Forum highlights acute health worker shortage

The WHO estimates that the world needs more than four million additional health workers, and 57 countries are suffering from an acute shortage. Sub-Saharan Africa is particularly affected by this crisis, with one million health workers needed for this region alone.

The crisis was the subject of the first Global Forum on Human Resources for Health, which called for immediate and sustained action to resolve the critical shortage of health workers around the world, setting out the essential steps that need to be taken over the next decade to turn the crisis around.

Nearly 1,500 participants, including donors, experts and more than 30 ministers of health, education and finance, endorsed the Kampala Declaration and Agenda for Global Action. The forum, held in Kampala, Uganda, and organised by the Global Health Workforce Alliance (GHWA), mandated the Alliance to monitor progress made on the Agenda and report its findings in 2010.

Dr Anarfi Asamoa-Baah, WHO Deputy Director- General, said: “Health workers are the cornerstone of health systems and action is long overdue. This forum and the Agenda bring much needed attention to the issue.”

The Agenda calls on all countries to give top priority to training and recruiting sufficient health personnel from within their own countries and to provide adequate incentives and better working conditions to ensure the retention of health workers. It calls on international and regional financial institutions to relax constraints such as public health recruitment ceilings, and calls on WHO to accelerate negotiations for a code of practice on the international recruitment of health workers.

“This is about much more than a health issue. It is about political choice. It is about quality of life and the dignity of individuals. Therefore, providing health workers for all is the responsibility of all societies and their governments,” said Dr Francis Omaswa, executive director of GHWA, which is based at WHO.

● For more information visit: Global Health Workforce Alliance


Oral microbiome database fills critical research need

Scientists have launched the first comprehensive database of the oral microbiome, which indexes the 600 distinct microorganisms currently known to live in the mouth.

Human Oral Microbiome Database (HOMD) is freely accessible online at <>. The database provides detailed biological entries for each species and an extensive catalogue of the thousands of genes that these microbes express.

According to Floyd Dewhirst, DDS, PhD, a leader of the project and a scientist at The Forsyth Institute which hosts the database, HOMD also introduces the first comprehensive nomenclature system to bring order to the naming of uncultured or previously unnamed oral microbes. The standardised numbering system helps to eliminate the Babel of confusing names and uninformative database designations that have frustrated scientists and sometimes hindered their research.

Lawrence Tabak, DDS, PhD, director of the US National Institute of Dental and Craniofacial Research said: “The HOMD fills a critical research need. The oral microbiome is extremely rich in data, and HOMD becomes the essential search engine for scientists to view and retrieve this information, generate novel hypotheses, make computational discoveries, and ultimately develop more biologically sound therapies to control oral diseases.”

The database also categorises each microbe by its 16S rRNA sequence, a distinctive fingerprint of genetic information that scientists have used for the past two decades to identify microorganisms. This sequence information allows the microbes to be placed in a family tree that shows how they are related to one another.


New TB test faster and more accurate

A new blood test could enable doctors to rule out tuberculosis (TB) infection within days rather than weeks, according to a new study published in March in the journal Annals of Internal Medicine.

The study, by researchers from Imperial College London and the University of Oxford, shows that doctors can determine that a patient does not have tuberculosis with 99% accuracy when using the new blood test, ELISpot-Plus, in conjunction with a skin test known as tuberculin skin testing, already in use.

TB is difficult to diagnose because many of its symptoms, such as fever, fatigue, and loss of appetite, are also commonly found in many other conditions. The combination of ELISpot- Plus and tuberculin skin testing is able to rule out TB within 48 hours, providing a much quicker result than existing testing methods, for which results take up to several weeks.

The new test combination could prevent patients who do not have TB from being subjected to further lengthy TB tests, and allow doctors to begin investigating other explanations for such patients' symptoms.

The new study showed that ELISpot-Plus alone was accurately able to determine TB infection in 89% of cases and tuberculin skin testing alone was able to determine TB infection in 79% of cases.

However, using both tests together was able to rule out TB infection with an accuracy of 99%. The ELISpot-Plus test works by detecting signs of a particular response that occurs when the immune system encounters TB infection. The test looks for a type of protein known as interferon-Y.

This is secreted by T cells in the immune system when they encounter antigens found in the bacterium mycobacterium tuberculosis, which causes most cases of TB. At present, the 'gold standard' for confirming whether or not a patient has TB involves growing cultures from sputum samples from a patient and analysing these cultures to see if they contain traces of mycobacterium tuberculosis.

This means that patients being tested for TB need to stay in hospital for three days, undergoing invasive procedures, to obtain necessary samples. They then wait for several weeks for the results.


Robotics in medicine gets shot in the arm

The Hamlyn Centre for Robotic Surgery - supported by the Helen Hamlyn Trust – has been set up at Imperial College London.

The centre will push forward the integration of robotics into medicine and patient care, with the aim of developing advanced robotic technologies that will transform conventional key-hole surgery, develop new ways of empowering robots with human intelligence, and create revolutionary miniature "microbots" that have integrated sensing and imaging for cancer surgery and treatment. Establishing this new centre has been made possible through philanthropic support totalling £10m from both the Helen Hamlyn Trust and Lady Hamlyn personally.

The Centre is to be co-directed by two UK pioneers in medical robotics, Professor Lord Ara Darzi who holds the Paul Hamlyn Chair of Surgery at Imperial College London and is an honorary consultant at Imperial College Healthcare NHS Trust and the Royal Marsden NHS Trust, and Professor Guang-Zhong Yang, Director of Medical Imaging at Imperial, supported by an interdisciplinary team of engineering and clinical scientists.

The funding initiates a major campaign to establish an international centre of excellence for medical robotics in the UK. Lord Darzi said: "Medical robotics and computer assisted surgery are used in a growing number of operating rooms around the world. This funding will allow the team to leverage our existing research programmes in pursuing adventurous, fundamentally new technologies that will allow more wide-spread use of robotics in medicine and patient care."

Professor Guang-Zhong Yang, who will be directing the basic sciences and engineering research of the new Centre, commented: "The need to perform delicate surgical procedures safely in tight spaces where the surgeon cannot see directly has created a growing demand for devices that act as extensions of the surgeon's eyes and hands.

This creates a unique opportunity of developing new robotic devices that build on the latest developments in imaging, sensing, mechatronics, and machine vision." He added: "The potential benefit of medical robotics to patients is exciting and one of the major focuses of the centre is to develop new technologies such as the 'perceptual docking' concept for seamless integration of machine precision with human intelligence to allow safe, ubiquitous applications of robotics in healthcare."


MDR-TB reaches highest levels ever

Multidrug-resistant tuberculosis (MDRTB) has reached the highest levels ever recorded, with an estimated 500,000 cases worldwide in 2006, according to a recent WHO report.

WHO emphasises that the response to the epidemic has been inadequate. “Given limited laboratory and treatment capacity, countries project they will provide treatment only to an estimated 10% of people with MDR-TB worldwide in 2008,” the WHO says in the report – Global Tuberculosis Control 2008.

The report finds that the pace of progress to control the tuberculosis (TB) epidemic slowed slightly in 2006, the most recent year for which data was available. Between 2001 and 2005, the average rate at which new TB cases were detected was increasing by 6% per year; but between 2005 and 2006 that rate of increase was cut in half, to 3%.

The reason for this slowing of progress is that some national programmes that were making rapid strides during the last five years have been unable to continue at the same pace in 2006.

There were 9.2 million new cases of TB in 2006, including 700,000 cases among people living with HIV, and 500,000 cases of multi-drug resistant TB (MDRTB). An estimated 1.5 million people died from TB in 2006. In addition, another 200,000 people with HIV died from HIV-associated TB.

As of this year deaths from a combination of HIV and TB are no longer classified as TB deaths, according to guidelines issued following a change in WHO classification of causes of death. Dr Margaret Chan, WHO Director- General, said: “We've entered a new era.

To make progress, firstly public programmes must be further strengthened. Secondly, we need to fully tap the potential of other service providers. Enlisting these other providers, working in partnership with national programmes, will markedly increase diagnosis and treatment for people in need.”

The Global Plan to Stop TB (2006- 2015), launched by the Stop TB Partnership ( in January 2006, sets forth a roadmap for treating 50 million people for TB. It aims to halve TB prevalence and deaths compared with 1990 levels by 2015.


New genomics centre to look at populations and disease

The US National Institutes of Health (NIH) has set up the NIH Intramural Center for Genomics and Health Disparities (NICGHD), a new venue for research about the way populations are impacted by diseases, including obesity, diabetes and hypertension.

NICGHD will employ a genomics approach, collecting and analysing genetic, clinical, lifestyle and socio-economic data to study a range of clinical conditions that have puzzled and troubled public health experts for decades.

The new director of the NICGHD, Charles N. Rotimi, PhD, an internationally renowned genetic epidemiologist, said: “The priority of our center will be to understand how we can use the tools of genomics to address some of the issues we see with health disparities.

“The availability of tremendous expertise and the remarkable research infrastructure at NIH will make our research activities more robust and will allow us to tackle questions in ways that were not feasible in the past.”

Building upon his previous research, Rotimi will continue efforts to develop genetic epidemiology models and population- genetics research projects that provide insights about the interrelationships of culture, lifestyle, genetics, genomics and health.


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