News in Brief

Indian Pediatrics 2002; 39:709

News in Brief

Money may not matter: A widely quoted study , making news in the western media, shows that paradoxically, the US despite spending more on neonatal intensive care, has poorer survival rates and higher infant mortality compared to UK, Canada and France. The detailed study from Dartmouth in USA compares neonatal resources and outcomes in USA with the other 3 countries. There are 6.1 neonatologists and 3.3 NICU beds/ 10000 live births in USA as compared to 3.7 neonatologists in Australia, 3.3 in Canada and 2.7 in UK. NICU beds in Australia and Canada are 2.6/10000 live births and 0.67 in UK.

But the crude death rate in USA is 4.7/1000 live births as compared to 3, 3.7 and 3.8 in Australia, Canada and UK respectively. Death rates in all weight groups were also consistently higher in the USA. But the clue to the mystery lies in the fact that in the USA 1.45% of babies are below 1.5Kg versus 1% in the other countries. Further all mothers are insured in Australia, Canada and UK while only 87% children and 78% women in USA were insured. The authors conclude that the free family planning advice and preconceptional and post conceptional counselling in Australia, Canada and UK play a decisive role in reducing low birth babies in these countries keeping mortality levels low (Pediatrics 2002;109:1036-1043).

Paradigm shift in health care systems: Do we live from day to day or do we imagine and plan ahead? The WHO says that the days of focussing on acute care medicine alone are over. People are living longer, are more urbanized and have more unhealthy life styles. This means chronic diseases are increasing. Developing countries which spend most reasources on acute care must conciously shift their attention to chronic disorders. This means physicians need to be trained in explaining lifestyle modifications, preventing disabilites, increasing patient empowerment, counselling and behaviour therapy. Community services and support systems have to be planned. Encouraging health vis a vis combating illness is the new mantra ( eBMJ 25 March 2002).

Alternative medicine: "Uncritical enthusiasts and uninformed sceptics" are both responsible for the sad state of traditional medicines. The WHO recently released the global strategy on Traditional Medicines on May 16. In the next few years it plans to concentrate on integrating these systems into the local health care systems after careful scrutiny of its safety, efficacy and rational use of complementary/alternative medical systems (The Lancet interactive 18 May 2002).

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