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PubMed1984

The economics of parasitic diseases: research priorities.

Parasitic diseases are primarily diseases of poverty. At serious risk are individuals, communities and countries least able to afford the costs of treatment or prevention. In turn, economic development projects which aim to increase income levels may lead to negative results because of increased transmission of parasitic diseases often results. In attempting to analyse the economic consequences of parasitic diseases and the economics of their control, economists have usually relied on the tools of cost-benefit analysis, cost-effectiveness analysis and financial analysis. These efforts are briefly reviewed in the paper. The results have been subject to considerable criticism because of conceptual and methodological problems. For example, most studies have not taken into account the epidemiology and natural history of the disease in estimating the associated economic losses, thereby leading to inappropriate conclusions. The UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases through its Social and Economic Research Scientific Working Group (SER-SWG) is promoting research on the economics of parasitic diseases. In an attempt to improve the usefulness and reliability of such studies, conceptual and methodological approaches have been suggested which are reported on here. To improve the research design of these projects, a conceptual framework is proposed which consists of four components: (1) baseline social, cultural and economic conditions influencing disease transmission; (2) resources already invested in the health system and investments in other related sectors such as agriculture, housing, water supply and sanitation; (3) health consequences resulting from (1) and (2); and (4) social and economic consequences resulting from (3). A key concern in relation to the framework is to determine the most useful basis for linking results from studies of one component to another so as to analyse more systematically the impacts of disease on individuals and society. Such studies are inherently interdisciplinary and close collaboration of economists with medical scientists and disease control programme staff is needed to ensure completeness and reliability of input data and results. Results from these studies could be used to inform national decision-makers about the social and economic consequences of the parasitic diseases and their control and, thus, should strengthen support for increased investment to reduce the parasitic disease burden in developing countries.

Communicable Disease Control↗

PubMed1992

Life after divorce--a five-year follow-up study of divorced middle-aged men in Sweden.

Twenty-seven men, between 35 and 49 years of age, were asked via a questionnaire for information about their life circumstances (housing and working conditions, economic situation), actual symptoms, perceived health and health-related behaviour 5 years after they had divorced. The information was compared to corresponding data from an earlier study carried out within 7 months after the legal divorce. Housing conditions and personal economy had improved and working conditions were still satisfactory. Perceptions of health were more positive and in particular earlier, frequently recorded psychological symptoms (uneasiness, anxiety, depression) had diminished. Alcohol and smoking habits remained unchanged and common, especially among manual workers with more than one divorce. Men living in a stable relationship with a new partner or who had custody of children had fewer social and medical problems than men living alone. These findings support the connection between social support and health.

Adult↗

PubMed2006

Effect of wealth inequality on chronic under-nutrition in Cambodian children.

The problems of food insecurity and under-nutrition remain particularly severe in countries recovering from recent wars or civil unrest, where improvements in economic conditions have tended to benefit the advantaged groups and resulted in widespread inequalities in health. Using information on 3235 children aged 0-59 month(s) included in the 2000 Cambodia Demographic and Health Survey, this study examined how economic inequality was associated with inequalities in chronic childhood under-nutrition. An under-nourished (stunted) child was defined as having his/her height-for-age more than two standard deviations below the reference median. Household wealth status was measured by an index based on household ownership of durable assets. Binary and multinomial logistic regressions were used for estimating the effects of household wealth status on moderate and severe stunting. The results indicated that children in the poorest 20% households were more than twice as likely to suffer from stunting as children in the richest 20% households (odds ratio [OR]=2.54; 95% confidence interval [CI] 1.91-3.39). Adjusting for child's age, sex, birth order, and duration of breastfeeding; age of mother at childbirth, body mass index, and education; and household access to safe drinking-water, hygienic toilet facility, residence, and geographic region made little difference to this effect (OR=2.05; 95% CI 1.28-3.28). The adjusted effect of wealth status was somewhat stronger on severe stunting (relative risk ratio [RRR]=2.26; 95% CI 1.22-4.18) than on moderate stunting (RRR=1.89; 95% CI 1.12-3.20). The study concludes that wealth inequality is strongly associated with chronic childhood under-nutrition and emphasizes that reducing poverty and making services more accessible to the poor will be key to improving the health and nutritional status of children in Cambodia.

Cambodia↗

PubMed1991

[HIV/AIDS in Eastern Europe epidemiology, prevention and control].

During recent years, in the eight countries of Eastern Europe (Albania, Bulgaria, The Czech-o-Slovakia, Hungary, Poland, Romania, USSR and Yugoslavia), the health situation has stagnated, or, in some areas, even deteriorated. The development trend of some common diseases and of risk factors emphasizes the uneven health development in Eastern Europe, and the increasing gap between health conditions in Eastern and Western Europe. The spread of the Human Immunodeficiency Virus (HIV) started relatively late in Eastern Europe, but has recently increased markedly in several countries. Partly as a result of the rapidly changing social and economic conditions in Eastern European countries, a dynamic expansion of this epidemic is taking place, and a sharp increase in the number of people infected with HIV may be expected over the next years. Intensive cooperation between WHO and the individual countries in Eastern Europe has been initiated in the fields of health promotion and disease prevention. One element of this cooperation has been to produce comprehensive National Aids Control Programmes in all these countries. External support of the Aids Control Programmes in Eastern Europe can help to prevent a rapid development of the HIV epidemic, and, in addition, have a catalytic effect on the development of all aspects of the primary health service in these countries.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Video lottery terminal access and gambling among high school students in Montréal.

BACKGROUND: Gambling is a risky behaviour that involves uncertain financial outcomes, can be addictive, and has been associated with strongly adverse social and public health outcomes. We wanted to assess whether socio-economic and gambling-related-opportunity environments of neighbourhoods affected the uptake of video lottery terminal (VLT) gambling among Montréal youth. METHODS: Spatial and statistical analyses were conducted to examine geographical patterns of neighbourhood socio-economic conditions, VLT sites (n=407), and high school locations (n=305) within the Montréal Census Metropolitan Area (CMA). VLT concentration within high school neighbourhoods was measured to examine how the number of VLT opportunities varies according to socio-economic status of the school neighbourhood. A student survey was analyzed using logistic regression analysis to explore the role of individual (student) characteristics and environmental (neighbourhood) characteristics in predicting the VLT gambling behaviours reported among a sample (n=1206) of high school students. RESULTS: Video lottery gambling opportunities are more prevalent near schools located in socio-economically deprived neighbourhoods compared with schools located in more affluent neighbourhoods. The principal individual risk factors for VLT gambling were shown to be male sex, peer VLT-use, substance use, as well as the after-school routines of youth. INTERPRETATION: The spatial distribution of VLTs reflects local geographies of socio-economic disadvantage and may have a pronounced impact on students attending schools in lower income neighbourhoods, especially those with individual risk factors. Efforts to reduce gambling-related public health costs may want to take into account the socio-spatial distribution of gambling opportunities, particularly in the local environments that youth frequent.

Adolescent↗

PubMed1993

[Current state and problems in the microbiology laboratory--organizing the laboratory].

The microbiological laboratory in the hospital has many roles including the rapid and precise identification of pathogenic bacteria in specimens, their antimicrobial susceptibility tests, microbial antigen detection using immunological methods and DNA hybridization methods, surveillance of bacterial milieu of the hospital environment, monitoring quality control of microbiological methods, to educate microbiological skills of staffs, the economical management of laboratory and so on. The last two issues are our major concerns. Improvement of the microbiological skills of the staff is most important in the laboratory, but is a time-consuming. From our experience, a technical expert, intermediately skilled technicians and beginners should always work in the laboratory, together. On the other hand, the economical management of the microbiological laboratory is also another concern. Although the mechanization of procedures comes to mind, it is hard to improve the economical conditions in the laboratory. Because of the control of the machines is not completely automatic and requires the knowledges and decisions of technical experts, the work force and running cost can not be reduced. As the technical expert can economize in the use of media or tests for identification of pathogens, good training of beginners into skillful successors, is important.

Humans↗

PubMed1994

[Child health in our world].

The health of children in poor countries is determined by their nutritional status and by the economic conditions of their families and societies. Socioeconomic differences are correlated with the infant mortality rate (IMR). The decline of the IMR in the industrialized countries mainly occurred before 1960. Programs for Primary Health Care cannot cope with the deterioration of economic problems due to the disadvantaged position of the poor countries in the world market. The typical clinical pattern of diseases in childhood in the tropics is essentially determined by the nutritional status (e.g. measles). The advantages of breastfeeding also relate to the immune response after immunization. The HIV-epidemic requires social assistance for the future of the AIDS-orphans in the first line. Additional assistance is needed for the procurement of medication, otherwise HIV-infected patients are in competition with non-HIV-infected patients.

Acquired Immunodeficiency Syndrome↗

PubMed1991

[Standardization of work in public health services].

Data are provided on labour norms, their functions and practical application at public health institutions. The role of labour norms setting under new economic conditions are considered; the determination of the cost of medical services, the number of personnel and salary fund. The necessity of scientific elaboration of the standard cost of medical care is substandiated on the basis of using stable and common economic standards.

Costs and Cost Analysis↗

PubMed1995

The economic status of vulnerable older women.

Although the economic condition of elderly people in the United States has improved greatly in recent decades, the public's concern for income security for certain segments of the elderly population--black women and Hispanic women, particularly if they are unmarried--lingers. Their economic status remains extremely low. This article discusses the income status and work experience of black and Hispanic older women.

Black or African American↗

PubMed1995

An ecological model of child maltreatment in a Canadian province.

The rate at which children are maltreated is one of the most sensitive measures of demographic, social, and economic conditions. Although the consequences of maltreatment and the effectiveness of treatment programs in reducing the incidence have been extensively studied, little attention has been given to identifying spatial variations in maltreatment in terms of characteristics of areas, especially demographic, social or economical. Maltreatment may differ markedly in terms of an area's socio-demographic and economic makeup and this phenomenon needs to be studied in a structural context. This study employs an ecological perspective to predict variations in the rate of maltreatment (including neglect and abuse) among children aged 0 to 19 years in Alberta, Canada in 1986. Several hypotheses are tested in a multivariate framework and the implications of the findings in assessing the effectiveness of intervention strategies are briefly discussed.

Adolescent↗

PubMed1998

Role of chewing and smoking habits in the etiology of oral submucous fibrosis (OSF): a case-control study.

Oral submucous fibrosis (OSF), a premalignant and crippling condition of the oral mucous membrane, was studied to identify its relationship to various chewing and smoking habits. Two hundred and thirty-six consecutive cases of OSF were compared with 221 control subjects matched for age, sex and socio-economic conditions. It was found that chewing of areca nut/quid or pan masala (a commercial preparation of areca nuts, lime, catechu and undisclosed colouring, flavouring and sweetening agents) was directly related to OSF. Also, pan masala was chewed by a comparatively younger age group and was associated with OSF changes earlier than areca nut/quid chewing. However, chewing or smoking tobacco with various other chewing habits did not increase the risk of developing OSF. It was also found that frequency of chewing rather than the total duration of the habit was directly correlated to OSF.

Adolescent↗

PubMed1999

Effects of production circumstances on expected responses for growth and carcass traits to selection of bulls in Japan.

Economic values of growth and carcass traits in Japanese beef cattle for production systems with various types of integration of levels/ stages (cow-calf and feedlot segments and the integrated system) and production circumstances (including 20% higher genetic levels of the traits, management, and economic alternatives) were used to examine responses to selection. Discounted economic values with interest rates of 0, 4.2 (Japanese average), and 8.4% were obtained to investigate the effect of discounting on selection efficiency. Traits considered were daily gain in the feedlot, marbling score, birth weight, weaning weight, and mature weight. The effects of discounting were small. Correlated responses to selection were not always economically favorable for all situations. Selecting bulls for the base situation (i.e., the typical biological and economic conditions for the production of Japanese Black cattle) resulted in negative genetic changes in weaning weight and mature weight in the feedlot segment. Higher genetic levels of daily gain and weaning weight affected efficiency of selection. Although effects of management and economic alternatives on responses to selection were generally small, lighter market weight influenced responses to selection. The results indicate that predicted correlated responses to selection are sensitive to production systems and some production circumstances.

Animals↗

PubMed1982

Evidence on occupational migration.

"This paper tests whether persons in highly skilled and higher-income occupations (who include professionals, managers, salespersons, clerical workers, and craftsworkers) are more likely to migrate when they perceive economic opportunities than persons in the lesser skilled and lower-income ones (who include operatives, transport workers, laborers, and service workers). "A simultaneous equations model of migration and employment change is specified for the nine major occupations defined in the U.S. census, and this model is estimated using occupation-specific data....This study is limited to an investigation of the impact of migration on a variable that was deemed to have been a significant determinant of the direction and magnitude of migration; this variable is occupation-related employment change by industry.... In order to analyze the migration response of persons in different occupations to varying economic conditions, this paper [includes] sections on theory and model specification, empirical results, and conclusions." Data are from the 1970 census.

Americas↗

PubMed2002

McKeown and the idea that social conditions are fundamental causes of disease.

In an accompanying commentary, Colgrove indicates that McKeown's thesis-that dramatic reductions in mortality over the past 2 centuries were due to improved socioeconomic conditions rather than to medical or public health interventions-has been "overturned" and his theory "discredited." McKeown sought to explain a very prominent trend in population health and did so with a strong emphasis on the importance of basic social and economic conditions. If Colgrove is right about the McKeown thesis, social epidemiology is left with a gaping hole in its explanatory repertoire and a challenge to a cherished principle about the importance of social factors in health. We return to the trend McKeown focused upon-post-McKeown and post-Colgrove-to indicate how and why social conditions must continue to be seen as fundamental causes of disease.

Developed Countries↗

PubMedDate not supplied

Doubtful future seen in hospital private giving.

Changing political and economic conditions facing hospitals have cast pale over role of private giving, according to the author. His analysis examines the trends which will impact health giving.

Economics, Hospital↗

PubMed2003

Managing costs, managing benefits: employer decisions in local health care markets.

OBJECTIVES: To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems. DATA SOURCES/STUDY SETTING: Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities. STUDY DESIGN: This is an observational study with data collection over a six-year period. DATA COLLECTION/EXTRACTION METHODS: The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions. PRINCIPAL FINDINGS: The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results. CONCLUSIONS: General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions.

Cost Control↗

PubMed2000

[Severity of dental caries in children and relationship with social and behavioral aspects].

OBJECTIVE: To identify social and behavioral conditions that could act as risk factors to the severity of dental caries in 12-year-old children. METHODS: Based on the oral health survey data obtained in Florianópolis, Brazil, in 1995, social and behavior conditions were compared between two 12-year-old children groups with dental caries with different severity: high and very high severity, and very low severity. In the interview, there were questions about each family were part of the interview, besides social-economic conditions and behavior aspects. RESULTS/CONCLUSIONS: The multivariate logistic regression analysis showed that the risk factors for dental caries with high severity were candy intake and family income. Children who consumes cariogenic products 2 or 3 times a day on a daily basis has 4.41 more chance of having dental caries with high severity when compared to children who consumes these same products only once a day - CI (OR) = [1.18; 16.43] ). Family income was the most important socialeconomic factor. Children whose family income is lower than five minimum wages has 4.18 more chance of having high severity dental caries when compared to children whose family income is higher than five minimum wages - CI (OR) = [1.16; 15.03]. The purpose of this study was to have a a better knowledge of dental caries occurrence in 12-year-old children who, in most cases, have a complete permanent dentition that showed the illness history.

Brazil↗

PubMed1989

Life after divorce: a study of newly divorced middle-aged men in Sweden.

Thirty-two divorced men aged 30 to 44 years answered a questionnaire within seven months after the dissolution of their marriages. They were asked for life circumstances (housing and working conditions, economic situation) and perceived health and a personal interview was also performed with most of the men. Primary health care records during the year of divorce were analysed according to number of visits and reasons for encounter. A majority of the men perceived working conditions as satisfying while about half of the men had moved to less satisfying housing conditions. They recorded a high number of psychological symptoms (insomnia, fatigue, anxiety) but this was not recognizable in the primary health care records. Ten men had had more than one divorce and in this sub-group there were several alcohol abusers. The importance of primary health care in the early recognition of the complex situation of divorced men is stressed.

Adult↗