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PubMed1993

Decline and unevenness of infant mortality in Salvador, Brazil, 1980-1988.

Data relating to infant mortality in Salvador, Brazil, were analyzed in order to determine how infant mortality evolved in various parts of the city during the period 1980-1988. This analysis showed sharp drops in the numbers of infant deaths, proportional infant mortality (infant deaths as a percentage of total deaths), and the infant mortality coefficient (infant deaths per thousand live births) during the study period despite deteriorating economic conditions. It also suggested that while these declines occurred throughout the city, the overall distribution of infant mortality in different reporting zones remained uneven. Among other things, these findings call attention to a need for further investigation of the roles played by various health measures (including immunization, control of respiratory and diarrheal diseases, encouragement of breast-feeding, and monitoring of growth and development) and of reduced fertility (resulting from birth spacing, use of contraceptives, and female sterilization) in bringing about declines in infant mortality during hard economic times.

Brazil↗
PubMed2000

[The effect of intensive traffic noise on well-being and self-assessed health status of urban population].

In the study health situation of inhabitants and their subjective reaction to different acoustic conditions in their place of living were analysed. Comparison of residents who spend most of the time in rooms at a street side with the residents who lived in rooms at a yard side revealed significant differences between the groups in mental state and self assessed health status. People, who live in worse acoustic conditions more often complain about difficulties and disturbances in different daily activities. They also more often reported different ailments, of which the most important are problems connected with cardiovascular system, feeling tiredness after night sleep, frequent nervousness and irritation. This group of people more often takes pain killers and tranquillisers. However, there was no difference between the groups in reporting diseases that could be associated with noise and were confirmed by physician. Observed differences in reporting negative symptoms and reactions mentioned above were not related to socio-economic and behavioral factors such as: gender, age, economical conditions or smoking which have similar distribution in both the groups.

Automobile Driving↗
PubMed2004

Free markets and dead mothers: the social ecology of maternal mortality in post-socialist Mongolia.

Beginning in 1990, Mongolia, a former client state of what was then the Soviet Union, undertook liberal economic reforms. These came as a great shock to Mongolia and Mongolians, and resulted in food shortages, reports of famine, widespread unemployment, and a collapse of public health and health care. Although economic conditions have stabilized in recent years, unemployment and poverty are still at disturbingly high levels. One important consequence of the transition has been the transformation of the rural, primarily pastoral, economy. With de-collectivization, herding households have been thrown into a highly insecure subsistence mode of production, and, as a consequence, have become vulnerable to local fluctuations in rainfall and availability and quality of forage, and many now lack access to traded staples and essential commodities. Household food insecurity, malnutrition, and migration of impoverished households to provincial centers and the capital of Ulaanbaatar are one result. Reductions to investments in the health sector have also eroded the quality of services in rural areas, and restricted access to those services still functioning. Evidence suggests that women are particularly vulnerable to these political-ecological changes, and that this vulnerability is manifested in increasing rates of poor reproductive health and maternal mortality. Drawing on case-study ethnographic and epidemiological data, this article explores the links between neoliberal economic reform and maternal mortality in Mongolia.

Adult↗
PubMed2005

The factors affecting the relation between the menarcheal age of mother and daughter.

BACKGROUND: Menarche is one of the most important biologic signals in the life of a woman. Menarche is a biological variable which has a significant genotypic component in girls. In recent years, many studies reporting the earlier onset of menarche owing to the improvement of socio-economic conditions have been published. DESIGN: We asked some questions about menarche to 1017 female students studying in the high schools of Manisa region in order to determine the menarcheal age and the correlation of menarcheal age between the mothers and daughters in our region. RESULTS: The mean age at menarche for the girls was 12.82+/-1.07 years and for the mothers was 13.6+/-1.39 years. The mean menarcheal age of the mothers was higher than the mean menarcheal age of the girls (P<0.001). This difference persisted independent of the socio-economic status, nutritional state and physical activity of the girls. There was a significant correlation between the menarcheal age of the girls and their mothers (r=0.262, P<0.001). This correlation existed in all the girls with different socio-economic status, nutritional state and physical activity. However, this correlation disappeared in girls with body mass index (BMI)>25 (r=0.04, P=0.813). In girls with BMI<25, there was a correlation between the menarcheal age of the girls and mothers (r=0.282, P<0.001). CONCLUSION: These results suggest that the menarche occurs earlier in the daughters than their mothers. The correlation between the menarcheal age of the girls and their mothers persists under all circumstances except in obesity. The mother's menarcheal age is a good predictor of the daughter's menarcheal age in non-obese girls and the BMI is an important factor.

Adolescent↗
PubMed2003

Changing cocaine use practices: neo-liberalism, HIV-AIDS, and death in an Argentine shantytown.

Cocaine consuming patterns are changing among young drug users who live in "The Villa," a shantytown located in Greater Buenos Aires. After years of drug injection dominance, cocaine snorting became the preferred drug consuming practice while deep and fast structural and cultural transformations have been taken place as part of the neoliberal program implemented in Argentina during the 1990s and the final economic default in 2001-2002. In this article, I analyze how drug users understand and explain these changing practices, including the following aspects: deteriorating economic conditions, the transformations of survival strategies, moral codes, social network organization, violence regulating mechanisms, criminal activity, and police repression. Based on an ethnographic study carried out during the last eight months in "The Villa," I suggest that intense and generalized cocaine injection in shantytowns has logistic, organizational, and structural requirements that cocaine snorting does not have. Particularly, I explore two main aspects associated with these changing cocaine consumption practices: the consequences of the many Acquired Immunodeficiency Syndrome (AIDS)-related deaths, which occurred among older drug injectors, and the progressive social fragmentation tied to the extreme economic deprivation, deepened social exclusion, and growing everyday violence.

Administration, Inhalation↗
PubMed1987

Thoughts on the future of orthodontic education and practice.

Only by involvement and constructive planning for our specialty can we as a group influence dental education--specifically, orthodontic training--and the conditions for practice we will face in the future. The development of undergraduate orthodontic teaching has been slow. It is argued that it is a necessity, and in our best interest, that we formulate an innovative curricular standard for orthodontic instruction to be included in the strategic planning for the future dental educational program. Regarding advanced training, orthodontics as a specialty branch of dentistry would be at a disadvantage if the number of places in orthodontic specialty programs is significantly reduced. Rather, assuming the accuracy of predictions of future increased demands for orthodontic care under decent economic conditions, it is suggested that if we allow for a slow but steady increase in the number of orthodontic specialists, we are going to create reasonably sound circumstances for future orthodontic specialty practice.

Dentistry↗
PubMed1996

Demographic survey of the level and determinants of perinatal mortality in Karachi, Pakistan.

A demographic survey was used to estimate the level and determinants of perinatal mortality in eight lower socio-economic squatter settlements of Karachi, Pakistan. The perinatal mortality rate was 54.1 per 1000 births, with a stillbirth to early neonatal mortality ratio of 1:1. About 65% of neonatal deaths occurred in the early neonatal period, and early neonatal mortality contributed 32% of all infant deaths. Risk factor assessment was conducted on 375 perinatal deaths and 6070 current survivors. Poorer socio-economic status variables such as maternal and paternal illiteracy, maternal work outside the home and fewer household assets were significantly associated with perinatal mortality as were biological factors of higher parental age, short birth intervals and poor obstetric history. Multivariable logistic analysis indicated that some socio-economic factors retained their significance after adjusting for the more proximate biological factors. Population attributable risk estimates suggest that public health measures for screening of high-risk women and use of family planning to space births will not improve perinatal mortality substantially without improvement of socio-economic conditions, particularly maternal education. The results of this study indicate that an evaluation of perinatal mortality can be conducted using pregnancy histories derived from demographic surveys.

Adolescent↗
PubMed2006

Political economy and population health: is Australia exceptional?

BACKGROUND: It is accepted knowledge that social and economic conditions--like education and income--affect population health. What remains uncertain is whether the degree of inequality in these conditions influences population health and if so, how. Some researchers who argue that inequalities are important, say there is a relationship between political economy, inequality and population health. Their evidence comes from comparative studies showing that countries with neo-liberal political economies generally have poorer population health outcomes than those with social or Christian democratic political economies. According to these researchers, neo-liberal political economies adopt labour market and welfare state policies that lead to greater levels of inequality and poorer population health outcomes for us all. DISCUSSION: Australia has experienced considerable social and economic reforms over the last 20 years, with both major political parties increasingly adopting neo-liberal policies. Despite these reforms, population health outcomes are amongst the best in the world. SUMMARY: Australia appears to contest theories suggesting a link between political economy and population health. To progress our understanding, researchers need to concentrate on policy areas outside health--such as welfare, economics and industrial relations. We need to do longitudinal studies on how reforms in these areas affect levels of social and economic inequality, as well population health. We need to draw on social scientific methods, especially concerning case selection, to advance our understanding of casual relationships in policy studies. It is important to find out if, and why, Australia has resisted the affects of neo-liberalism on population health so we ensure our high standards are maintained in the future.

Journal Article↗
PubMed1997

[Current antibiotic prophylaxis in colorectal surgery].

Over a one-year period (November 1996 to November 1997), in the Emergency Surgery Clinic perioperative parenteral antibiotic prophylaxis during colorectal operations is performed in a series of 32 patients, admitted on an emergency and deferred urgency basis, or for routine operative treatment. Of them 30 present malignant processes involving colon and rectum, and two--inflammatory diseases. All patients receive single i.v. injections with Cephalothin/Cefazolin at dose 2.0 g and Metronidazole 0.5 g immediately after anesthesia induction. In nine cases additional early treatment is necessitated--within 24 hours after the operative intervention--by administration of the same drug combination 4 times at 6-hour intervals, and in another two prophylaxis is substituted for continuous 5-day treatment using the same therapeutic scheme. In 30 patients the postoperative period runs a course free of noteworthy complications. In two instances there is evidence of operative wound suppuration, and in further two--urinary tract infection development unrelated to the antibiotic prophylaxis applied. The specific features characterizing the application of antibiotic prophylaxis during colorectal surgery are discussed, and appropriate drug therapy schemes are recommended, consistent with worldwide and Bulgarian experience along this line, as well as with the concrete hospital and economical conditions in this country. Special emphasis is laid on two aspects: optimization of the timing of antibiotic agent/agents injection, and reaching peak serum and tissue bactericidal concentrations in the immediate vicinity of the surgical incision; optimization of the duration of antibiotic prophylaxis on the ground of well established indications for the application of antibiotic prophylaxis in colorectal surgery in compliance with the dynamic patterns of intra- and postoperative septic risk. The modest number of patients subjected to updated parenteral perioperative antibiotic prophylaxis does not warrant a definitive interpretation of the data from the comparative clinical and pharmaco-economical analyses performed. Nevertheless, the preliminary results point to the economical expedience of the therapeutic approach suggested.

Adult↗
PubMed1992

Changes in biological status of the Jastarnia population over the last 20-year period.

The objective of this paper is to analyze changes in the biological condition of the inhabitants of Jastarnia (Hel Peninsula), who were examined three times during 1963-87. A total of 1791 persons of both sexes, aged from 3 to 80 years were under study. A total of 20 somatic and physiological traits were considered. According to the data of the Central Statistical Office (available from 1976) the birth rate in Jastarnia increased in 1987 but mortality increased even at a higher rate so that the increase of the population (per 1000 inhabitants) was reduced from 6.8 in 1976 to 3.7 in 1987. A factor analysis, used to estimate socio-economic conditions of two generations of this town, has shown that the apartment size and income of a family (factor 1) explained the highest percentage of the variance of the traits considered. Education of parents was on the second position (factor 2). The next factor (3) represented biological properties of parents measured by their stature. The last one (factor 4) characterized family size in the second generation, for the first generation this trait being related with factor 2 (culture). A tendency to slim body was observed in children and youth. However, the ratio of chest circumference to stature (Marty index) did not change, which can be explained in terms of the adaptation to maritime climate. The content of adipose tissue increased in children and youth, and also the vital capacity of lungs in relation to stature (Ziemssen index) increased in children. Blood pressure at rest was reduced in 1987, but systolic blood pressure at work was increased. An increase in the minute respiration rate and reduction of chest extension in the contemporary youth seem to be rather unfavorable.

Adaptation, Physiological↗
PubMed1992

Women's workload and its impact on their health and nutritional status.

This paper highlights various issues in relation to the workload of women in developing countries and its impact on health and nutritional status. The determining factors in women's workload and work-time and the methods employed for assessment are described. The drawbacks of the methods used and the resulting inconsistencies in the data are reviewed. How women are subjected to different health stresses owing to their productive and reproductive roles has been examined under three categories of work: economic, domestic and agricultural. The interaction of women's workload and health is complex and multifactorial owing to variations in the environment and socio-economic conditions within developing countries. There is a critical need to re-examine the assumptions existing about women's workload in programmes aimed at reducing work-time and workload of women in developing countries.

Developing Countries↗
PubMed1999

The changing face of paediatrics in the English-speaking Caribbean.

Childhood mortality and morbidity patterns in the English-speaking Caribbean have changed significantly over the past 40 years. Acute respiratory illness, physical injury and conditions originating in the perinatal period have replaced malnutrition, gastroenteritis and other infectious diseases as major causes of illness and death in Caribbean children. Although population growth has slowed down, about one-third of the population of the English-speaking Caribbean remains under the age of 15 years. Infant mortality rates have also fallen but the major contributor to this decline has been a reduction in post-neonatal deaths. The decrease in mortality and morbidity from infectious diseases has led to a prominence of disorders originating in the perinatal period, psychosocial problems and chronic childhood disorders. Adverse economic conditions are held culpable for the re-emergence of protein energy malnutrition (PEM) and pulmonary tuberculosis in some territories. There is an urgent need to focus attention on the areas of perinatal and adolescent health, childhood disability, accidental and non-accidental injury, sexual abuse and human immunodeficiency virus (HIV) infection. Immunization programmes also require continuing support and expansion. These tasks cannot be accomplished without meaningful long term investment of financial and human resources in the health and educational services of the region.

Adolescent↗
PubMed2004

Relationship between economic development and suicide mortality: a global cross-sectional analysis in an epidemiological transition perspective.

AIM: The aim of this study was to analyse the relationship between suicide rates and economic development within the theoretical framework of epidemiological transition. RESULT: A weak positive correlation was found between suicide rates and GNP per capita in both sexes for all ages. DISCUSSION: According to previous studies, there is a clear decline in deaths due to unintentional injuries with improved economic conditions. This example of a man-made disease that declines during the fourth stage is in agreement with the theory of epidemiological transition. However, our results found the opposite pattern for deaths due to intentional self-inflicted injury. CONCLUSION: Mortality rates due to unintentional and intentional self-inflicted injury show deviating patterns from an epidemiological transition perspective.

Cross-Sectional Studies↗
PubMedDate not supplied

The performance measurement manifesto.

The leading indicators of business performance cannot be found in financial data alone. Quality, customer satisfaction, innovation, market share--metrics like these often reflect a company's economic condition and growth prospects better than its reported earnings do. Depending on an accounting department to reveal a company's future will leave it hopelessly mired in the past. More and more managers are changing their company's performance measurement systems to track nonfinancial measures and reinforce new competitive strategies. Five activities are essential: developing an information architecture; putting the technology in place to support this architecture; aligning bonuses and other incentives with the new system; drawing on outside resources; and designing an internal process to ensure the other four activities occur. New technologies and more sophisticated databases have made the change to nonfinancial performance measurement systems possible and economically feasible. Industry and trade associations, consulting firms, and public accounting firms that already have well-developed methods for assessing market share and other performance metrics can add to the revolution's momentum--as well as profit from the business opportunities it presents. Every company will have its own key measures and distinctive process for implementing the change. But making it happen will always require careful preparation, perseverance, and the conviction of the CEO that it must be carried through. When one leading company can demonstrate the long-term advantage of its superior performance on quality or innovation or any other nonfinancial measure, it will change the rules for all its rivals forever.

Economic Competition↗
PubMed2003

Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health.

In this paper, we attempt to verify that neighborhood economic structure influences individual health over and above other individual characteristics, and to comparatively evaluate the effects of neighborhood concentrated affluence, concentrated poverty and income inequality in relation to individual health in the USA. We also explore physical environment, health-enhancing services, social hazards (crime) and social resources as mechanisms operating at the neighborhood level that may help to explain the influence of structural economic conditions on health. We use Hierarchical Ordinal Logit Models to examine a rich multi-level data set. Results indicate that affluence exerts significant contextual effects on self-rated health while poverty and income inequality at the neighborhood level are not important structural factors. Moreover, we find that a composite measure of social resources distinguishes itself in both explaining the impact of concentrated affluence and exerting an independent contextual effect on individual health. Physical environment, or the level of physical disorder in the neighborhood, also mediates the effect of affluence on self-rated health, although to a lesser degree than social resources. Our empirical findings suggest that different dimensions of economic structure do not in fact have unique and additive contributions to individual health; the presence of affluent residents is essential to sustain neighborhood social organization which in turn positively affect health.

Adult↗
PubMed1998

Dental condition and identification marking of dentures in homes for the elderly in Göteborg, Sweden.

Denture marking is of crucial importance especially in homes for the elderly where dentures could be misplaced, particularly during cleaning by staff where there is a chance of loss or mix-up. Recent research regarding denture marking in homes for the elderly shows that only about 50% of the dentures were marked and that the issue should receive attention. The aim of this study was to investigate the number of subjects with natural teeth and the number of edentulous subjects in homes for the elderly in Göteborg, Sweden. The results of the present work show that only about 35% of the complete dentures were ID-marked. Thus, even if the number of complete denture wearers is few, in Sweden presently there are predictions that dentures will become more common in the future, and also in other parts of the world owing to the socio-economic conditions of today and likely in the future.

Aged↗
PubMed2001

Marital fertility in Lebanon: a study based on the population and housing survey.

This study tested the general economic theory of fertility within the contextual setting of the Lebanese society, by using the 1996 Population and Housing Database Survey. The theory argues that the household's demand for a child is closely related to different services and utilities ascribed to that child. It also claims that fertility as such is income-inelastic, but becomes positively associated with the household's income when the notion of child-quality is added to the model. Findings confirm the baseline inverse association between an index of the household's socioeconomic status (HSES) and the cumulative fertility level. However, when women's education was added to the model, an interaction was observed whereby the illiterate subgroup--unlike the educated--was at higher risk of having a large number of children with improvement in their economic conditions. A similar interaction was found between women's and husband's education. It was concluded that in response to higher socioeconomic status, illiterate women end up supplying an excess number of children, an effect mediated by the shortening of lactation period, which is in turn triggered by a higher access to breast milk substitutes. On the other hand, their educated husbands demand 'child quantity' since this educational gap grants them more power to decide their family size. In contrast, educated women demand child 'quality' as they expect both material and opportunity costs of having a child to coincide with the norms and values of their social class. Their lower supply of births with increased economic well-being is primarily attributed to a higher use of modern contraceptive methods. Other factors investigated in this study included the potential effect of family structure on fertility, and control was done on a number of other sociocultural and demographic variables, such as women's work status, husband's occupation, age at marriage and area of residence.

Analysis of Variance↗
PubMed2004

The wheezy infant -- immunological and molecular considerations.

Most of the data on the pathogenesis of asthma is based on information obtained through bronchial biopsies and bronchoalveolar lavage in adults and young adults. Ethical considerations linked to the invasive nature of airway endoscopy have limited the studies on the pathophysiology of asthma in infancy and early childhood. Although there is evidence that an asthma-like inflammation, with increased inflammatory cells and thickening of the lung basement membrane, may be present also at a very early age, clinical and epidemiologic studies suggest that asthma manifestations in preschool children may significantly differ from those observed in older subjects. In western countries, the vast majority of infants and young children has episodic (or intermittent) asthma, and the exacerbations generally defined "wheezing episodes" occur more frequently with a seasonal pattern being usually related to acute viral infections. There is strong epidemiological evidence that approximately 2/3 of all children who wheeze because of viral infections in early life (and are not atopic) have a transient condition that tends to disappear during early school years. All respiratory viruses may be implicated in the wheezing episodes, the principal being respiratory syncytial virus (RSV) and, with a lower frequency, adenovirus and parainfluenza viruses during the first 3 years of life, and rhinoviruses after that age. Infants and preschool children have on average 6-8 "colds" per year, but the illness tends to be limited to the upper respiratory tract alone in a considerable proportion of individuals, without causing symptomatic involvement of the lower respiratory tract. The variety of factors determining the different outcomes are only partially known, but complex interactions between the intrinsic pathogenicity of the virus and host factors, including the socio-economic conditions of the family, are central to define the type of manifestations and the severity of the process.

Antigen-Antibody Reactions↗