Health Delivery

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A challenge of acculturation: the Ethiopian community in Israel

For most Ethiopian immigrants arriving in Israel, diabetes was an unknown illness. However, current studies show that its prevalence is now high in this population. The diagnosis and management of diabetes among Ethiopian immigrants present a real challenge of acculturation. In response to this challenge, a community-based project called Tene Briut was created. Tene Briut promotes culturally-appropriate prevention, detection and management activities, with a major contribution from Ethiopian health professionals and community leaders.

Argentina's crisis triggers health emergency - The diabetes community's response

Diabetes affects an estimated 3.3% of the adult population in Argentina. For many of these people, insulin is a life-sustaining drug. Without uninterrupted access to insulin, people dependent on this drug for survival face the real possibility of death, some within days. The collapse of the reimbursement system and speculation have caused grave interruptions in the supply of medicines such as insulin and now an emergency response is expected from the Argentinean authorities.

Skills, strategies and sunshine: education in the Carribean

According to Diabetes Atlas 2000, there are 21.4 million people with diabetes living in the North American region of the International Diabetes Federation (IDF). Prevalence rates of diabetes are high in this region as compared to Europe and Africa. The Caribbean countries in particular have a disproportionately high number of inhabitants with diabetes. Indeed, several islands in the Caribbean rank in the top 10 of all IDF member countries in terms of diabetes prevalence. The need for diabetes education in the region is therefore high.

Barriers to insulin accessibility: a hazard to life and health

For many people with diabetes insulin is essential to health. Indeed, there are few other conditions where the replacement of a hormone that the body has ceased producing can make an acute difference between life and death. Nevertheless, a recent data-gathering project in Central and Eastern Europe illustrated that, almost 80 years after its discovery, access to insulin supplies is still problematic.

Comprehensive care in a low-income country: the Ghana experience

In the 1950s and 1960s diabetes prevalence in Ghana was estimated at between 0.2% and 0.4% in adults. However, a recent analysis of admissions to the largest hospital in the country reveals that diabetes accounts for 6.8% of all adult admissions. Despite the fact that diabetes is clearly a major health problem in Ghana, the country has no separate diabetes healthcare policy. To address these issues, a three-year national programme, the Ghana Diabetes Programme, was initiated in 1995.

Setting the standards in England

In England we are currently increasing public spending on health faster than any major country in Europe. But, along with investing more, we need to do things differently. We need to look more radically at how health services are provided within a network of health and social care, shifting the balance between what we do in hospitals and what we do elsewhere. These are the principles that we will apply to modernizing diabetes treatment and that will underpin the ongoing work of the National Service Frameworks (NSF).

Complementary therapies

'Complementary therapies' have been in use for thousands of years. Today they are increasingly popular with the general public and many health professionals, especially nurses and general practitioners. Despite the wide availability of conventional medications, over 50% of the populations of most Western countries use complementary therapies. This figure may be even higher in other cultures. Many complementary therapies can be used by people with diabetes, but there are associated risks that need to be considered.

Poverty, stress and unmet needs: life with diabetes in the Gaza Strip

The political and social situation in the Gaza Strip remains tense, with considerable disruption of normal economic and social activity. Such an environment is rarely conducive to the delivery of continuing medical care. In this article Panagiotis Tsapogas, Medical Co-ordinator of the Greek section of Médecins Sans Frontières (Doctors Without Borders) in Gaza, 2002-2003, reports on the difficulties faced by Palestinian people with diabetes in Gaza, and makes a call for the provision of improved diabetes care.

Pregnancy and eye disease

Diabetic retinopathy is a disease of the small blood vessels of the retina, which is the lining of the back of the eye that senses light. Several factors contribute to the progression of this complication of diabetes: poor metabolic control, rapidly improved metabolic control, long duration of diabetes, high blood pressure and pregnancy. Pregnancy-induced progression of diabetic retinopathy can be sight-threatening.

The heart of the matter: cardiovascular disease

While pre-menopausal women without diabetes are protected from cardiovascular disease (CVD), women with diabetes lose the protective effect of female sex hormones. Consequently, CVD is the leading cause of death and disability in women with diabetes. However, by knowing and controlling the risk factors for CVD, one can do much to prevent or delay its development—even in this high-risk group.

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