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PubMed2003

Complexity theory in the management of communicable diseases.

In nature, apparently complex behavioural patterns are the result of repetitive simple rules. Complexity science studies the application of these rules and looks for applications in society. Complexity management opportunities have developed from this science and are providing a revolutionary approach in the constantly changing workplace. This article discusses how complexity management techniques have already been applied to communicable disease management in Wales and suggests further developments. A similar approach is recommended to others in the field, while complexity management probably has wider applications in the NHS, not least in relation to the developing managed clinical networks.

Communicable Disease Control↗
PubMed1993

Non-communicable diseases in the tropics.

The way of life in many developing countries in the tropics is in a state of transition--from traditional to "modern", with its associated industrialisation, urbanisation and cultural readjustment. Infectious diseases are giving way to non-communicable diseases, such as cardiovascular diseases, adult onset diabetes, cancers, trauma and non-infectious respiratory diseases, as major causes of morbidity and premature mortality. The epidemiology, causality, prevention and treatment of these conditions is summarised in the context of developing countries.

Cardiovascular Diseases↗
PubMed2001

Critical issues in the economic evaluation of interventions against communicable diseases.

Economic appraisal seeks to provide policy-makers with guidance about how scarce resources can be used to derive the greatest possible social benefit. Its use in the health sector has increased dramatically over the last decade although much of it has been focused on the problems of the more developed countries. The relatively sparse literature on communicable diseases has been dominated by interventions related to HIV/AIDS, hepatitis, malaria and tropical diseases. Reviews of this literature from the perspective of specific conditions such as Hepatitis B are already available, and recently the entire literature has been evaluated against the technical criteria for economic evaluations published in standard textbooks. Accordingly, this paper focuses on issues which would make economic appraisal more useful to policy-makers than it currently is. Given that few countries have the resources to undertake all the necessary analysis in their own settings, it is important that studies in one setting are undertaken in a way that allow generalisability to similar settings. Some of the most important challenges this poses for cost-effectiveness analysis (CEA) are identified. Firstly, incremental analysis is appropriate to local decision making when policy-makers are constrained to keep the current interventions and can consider only marginal improvements. However, it does not allow re-evaluation of existing interventions and is not transferable across settings. A version of Generalised CEA is proposed as an alternative. Secondly, data on costs and effectiveness are often not presented appropriately. The challenge for effectiveness is to adjust the evidence from efficacy studies to allow for different patient or population groups, and local variations in adherence, coverage, and infrastructure. For costs, it is important for studies to report the physical resources used in an intervention as well as unit prices. Thirdly, some long-term effects are still not well incorporated into CEA, especially those affecting child development and drug resistance. These questions are technically challenging and require more concerted efforts over the next few years. Finally, it is important for analysts to provide decision-makers with estimates of the resources that would be required to implement interventions claimed to be cost-effective. These improvements would better enable the evidence from economic analyses to enter the policy debate and be weighed against the other goals and objectives of the health system when allocating scarce resources.

Communicable Disease Control↗
PubMed1996

Risk profiles for non-communicable diseases in rural and urban schoolchildren in the Republic of Cameroon.

OBJECTIVES: In developing countries, there is evidence that the median age of the population and the life expectancy at birth are increasing as a result of decreasing fertility rates and infant mortality. The result is an aging population more prone to non-communicable diseases such as diabetes, cancer, or heart disease later in life. In addition, changing lifestyle factors such as tobacco use, physical inactivity, and high fat diets, may accelerate the emergence of such chronic diseases as major causes of death and disability in these countries, particularly in urban areas. To test the premise that urban living predisposes residents to reduced activity levels, less healthy diets, cigarette smoking, elevated blood pressure, and increased body fat early in life, we studied rural/urban differences in these risk factors among schoolchildren in the Republic of Cameroon. METHODS: One hundred and nineteen Class 7 schoolchildren (50 urban and 69 rural) were interviewed concerning diet, physical activity, smoking, and alcohol use; blood pressure and anthropometric measurements were also taken. RESULTS: Physical activity among rural children was more than twice that of urban children, and most of the activity for rural children was work-related. Rural children consumed fewer foods containing fat and more fruits and vegetables. Adjusting for age, systolic and diastolic blood pressures of urban boys were higher than those of rural boys, and among urban children there was a trend toward a larger age-adjusted mean body mass index (BMI). There were no differences in alcohol or tobacco use between urban and rural children. CONCLUSIONS: In this study, urbanization was associated with a less active lifestyle and a dietary pattern that was higher in fat and lower in fruit and vegetable intake. Since risk factors for non-communicable diseases tend to appear early in life and track into adulthood, it is important to identify those children, or groups of children, with unfavorable risk profiles and to structure health education and promotion programs to modify these trends.

Adolescent↗
PubMed1999

Control of diphtheria: guidance for consultants in communicable disease control. World Health Organization.

These guidelines for the control and management of diphtheria are intended for consultants in communicable disease control and regional epidemiologists in England and Wales. They are intended to complement existing guidance from the World Health Organization. The guidelines cover the immediate steps to be taken following identification of a case, what is required to confirm the diagnosis, steps to be taken to minimise the likelihood of further linked cases, and what should be done to disseminate information after a case.

Anti-Bacterial Agents↗