1271
Research and Training in Cali, Colombia. He published
on the of infectious hepatitis, salmonellosis, and enteropathogenic Escherichia coli in children, and on the use of toxoid for the prevention of neonatal tetanus. In 1966 he initiated WHO’s division of Research, Epidemiology, and Communications Science (RECS) in Geneva. He soon concluded that disease control programmes could succeed only with popular participation, a recurring theme following his spell in Te Araroa. He was appointed director of WHO’s division of Strengthening Health Services (SHS) in 1971. He advocated primary health care (PHC) that is controlled by the people (rather than the professionals), that is equitable, and that focuses on health needs of disadvantaged social groups, and many of his proposals were incorporated into the 1978 Declaration of Alma Ata. Newell returned to New Zealand in 1977 as professor of community health at Wellington School of Medicine. He was behind the establishment of New Zealand’s area health boards, the College of Community Medicine, and the postgraduate diploma in community health. In 1984 he moved to the Liverpool School of Tropical Medicine as Middlemass Hunt professor of tropical community health and head of the department of international community health (ICH). Under Newell, ICH’s philosophy reflected continuing commitment to the PHC ideal and to its implementation: it formed the basis for a major revision of the Liverpool Masters course in community health and for a range of work programmes set up to strengthen district health systems. Newell recognised that district health systems could only improve if the central policy environment was right. Under his leadership, ICH set up collaborative research, teaching, and service links with regional (Mersey) and district (Wirral) NHS authorities. ICH staff have worked with a range of donor agencies, including multilaterals and non-governmental organisations. ICH has also supported teaching institutions in the developing world and in
epidemiology
Europe. At my first meeting with him at 3 am one summer morning in 1984 when I was working in Nepal, I expected a few minutes’ discussion before he slept off the effects of the flight from Liverpool. Instead he questioned me for several hours to "find out the shape of my head". On hearing of Ken’s death my first thought was that "we had so much unfinished discussion". Many colleagues felt the same. David Nabarro
2 salary, but if somebody more senior were selected, secondment might be the solution, suggested Mr Clarke. The director is expected to look after clinical and operational research and will be left to set up his own ad hoc groups of advisors; and there are plans to draw from the NHS to increase the research management division in the Department of Health. As for funding of the research-Mr Clarke said that it was for the director to advise the Government on the adequacy of resources and to help in formulating the Department’s expenditure bids.
grade
1. Priorities
m Medical Research. Government response to the third report of the House of Lords Select Committee on Science and Technology. 1987-88 Cm 902. London: HM Stationery Office, 1989. 2. Priorities in Medical Research. Select Committee on Science and Technology Session 1989-90 4th report (supplementary report); HL Paper (51). London: HM Stationery Office 1990. Pp 15. £4.95.
Zidovudine and needlestick exposure
placebo-controlled trial of zidovudine given prophylactically to people exposed to HIV via a contaminated needlestick injury in a hospital setting is underway. Understandably, there is a reluctance to wait for the final results, especially since encouragement is to be had from cat and mouse models. There is no certainty, however, as shown by two failures--one in the Netherlands and the other in Australia. In Amsterdam a 58-year-old patient having his redblood-cell mass investigated was injected by mistake with a syringe left over from a test on an HIV seropositive man.1 The amount of A
infected blood was not more than one-fifth of a millilitre. The error was picked up quickly and zidovudine was started within 45 minutes. Even so, HIV-1p24 antigen was detected on day 30 with seroconversion 11 days later. Drug resistance of the HIV strain was not the explanation. The Australian incident (see p 1280) is more typical of occupational exposure to HIV-a major needlestick injury followed by prompt zidovudine prophylaxis, but again markers of HIV infection developed. Boucher CAB, Hollak CEM, et al. Failure of zidovudine prophylaxis after accidental exposure to HIV-1 N Engl J Med 1990; 322: 1375-77.
1. Lange JMA,
When disaster strikes a public-health problem, disasters can be particularly devastating in third-world countries, where resources are already tightly stretched. Disasters not only cause death, injury, anxiety, and depression but also increase the risk of disease epidemics and
As
Noticeboard Directorship of NHS research and development The post of director of research and development in the National Health Service will replace that of chief of research and development (advertised in The Lancet on March 17) that the Government had proposed’ (see Lancet Jan 6, p 42) as an alternative to the National Health Research Authority recommended by the House of Lords Select Committee on Science and Technology. This revision was made after concerns were expressed by the Select Committee about certain aspects of the post of chief of research and development, among them the wide range of functions expected of an individual, the time he would be able to allocate to NHS work, and the fact that the chief was not to be given a seat on the NHS Management Executive. The director, however, will be a full member of the Executive, which puts him at the centre of decision-making, said Mr Kenneth Clarke, Secretary of State for Health, on April 25, when he answered questions from the Select Committee on what clout and credibility the director would have and what freedom and funding he would receive to carry out his duties.2 Mr Clarke sees the director as an "NHS man" but with duties to help the Government with public health, health service, and personal social services policy. The advisory function on public health will not alter the responsibilities of the chief medical officer, explained Sir Christopher France, Permanent Secretary, Department of Health, who was also present at the meeting; the concerns for research were a longer-term focus than those of the chief medical officer. The directorship commands a civil service
They disrupt routine health services and preventive care programmes and often cause severe food shortages, leading to widespread famine. Furthermore, disaster may provoke large population movements away from the incident zone, with the consequence that health services in surrounding areas become environmental hazards.
overburdened and ineffective. The World Health Organisation defines a disaster as "any occurrence that causes damage, ecological disruption, loss of human life and deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community". This definition includes natural disasters, such as flood, famine, or drought, and those which are man-madefor example, industrial accidents, environmental contamination, war, and civil strife. The compelling need for assistance to disaster-struck areas prompted WHO to expand its already established emergency relief unit to form the Emergency Preparedness and Response Unit (EPRU) in 1987. The specific objective of this unit is to make sure that countries are better prepared to deal with a disaster, through the implementation of protective measures, improved early warning systems, and more accurate risk assessment. The EPRU emphasises that "The capability to plan for and react to disasters [should] eventually become an endeavour of self-reliance rather than external intervention". To help to reduce the catastrophic effects of disasters in the 1990s, WHO has summarised its approach to disaster management in a publication, Health for All when a Disaster Strikes. This report
Research and Training in Cali, Colombia. He published
on the of infectious hepatitis, salmonellosis, and enteropathogenic Escherichia coli in children, and on the use of toxoid for the prevention of neonatal tetanus. In 1966 he initiated WHO’s division of Research, Epidemiology, and Communications Science (RECS) in Geneva. He soon concluded that disease control programmes could succeed only with popular participation, a recurring theme following his spell in Te Araroa. He was appointed director of WHO’s division of Strengthening Health Services (SHS) in 1971. He advocated primary health care (PHC) that is controlled by the people (rather than the professionals), that is equitable, and that focuses on health needs of disadvantaged social groups, and many of his proposals were incorporated into the 1978 Declaration of Alma Ata. Newell returned to New Zealand in 1977 as professor of community health at Wellington School of Medicine. He was behind the establishment of New Zealand’s area health boards, the College of Community Medicine, and the postgraduate diploma in community health. In 1984 he moved to the Liverpool School of Tropical Medicine as Middlemass Hunt professor of tropical community health and head of the department of international community health (ICH). Under Newell, ICH’s philosophy reflected continuing commitment to the PHC ideal and to its implementation: it formed the basis for a major revision of the Liverpool Masters course in community health and for a range of work programmes set up to strengthen district health systems. Newell recognised that district health systems could only improve if the central policy environment was right. Under his leadership, ICH set up collaborative research, teaching, and service links with regional (Mersey) and district (Wirral) NHS authorities. ICH staff have worked with a range of donor agencies, including multilaterals and non-governmental organisations. ICH has also supported teaching institutions in the developing world and in
epidemiology
Europe. At my first meeting with him at 3 am one summer morning in 1984 when I was working in Nepal, I expected a few minutes’ discussion before he slept off the effects of the flight from Liverpool. Instead he questioned me for several hours to "find out the shape of my head". On hearing of Ken’s death my first thought was that "we had so much unfinished discussion". Many colleagues felt the same. David Nabarro
2 salary, but if somebody more senior were selected, secondment might be the solution, suggested Mr Clarke. The director is expected to look after clinical and operational research and will be left to set up his own ad hoc groups of advisors; and there are plans to draw from the NHS to increase the research management division in the Department of Health. As for funding of the research-Mr Clarke said that it was for the director to advise the Government on the adequacy of resources and to help in formulating the Department’s expenditure bids.
grade
1. Priorities
m Medical Research. Government response to the third report of the House of Lords Select Committee on Science and Technology. 1987-88 Cm 902. London: HM Stationery Office, 1989. 2. Priorities in Medical Research. Select Committee on Science and Technology Session 1989-90 4th report (supplementary report); HL Paper (51). London: HM Stationery Office 1990. Pp 15. £4.95.
Zidovudine and needlestick exposure
placebo-controlled trial of zidovudine given prophylactically to people exposed to HIV via a contaminated needlestick injury in a hospital setting is underway. Understandably, there is a reluctance to wait for the final results, especially since encouragement is to be had from cat and mouse models. There is no certainty, however, as shown by two failures--one in the Netherlands and the other in Australia. In Amsterdam a 58-year-old patient having his redblood-cell mass investigated was injected by mistake with a syringe left over from a test on an HIV seropositive man.1 The amount of A
infected blood was not more than one-fifth of a millilitre. The error was picked up quickly and zidovudine was started within 45 minutes. Even so, HIV-1p24 antigen was detected on day 30 with seroconversion 11 days later. Drug resistance of the HIV strain was not the explanation. The Australian incident (see p 1280) is more typical of occupational exposure to HIV-a major needlestick injury followed by prompt zidovudine prophylaxis, but again markers of HIV infection developed. Boucher CAB, Hollak CEM, et al. Failure of zidovudine prophylaxis after accidental exposure to HIV-1 N Engl J Med 1990; 322: 1375-77.
1. Lange JMA,
When disaster strikes a public-health problem, disasters can be particularly devastating in third-world countries, where resources are already tightly stretched. Disasters not only cause death, injury, anxiety, and depression but also increase the risk of disease epidemics and
As
Noticeboard Directorship of NHS research and development The post of director of research and development in the National Health Service will replace that of chief of research and development (advertised in The Lancet on March 17) that the Government had proposed’ (see Lancet Jan 6, p 42) as an alternative to the National Health Research Authority recommended by the House of Lords Select Committee on Science and Technology. This revision was made after concerns were expressed by the Select Committee about certain aspects of the post of chief of research and development, among them the wide range of functions expected of an individual, the time he would be able to allocate to NHS work, and the fact that the chief was not to be given a seat on the NHS Management Executive. The director, however, will be a full member of the Executive, which puts him at the centre of decision-making, said Mr Kenneth Clarke, Secretary of State for Health, on April 25, when he answered questions from the Select Committee on what clout and credibility the director would have and what freedom and funding he would receive to carry out his duties.2 Mr Clarke sees the director as an "NHS man" but with duties to help the Government with public health, health service, and personal social services policy. The advisory function on public health will not alter the responsibilities of the chief medical officer, explained Sir Christopher France, Permanent Secretary, Department of Health, who was also present at the meeting; the concerns for research were a longer-term focus than those of the chief medical officer. The directorship commands a civil service
They disrupt routine health services and preventive care programmes and often cause severe food shortages, leading to widespread famine. Furthermore, disaster may provoke large population movements away from the incident zone, with the consequence that health services in surrounding areas become environmental hazards.
overburdened and ineffective. The World Health Organisation defines a disaster as "any occurrence that causes damage, ecological disruption, loss of human life and deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community". This definition includes natural disasters, such as flood, famine, or drought, and those which are man-madefor example, industrial accidents, environmental contamination, war, and civil strife. The compelling need for assistance to disaster-struck areas prompted WHO to expand its already established emergency relief unit to form the Emergency Preparedness and Response Unit (EPRU) in 1987. The specific objective of this unit is to make sure that countries are better prepared to deal with a disaster, through the implementation of protective measures, improved early warning systems, and more accurate risk assessment. The EPRU emphasises that "The capability to plan for and react to disasters [should] eventually become an endeavour of self-reliance rather than external intervention". To help to reduce the catastrophic effects of disasters in the 1990s, WHO has summarised its approach to disaster management in a publication, Health for All when a Disaster Strikes. This report
