These laws have been set up to protect people who live in some countries having a large number of expatriates or immigrants, and the AIDS carriers play an important role in the transmission of HIV Whitman, n. This means that the loophole in the government policies can make people feel disappointed with the government.
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It is shown that government should take measures instantly. According to Wagner and Amato , in spite of the number of Central American migrants crossing Mexico to reach the United States has decline almost 70 percent over the last five years, it does not show that is an optimistic condition, however, the local government does nothing, although they were aware of this outcome.
This shows the governments need to restrict the illegal immigrants. Another political factor is the lack of political control of blood transmission.
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For example, governments in developing countries do not pay attention to the safety measures and disinfections in the hospitals. This means many people can easily get infected by sharing syringes or using dirty needles. According of a WHO , there are 21 million hepatitis B injection, 2 million hepatitis C injections and , HIV cases caused by reuse of syringes.
In addition, people in some communities, do not know about the risk given by the re-use needle. Government should apply strict control on the hospitals. In Russia, the government uses some political force to protect people. Russian government should do much more to prevent the spread of HIV among an estimated two million drug users Galpin, It is believed that there are 1 million people getting HIV by sharing the needles Galpin, This proves that the governments need to make the law firmer and strengthen the control. The other factor causing HIV is the psychological status. Psychological factors contribute to the spread of HIV among women.
Women, especially in urban areas, experiencing some psychological health matters or traumatic events take up a high proportion of HIV transmission such as sexual behavior, injection drug use etc. Heavy psychological stress may result in unhealthy mental status. Women, who have been abused, are likely to suffer from mental diseases, for instance, posttraumatic stress disorder PTSD which may affect their behavior and attitude towards HIV Sharp et al. For example, women who have personal traumatic experiences are more possible to have high risk sex that can enlarge the possibility of HIV infection Sharp et al.
It is also mentioned by Sharp S. That means some individuals who are infected HIV are frantic and they are not aware the consequences. Due to this behavior, they will probably become HIV infected and transmit the virus to others.
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However, the Canadian aboriginals not only use drugs themselves, but also contract HIV from their sexual patterns who injecting drugs Sharp et al. In summary, women who have psychological matters need to be treated and informed about the risks or the illness. Moreover, chronic anxiety, panic, stress and depression can lead to injure immunologic function which has an impact on HIV. Mental stress increases the content of hormone cortisol, more cortisol in the body decline T cells rapidly.
In the relation to this cortisol will increase fold than normal period. This high level risk may result in dangerous infections and high rate of death. Some people have AIDS-phobia and they do not have medical checks and thus they are not aware of the fact they carry the virus. The symptoms of that type of phobia include weight loss, wasting, decrease T cells counts and other signs considered indicative AIDS. Professor Dorian also thinks that a beneficial psychological status can have a positive result for a disease The Unhived Mind Website, Above all, both psychological diseases and conditions can affect HIV, people in urban areas especially women have a high rate of infection.
That means psychology has a significant effect on HIV. Student feedback is compulsory through Likert Scale scores but all have the option to provide free text, which students did. These were analysed for themes. A sample of 58 essays were selected and analysed. The majority of the essays were well written and focussed on a particular global health topic within low, middle or high income countries and synthesised this in relation to a number of Johnson et al LOs. There was a wide selection of countries mentioned, with the majority of lower income countries discussed focussing on Africa and the most common high income countries discussed included the UK and the USA.
A minority of students chose to compare a global health issue between different high income countries, for example Ireland and the USA. The majority of students used this short essay to discuss GH as directed rather than restricting themselves a summary of their elective, only 13 students explicitly limited themselves to this approach. It should be noted that all students are required to submit an elective portfolio with their detailed elective plans and preparation separate to the GH essay. There was good coverage of most of the global health themes from Johnson et al Johnson et al.
The most frequently covered LOs were Global burden of disease; Socioeconomic and environmental determinants of health; Cultural diversity and health; Global health governance and Health systems. Within the LOs of Global burden of disease there was a wide coverage of global epidemics and diseases including both communicable and non-communicable diseases.
Some essays also discussed the practice of open defecation in India, focussing on the cultural determinants and its impact on disease spread. There was a wide coverage of non-clinical determinants of health across the essays which included discussion of environmental, social, cultural, educational and gender factors.
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The theme of women as a vulnerable group with particular health needs in LMIC was a recurring theme, particularly with regard to FGM, reproductive health and increased vulnerability to contracting HIV. Cultural diversity and health was explored through a range of topics including FGM, migrant populations within Western society and the reliance on traditional healers versus Western medicine in certain LMIC.
Many of the essays were able to demonstrate an awareness of the complexity of global health governance and mentioned the roles of international organisations. Some of the essays made a specific reference to global health and its importance to undergraduate medical education. Many of the essays focussed on the issue of poor access to healthcare in LMIC, focussing on the aspiration of universal health care for all. Students recognised that these differences between healthcare systems were determinants of poor health in LMIC compared to high income countries.
A minority of the essays made a comparison of public versus private healthcare systems between high income countries. These focussed on the themes of efficiency versus expenditure between the two systems and variable outcomes, often linked to morbidity and mortality data, in different aspects of public and private systems. These focussed on health inequalities in vulnerable groups such as women and children LMIC and minority migrant populations within high income countries.
Although many of the essays mentioned the World Health Organisation WHO , they did not expand on this or specifically discuss the role of WHO as an international representative of national governments for health. Free text feedback from students was analysed, with emerging themes being mixed between positive, neutral and negative. More than third of these students 46 were very positive about the assignment, which they had found useful, interesting and had enjoyed the essay format of the assessment.
Most were positive and some students indicated there should be more global health teaching in the curriculum and a few felt that the word limit had been too restrictive to write an insightful essay with any depth. A minority of students felt that the assignment had been a distraction from clinical learning. This research has demonstrated that an essay assignment is an appropriate means for assessing a wide range of global health learning outcomes as described by Johnson et al. However, a minority of themes are not easily assessed by essay format and demonstrate the importance of diverse learning methods for students to achieve all global health competencies.
Although not formally assessed in the elective placement, these outcomes would be implicit in the overall experience of students undertaking their elective placement. The data was coded independently, without any knowledge of the student cohort, their awarded marks and neither has the researcher attended any symposia, although she had access to the materials. Historical analysis of the cohorts from and presentations at conferences relating to the previous work was shared with her. This is a large medical school so a rich and varied student cohort, with their own varied learning trajectories, life experiences and aspirations, enabling students to draw on a broad base to complement symposia.
This is a relatively high stakes assignment as it contributes to the final ranking for graduate job applications Foundation year 1 and 2 in UK , and failure in this component could result in lack of progression for some students. This may be a strength in that students endeavour to gain a competitive grade in this assignment.
Equally with data from one school, and therefore a single institution focus, what the implications are for a wider uptake of short essay writing on GH needs to be tested. This paper focused just on the one cohort of medical students as it was not feasible or practical to combine all the data, in part because the symposia content and pedagogy evolved over time. It focuses on an assignment but details of symposia content and process are not described.
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Apart from the demands of marking, such as time, standard- setting, coping with diversity of content, both the markers and students found this acceptable and not onerous. These are the technicalities rather than the academic value but nonetheless need to be an integral part of curriculum management. Students live and work in diverse settings, with populations from many backgrounds, particularly in urban settings and conurbations such as capital cities in Western Europe and North America.
Regardless of elective plans it will be important to prepare junior doctors to deal with individual clinical patient needs and to appreciate how management plans will be implemented in the patient context, to possibly be advocates for patients and to be aware of the local health needs of the population in which they work.
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GH, an emerging epistemology, is likely to have increased content and dedicated time in future curricula but it will be important to have clarity about rationale, level, content, learning outcomes and assessment. There should be ongoing reviews about assessing learning needs as GH becomes more explicit in various other aspects of curricula and reviewed for pragmatic reasons such as the student load, crowded curricula, the faculty demands as well as providing an appropriate curriculum to prepare junior doctors.
At the time Elsabagh et al did their funded elective project in Vanuatu they were already aware of the challenges emerging about malaria prevention generally and specifically in that local area and able to design and conduct a pragmatic and context specific study. Not only did they prepare their proposals, conduct the study but additionally were able to publish their work. Being able to write well is a skill all graduates should have, especially when articulating the complex concepts associated of GH.
Our experiences have shown that public health and social sciences are essential and may be the basis of GH teaching. GH is not international health Peluso et al. The Johnson et al themes Johnson et al. She has presented related research at many international conferences. Bhutta, Z. Personal Vignettes. Personal Vignette 1: Connected in El Salvador.
Personal Vignette 2: Inequity at a Guatemalan intersection. The authors very much appreciate this financial support. None of the funding institutions had any role in the preparation, review, or approval of the manuscript. The views expressed in this commentary are those of the authors and do not reflect those of any institution. National Center for Biotechnology Information , U. Published online Oct Author information Article notes Copyright and License information Disclaimer.
Corresponding author. William B Ventres: moc. Received Apr 3; Accepted Oct 6. This article has been cited by other articles in PMC. Abstract Background There is a growing understanding of the role social determinants such as poverty, gender discrimination, racial prejudice, and economic inequality play on health and illness.
Summary Introspective reflection can help professionals in global medicine and public health recognize the dynamic roles that they play in the world.
Background The influence of social determinants on global health has been well documented [ 1 ],[ 2 ]. What do we make of the immense divisions that exist between and within societies? Discussion Asking questions in global health education and practice Common questions can be asked of all those engaging in the work of global medicine and public health.
Do we sense fear or anxiety in ourselves? Cultivating a personal consciousness Our responses in turn depend on how feelings and thoughts inform our values. Developing an introspective gaze in global health What new understandings might such an introspective gaze offer us? Summary As we work to ameliorate inequities and improve health outcomes, we as educators and practitioners in global medicine and public health confront many challenges. Competing interests The authors declare that they have no competing interests.
Additional file. Supplementary Material Additional file 1: Personal Vignettes. Click here for file 29K, doc. Why justice is good for our health: the social determinants of health inequalities. Structural violence and clinical medicine. PLoS Med.
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