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PubMed1999

National Health Accounts development: lessons from Thailand.

National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128,305.11 million Baht; 84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in 1994 was 180,516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP. There is also a large difference in the public and private proportion of consumption expenses, at 46:54 in NHA and 18:82 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accurate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in the National Statistical Office Household Socio-Economic Survey. Secondly, partnership building with NESDB and other financing agencies is needed in the further development of the financial information system to suit the biennial NHA report. Thirdly, expenditures need breaking down into ambulatory and inpatient care for monitoring and the proper introduction of policy instruments. We also suggest that in a pluralistic health care system, the breakdown of spending on public and private providers is important. Finally, a sustainable NHA development and utilization of NHA for planning and policy development is the prime objective. International comparisons through collaborative efforts in standardizing definition and methodology will be a useful by-product when developing countries are able to sustain their NHA reports.

Data Collection↗

PubMed1994

Inhibitory effects of nordihydroguaiaretic acid on ETA-receptor-mediated contractions to endothelin-1 in rat trachea.

1. It has been shown previously that nordihydroguaiaretic acid (NDGA) inhibits endothelin-1 (ET-1)-induced contractions in rat isolated tracheal smooth muscle. To investigate the underlying mechanisms, this study examined the effects of NDGA on various aspects of the ETA and ETB receptor-effector systems which mediate ET-1-induced contractions in this preparation. 2. NDGA inhibited contractions induced by each of the isoforms of ET (ET-1, ET-2 and ET-3) but not those induced by the ETB receptor-selective agonist, sarafotoxin S6c, the cholinoceptor agonist, carbachol or the depolarizing spasmogen, KCl. 3. Quantitative autoradiographic studies of [125I]-ET-1 binding to rat tracheal smooth muscle indicated that NDGA was not an ET receptor antagonist. 4. NDGA inhibited the ETA receptor-mediated, intracellular Ca(2+)-dependent contractions induced by 100 nM ET-1 in Ca(2+)-free solution (by 75%, P < 0.01). Furthermore, NDGA markedly inhibited the contractions induced by ryanodine and cyclopiazonic acid; contractions purportedly due to Ca2+ release from intracellular stores. 5. Like NDGA, the sarcoplasmic reticulum Ca(2+)-ATPase inhibitors cyclopiazonic acid and thapsigargin inhibited contractions to ET-1, but not carbachol or KCl. However, cyclopiazonic acid, but not NDGA, also (a) induced transient contractions in rat trachea, (b) potentiated contractions induced by KCl, and (c) potentiated the extracellular Ca(2+)-dependent phase of ET-1-induced contractions, indicating that NDGA did not inhibit ET-1-induced contractions through Ca(2+)-ATPase inhibition and depletion of sarcoplasmic reticular Ca2+. 6. In control preparations, ET-1 induced a slowly developing, sustained contraction. However, in the presence of NDGA or the ETA receptor antagonist, BQ123, ET-1-induced contractions resembled the transient contractions induced by sarafotoxin S6c. In nominally Ca2+-free solution, ETA receptor mediated contractions induced by ET-1 developed very slowly and were inhibited by NDGA.7. Additional studies indicated that the inhibitory effects of NDGA on endothelin-1-induced contractions were not the result of any significant actions of NDGA on lipoxygenase, cytochrome P450, L- orT-type Ca2+-channels, Na+-channels or protein kinase C.8. In summary, NDGA selectively inhibited ET-1-induced contractions in rat tracheal smooth muscle via a lipoxygenase-independent mechanism involving inhibition of the ETA but not the ETB, receptor effector system. NDGA did not appear to inhibit the initial events in the ETA signal transduction pathway, such as receptor binding and protein kinase C activation. However, NDGA inhibited the intracellular Ca2+-dependent component of ET-1-induced contraction, possibly by inhibiting mobilisation of intracellular Ca2+. As an apparent direct consequence of inhibiting the ETA receptor-effector system, NDGA markedly changed the time course of ET-1-induced contractions; from a slowly developing and sustained contraction into a transient contraction resembling that induced by sarafotoxin S6c.

Animals↗

PubMed1999

A time-series analysis of caries status among adolescents in relation to socioeconomic variables in Göteborg, Sweden.

The aim of this study was to detect, using time-series analysis methods, whether measurable socioeconomic adjustments for the time period 1986-96, as presented by caries index values, could be related to a new trend in caries status development for specific age groups leaving the free state-organized dental care system. In the study, Göteborg was divided into four districts. The study showed a favorable development in dental health for the 15-19 age group. However, the caries incidence index DSa (decayed approximal surfaces) values showed no or only negligible signs of lower mean values. During the study period, the study showed an unfavorable trend concerning the socioeconomic variables related to health care. However, the incongruity for the different districts between the trend results of the caries index values and the contemporaneous socioeconomic variable development indicated few signs of relationship. In relation to general discussions of environmental questions, the idea of sustainable development was discussed when applied to the field of dental care. The results of this study indicate that dental health, in times of major economic adjustments and lack of resources for health care for the 15-19 age group in Göteborg--as interpreted by the caries indices used is an example of sustainable dental health development.

Adolescent↗

PubMed2005

Forecasting environmental equity: air quality responses to road user charging in Leeds, UK.

Sustainable development requires that the goals of economic development, environmental protection and social justice are considered collectively when formulating development strategies. In the context of planning sustainable transport systems, trade-offs between the economy and the environment, and between the economy and social justice have received considerable attention. In contrast, much less attention has been paid to environmental equity, the trade-off between environmental and social justice goals, a significant omission given the growing attention to environmental justice by policy makers in the EU and elsewhere. In many countries, considerable effort has been made to develop clean transport systems by using, for example, technical, economic and planning instruments. However, little effort has been made to understand the distributive and environmental justice implications of these measures. This paper investigates the relationship between urban air quality (as NO2) and social deprivation for the city of Leeds, UK. Through application of a series of linked dynamic models of traffic simulation and assignment, vehicle emission, and pollutant dispersion, the environmental equity implications of a series of urban transport strategies, including road user cordon and distance-based charging, road network development, and emission control are assessed. Results indicate a significant degree of environmental inequity exists in Leeds. Analysis of the transport strategies indicates that this inequity will be reduced through natural fleet renewal, and, perhaps contrary to expectations, road user charging is also capable of promoting environmental equity. The environmental equity response is, however, sensitive to road pricing scheme design.

Air Pollution↗

PubMed2005

Land resource sustainability for urban development: spatial decision support system prototype.

Land resource sustainability for urban development characterizes the problem of decision-making with multiplicity and uncertainty. A decision support system prototype aids in the assessment of incremental land development plan proposals put forth within the long-term community priority of a sustainable growth. Facilitating this assessment is the analytic hierarchy process (AHP), a multi-criteria evaluation and decision support system. The decision support system incorporates multiple sustainability criteria, weighted strategically responsive to local public policy priorities and community-specific situations and values, while gauging and directing desirable future courses of development. Furthermore, the decision support system uses a GIS, which facilitates an assessment of urban form with multiple indicators of sustainability as spatial criteria thematically. The resultant land-use sustainability scores indicate, on the ratio-scale of AHP, whether or not a desirable urban form is likely in the long run, and if so, to what degree. The two alternative modes of synthesis in AHP-ideal and distributive-provide assessments of a land development plan incrementally (short-term) and city-wide pattern comprehensively (long-term), respectively. Thus, the spatial decision support system facilitates proactive and collective public policy determination of land resource for future sustainable urban development.

Conservation of Natural Resources↗

PubMedDate not supplied

Managing the ecosystem to improve human health: integrated approaches to safe drinking water.

The ecosystem approach to human health is a holistic concept of health for both humans and the environment in which they live. This approach requires a holistic management of all facets of the ecosystem, be they physical, biologic, or indeed human-such as culture, economy, and developmental needs. This paradigm may at first glance seem theoretical and difficult to put into practice in everyday field research. However, using basic human needs, such as water and sanitation, as entry points illustrates how ecosystem health can indeed prove a powerful tool for sustainable development, promoting both human well-being and sustainable ecosystems. The authors describe the efforts of international agencies, particularly the International Development Research Centre (IDRC), to promote household safe drinking water security in developing countries. Essential to the success of these endeavors are strong partnerships with communities, research institutions, and donor agencies. The roles of these players are delineated. An important feature of IDRC projects, which is critical to their success, is the establishment of a simple, community-based water-quality monitoring program that the people can maintain with the limited resources available to them. The process and outcomes of past IDRC projects are presented and ongoing efforts are described.

Community Participation↗

PubMed1993

Risks of developing supraventricular and ventricular tachyarrhythmias after implantation of a cardioverter-defibrillator, and timing the activation of arrhythmia termination therapies.

The clinical courses of 39 consecutive recipients (mean age 61 +/- 12 years, and mean left ventricular ejection fraction 0.32 +/- 0.15) of an automatic implantable cardioverter-defibrillator (ICD) were examined to determine the risks of developing ventricular tachycardia (VT) and supraventricular tachyarrhythmias (SVT) after surgery, with ventricular response rates fulfilling ICD detection criteria. ICD system leads were implanted by thoracotomy in 25 patients and by using nonthoracotomy lead systems in 14. Six patients (18%) developed SVT after surgery, whereas 14 (36%) developed sustained VT. The median times to the development of both SVT and VT were 2 days. By actuarial analysis, the probability of developing VT after surgery was significantly greater than that of SVT during hospitalization (p = 0.04). This significant excess of postoperative VT over SVT was most marked in patients aged < or = 61 years, those who received nonthoracotomy rather than epicardial lead systems, those who presented with VT rather than ventricular fibrillation, and those who received > 20 intraoperative defibrillation shocks. These observations recommend the activation of ICD therapies immediately after implantation.

Age Factors↗

PubMed2002

[Distance learning in postgraduate training of professionals. Example of occupational medicine specialization].

The rapid development of science, technology, economy and the society has one along with the wide recognition of lifelong education and learning society concepts. Scientific centres worldwide conduct research how the access to the information and multimedia technology could bring about positive changes in our lives including improvement in education and the learning environment. Mankind development in conformity with social progress and sustainable development faces a new educational concept of learning society and open education in the information age, supported with multimedia and data processing technology. Constrains in resources availability for broadening the access to education had led to search for alternative, more time and cost-effective systems of education. One of them is distance learning, applied with success in many countries. The benefits of distance learning are well proven and can be extended to occupational medicine. Major advantages include: the integration of studies with work experience, flexibility, allowing studies to be matched to work requirements, perceived work and leisure timing, continuity of career progression. Likewise is in Poland this form of education becomes more and more popular. The distance education systems have been seen as an investment in human resource development. The vast variety of courses and educational stages makes possible the modern method of knowledge to be easily accessible. Experience of the School of Public Health in Łódź in distance learning had shown remarkable benefits of the method with comparable quality of intramural and distance learning in respect of the knowledge and experience gained by students.

Clinical Competence↗

PubMed2005

Vulnerability to global environmental changes in Argentina: opportunities for upgrading regional water resources management strategies.

There is evidence of the increasing economic losses from extreme natural events during the last decades. These facts, thought to be triggered by environmental changes coupled with inefficient management and policies, highlight particularly exposed and vulnerable regions worldwide. Argentina faces several challenges associated with global environmental change and climate variability, especially related to water resources management including extreme floods and droughts. At the same time, the country's production capacity (i.e. natural resource-based commodities) and future development opportunities are closely tied to the sustainable development of its natural resource endowments. Given that vulnerability is registered not only by exposure to hazards (perturbations and stresses), but also resides in the sensitivity and resilience of the system experiencing such hazards, Argentina will need to improve its water management capacities to reduce its vulnerability to climate variability and change. This paper presents the basic components of the vulnerability analysis and suggests how it can be used to define efficient water management options.

Argentina↗

PubMedDate not supplied

Indicators for a sustainable society.

This study presents a set of 20 indicators that could be suitable for monitoring the progress of our society on the path to sustainable development. Based on the concept of a sustainable society, which explicitly links the four aspects of health, social equity, economy and environment, these indicators are meant for large administrative areas, and use mostly already available data. The approach is global and symbolic in order to be able to facilitate the integration of the four aspects in the public's mind. It is information for action that could be used in a systematic way for presentation to the general public and to decision-makers, in the manner of everyday economic or weather indicators.

Canada↗

PubMed1988

Autonomic modulation of ventricular arrhythmia in cesium chloride-induced long QT syndrome.

To evaluate autonomic influence on arrhythmogenesis in an animal preparation of triggered activity, we gave increasing doses of cesium chloride (0.125 to 5.0 mmol/kg iv) to 24 dogs distributed equally among four protocols of autonomic intervention: control, total denervation, beta-blockade, and left stellate stimulation. All dogs underwent atrioventricular node ablation followed by ventricular pacing. A left ventricular endocardial monophasic action potential (MAP) catheter allowed for detection of "MAP early afterdepolarizations" (mEAD). mEAD amplitude was measured relative to MAP amplitude. Cesium chloride (CsCl) increased both MAP duration (132% after 0.125 mmol/kg to 188% after 1.0 mmol/kg; p less than .001) and mEAD amplitude (20% after 0.125 mmol/kg to 49% after 1.0 mmol/kg; p less than .001) in a dose-dependent fashion. All dogs exhibited ventricular ectopy at roughly equivalent doses (0.88 +/- 0.5 mmol/kg). Cesium's peak effect on MAP characteristics, sinus node automaticity, and systolic blood pressure coincided with the onset of sustained ventricular tachycardia (VT). Whereas control and denervated dogs developed VT after similar doses of CsCl (1.21 +/- 0.1 vs 1.12 +/- 0.14 mmol/kg; p = NS), none of the six beta-blocked dogs developed sustained VT. Conversely, those dogs having undergone stellate stimulation developed VT after smaller doses (0.58 +/- 0.34 mmol/kg; p less than .001) and with earlier onset (12 vs 30 sec; p less than .025). After 0.5 mmol/kg of CsCl, left stellate stimulation augmented relative mEAD amplitude compared with control (51% vs 38%; p less than .001), whereas beta-blockade had little effect (39% vs 38%; p = NS). Autonomic intervention as such can affect the arrhythmogenicity of CsCl and similarly alter MAP characteristics. Furthermore, as beta-blockade can prevent sustained arrhythmia without eliminating mEADs, autonomic tone appears to modulate the expression of mEADs as sustained VT.

Action Potentials↗

PubMed1997

Defining goals and conditions for a sustainable world.

Sustainable development is being approached component by component--socioeconomic, sustainable agriculture, transportation, forestry, energy use, cities, and the like--but, leaving a habitable planet for future generations will require the development of a widely shared paradigm. Further, the paradigm should be ecological from a scientific point of view. This development will be facilitated by a discussion of goals and those conditions necessary to meet them. The presently shared paradigm is that economic growth is the cure for all of society's problems, such as poverty, overpopulation, environmental degradation, and the increasing gap between rich and poor. A paradigm shift from growth to sustainability might result either from suffering painful consequences of continuing to follow out-moded paradigms or by discussing what sort of ecosystems will be available to future generations. The purpose of this paper is to help initiate such a discussion.

Ecosystem↗

PubMed2006

Evolution of blood pressure and cholesterol in stage 1 hypertension: role of autonomic nervous system activity.

OBJECTIVE: Controversy remains concerning the pathogenetic mechanisms for the relationship between sympathetic activity, hypertension and lipid abnormalities. We tested the hypothesis that a condition characterized by sympathetic predominance may affect the evolution of blood pressure and lipids in the early stage of hypertension. METHODS: We prospectively studied 163 young stage 1 hypertensive individuals and 28 normotensive control individuals. The hypertensive subjects were divided by cluster analysis into two groups according to low frequency and high frequency components of heart rate variability. Large artery and small artery compliance was assessed at the end of the follow-up. RESULTS: Fifty-nine subjects showed reduced total power and signs of sympathetic predominance in the resting condition, on standing and during mental stress (group 1). At baseline, they had similar blood pressure and metabolic data to the rest of the group (n = 104, group 2) and a greater white-coat effect (P = 0.03). During a 6-year follow-up, 23.7% of group 1 subjects versus 9.6% of group 2 subjects developed sustained hypertension requiring antihypertensive treatment (P = 0.02). In group 1 subjects, there was also a greater increase in total cholesterol (P = 0.01) than in group 2. In addition, at the end of follow-up group 1 subjects had impaired large artery compliance (P < 0.001 versus group 2). CONCLUSIONS: These data indicate that a condition characterized by sympathetic predominance may favour the development of sustained hypertension and hypercholesterolemia early in life, and lead to increased susceptibility to vascular complications. They further indicate that the increased white-coat effect is not an innocent phenomenon.

Adult↗

PubMed1997

The Wellcome Trust population initiative.

This paper describes what the Wellcome Trust has done and aims to do through its population initiative. The Trust is required to spend its funds to improve the physical welfare of mankind, and in this context there can be no more important issue than the rapid changes that are occurring in the human population. The Trust's first involvement was to help fund the New Delhi population summit covered by the world's scientific academics in 1993 and, following discussions with authorities in the field, initiated its funding programme in 1995. Through this programme, the Trust hopes to bring about improved understanding of the relationship between reproductive health, population growth, and sustainable development and create cadres of high quality research scientists in relevant disciplines. Uniquely, funding is available under this programme to suitably qualified applicants from any country other than the USA.

Africa↗

PubMed2005

Capacity building for sustainability: towards community development in coastal Scotland.

Capacity building is widely recognised as a central feature of Integrated Coastal Zone Management (ICZM). Yet, although increased community capacity can potentially empower local communities with the ability to tackle the impacts of socio-economic change, an evaluation of ICZM performance reveals a limited interest in advancing community development initiatives. This weakness is particularly apparent in Scotland. Whilst coastal communities in Scotland have been found to suffer from a range of significant socio-economic problems, Scottish approaches to ICZM have failed to improve local development trajectories. In response, this paper considers the degree to which community based partnerships can assist in the delivery of sustainable development benefits.

Conservation of Natural Resources↗

PubMed2001

Effect of different pacing protocols on the induction of atrial fibrillation in a transvenously paced sheep model.

In different animal models rapid atrial stimulation led to a shortening and maladaptation to rate of the atrial effective refractory period (AERP). This atrial electrical remodeling resulted in an increased vulnerability to atrial fibrillation (AF). These experimental findings formed the rationale for a stringent pursuit of sinus rhythm in patients with AF, since this would prevent or reverse atrial remodeling. This study tested the hypothesis that a reduction of arrhythmia burden would lead to a decreased vulnerability for AF. Different rapid atrial pacing protocols in a sheep model were used. During 15 weeks, 13 animals were continuously rapid paced and 7 animals were intermittently burst-paced, resulting in rapid atrial activation during 100% versus 33 +/- 4% of the time, respectively. In the continuously paced group, 77% of the animals developed sustained AF (i.e., > 1 hour) versus only 29% in the burst-paced group (P < 0.05). However, there was no difference in mean AERP shortening over time, nor maximal AERP shortening per animal, between both protocols. Minimal AERP was 103 +/- 5 ms in the continuously paced group and 107 +/- 5 in the burst-paced group (P = NS). Significant changes could be identified in effect on P wave duration, AVN function, and atrial dilation. Conduction slowing was more pronounced in the continuously paced group with a maximal P wave duration of 136 +/- 4 ms in this group versus 116 +/- 5 in the burst-paced group (P < 0.05). In the continuously paced group, the right atrial area significantly increased from 2.5 +/- 0.1 cm2 at baseline to 4.2 +/- 0.2 cm2. In the burst-paced group there was no significant atrial dilatation (from 2.6 +/- 0.1 to 2.8 +/- 0.1 cm2). In conclusion, limiting atrial arrhythmia burden slowed the development of sustained AF in this sheep model. This was not mediated by a decreased influence on atrial refractoriness but seemed to be dependent on smaller changes in atrial conduction and dimensions.

Animals↗

PubMed2005

[Population structure and community characteristics of Pseudotaxus chienii in Fengyangshan National Natural Reserve].

Pseudotaxus chienii, an endemic plant in China, is one of the second grade state protection wild plants, and distributes in Fengyangshan Natural Reserve as one of its concentrative dwelling places. A survey in the region was carried out on 10 communities, which were dominated by P. chienii. The analysis on its size structure, spatial distribution pattern and community characteristics showed that the populations of P. chienii could grow in the communities dominated by Rhododendron simiarum, Fokienia hodginsii-R. simiarum, and evergreen broad-leaved forests. In R. simiarum communities, the size structure, survival curve, and overwhelming community distribution pattern of P. chienii showed a sustaining development, while in communities dominated by F. hodginsii-R. simiarum, though the size structure was declining, the survival curve was Deevy- III type. Plenty of plantlets were still existed, and the populations kept steady. Two types were considered to be the most suitable ones for P. chienii populations. The important value of P. chienii reached 5% - 10%. In evergreen broad-leaved forests, the populations of P. chienii showed to be a declining type, and the survival curve was Deevy- II type. The distribution pattern was random, indicating that P. chienii populations could not fit for survive in this kind of communities. Correlation analysis showed that P. chienii populations had a positive correlation with R. simiarum and F. hodginsii, but a negative correlation with Cyclobalanopsis stewardiana and Schima superba. P. chienii could associate to the habits with the community canopy density of about 0.6 - 0.8. From the results mentioned above, the populations of P. chienii could be able to sustain and develop, and the existing habitat in Fengyangshan should be protected effectively. The protection of P. chienii requires more basic work to establish efficient measures to protect its habitat.

China↗

PubMed2004

[The preparation and in vitro release test of sustained release delivery gutta-percha point containing metronidazole].

PURPOSE: To develop sustained release delivery gutta-percha point containing metronidazole (SRDGM) for root canal disinfection, and determine the drug concentration in vitro and the time that the device maintains the effective drug concentration. METHODS: The gutta-percha was selected as the carrier and adsorbed metronidazole etc. The point was coated with mixation of ployethylene glycol and acetate fibre to prepare the groups of SRDGM.The group that released the longest period of the effective drug was selected for the following study. Eight teeth were selected, the SRDGM was used to disinfect the root canal. The adsorption was measured for 24 hours and 10 days. RESULTS: The SRDGM contained metronidazole 2013 microg, it could release 68.24% of the total drug in 24 hours in vitro. The effective metronidazole concentration released lasted more than 10 days. On the 10th day, there was also 33.13 microg/ml metronidazole released which was more than minitory inhibitory concentration of metronidazole. CONCLUSIONS: SRDGM could carry the metronidazole and control the release rate. It could maintain the effective drug concentration for a long time (>10 days) in root canal.

Anti-Infective Agents↗