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PubMed1995

Prolegomena for an anti-dictatorship campaign.

This work represents a derivative of a greater study in which adequate values should be given to the psychological component of dictatorship and tyranny within the framework of certain social conditions, economic possibilities of societies, and political events that begin and end all political differences and chaos. Society, economy, and politics are simultaneously the feeding places and hunting ground where ambitious individuals and suggestible masses meet. This "fortunate meeting" leads to dictatorship, which wouldn't be possible without these two psychological components. In our life we have become aware of the irresistible fascination between the masses and a future dictator who uses the masses for the encouragement of his own defenses embodied in narcissism, hatred, and personal will. However, we shouldn't forget that the dictator's characteristics and aspirations represent mostly the fragments of a frustrated childhood and extreme personal outrage and weakness. The author is not on safe ground while tracing the most convincing historical background to confirm his thesis about the appearance of the dictator and dictatorship, however neither can he find a firm stand for its prevention on these phenomena. On the contrary, these shoudn't be any delusions concerning our times and Middle-European conditions, because the appearance of a dictatorship is possible always and everywhere--just the colors are changed. Therefore, it is quite necessary to lead a permanent antidictatorship campaign. Why? Because dictatorship is always possible although it can appear in different forms and can be based on shrewd illusions. Group interests become the most obvious source of a dictatorial invasion. Today, nationalism, fed by the retardate religious remnants from the past, is on the offensive.(ABSTRACT TRUNCATED AT 250 WORDS)

Democracy↗
PubMed1993

[Paths of food hygiene in Poland].

Varying economic conditions and management systems in different countries have determined the foundation of legal regulations for sanitary food control. The legal system in Poland in the years 1795-1928 was subject to the laws of three partitioning powers: Prussia, Russia and the Austro-Hungarian Empire. On March 28, 1928, the President of Poland passed three decrees equivalent to acts which had a significant impact on sanitary food control. The decrees took into account the following issues: animal protection, food products inspection and evaluation of slaughter animals and meat. For the people of Poland, who in the first half of the 20th century lived within the boundaries drawn by the partitioners, it was important that the legal systems had been based on German law, regarded the best possible at that time. Although the decrees were based on Prussian and Austrian regulations, the infrastructure of food production, of food trade and hygiene in Poland until 1945 was built on the Russian administrative foundation (2/3 of Polish territory) (Fig. 1). After World War II, the economic system established in Poland was subordinate to Soviet rules. This included food manufacturing plants as well as the system of food control. In 1989 Poland came through deep political and economic changes, but the legal system has remained the same. However, there are disputes about the scope between the National Hygiene Inspectors (PIS) operating under the Ministry of Health and Veterinary Hygiene Inspectors (WIS) subject to Woivod's Office.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2000

A South-East Asian perspective.

In order to discuss the subject of occupational medicine in the next century, changes in the present demographic profile and work activity must be considered first. Only then can the challenges be identified, and appropriate strategies be formulated to respond to them. In the diverse countries of South-East Asia, improved health and work conditions, the advent of new technology, a redistribution of work activity, and an ageing workforce can be expected. Two other factors that have specific impact in the region are the recent financial crisis and the occurrence of an international environmental haze from forest fires. The various countries in South-East Asia, which are in different stages of development, and have different problems and priorities, will respond differently to the demands for occupational health. It is likely that there will be a shift in the focus of current health care activities towards specific work sectors, the recognition of new hazards at work, the identification of newly emerging work related diseases, and an increase in health promotion in the workplace. Hopefully, there will be improved training of health professionals to ensure that there are adequate numbers and that they are well prepared to face these changes. Responsive, appropriate and well enforced labour legislation to protect the health of all workers, and international cooperation in occupational and environmental health are also required. As global and regional economic conditions continue to remain unstable and the impact of the crisis further takes its course, the final effect on occupational health in South-East Asia remains to be seen.

Asia, Southeastern↗
PubMedDate not supplied

Comparing the health status of VA and non-VA ambulatory patients: the veterans' health and medical outcomes studies.

The purpose of this study was to compare health status and disease profiles of ambulatory patients in specific Veterans Administration (VA) and civilian healthcare settings. A random sample of 2425 male veterans seeking care at 4 Boston-area VA outpatient clinics, who took part in the Veterans Health Study (VHS) in 1993-1995, were compared to 1318 male patients seeking civilian outpatient care in 3 major metropolitan areas covered in the Medical Outcomes Study (MOS) in 1986. The MOS sampled patients who had 1 of 5 conditions--hypertension, noninsulin-dependent diabetes, recent myocardial infarction, congestive heart failure, or depression. These 2 samples were age adjusted and compared in terms of the SF-36 Health Status/Quality of Life measures, and a list of 100 clinical variables (diagnostic, symptom, and medical event reports) collected with comparable instruments by a trained clinical observer. Individual odds ratios (VHS to MOS) were calculated for each measure and clinical variables. SF-36 measures of patient health in the VHS were lower than those in the MOS by more than one half of a standard deviation (SD) on 4 of 8 scales, by more than one quarter of a SD on the other 4, by 58% of a SD on the physical health summary scale, and by 37% of a SD on the mental health summary scale (P < .0001 in all cases). The median odds ratio was 2.2 among the SF-36 scales and 1.9 among clinical variables. Outpatients in the 4 VA clinics had more than twice the illness burden than did patients in the MOS. Current economic condition and service-connected disability explain most, if not all, of the differences. The differences were clinically and socially meaningful and would be consistent with substantially higher expected healthcare use.

Ambulatory Care Facilities↗
PubMedDate not supplied

[Strongyloidosis in Canavese: 4 cases seen at the 'Ospedale di Ivrea-Castellamonte. Epidemiological and clinical considerations].

From May 1988 to September 1990 the microbiology laboratory of the Ivrea-Castellamonte Hospital (Province of Turin) carried out 1464 coproparasitological investigations. 0.5% of the samples, coming from 5 patients, proved to be Strongyloides stercoralis positive. 4 cases were diagnosed in recovery conditions, and on these we carried out a retrospective study (taking into consideration some epidemiological and clinical aspects). The average age of these patients, three men and one woman, was 70.5; all native of the Canavese and resident in agricultural zones; two farmers still working, a worker and a retired worker. All of them presented one or more associated pathologies and/or a tendency to parasitosis. The clinical picture was characterized by abdominal pain, present in three cases, while diarrhoea was observed in only one case; a slight temperature in two, a high temperature in one; nettle-rash manifestations in one case and breathing symptomatology in two. In two cases there appeared abdominal relaxation (meteorism) and in one of these there was a serious paralytic ileus. Eosinophilia was present in all the patients, even if at different levels (from 5.9% to 20%). The treatment was carried out with different drugs: mebendazole in two cases, thiabendazole in one and "pyrvinium pamoate" in another. Our conclusion is that there exist in the Canavese the climatic, environmental and social-economical conditions which can favour Strongyloidiasis.

Abdominal Pain↗
PubMedDate not supplied

Tropical obstetrics and gynaecology. 2. Maternal mortality.

Estimates of maternal deaths per 100,000 births are 270 for Latin America, 420 for Asia and 640 for Africa, compared to only 30 in developed countries. In places with high maternal death rates, women who fail to receive antenatal care and who then report to hospital only when their lives are threatened by major obstetric complications constitute the crux of the problem. In reducing maternal deaths in such places, especially in Africa, the need is to provide vigorous treatment for the unbooked emergencies and, at the same time, work towards the removal of the cultural, health and socio-economic conditions which create the unbooked emergencies. The first objective can be achieved through developing a network of first referral hospitals so that life saving measures are accessible to all who need them before it is too late. The second objective can be realized only through the universal provision and utilization of basic but professional antenatal care and also through modernization of the society as a whole. For all of these goals, universal formal education is fundamental.

Africa↗
PubMed2006

Intergenerational effects of preterm birth and reduced intrauterine growth: a population-based study of Swedish mother-offspring pairs.

OBJECTIVE: To estimate the intergenerational effects of preterm birth and reduced intrauterine growth. DESIGN: Population-based cohort study. SETTINGS: Mother-first-born offspring pairs recorded in the Swedish Medical Birth Registry. POPULATION: Children born before 2001 to 38 720 women born in 1973-75. METHODS: The relationships between the mother's and the child's birth characteristics were estimated using logistic regression analysis. Adjustments were made for smoking habits, body mass index (BMI), and current and childhood socio-economic conditions. Analyses were performed on all mother-offspring pairs and on the pairs for which information on neither of the included background variables was missing (n= 24 520). MAIN OUTCOME MEASURES: Preterm birth (<37 weeks of gestation) and small for gestational age (SGA) (<-2 SD of the Swedish standard). RESULTS: Mothers who themselves had been born preterm were not significantly more likely to deliver their own children preterm, compared with those who had been born at term (adjusted OR 1.24, 95% CI 0.95-1.62). Also, preterm birth in the mothers did not influence the occurrence of SGA in the children. However, the odds ratio for giving birth to SGA and preterm children, respectively, was higher among SGA mothers (OR 2.68, 95% CI 2.11-3.41 and OR 1.30, 95% CI 1.05-1.61). Mothers whose intrauterine growth was moderately reduced but who did not meet the criterion of being born SGA were also at higher risk of giving birth to both preterm and SGA children, respectively. CONCLUSIONS: The present study showed evidence of intergenerational effects of reduced intrauterine growth even when socio-economic factors as well as BMI and smoking were adjusted for. There was, however, no consistent intergenerational effect of preterm birth.

Adult↗
PubMed2004

Regional trends in Portuguese gastric cancer mortality (1984-1999).

The international decline in gastric cancer is mainly attributed to improved socio-economic conditions. However, some southern and eastern European countries showed slower and later decline, reflecting a less favourable general environment The same probably applies to regional differences within countries, making national indicators potentially misleading. Fitting log-linear Poisson models we compared trends in gastric cancer mortality (1984-1999) across 18 Portuguese regions. Pearson correlation coefficients were computed to assess the regional association between decline in cancer mortality and baseline cancer mortality and variation in indices of social development and medical care. National gastric cancer mortality changed -2.0% year in men and -2.2% year in women. The regional yearly variation in mortality ranged from -3.5% [95% confidence interval (CI) -4.5 to -2.5] to -0.6% (95% CI -1.4 to 0.2) in men, and from -3.7% (95% CI -4.8 to -2.7) to -0.8% (95% CI -1.6 to 0.0) in women. Regional variation was not significantly associated with baseline gastric cancer mortality (r = 0.18, P = 0.47), but with the variation in post-neonatal mortality (r = 0.59, P = 0.01). In Portugal, gastric cancer shows a wide regional variation in frequency trends. The correlation with known indicators of social and economic development indicates that future improvement in gastric cancer rates is expected in parallel with a more widespread development.

Adult↗
PubMed2001

Mental health in Asia: social improvements and challenges.

Remarkable improvements in economic conditions and a considerable upgrade in the quality of life have been observed in many parts of Asia during the past several decades. At the same time, many mental health challenges face the people of Asia. Various social mental health indexes are reviewed here, with available data from China, Japan, Korea, Singapore, Malaysia, and other Asian societies. The data are compared with data from the United States, Australia in the Pacific Rim, and some other Western countries to examine patterns of similarity or difference between East and West in the process of modernization. Common trends in mental health issues associated with rapid sociocultural change observed in different Asian societies are discussed, as well as the relative shortage of mental health personnel available in many Asian societies. It is emphasized that, in addition to expanding psychiatric services, there is an even more urgent need to promote mental health knowledge and concern through education in the general population. Mental health needs to be cultivated and maintained by social forces and cultural strengths. It is stressed that there is a challenge for Asian people to advance mental health beyond economic development in the 21st century.

Asia↗
PubMed1996

Application of a classical model of competitive business strategy to orthodontic practice.

This study explored how market forces might affect the business aspects of orthodontic practices; in particular, profitability. The forces identified were (1) intensity of rivalry, (2) threat of new entrants, and (3) bargaining power of buyers and suppliers. A mail survey instrument was used to collect the data. Results showed that more than half the surveyed practices show an increase in new case starts despite weak economic conditions. Although satellite offices and marketing increase the overhead, they do not add to net profit. New entrants are a threat to existing practices, as are the substitute discretionary spending by the consumer. Interestingly, while some orthodontic practices have joined the managed care programs, a majority of them realize neither increased patient load nor profit. Our data seem to indicate that orthodontic practices have not been successful in "cost containment" with their marketing, number of employees, computerization or inventory. Collectively, the results of this study suggest that success in an orthodontic office is primarily dependent on the practitioner's personality traits, rather than rigidly applied business principles.

Attitude of Health Personnel↗
PubMed2005

Seroprevalence of hepatitis A antibodies in relation to social factors--a preliminary study.

INTRODUCTION: Hepatitis A is a benign illness in children with the rare possibility of fatal complications. Although an endemic disease, very few studies have been done in children regarding the seroprevalence of hepatitis A antibodies in Sri Lanka. OBJECTIVES: (i) To document the seropositivity for hepatitis A in a group of children admitted to a paediatric ward. (ii) To determine the relationship of hepatitis A viral infection to social factors in these children. METHOD: A prospective, descriptive, cross-sectional study was carried out in a ward at the Lady Ridgeway Hospital for 7 months from September 2001. Children admitted on predetermined days, needing venepuncture for their presenting illness, were studied while those who were seriously ill were excluded. Written consent was obtained and a questionnaire with details of socio-economic conditions, personal hygiene practices of the mother, access to water and sanitation and health related behaviour was administered. Total antibodies to hepatitis A were detected by ELISA on a sample of blood taken from each patient. RESULTS: Two hundred and eighty eight samples of blood were analysed. None of the children were immunised against hepatitis A. There were 158 boys (54.9%). Thirty one (10.8%) of the 288 patients had antibodies against hepatitis A. The seroprevalence was 11.6% in children under 10 years of age. Majority (78%) were from families with a monthly income of less than Rs 10,000/-. Fifteen (48.4%) of the 31 seropositive children were from families earning less than Rs 5000/- per month. Belonging to social classes IV and V and having mothers with only primary education were factors significantly associated with seropositivity. No significant difference in the presence of antibodies was observed regarding the personal hygiene practices analysed and access to basic amenities. Health related behaviour practices analysed were significantly associated with the presence of hepatitis A antibodies. CONCLUSIONS: Seroprevalence of 10.8% was observed in a selected group of children. Factors such as poor socio-economic background and having mothers with only primary education were associated with hepatitis A virus (HAV) antibodies as were certain health related behaviour practices of children.

Adolescent↗
PubMed2000

Is low income a constraint to contraceptive use among the Pakistani poor?

This paper examines whether low income is a barrier to contraceptive use in Pakistan, a country in which economic conditions are deteriorating at a time when the private sector is becoming a more important supplier of contraception. Multivariate regression analysis performed using the Pakistan Contraceptive Demand Survey suggests that low income is a deterrent to modern contraceptive use in Pakistan. This is particularly the case for contraceptive methods supplied through the private sector. It is concluded that, if the aim of family planning programmes is to reach low-income people, the prices of contraceptives supplied through the private sector should be kept as low as possible.

Adolescent↗
PubMed2002

[Prevalence of anaemia in pregnancy and analysis of the underlying factors].

OBJECTIVE: To determine the prevalence of anaemia and to evaluate the factors that condition its occurrence.Setting. Out-patient clinics in the La Plata area, Buenos Aires, Argentina. DESIGN: Observational and prospective study. PARTICIPANTS: All the pregnant women consulting for the first time, excluding those with prior pathology or regular use of medical drugs. MEASUREMENTS: Anaemia was defined at values of Hb < 11 g/dl. Questionnaires were administered for general data and the type of nutrition, and a complete haematological report was compiled. RESULTS: 1218 pregnant women started the study. Anaemia was detected in 196 of them (16%), with average Hb 9.88 g/dl. Between normal and anaemic pregnant women, the following differences were found between the first and second consultations: weight (64.44 vs 59.50, p < 0.00001), family income (US$744.36 vs 568.28, p < 0.0001), kilocalories ingested (2,488.44 vs 2,204.28, p = 0.01), percentage of proteins in diet (15.73 vs 13.69, p = 0.002), and weekly iron consumption (15.24 mg vs 13.04, p < 0.0001). CONCLUSIONS: Pregnant women run a greater risk of suffering anaemia if they have diets of < 1800 kcal, < 13% proteins, less than 7 mg of iron per week, and haemic iron < 10%; and family income below US$400. Ensuring a proper diet and improving the social and economic conditions of this population group will reduce the risk of anaemia during pregnancy and its perinatal consequences.

Adult↗
PubMed2001

Should programmes for community-level meningococcal vaccination be considered in Australia? An economic evaluation.

BACKGROUND: Disease due to serogroup C Neisseria meningitidis is life-threatening and potentially preventable by vaccination. In 1999, the UK instigated mass vaccination after a sustained increase in serogroup C meningococcal disease. In the same year, Victoria, Australia experienced a similar change in disease epidemiology. It is timely to undertake an economic evaluation of options for community vaccination in Australia based on local data. METHODS: Cost-effectiveness and cost-benefit analyses of three options for use of polysaccharide vaccine were undertaken for a hypothetical population aged 15--19 years. Baseline analyses assumed 5 years' duration of vaccine protection following a single year of programme implementation. Sensitivity analyses of key variables were performed, including vaccine coverage and effectiveness, case fatality rate and the discount rate. Outcomes included the number of people vaccinated, cases averted, life-years saved and disability-adjusted life-years (DALY) averted. Cost-benefit analysis used lost earnings avoided as a measure of vaccination benefit. RESULTS: Vaccination of people aged 15--19 years in a defined population with a high rate of disease was the most cost-effective option. Compared with no vaccination and assuming 5 years' duration of protection and exclusion of direct cost savings, this resulted in a discounted cost per life-year saved of $23,623, a cost per DALY avoided of $21,097 and benefits exceeding costs in discounted terms. The 'break-even' incidence rate for this option with exclusion of direct cost savings was 14.0/100,000. CONCLUSIONS: Community use of polysaccharide vaccination may be cost effective in Australia under certain conditions. Economic evidence favours use of vaccination in well-defined populations with a high rate of disease. Policy decision-making also requires consideration of non-economic factors, including feasibility of implementation and risk perception by the community.

Adolescent↗
PubMed2001

Relationship of intestinal parasites to the environment and to behavioral factors in children in the Bolikhamxay Province of Lao PDR.

From March to July 1998 the infection rates of 732 children aged below 15 years were assessed. The investigation was conducted in selected villages of the Bolikhamxai Province in Lao PDR. Socio-economic conditions and behavioral pattern were studied. The three soil-transmitted helminths, Ascaris lumbricoides, Trichuris trichiura and hookworm were found with prevalence rates of 67.14, 17.49 and 12.83%, respectively. Infection rates with other intestinal parasites were negligible. Of the children investigated, 56.7% harbored one and 20.45% more than one parasite. Except for hookworms, no statistically significant differences were found between genders. The probability of being infected with A. lumbricoides is associated with living in mountainous areas. For hookworms, infection is associated with staying in the plains. A river in the vicinity of the village is linked with the probability of being infested with Trichuris trichiura. Not to belong to a family with the ability to own expensive items increases the probability by almost two times of getting infested with A. lumbricoides. Unhygienic behavioral factors were important in increasing the probability of suffering from A. lumbricoides and T trichiura infection. Behavioral factors did not seem to be related to hookworm infections. It was concluded that after mass treatment, besides promoting the construction of toilets, it is also important to improve personal hygiene so that a lasting impact on the infection rate of the most prevalent parasites in Lao PDR could be achieved. Measures to control parasitic infections do not have to be postponed until a marked improvement of the economic situation has occurred.

Adolescent↗
PubMed2006

Control and prevention of avian influenza in an evolving scenario.

Continuing outbreaks of highly pathogenic avian influenza (HPAI) across Eurasia and in Africa, caused by a type A influenza virus of the H5N1 subtype appear out of control and represent a serious risk for animal and public health worldwide. It is known that biosecurity represents the first line of defence against AI, although in certain circumstances strict hygienic measures appear to be inapplicable for social and economic conditions. The option of using vaccination against AI viruses of the H5 and H7 subtypes, has made its way in recent times--primarily as a tool to maximise the outcome of a series of control measures in countries that are currently infected, but also as a means of reducing the risk of introduction in areas at high risk of infection. In developing countries vaccination programmes in avian species have been recommended recently, however it will require concurrent management of local husbandry practices and industry compliance to eradicate the disease rather than the establishment of an endemic situation. Other key deliverables expected for this control strategy include maintaining a major source of food for rural communities and the preservation of the commercial viability of the local poultry industry. In developed countries vaccination is being used as a means of increasing resistance of susceptible animals to reduce the risk of introduction from the reservoir host or to reduce secondary spread in densely populated poultry areas. The recent joint OIE/FAO summits recommended applying vaccination, using the differentiating infected from vaccinated animals (DIVA) strategy when there is risk of major spread and depopulation is not feasible or desirable. Particularly in developing countries, stamping out of infected animals does not seem to be an appropriate means of reducing the spread of infection, if food supplies are to be guaranteed and economic consequences minimised. Crucial points to the success of a vaccination campaign are the implementation of complex territorial strategy involving upgraded biosecurity, monitoring vaccine efficacy, identification of field exposure and the appropriate management of infected flocks, regardless of vaccination status. Granting financial support for the compensation of farmers is also a key part of this strategy. Poultry veterinarians working for the industry or for the public sector represent the first line of defence against the pandemic threat and for the prevention and control of this infection in poultry and in wild birds.

Animals↗
PubMed1998

Intensive care use in a developing country: a comparison between a Tunisian and a French unit.

OBJECTIVES: To compare the variations in intensive care (ICU) outcome in relation to variations in resources utilization and costs between a developed and a developing country with different medical and economical conditions. DESIGN AND SETTING: Prospective comparison between a 26-bed French ICU and an 8-bed Tunisian ICU, both in university hospitals. PATIENTS: Four hundred thirty and 534 consecutive admissions, respectively, in the French and Tunisian ICUs. MEASUREMENTS: We prospectively recorded demographic, physiologic, and treatment information for all patients, and collected data on the two ICU structures and facilities. Costs and ICU outcome were compared in the overall population, in three groups of severity indexes and among selected diagnostic groups. RESULTS: Tunisian patients were significantly younger, were in better health previously and were less severely ill at ICU admission (p < 0.01). French patients had a lower overall mortality rate (17.2 vs 22.5%; p < 0.01) and received more treatment (p < 0.01). In the low severity range, the outcome and costs were similar in the two countries. In the highest severity range, Tunisian and French patients had similar mortality rates, while the former received less therapy throughout their ICU stays (p < 0.05). Conversely, in the mid-range of severity, mortality was higher among Tunisian patients, and a difference in management was identified in COPD patients. CONCLUSION: Although the Tunisian ICU might appear more cost-effective than the French one in the highest severity group of patients, most of this difference appeared in relation to shorter lengths of ICU stay, and a poorer efficiency and cost-effectiveness was suggested in the mid-range severity group. Differences in economical constraints may partly explain differences in ICU performances. These results indicate where resource allocation could be directed to improve the efficiency of ICU care.

Adult↗
PubMed1998

Sustainable development and quality of life: expected effects of prospective changes in economic and environmental conditions.

In the context of "sustainable development", we studied which attributes are important to people's quality of life (QoL) and which changes in QoL people would expect from future economic and environmental improvements or deteriorations. About 200 adult subjects evaluated the relative importance of 22 different QoL attributes. They subsequently indicated expected changes in those attributes, under three different scenarios in which economic and environmental conditions would either improve or deteriorate. On average, subjects judged the QoL attributes "healthy", "family", "environmental quality", "nature" and "safety" to be most important, while "recognition", "comfort", "status" and "spiritual life" were found least important. The most important QoL attributes as well as "security" were judged as more important by women than by men. Also observed were income and age effects on relative attribute importance. Our (Dutch) subjects expected significant and varied negative QoL changes from an environmental-deterioration scenario involving either an improved or a deteriorated economy. In contrast, they had mixed positive-negative QoL expectations about environmental improvement combined with economic deterioration. Subjects high in environmental concern assigned greater weight to "environmental" QoL attributes, and they expected environmental improvement versus deterioration to more strongly affect their QoL-attributes "environmental quality", "nature", "health" and "unity with nature", than did subjects low in environmental concern. We conclude that quality of life can be meaningfully conceived as a multi-attribute value concept, useful for assessing the expected effects of future economic and environmental conditions. Suggestions are given for methodological improvement and for further research.

Adolescent↗