An ecological framework for improving child and adolescent health.

The rise in non-communicable disease as a principal cause of premature mortality and a continuing failure to address health inequalities requires a critical examination of prevailing paradigms in health. In this paper, we offer ecology as an alternative way to view health need and as a guide to action to enhance human health and model a healthy economy. After describing the shortcomings of the prevailing biophysical approach to health, we describe an ecological approach to health that brings to the forefront social and environmental determinants and empowers health workers together with their communities to achieve a health-affirming society and economy.

Essential surgery: the way forward.

Introduction: Very little surgical care is performed in low- and middle-income countries (LMICs). An estimated two billion people in the world have no access to essential surgical care, and non-surgeons perform much of the surgery in remote and rural areas. Surgical care is as yet not recognized as an integral aspect of primary health care despite its self-demonstrated cost-effectiveness.

Initiating and developing clinical services, training and research in a low resource setting: the Malawi ENT experience.

Background: Sub-Saharan Africa countries like Malawi have a paucity of ear, nose and throat (ENT) data, services and training opportunities.

Objective: To reflect on new Malawian ENT experience and to propose guidelines to poorly resourced countries.

Design: Analysis of data predating and following establishment of ENT services in Malawi.

Diagnostic biopsy of lymph nodes of the neck, axilla and groin: rhyme, reason or chance?

Introduction: Improving patient pathways of care is becoming increasingly important in the delivery of timely, appropriate surgical care. With this aim, we analysed the referral and management pathway of patients undergoing diagnostic superficial lymph node biopsy.

Patients And Methods: A retrospective review of case notes of patients undergoing diagnostic superficial lymph node biopsy over 3 years, 1998-2000 at the Bradford Hospitals NHS Trust.

Dysphagia with a thyroid nodule: is there a primary aerodigestive malignancy?

Three cases of laryngopharyngeal primary squamous cell carcinoma presenting with thyroid nodules are described. The key message to take away from these cases is that patients with advanced malignancy of the upper aerodigestive tract can present with a thyroid nodule.