|13 October 2004
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Due to the length of this story, Part 1 was published in the previous issue.
To gain firmer control of the country, Kabila expelled Rwandan troops in 1998, but this prompted mutinies by the army and drives by Rwanda and Uganda and rebel groups to overthrow him. The Congolese army and Rwandan Hutu militias, and within half a year the armies of Angola, Namibia, Chad, and Zimbabwe, came to his government's defense, leading to Africa's worst ever war, which some have called Africa's first world war. Control of diamond mining may have provided part of the motivation for so many factions to enter the war. Most of the fighting took place in eastern DR Congo between 1998 and 2001. Since then, a series of peace accords helped reduce tensions, and most foreign troops left the country in 2002, although sporadic violence still continues. The United Nations Mission in the Democratic Republic of Congo (MONUC) has several thousand peacekeeping troops in the country, most of which are contributed by Uruguay, South Africa, Bangladesh, Nepal, and Pakistan, and has an annual budget of $600 million to attempt to prevent fresh outbreaks of violence, disarm militia members, and facilitate humanitarian aid.
According to a survey by the International Rescue Committee, which compared death rates in the war-torn eastern part of the country with those from the relatively peaceful west, about a third to a half million of the excess deaths in the east were violent, while most of the rest were from infectious diseases induced by war-related displacement, severe poverty and social disruption. Fever and diarrhea caused about a third to a half of deaths in the survey.
The country is currently led by Joseph Kabila, the son of Laurent Kabila, who was assassinated by his bodyguard in January 2001. National elections scheduled for July 2005 would be the first since independence from Belgium in 1960.
As high demand has bid oil past $50 a barrel, Saudi Arabia's oil minister said it may raise supply by 3 million barrels/day in 2 years.
A recent survey by condom maker Durex reported that people have sex an average of 103 times per year. The company conducted the survey by internet, which might have skewed the results. However, other studies gave similar results, such as a home interview study of 40-70 year old men in Boston, USA, who reported an average sex frequency of 78 times per year. The results of the Durex survey varied by country, from the most active France at 137, China at 90, India at 82, to the least active Japan at 46.
Remarkably, although Chinese and Indians had sex with similar frequency, they were at nearly opposite ends of the international spectrum in number of partners, with Chinese claiming the most of any country, at 19.3, and India near the least, at 3.7. The average was 10.5. Fortunately for AIDS control efforts if the survey is accurate, Chinese claimed below average rates of unprotected sex, with only 31% admitting ever having unprotected sex without knowing their partner's sexual history.
Heart disease has been the leading cause of death in the United States for over 80 years. But since the 1960s, the death rate for coronary heart disease (CHD), the major form of heart disease leading to death, has steadily and dramatically declined in the US, where CHD now kills nearly one million fewer people annually than would have been expected had the rate remained at its 1960s peak. Further progress is now threatened by rapidly growing obesity and diabetes, while in the developing world the number of CHD deaths is rapidly rising as the population ages and as lifestyle and diet become westernized. Yet the reduction in heart disease in the US remains clearly one of the greatest successes in public health.
The remarkable progress against CHD began with research decades ago. Landmark epidemiologic investigations, including the Framingham Heart Study, which has followed the health of thousands of residents of the town of Framingham, Massachusetts since 1948, and international comparisons by Ancel Keys, helped determine the major risk factors which are so familiar to us now: smoking, high blood cholesterol, high blood pressure, diet (eating too much fat, cholesterol, and sodium), obesity, and lack of exercise.
The US coronary heart disease death rate (shown per 100,000 people per year) has declined from the peak rate of 1968.
Studies in the 1960s then looked at whether actively lowering risk factor levels would reduce CHD risk. In the following decades, clinical trials demonstrated the efficacy of drugs to reduce blood pressure or cholesterol levels. Public health interventions to reduce heart disease were two-pronged: both deep, aimed at high-risk people, and wide, aimed at the entire community. The National High Blood Pressure Education Program, begun in 1972, and the National Cholesterol Education Program, started in 1985, used this dual approach and targetted doctors, patients, and the general population.
Smoking policies were implaced, millions quit smoking, diets changed, and screening for and treating hypertension and high blood cholesterol became common. CHD detection, treatment, and care improved over time, with more heart disease specialists, more emergency heart attack services, an increase in coronary-care units, and new drugs for controlling blood pressure, blood clots, and cholesterol. As a result:
In addition, research has identified new risk factors, such as blood levels of homocysteine, fibrinogen, and C-reactive protein, that are starting to be used to identify high-risk people for early prevention. However, heart disease is still the number one cause of death and of disability in the US, due to multiple factors. Most people with hypertension do not have the condition controlled at levels below 140/90 mm Hg. Risk factor levels and death from CHD are relatively high among poor people. In addition, the prevalences of obesity and of diabetes, which increase heart disease risk, have increased among both children and adults.
Although CHD death rates are higher in developed countries, most cases actually occur in developing nations, where the rapidly growing and aging population are increasing the pool of people at risk for heart disease. At the same time, rising incomes allow people to reduce physical activity, eat more fatty diets, and smoke more. As a result, CHD is projected to jump from the world's 5th greatest contributor to overall disease burden (a combination of death and disability) in 1990 to the number one contributor by 2020. It is now a race against time to apply the lessons already learned in the fight against CHD to the global war on heart disease.
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