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PubMed2005

The Burden of Obstructive Lung Disease Initiative (BOLD): rationale and design.

Quantifying COPD prevalence worldwide is needed to document COPD's effect on disability, health care costs, and impaired quality of life and to inform governments and health planners. As an adjunct to data obtained from population-based studies, and for countries where a fully powered prevalence survey cannot be done, modeling of COPD prevalence and its economic burdens can help estimate potential health care needs and costs. For comparability, standardized methods for prevalence surveys are needed that can be used in countries at all levels of economic development. The Burden of Obstructive Lung Disease (BOLD) Initiative has developed a set of methods for estimating COPD prevalence and a model for assessing its economic impact, and piloted these methods in China and Turkey. The methods were revised to reflect the findings in the pilot studies, and BOLD is now making the standardized methods available worldwide. The BOLD Operations Center provides training, materials, quality control, and data analysis. BOLD emphasizes data quality control at every stage of the process. Data from paper forms completed in the field are entered electronically to a specially designed secure Web platform. Pre- and post-bronchodilator spirometry testing is done on all participants, and all spirometry data are reviewed for quality. Questionnaires are used to obtain information about respiratory symptoms, health status, exposure to risk factors, and economic data about the burden of COPD. BOLD's standardized methods will provide a uniform way to compare COPD burden within and between countries, and where differences are found, to explore explanations for these differences.

Cost of Illness↗
PubMed1988

Determinants of temporal and areal variation in infant mortality in Germany, 1871-1933.

This article investigates how sociodemographic, economic, medical, and public health factors influence infant mortality by using data about German administrative areas from 1871 to 1933. Marital fertility has the largest impact on infant mortality, followed by illegitimacy, medical care, urbanization, and infant welfare centers. The variables considered here account for most of the variation in infant mortality. Some of the unexplained variance is due to factors associated with regions, such as breastfeeding patterns, and with time periods, such as national health insurance. The analyses found no evidence that advances in medical technology affected infant mortality or that the influence of economic development changed over time.

Child Health Services↗
PubMed2004

Efficiency and sustainability of using resources in Estonian primary health care.

AIM: To assess the efficiency and sustainability of using health resources in Estonian primary health care during 1998-2002. Three economic criteria--allocative efficiency, technical efficiency, and financial sustainability were analyzed from the original set of indicators, in parallel with the analysis of the Estonian economic development in 1998-2002. METHOD: Routinely collected data from the Estonian Health Insurance Fund, the Department of Statistics and Analysis of the Ministry of Social Affairs, and Statistical Office of Estonia were used. All together, 22 empirical indicators that cover the most important areas of primary health care provision and utilization for the period 1998-2002 were calculated. RESULTS: Since 1999, Estonian economic growth has been approximately 7% each year. In 2000-2002 the average growth of consumer prices was approximately 4%. The number of family doctors has increased because the relevant education has been provided on a regular basis. Family doctors are using both group and solo practice. The size of family doctors' patient lists has stabilized, but can still vary between different counties and between countryside and towns because of variations in the density of population in different areas. The new combined system of financing primary health care provides a financial sustainability in using resources in Estonian primary health care. CONCLUSION: Similar sets of indicators may prove useful in other countries of Eastern and Central Europe which are undergoing rapid changes in their health systems, yet do not have the complex health information systems like those in the countries from Organisation for Economic Co-operation and Development (OECD), and enable comparative analyses between them.

Efficiency, Organizational↗
PubMed2000

Neurocysticercosis and epilepsy in developing countries.

Neurocysticercosis is a disease of poverty and underdevelopment. Little is known about the natural history of the infection in humans, but some of the mechanisms whereby the parasite remains silent and evades the host immune response are understood. Symptomatic neurocysticercosis usually results from host inflammatory response after parasite death, and the clinical manifestations can be diverse. There is no evidence that cysticidal treatment does more good than harm in addition to conventional antiepileptic treatment. Population control measures involving immunisation or mass treatment have not shown long term effectiveness.Epilepsy, similarly to neurocysticercosis, is a largely unrecognised but increasing burden on the welfare and economies of developing countries. The technology of drug treatment and psychosocial rehabilitation is well known but requires widespread and effective dissemination at low cost. There is little epidemiological data on risk factors for epilepsy in developing countries on which to base prevention strategies. The public health prioritisation of chronic disorders such as epilepsy remains a challenge for policy and practice in developing countries. For both neurocysticercosis and epilepsy, there is a dilemma about whether limited public resources would better be spent on general economic development, which would be expected to have a broad impact on the health and welfare of communities, or on specific programmes to help individual affected people with neurocysticercosis and epilepsy. Either approach requires detailed economic evaluation.

Cost of Illness↗
PubMed1991

Disease control priorities in developing countries: health policy responses to epidemiological change.

Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parasitic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Economic injury levels and sequential sampling plans for Mexican bean beetle (Coleoptera: Coccinellidae) on dry beans.

Field studies were conducted during the growing seasons of 1995 and 1996, in Scotts-bluff, Nebraska, to determine yield-loss relationships for Mexican bean beetle (Epilachna varivestis Mulsant) on dry bean (Phaseolus vulgaris L.). Results of those experiments were combined with data from other studies previously conducted to develop economic injury levels (EILs), economic thresholds (ETs), and a sequential sampling program for Mexican bean beetle. Yield loss was regressed against larvae/row-m, and the slope of the linear regression (113 kg/ha per larvae/row-m) was used as the DI (yield loss/insect density) variable in EIL calculations. The EILs calculated in larvae/row-m were converted to egg masses/row-m and adjusted to reflect average survivorship to the adult stage. An example EIL for esfenvalerate at 0.509 (formulation) liter/ha (0.0453 gal/a) and crop value of 0.44 dollars/kg (20 dollars/100 lbs) was 17.78 larvae/row-m. The corresponding ET is 1.04 egg masses/row-m, which reflects an average of 54.6 eggs/egg mass and 33% survival rate from egg to injurious stages. Sequential sampling plans were calculated based on a negative binomial distribution using parameter k estimated from previous research. Because sampling is based on egg masses, growers can make management decisions and take management actions before significant injury occurs. Also, ETs can be adjusted to include the occurrence of natural mortality in the egg and early instars. Analyses demonstrated that relatively minor variation in ETs has substantial impact on sequential sampling plans, including parameters such as average sample number. An interactive spreadsheet was developed that allows users to input economic and other data specific to their situation to calculate Mexican bean beetle EILs, ETs, and sequential sampling plans.

Animals↗
PubMed1999

New understanding in obesity research.

A public-health approach considers the relevance of nutritional research in the prevention and management of obesity. Well-defined and internationally-agreed definitions based on BMI allow an assessment of the worldwide prevalence of overweight and obesity. There are about 250 million obese adults in the world, and many more overweight. Obesity is emerging in the Third World, first in urban middle-aged women. With economic developments, obesity then occurs in men and younger women. In the West childhood obesity is rapidly emerging, with concern that early-onset obesity is especially hazardous. In Asians the risks of excess visceral fat occur at lower body weights than in Caucasians. The propensity to visceral obesity in Asians may relate to malnourished mothers and low birth weight. The International Obesity Task Force is considering many issues, including the health economics of obesity. It has developed a strategy to define childhood obesity, which in children over 6 years is likely to predict long-term weight and health problems. While the search for genetic markers of obesity continues, with particular interest in the leptin gene, it is clear that societal change, with the decline in physical activity and the passive overconsumption of high-fat diets are major contributors to the global increase in obesity. The public-health aspects of obesity research are therefore challenging.

Asia↗
PubMed1992

Some problems of medicodemographic development in the former USSR.

The republics of the former USSR show great diversity in life expectancy, and in morbidity and disability prevalence rates. The diversity in life expectancy is strongly influenced by the different age, sex and cause-specific mortality rates obtaining in each republic. These in turn are determined by environmental, climatic and topographic features, as well as by social and economic development and lifestyle, including nutritional habits. In addition, large urban and rural differences are noted which may be partly accounted for by the restricted access to and low quality of health care in rural areas. Mortality, morbidity and disability rates have also shown unfavourable trends between 1965 and 1989 in many of the republics. The authors suggest further research to elucidate observed mortality, morbidity and disability differentials and trends, viz. analyses using finer breakdown of the population; examination of risk-factor-pattern data for mortality and morbidity by social groups and regions; the collection of data on health and demographic problems of ethnic minorities; greater use of socioeconomic development indicators at the regional level; surveys of individual opinions on perceived health, health requirements and quality of care received; and the development of appropriate medicodemographic models for analytic and forecasting purposes.

Adolescent↗
PubMed2006

[Development, health-industrial complex and industrial policy].

This paper puts health questions within the context of national development and industrial policy. It follows the idea of structuralist, Marxist and Schumpeterian approaches, in which industry and innovations form determining factors for the dynamism in capitalist economies and relative positions within the world economy. All countries that have developed and started to compete under better conditions with advanced countries have had an association between strong industry and an endogenous knowledge, learning and innovation base. However, in the field of health, this vision presents problems because business interests move according to the economic logic of profit rather than to meet health needs. The notion of the health-industrial complex is an attempt to provide a theoretical reference that enables linkage between two distinct types of logic: health and economic development. This study has sought to show, on the basis of foreign trade data, how disregard for the logic of health policy development has led to a situation of economic vulnerability in this sector, which may limit the objectives of universality, equality and comprehensiveness. Within this context, a cognitive and political break with these antagonistic visions that put health needs on one side and industrial needs on the other is proposed. A country that aims to reach a condition of development and independence requires strong innovative industries and an inclusive and universal health system, at the same time.

Biomedical Research↗
PubMedDate not supplied

Cardiovascular disease and global health: threat and opportunity.

The transition in global health from infectious to chronic disease, especially cardiovascular disease, poses a threat to the economies of the less developed world. As a more sophisticated workforce becomes a highly valued and harder-to-replace economic investment, the increasing prevalence of cardiovascular risk factors becomes a threat to economic development. The next two decades offer a critical period for intervention to blunt the impact of these diseases. The response of the global assistance community has been inadequate and without impact. A new global health assistance paradigm is needed to support long-term prevention strategies to combat this epidemic.

Adult↗
PubMed2002

A national sampling survey on birth weight in 1998 in China: mean value and standard deviation.

OBJECTIVE: To understand the distribution of live birth weight in China. METHODS: A national survey on live birth weight was performed during July-October, 1998 in China, with stratified sampling. Totally, 22 350 live newborns (11 584 males and 10 766 females) with 28 weeks or more of gestation were measured for their birth weight in the sampling sites during 1998. RESULTS: The ratio of male to female newborns measured was 1.08. The rates of multiple birth and preterm birth (< 37 weeks of gestation) were 1.8% and 3.5%, respectively. Live birth weight was higher in the urban areas (3 301 g) than that in the rural area (3 225 g) (t = 9.4. P < 0.001), the highest in the coastal areas (3 262 g), middle in the inland areas (3 254 g) and the lowest in the remote areas (3 115 g) (F = 177.9, P < 0.001), with a decreasing trend. Live birth weight in the first-class rural areas approximated to that in the urban areas, and that in the second-class, third-class and fourth-class rural areas decreased significantly. The average live birth weight in the fourth-class rural areas was 200 g lower than that in the urban areas. CONCLUSIONS: Generally, the average live birth weight in China was closed to that in the developed countries. But, a big difference in the average live birth weight between regions with varied economic development and health care condition was observed. An intervention measure should be implemented in the poverty-stricken rural areas to increase their average live birth weight.

Birth Weight↗
PubMed1976

A history of orthopedics in San Francisco and the West.

The unique development of early medical specialization in the West can be traced to California's geography and economic development. Such early specialization produced men with orthopedic inclinations. Early orthopedists founded the first medical school and the first modern teaching hospital, helped to found Stanford's Lane Medical Library and made the first use of x-rays in the West. In addition many of these orthopedists were prominent in the political and social activities of the time.

California↗
PubMed2000

Methodological framework for developing decision support systems (DSS) for hazardous materials emergency response operations.

The production, storage, and transportation of hazardous materials are processes of vital economic importance for any advanced and technologically complex society. Although the production and distribution of hazardous materials is associated with economic development, there is a significant potential danger to the natural and social environment in the event of their accidental release, a fact that prompts for the development and implementation of methods and techniques that aim to improve hazardous materials risk management decisions. The objective of this paper is to present a unified framework for developing a Decision Support System (DSS) for supporting a vital function of risk management, namely the management of emergency response operations. The proposed framework recognizes the peculiarities of the hazardous materials decision-making environment which is characterized by: (i) multiple stakeholders, i.e., persons and organizations involved in and affected by hazardous materials risk management decisions; (ii) lack of a formal management structure for monitoring and controlling in a unified manner all Emergency Response Resources; (iii) lack of clear distinction and fragmentation of responsibilities of the actors involved in risk management operations; and (iv) dynamic/real-time decisions, i.e., risk determinants change over time. The proposed framework was used in order to develop a DSS for managing emergency response operations for large scale industrial accidents in Western Attica, Greece.

Decision Making↗
PubMed1980

Health development and political policy: the lesson of Cuba.

In comparison to other Latin American countries at a similar or more advanced stage of economic development, Cuba has a relatively high ranking on major health status indicators. This paper examines the reasons for this contrast and concludes that they are largely political. This suggests that the severe health deficiencies of most developing countries are not inevitable consequences of poverty.

Adult↗
PubMed2005

Analysis and implications of the determinants of healthcare expenditure in African countries.

The income elasticity of health care spending in the OECD countries tends toward luxury good values. Similar studies, based on more recent data, and capable of informing macroeconomic health policies of the African countries, do not currently exist. How the health care expenditure in Africa responds to changes in the Gross Domestic Products (GDP), Official Development Assistance (ODA), and other determinants, is also relevant for health policy because health care is a necessity in the 'basic needs' theory of economic development. This paper presents econometric model findings of the determinants of per-capita health expenditure (in PPPs) for 26 African countries, using the flexible Box-Cox model regression methods and 1995 cross-sectional data (sources: WRI, UNEP, UNDP, The World Bank). The economic and other determinants, capturing 74 percent of the variations in health expenditures, include per-capita GDP (in PPPs), ODA (US dollar), Gini income inequality index, population dependency ratio, internal conflicts, and the percentage of births attended by trained medical workers. Income inequality dampens, while the ODA and population per health personnel raise health care expenditure. The GDP elasticity of about 0.6 signals the tendency for health care to behave like a technical 'necessity'. Implications for sustainable basic health development policies are discussed.

Africa↗
PubMed2000

Potential of Listeria hazard in African fishery products and possible control measures.

Africa contributes 5.54 million MT (4.5%) to the world harvest of aquatic organisms. Fisheries represent a vital sector for many countries in Africa, both for domestic food supply, employment opportunities and foreign exchange earnings. Despite the low level of African fish production and export in comparison with the other continents, fish represent the major protein Source in many countries (36-58% of animal proteins in C te d'Ivoire, Congo, Senegal, Angola) and fishing is a vital activity for Senegal, Mauritania, Morocco, Ghana, Tunisia and other countries. In fact, it is the main sector for foreign exchange earnings in countries such as Senegal and Mauritania (Ababouch, 1998b; 1999). Consequently, expansion of export and development and production of value-added products in Africa for export are strategic keys for future economic development. This will require the implementation of reliable in-plant HACCP-based quality and safety control systems. Unfortunately, very little in known about the prevalence and ecology of Listeria in food, especially as it relates to seafood safety. This paper discusses the potential of Listeria hazard from African fishery products and speculates on some possible control measures.

Africa↗
PubMed1989

Better health--but not for all: the Swedish Public Health Report, 1987.

This article is a summary of the Public Health Report submitted to the Swedish Parliament in 1987. Health development, especially that of underprivileged groups, is regarded as an indicator of the quality of social and economic development of the country. Sweden is a very egalitarian country, but in spite of decreasing inequalities in living standards, the Report shows increasing inequalities in health. At the same time, the state has put restraints on health care spending, and the shift in the health care budget toward more primary care has stopped. This development seriously impairs the ability of the health and medical services to cope with inequities described in this Report.

Adolescent↗
PubMedDate not supplied

Putting the wrong fuel in the tank.

Three recent observations when considered together indicate means whereby the health of Western countries could be improved and certain diseases still rare in developing countries avoided. The first is the recognition that many of the commonest chronic disorders in more economically developed countries are characteristic of modern Western lifestyles; the second is that these disorders can be considered to be manifestations of maladaptation to a new environment; and the third is the knowledge now available of the types of environment to which man has, through evolution, adapted.

Diet↗