term refers to the stages of the insect, and not the ones that occur in the human hostRo. The higher Ro means high malaria prevalence in a given region.The m), II) number of blood intakes per mosquito in one day (a), III) efficiency of the malaria transmission system (b), IV) possibility of a mosquito becoming infectious (pn)Vectorial capacity (C) is directly influenced by: i) number of female mosquitoes per person , the socio-ecological model, and the social and behavior change communication.According to the Brazilian National Commission on SDOH, SDOH are social, economic, cultural, ethnic/racial, psychological, and behavioral factors that influence the occurrence of health problems and their risk factors in the population. The Commission on Social Determinants of Health of the WHO adopts a shorter definition, according to which SDOH are the social conditions in which persons live and workThe Dahlgren and Whitehead model about the SDOH establishes four layers of determinants: i) proximal , ii) social and community networks, iii) living and working conditions, and iv) distal From the socio-ecological model, the various levels of influence are examined to find the critical point for changes, as well as the individual motivation and knowledge and the social/gender norms, skills, and, favorable environment. This model considers the individual behavior as the product of multiple individual, social, and environmental influences, and it combines the individual change in order to influence the social context in which the individual operates. In this model, the levels of analysis are represented by rings that show the domains of influence and the persons representing them at each level. The first ring, named “individual”, represents the most affected persons. The second and third rings represent the persons who have direct contact with those most affected and who influence their attitudes, beliefs, and actions, shaping the community and gender norms and/or access to, and demand for, community resources and existing services. The fourth ring, the widest, includes those who indirectly influence those most affected by the issue and represents the favorable environmentMozambique, as many countries in sub-Saharan Africa, has a high illiteracy rateSocial and behavior change communication (SBCC) is an interactive, researched, and planned process that aims to change social conditions and individual behaviorsThe sharing of information about measures of malaria prevention through “social and community networks” (second layer in the Dahlgren and Whitehead model) and rings two and three of the Social-Ecological Model may influence the education of persons and their individual and/or collective lifestyles.,In communities where the engagement in the fight against malaria has been achieved, programs for the control and elimination of malaria can be successful,,Factors such as exposure to messages, risk perception, self-efficacy, response efficacy, and knowledge on the transmission and symptoms of malaria are associated with preventive behaviorsThe use of various approaches can be a synergistic strategyApproaches using community radio, pamphlets, lectures, dances, theater, community dialogs, among others, should be considered as synergistic approaches and not as replacements for one or the other. These approaches of SBCC should be a process of mobilization and empowerment of the community, used to provide information, skills, and confidence to communities to gain control over decisions related to their own lives.The network of community volunteers that make a health committee, in addition to community leaders, volunteers from religious faiths, political parties, traditional health practitioners, all trained in malaria prevention and different approaches of SBCC, can be a precious resource to support health professionals and fortify the key malaria interventions: insecticide-treated nets and/or IRS associated with case management.Teachers, especially in the primary education, may also be promoters of behavior change when transmitting malaria knowledge to students. This will influence their future behavior toward malaria prevention. On the other hand, students will be able to disseminate information in their communities and households.Innovative ways to transmit preventive messages on malaria for behavior change should be explored to increase the effectiveness of the synergism of the channels of SBCC.The provision of key interventions for vector control (insecticide-treated nets and/or IRS) and case management may not be enough to reduce the burden of malaria in Mozambique. Social and behavior change communication can play an important role which might be of similar and/or greater value than vector control. Interventions on social and community networks may be an important point of access for the various methodologies and approaches of social and behavior change communication.


Revista de Saúde Pública, in the 50 years of its publication. A narrative review study was carried out using PubMed, as it is the search database that indexes all issues of the journal. From 1967 to 2015, 162 manuscripts specifically focused on oral health themes were published. This theme was present in all volumes of the journal, with increasing participation over the years. Dental caries was the most studied theme, constantly present in the journal since its first issue. Periodontal disease, fluorosis, malocclusions, and other themes emerged even before the decline of dental caries indicators. Oral health policy is the most recurring theme in the last two decades. Revista de Saúde Pública has been an important vehicle for dissemination, communication, and reflection on oral health, contributing in a relevant way to the technical-scientific interaction between professionals in this field.This study describes the scientific production on oral health diffused in  To guide this action, it is essential to conduct epidemiological studies, of planning and management, and studies on social sciences in health specifically focusing on such conditions in its multiple dimensions.Revista de Saúde Pública (RSP). When celebrating its 40 years, we noted that oral health was one of the main thematic areas of the journalThis understanding permeates the entire history of On the occasion of RSP’s 50th anniversary, the present study aimed at describing the scientific production on oral health issues diffused in the journal throughout its history.We carried out a narrative review study. For the retrieval of the published articles, we used the PubMed search database, which indexes all issues of the journal. Two examiners conducted the search independently and resolved conflicts by consensus. The selected articles were classified in subthemes and synthesis for presentation purposes.From 1967 to 2015, RSP published 162 manuscripts specifically focused on oral health themes, including original articles, theoretical review, reviews, editorials, and previous notes. The Dental caries was the oral health condition that most motivated studies on the pages of RSP. It was also a constant theme during the five decades of the journal. Sixty-nine articles assessed the prevalence of dental caries in the population in general and in specific groups, inequality in its distribution, preventive resources, and methodological aspects of the forms of measuring the severity.,Already in its early years, dental caries prevalence was described for different cities, having as reference the addition of fluoride in the water supply systemAnticipating the concern with social inequalities in health, pioneering studies addressed differences in the prevalence of dental caries according to social strata. In the first issue of RSP, Souza et al.In the latest period, a decline in the prevalence of dental caries was observed. Articles published in RSP described and analyzed empirical data justifying this observation. Narvai et al.,,However, the decline in dental caries prevalence was accompanied by increased inequality of their indicators between the social strata. This phenomenon, referred to as polarization of dental caries experienceMethodological aspects of measures of dental caries in the population also motivated pioneering studies on RSP. In 1973, SouzaAnalytical techniques widely used in studies on public health also had pioneer application to the area of oral health in the pages of RSP. Linear regression,,Still considering original themes of research in oral health, RSP has published studies that, in time, have had an impact on the prevention of dental caries. Mouthwashes and topical applications of fluoride gel in mouth trays were object of study already in the first volumes of the journal, becoming popular in BrazilThe aging of the population, a theme so important to contemporary public health, motivated studies on oral health in RSP in different periods. Dental caries, periodontal disease, dental loss, and prosthetic use were discussed, in 1992, in a study identifying the need for specific odontological policies and programs for older peopleFigueiredo et al.The welfare of professionals working with oral health have also motivated studies. Regarding the decrease in risk of infection of these professionals, Martins and BarretoEven before the decline of dental caries indicators, other oral health themes emerged as public health problems, requiring action of health authorities and health services. In particular, several studies of RSP focused on distribution, forms of measurement, associated factors, and consequences of malocclusion, gingival inflammation, and periodontal diseases, conditions widely prevalent.Tomita et al.Dental fluorosis, another emerging theme on the agenda of priorities in public health, was present in the pages of RSP in the last two decades of its 50 years. Studies with different methodological schemes assessed its prevalence and its perception by the population as well as the related beliefs and attitudes. Lima and Cury,Oral cancer and orofacial clefts are less prevalent conditions; but their severity justifies the inclusion on the agenda of priorities in public health. These themes are also present in RSP, in the latest period. Loffredo et al. estimated the incidence of oral clefts in BrazilThe planning of dental services for patients requiring special care has also been the object of studies published in RSP. Oliveira et al.The study on oral health policies stood out in the last two decades. About a third of the articles published in RSP in this period addressed oral health policies and related issues of the planning and management of dental services. Such studies proposed and evaluated programs such as fluoridation of the water supply network, preventive procedures and of oral health promotion, the importance of the auxiliary professionals composing oral health teams in direct provision of services, and the dental care in public and private networks.Even before the Brazilian Unified Health System (SUS) was deployed, Vitor Gomes PintoLacerda et al.Camargo et al.Programa Brasil Sorridente (Smiling Brazil Program), Scherer and SchererOn the occasion of the ten-year anniversary of the RSP has been an important vehicle of communication of scientific knowledge in the field of collective oral health. Since its first issue, and in all its volumes, the journal has been publishing search results about oral health themes of interest to public health, contributing to scientific reflection, professional training, and health planning. The Brazilian Ministry of Health recognized the importance of the journal for the scientific communication in the field of oral health, choosing it to publish, in 2013, a supplement to studies describing and analyzing the results of the National Survey on Oral Health, the epidemiological survey, also known as SBBrasil 2010.Dental caries has held a prominent position in the published articles. It was also the study on dental caries that, in part, promoted the discussion of methodological innovations, both in terms of its evaluation in epidemiological investigations, and in statistical techniques of analysis. Over time, other harms to oral health, such as adverse periodontal conditions,fluorosis, malocclusions, and oral cancer, were explored according to varied theoretical-methodological perspectives and linked to the Brazilian context.The growth of publications in the thematic area of policies, planning, management, and evaluation of oral health services sought to answer, among other priorities, the problem represented by dental caries, including demands for qualified services to handle its direct demonstration or more severe consequences. Publications diffused in RSP expose a set of major transformations in scientific thought and valuation of the oral health theme.The synthetic description of these studies provides identifying the involvement of different oral health themes in the evolution of the agenda of priorities in public health. The journal has been employed by researchers in the field as an instrument of dissemination, communication, and reflection of scientific knowledge, contributing in a relevant way to education and technical, scientific, and professional interaction.