User:Sangmkim/sandbox

• Health in Cambodia The quality of health in Cambodia is rising along with its growing economy. Health reform of Cambodia in the 1990s successfully improved the health of the population in Cambodia, placing Cambodia on a track to achieve the Millennium Development Goal targets set forth by the United Nations.^[1] As a result of the reform, mortality rates significantly dropped. Similarly, life expectancy at birth in 2010 was 62.5 years, a 1.6 folds increase from 1980. On the other hand, there exists some problems that needs to be addressed. For example, in 2005, total healthcare expenditures accounted for 6.4% of GDP, the highest in Southeast Asia.^[2] In addition, in 2015, 61% of the total health expenditure had been estimated to be provided with out-of-pocket payments, which might be unaffordable to poorer segment of population in the country. ^[1] ·     Introduction o  Health Systems Context: a brief background of history, economy, and governance. § Cambodia gained its independence from France in 1953. Soon after, a coup d’état supported by the United States in 1970 brought down the government of King Norodom Sihanouk and installed an unstable republican regime, which was soon overthrown by the Khmer Rouge. The Khmer Rouge initiated an internal genocide that destroyed the economy and city, massacred intellectuals, and crumbled the country apart, resulting in total deaths of around 1.7 million people (21% of the population). The Khmer Rouge came to demise at 1989, and the United Nations took over to and sponsored a national election that supported numerous developmental agencies and nongovernmental organizations (NGOs) to come into Cambodia, which helped in the rebuilding of the country. § Cambodia is no longer a country of conflicts, as it has experienced a period of relative political stability in response to 1998 election. As a response to the political stability, the country has experienced significant and consistent economic growth. To be specific, Cambodia experienced gross domestic product (GDP) increase more than 7% per year. As of 2012, Cambodia has reached GDP per capita of USD $944, right on the verge of achieving the threshold for lower middle-income country status of USD $1035. (World Bank, 2014a) § Although the economy has been growing, the gains have not been equally distributed. Most of the income gain has been distributed exclusively to the urban population. (World bank, 2014a) o  Health Care Inequality § Inequality in health care persists between people of different socioeconomic backgrounds, prominently contrasted between the rural and urban population. According to the CDHS data in 2010, the rate of children under 5 with moderate to severe malnutrition or with acute respiratory infection was more than twice as high in children living in rural areas compared to those living in urban areas, as well as children in lowest quintile household compared to those in highest quantile household. o  Life expectancy Average life expectancy at birth was determined to be about 71.4 years in 2012. Specifically, the average life expectancy for females has been 74.2 years, and the average for males has been 68.8 years. This is a significant, more than two times longetivity increase from only 29.6 years in 1980. o  Dual Burden of Disease § Dual Burden of disease refers to the prevalence of both infectious and chronic disease in each population, mainly due to shifts in diet and physical activity pattern in response to globalization, especially in the low and middle countries. (cite a study about dual burden of disease in Cambodia) Currently, rate of non-communicable diseases occurring in Cambodia has been rising, and mortality due to non-communicable increasingly matching up with the number of death due to infectious disease. § Such dual burden/epidemiological transition from infectious to chronic disease burden has been identified, as the burden death due to infectious disease has shifted towards deaths due to injuries and chronic diseases, bush as cardiovascular disease, cancers, and respiratory diseases. § Malnutrition remains to be a major risk factor for children’s health. Childhood stunting, wasting, and underweight due to malnutrition remains to be a problem in Cambodia (NIS, 2011) § Obesity has been an important World Health Organization (WHO) (2006).The impact of chronic disease in Cambodia. Geneva: WHO (Facing the Facts) (http://www.who.int/chp/ chronic_disease_report/cambodia.pdf, accessed 6 June 2013 ·      World Health Organization (WHO) (2011a). Non-communicable diseases § Mortality data suggests emerging burdens specifically from injuries (traffic accidents), high blood pressure, heart disease, and liver cancer. § World Health Organization (WHO) (2011a). Non-communicable diseases ·     Common Health Problems o  Infectious Diseases § Acute respiratory infections remain the leading cause of reported death due to infectious disease. (WHO 2011b) § Tuberculosis ·     Tuberculosis incidence and prevalence declined significantly, and within just 20 years from 1990 to 2010, the incidence rate declined by 25%, and the prevalence rate declined by 48%. Efforts through active screening, such as outreach activities conducted by the National Centre for Tuberculosis and Leprosy Control (Mao et at., 2012), and introduction of directly observed treatment short course (DOTS) in 1990s drastically (Wong et. al., 2013) drastically reduced burdens due to TB in Cambodia. § Malaria ·     Malaria remains to be an endemic in the rural Cambodia, affecting more than 3 million people. Although the reported cases of malaria and malaria mortality have decreased, since the disease is more prevalent in the rural areas where there are no public health facilities that keeps track of the numbers, the actual number of cases are expected to be much higher. (NMC, 2013) § Dengue fever ·     Dengue fever is especially prevalent among children in between 4 to 6 years old, living in urban Cambodia. Dengue fever was introduced in Cambodia in 1980, the incidences have been increasing since then. However, the case fatality rate has decreased from 15% to 0.3% from 1980 to 2010 (NCPEMC, 2011) § HIV/AIDs ·     HIV emerged as a major infection affecting the lives of approximately 2.4% of the population in the 1998. Major public health work has been done to reduce the prevalence rate through implementing education and promoting safe sex via condom use targeted to specific population who are the cores of the infection web, including commercial sex workers, injecting drugs users, men who have sex with men. Some of the interventions implemented include awareness of safer sex and condom use campaine, universal access to HIV testing, and prophylaxis to HIV positive mothers to reduce mother-to-child transmission of the virus. o  Chronic Diseases § Diabetes ·     A survey from MOH done in 2010 indicated that 2.9% of population among adults aged 25 – 64 years had diagnosed diabetes. § Hypertension ·     Similar, 11.2% of the population among adults aged 25 – 64 years self-identified as having been diagnosed as having high blood pressure. [MOH, university of health sciences, WHO, 2010] o  Injury § Since 1996, reported incidences of death due to injury have increased drastically in corollary to increasing number of vehicles. According to the health data from MOH, being male and being a motorcycle rider contributed most significantly to the burden, accounting for 80% and 67% of all mortalities due to injuries in 2010, respectively. o  Child Health § Prematurity, pneumonia, birth asphyxia, diarrhea, and injuries remain the top 5 killers of children under 5 years of age in Cambodia. (who1013b). Notably, the rate of diarrheal disease and measles decreased significantly in response to high vaccination coverage campaign set forth by the Ministry of Health. ·     Public Health in Cambodia o  Unsafe drinking water and lack of sanitation facilities are major risk factors of infectious disease, especially diarrhea. However, such sanitary conditions have been improving since the 1990s with the economy and governance of the nation. Specifically, in 2010, it was estimated by the WHO that around 64% of the households were able to receive safe drinking water, with urban counterparts of the country receiving higher rates (87%) of improved water than the rural counterpart (58%) [WHO 2013] o  Humanitarian & Health aids Organization and Governance § Ministry of Health (MOH) ·     Ministry of Health in Cambodia has been taking the leading role in improving the health of the people in Cambodia. Established in 1990s when help from the NGO and external government aids were welcomed in Cambodia after the relative political stability. Thanks to the MOH, public health administration governance has been centralized and organized so that decisions and actions are facilitated to act quickly and critically in response to public health problems. Specifically, the MOH follows the current Health Strategic Plan 2008-2015 to better the health of the nation. o  Governmental Subsidies § Under the supervision of Cambodian Ministry of Health, governmental health facilities are reimbursed for treatment of the low-income patients. In 2012, it was estimated that subsides were given to around 25,000 inpatients and outpatients, with total expenditure adding to USD $285,000. (Men et al., 2011) However, such governmental infrastructure is not available in the rural provinces: NGOs take bigger roles in the rural healthcare setting in Cambodia. ·     Region (Province) specifics
• Harvard Medical School (HMS) is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts. The school has a large and distinguished faculty to support its missions of education, research, and clinical care. These faculty hold appointments in the basic science departments on the HMS Quadrangle, and in the clinical departments located in multiple Harvard-affiliated hospitals and institutions in Boston. There are approximately 2,900 full- and part-time voting faculty members consisting of assistant, associate, and full professors, and over 5,000 full or part-time, non-voting instructors.

Curriculum[edit | edit source]

In 2015, Harvard introduced the new "Pathways" curriculum, an approach which combines the problem based learning approach developed at McMaster University Medical School, with more student centered electives after core clerkship. This most recent revision to the curriculum "foster active learning and critical thinking; earlier clinical experience; and advanced clinical and student-tailored basic/population science experiences that will provide customized pathways for every student." Prior to 2015, Harvard had utilized the "New Pathway" curriculum, which was mainly centered on problem based learning.

Foundational Pathways - Years I & II

For their first and second years of medical education, HMS students are taught the basic scientific knowledge that will become the basis of specialized mastery pertaining to the field. Subjects within such category include: fundamentals of anatomy, histology, biochemistry, and molecular and cellular biology; genetics; immunology; and introductory pharmacologic principles. There are two courses that were added to this introductory period with the advent of "Pathway" curriculum, and they are "Foundation and Immunity in Defense and Disease," which serves as foundations for further study of the organ systems.

After having built the foundations on basic sciences, students then receive educations focused on fundamental social and population sciences - "health care policy, social medicine, clinical epidemiology and population health, and medical ethics and professionalism," shedding lights on non-scientific aspects of clinical care that are thought to be vital in becoming a successful healthcare providers. Then, the remaining pre-clerkship curriculum focuses on education of the organ systems, with organ-system-based modules - "Homeostasis I and II and Mind, Brain, Behavior and Development, anatomy, physiology, pathophysiology, pathology, pharmacology, imaging, and nutrition."

In addition to the academic didactics, the students engage in longitudinal clinical course, "The Practice of Medicine," integrated with basic and social sciences courses that introduces the students to practical clinical skills such as "patient-doctor communication, the physical exam, the dynamics of working in clinical teams and systems, and the process of developing a differential diagnosis." The "Pathway" curriculum finally exposes HMS medical students to clinical exposure through Principal Clinical Experience into Year II.

Advanced, Tailored Pathways - Years III & IV

In their third and fourth years of medical school, students are allowed to customize their route through the rest of the curriculum, following their passion and specializing in an area within medicine that attracts their curiosity and passion. In addition, the curriculum offers more advanced and rich scientific educations to the students in their third year, now prepared to digest these rigorous information and integrate them into the clinical perspective, with their previous exposure to clinical practice through earlier Principal Clinical Experience. The third and fourth years are laid out for students to "take advantage of myriad opportunities across Harvard University and around the world."

The Harvard-MIT Division of Health Sciences and Technology (HST) offers an alternative MD program with a stronger emphasis on biomedical research. The HST MD program is significantly smaller than the Pathways program, accepting only 30 applicants every year.

• Today, I am going to edit an article one the "White Man's Burden"
• I decided to change my topic to "Harvard Medical School" because I have been very into them lately.

Is each fact referenced with an appropriate, reliable reference?

         No. However, overall, it seems that the article definitely lacks enough references. In total, there are only 20 references, and about half are from news articles that could be based on subjective opinions. However, the topic itself deals with very factual information, so the references seem relatively reliable.

Is everything in the article relevant to the article topic? Is there anything that distracted you?

-Everything seems to extent relevant to the article topic. They did not have much subjective voices to the writings. Mostly deals with factual information.

One thing that distracted me was that they had an extensive list notable alumni section that is perhaps longer in view than that of other sections with writings. I felt either the list should occupy less space of the article or details should be added to both the sections already existing and new sections.

Is the article neutral? Are there any claims, or frames, that appear heavily biased toward a particular position?

The article is overall very neutral, but as we have learned from readings for the class, this article as a medium could “hide some aspects of HMS, and highlight other qualities” that could potentially result in biased impression of the school. For example, under the Student Life section of the page, they only discuss about second-year show and societies. In addition, the article seems to give a heavy focused impressions on the global aspects of the school, whereas I am pretty sure HMS has significant beneficial impacts on the community and within the country.

Where does the information come from? Are these neutral sources? If biased, is that bias noted?

These information come from variety of resources, many of which are newspaper articles that may not be so neutral. However, there does not seem to be much bias visible in the writing.

Are there viewpoints that are overrepresented, or underrepresented?

Yes, as mentioned above, I feel like most of the information presented is underrepresented. There just is not enough information. However, the notable alumni section seems to be overrepresented, potentially biasing the readers of the magnitude of greatness of the school.

Check a few citations. Do the links work? Is there any close paraphrasing or plagiarism in the article?

I checked up most of the citations because there were not as much. Some does not work (deleted articles from the news journals) Some links are books, which are not accessible through links. Some are directly from Harvard medical school homepage. There were little signs of plagiarism because the newspaper sources are translated into historical context in the Wikipedia page.

Is any information out of date? Is anything missing that could be added?

The information is not out of date. This article in Wikipedia is created 2013 and there have been revisions until now. However, I feel like I would be able to add much more information that could give more comprehensive view about Havard medical school. Since the article covers very little aspects of HMS, I would add more sections, and also build on the previous sections such as History, and Student Life with proper citations. The introductory section needs more citations more than anything because it lacks any citations.