'Between Combat boots and Birkenstocks'-Lessons from HIV/AIDS, SARS, H1N1 and Ebola.

OBJECTIVES: In late 2013, an Ebola outbreak quickly grew into an epidemic of extraordinary magnitude, killing more people than all previous Ebola outbreaks combined. Although the epidemic was unprecedented, the world had previously experienced several acute public health emergencies requiring global coordination. HIV/AIDS, SARS and H1N1 tested global response, and in each case coordination proved problematic, making the 2013-2015 Ebola epidemic no exception. The purpose of this project was to identify persistent vulnerabilities within global public health emergency response and to identify areas for future research and improvement. STUDY DESIGN: Non-systematic review and qualitative interview study. METHODS: Using PubMed and Google, a comprehensive search of articles connected to the HIV/AIDS, SARS, H1N1 and Ebola responses was conducted. Then, 21 key responders involved in those emergencies, primarily from the US Centers for Disease Control and Prevention, participated in in-depth interviews. The content analysis and in-depth interview data were analysed using MAXQDA analysis software. RESULTS: A number of issues emerged, including cultural and political clashes within relevant agencies and a lack of confidence in those agencies, policy barriers that hinder long-term international response, a shortage of personnel and resources, itemized funding streams that limit flexibility to direct resources, and challenges to deploying responders internationally. CONCLUSIONS: The data suggest that the world remains ill prepared to handle sustained responses and global pandemics. The study identified major vulnerabilities persistent within US-led global public health response and offers recommendations for further focused research to fully understand why these challenges persist.

A qualitative study of a food intervention in a primary school: Pupils as agents of change.

This study explored the impact of a school-based kitchen project at a large inner London school. Timetabled kitchen classroom sessions (90 min every fortnight) were held with all 7-9 year old pupils. Semi-structured focus group discussions (with 76 pupils, 16 parents) and interviews (with headteachers, catering managers and specialist staff) were conducted at the intervention school and a matched control school. Categories and concepts were derived using a grounded theory approach. Data analysis provided three main categories each with their related concepts: Pupil factors (enthusiasm and enjoyment of cooking, trying new foods, food knowledge and awareness, producing something tangible); School factors (learning and curriculum links, resource implications and external pressures) and Home factors (take home effects, confidence in cooking and self-esteem, parents' difficulties cooking at home with children). Children's engagement and the opportunity to cook supported increased food awareness, skills and food confidence. In the grounded theory that emerged, take home effects beyond the school gate dominate, as children act as agents of change and influence cooking and food choice at home. These short term outcomes have the potential to lead to longer term outcomes including changing eating behaviour and diet.

A regional programme to collect plasma for preparation of human immunoglobulin anti-rabies.

We identified over 100 recipients of rabies vaccine (human diploid cell vaccine) and recruited them as plasma donors. Some were plasmapheresed at static centres, others by mobile teams. The operation of these teams is described in detail. No plasma was sent to the Fractionation Centre until the date of vaccination had been checked. Assay results showed that the majority of plasma collected between four and 20 weeks after the second dose of vaccine contained 6 or more IU/ml.

The boundaries of the self and the unhealthy other: reflections on health, culture and AIDS.

Most accounts of the cultural stigmas associated with AIDS have not adequately considered the meanings through which the stigmatizing self imagines his/her difference from the stigmatized other. This paper argues that 'health' is a key concept in the fashioning of identity for the modern and contemporary middle class and that the 'unhealthy' come to be represented as the other of this self. 'Healthy' and 'unhealthy,' however, must be understood both in their biomedical meanings and in their implicit metaphorical meanings. The 'unhealthy,' 'contagious,' 'sexually deviant,' and 'addicted-minority' other--all condensed in the negative symbolism of AIDS--have become images which are mobilized as part of a cultural politics of reconstructing the self in conformity with intensified mandates for self-control. The expulsion of 'unhealthy' meanings from the self, an act of patrolling the borders of identity, finds its projected physical location in the figure of the person with HIV-AIDS.

Healthism and the medicalization of everyday life.

This article considers some implications of the new health consciousness and movements--holistic health and self-care--for the definition of and solution to problems related to "health." Healthism represents a particular way of viewing the health problem, and is characteristic of the new health consciousness and movements. It can best be understood as a form of medicalization, meaning that it still retains key medical notions. Like medicine, healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being.

State health care policymaking: the Tennessee Primary Care Act of 1973.

Departments of public health have played a relatively limited direct role in providing primary care to medically underserved areas, a function which has long been the province of the private medical practitioner. This article reports on the personal experiences of the author in investigating the circumstances which led the state of Tennessee to deviate from this norm with its Primary Care Act of 1973. The limited scope of the measure and the timing of its introduction, together with careful attention to the dynamics of health care politics, were critical to the passage of the Act. Even though considerable time has elapsed since this article was written, and increased interest in primary care is evident in other areas and at various levels of government, the obstacles and issues involved in providing care to underserved areas remain topics of debate in Tennessee and elsewhere.

Radical trachelectomy: a way to preserve fertility in the treatment of early cervical cancer.

In the Centenary year of Wertheim's hysterectomy for the treatment of invasive cervical cancer, it is appropriate to look at less radical methods of managing early stage disease. Radical trachelectomy with pelvic lymphadenectomy is a conservative but locally radical procedure, preserving the corpus uteri and therefore fertility potential. The first 10 cases in a pilot study are presented. One patient has required post-operative radiotherapy and another a completion radical hysterectomy. Three live births by caesarean section and three other pregnancies have resulted. Careful selection within strict criteria may allow this more conservative approach without compromising cure. These procedures should be carried out in referral centres with continuing follow up and review.