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[Distribution of physicians in Costa Rica].

This article provides detailed information on the location of medical practitioners of Costa Rica by rural and urban area and by province, further broken down by medical specialty and place of practice. The data were obtained from a survey made from 1967 through 1975. The authors emphasize the apparent close correlation between the development of health institutions, the characteristics of the health care given the population, and the level of economic development of a country.

Costa Rica↗

Managing fish, flood plains and food security in the Lower Mekong Basin.

The "Lower Mekong Basin" in this paper refers to the part of the Mekong River Basin which is shared by Cambodia, Laos, Thailand and Viet Nam, all members of the Mekong River Commission, consisting of approx. 2,400 km of mainstream river, numerous tributaries and huge flood plains. Few river basins produce as much fish as the Mekong River Basin, and the fishery in the Lower Mekong Basin is among the biggest and most productive inland fisheries in the world. The flood plains of the Lower Mekong produce some four times as much fish per square kilometre as the North Sea, which is among the most productive marine areas in the world. It is quite clear that the fisheries in the Mekong Basin are very important for the population in respect to their food security and income. Its importance in nutrition is highest in the rural areas, where there are few other low cost sources of protein, and even in highland areas fish is of crucial importance in the diet. Most fish species in the Mekong Basin are migratory, and the economically most important ones are certainly so. However, with economic development gaining speed, the impact on migratory patterns and the competition for the water resources are becoming stronger. The water resources offer a large number of opportunities, and a lot of economic activities need access to the water resources for their development. However, what is seen in one sector as an opportunity may be considered as a threat in another, and a careful balance is necessary in order not to lose opportunities in important sectors. The fate of a large number of river basins in the world is frightening. Most have been left biologically near dead, with some of the big rivers reduced for a time, or forever, to be used as waste water canals for the new industries, and others almost dried out from excessive water extraction before they reach the sea.

Agriculture↗

Fatal occupational injuries in the construction industry of a new development area in east China, 1991 to 1997.

Two hundred thirty-five work-related deaths occurred in the construction industry in a new economic development area in eastern China between 1991 and 1997. These fatalities represented 55% of all occupational deaths. The average annual mortality rate was 51.5 per 100,000 construction workers. Falls were the leading cause of death (46.4%). Falls, collisions, struck by/against something, electrocutions, and excavation cave-ins were the main fatality antecedents, accounting for nearly 93.6% of all fatalities. The most common antecedents for incidents with multiple fatalities were falls, crane-related events, poisoning, and fire. These categories of antecedents were similar to those encountered in the construction industry in the United States. These data suggest that organizations need to focus on these event types when planning their prevention activities. Moreover, improved surveillance systems including computerized databases with narrative descriptions of injury events, antecedent factors, and person-time at-risk data are needed to target interventions more precisely.

Accidents, Occupational↗

Socio-economic status of the family and health problems in the preschool child. Lack of correlation in a Swedish sample.

Recent reports from countries with a highly developed economic status point out the association of well-being of children with socio-economic factors. The aim of the present investigation was to examine the extent to which health problems, i.e. functional impairments, diseases and handicaps, in 4-year-old children are related to socio-economic factors. The analysis was based on data from 7 173 children who had undergone the routine general health screening of 4-year-olds in the county of Uppsala. In the statistical analysis the main emphasis was laid on an explanation of the variance on the individual plane. The results showed that the correlations between health problems and socio-economic factors in general were weak or non-existent. An explanation of the lack of correlation in our sample might be that Sweden had succeeded in largely eliminating the health problems associated with external living conditions of the family. If differences between population groups do exist--and in the light of findings from other investigations it seems highly probable that they do--then these differences are probably to be sought in families' way of functioning, in the internal and external pattern of communication, in the general emotional climate and in the degree of social integration in the society.

Child Development↗

Total approach is a must for small and medium enterprises to attain sustainable working conditions and environment, with special reference to Bali, Indonesia.

Attention and assistance to enhance the role of small and medium scale enterprises (SMEs) by the government is more emphasized due to the success of SMEs in earning significant amount of foreign currency when Indonesia had to face economical crisis in 1997. This policy has been highly recognized again since the bombing tragedy in 2002; with the excellent evidence to show how important SMEs is in helping and maintaining the economic development of Bali. But in the implementation the assistance needs to be remanaged again in a more proper and appropriate way to attain the ultimate goals. The three economic potentials, agriculture in broad sense, tourism and SMEs (cottage industry included), must be developed in harmony, interdependence, support and complementary each other, if possible as synergist to obtain sustainable development of Bali. While assistance to SMEs must be done in a more coordinated way among the government technical offices, universities, NGOs, banking, and other social community institutions. By doing so, there would be no duplication or gap, nor creation of new disadvantageous problems. It could be in form of ergonomics, occupational health and safety impacts and problems in particular, and in adverse working conditions and environment in general. Therefore it is a must at this moment to carry out total approach in helping SMEs, by integrating the effort to improve their working conditions and environment, built-in within the effort to enhance SMEs'quality of life through economic assistance. In this process a total approach through SHIP approach and Appropriate Technology intervention must be done wisely and timely. By so doing, SMEs'sustainable working conditions and environment shall be attained.

Capital Financing↗

Taiwan, R.O.C.: perspectives in school health.

Continuous economic development and evolving social systems have created unique challenges for school health personnel in Taiwan. Due in part to economic growth and an improving health care system, average life expectancy has increased markedly for males and females since 1950. Traditional leading causes of death such as pneumonia, tuberculosis, and gastroenteritis have been replaced by accidents, neoplasms, and cardiovascular diseases. Schoolchildren suffer from various disorders that include hepatitis B, dental caries, and health problems related to scholastic pressure such as myopia, anxiety, and depression. However, new problems such as violence, substance use, and teen-age pregnancy may develop in the future. In response to the challenge, an extensive school health program has emerged that emphasizes school health instruction, school health services, and a healthful school environment. Increased attention has focused on teacher preparation in health education, and a cooperative approach to school health promotion emphasizes school, community, and interagency cooperation. Prompted by the establishment in 1980 of the Graduate Institute of Health Education, National Taiwan Normal University, school-based research initiatives have increased dramatically. Eighteen recommendations for further improvement are offered.

Delivery of Health Care↗

Everyday health histories and the making of place: the case of an English coastal town.

During recent years, health geography has focused increasingly on how people's experiences of health and places are interrelated. This has included historical research on a variety of well-known places and remarkable events. In contrast, relatively little attention has been paid to how health and health care can be influential historically to the development, image and identity of 'everyday' and ordinary places. We focus on the case of a small town in Southern England to demonstrate the long and diverse historical connections that exist between health and such places. Using both historical documents and local literature, the paper reviews early invasions and incursions, epidemics of infectious disease, the development of a therapeutic seaside resort, the impacts of the Second World War, and more recent social and economic developments associated with an ageing population. Complex and diverse health-related histories are shown to be interwoven with local and extra-local histories including those of national or international significance. We argue that health histories can be integral to shaping the past and present of places and our broader understandings and interpretations of them. From a disciplinary perspective, we contend that by adopting theoretical perspectives from cultural geography, an enhanced historical geography of health could disentangle these historical strands, tell these important stories and put everyday health histories in their place.

Community Health Services↗

Histological assessment of tissue repair after treatment of human schistosomiasis.

Schistosomiasis is one of the main health problems hindering socio-economic development in Egypt. It affects millions at an early age, diminishing productivity and exerting a significant socio-economic impact. Schistosomiasis endemicity in Egypt varies in different areas. Schistosoma mansoni, with a prevalence generally ranging between 20 to 40%, has replaced Schistosoma haematobium in the Nile Delta, and the latter is now localized to upper Egypt with low endemicity levels (5-10%). The pathology of schistosomiasis consists essentially of a series of chronic inflammatory lesions produced in and around blood vessels by eggs or their products and sometimes by dead adult worms. If the ova continued to be deposited in sufficient numbers and over several years, they would ultimately lead to progressive fibrosis of the portal tracts and urinary bladder, or may be carried in blood and become trapped in the lungs, gastro-intestinal and genital tracts with only occasional association with other organs. The etiology of human pipe-stem fibrosis is still not understood. The host immune response and frequency of exposure and the time of re-infection interval appear to be involved in the overall process of fibrosis. Additional factors are probably involved in the human disease as genetic host susceptibility, malnutrition, repeated infections and repeated treatment, mixed infections including hepatitis, tuberculosis and typhoid. Reversibility of the fibrosis might be related to the proportion of the collagen types present. Immuno-histopathological demonstration of various types of collagen confirms the importance of time for administration of the treatment and period of follow-up. According to previous studies, the timing for treatment affects the reversibility of liver fibrosis emphasizing the importance of early treatment of schistosomiasis to prevent complications.

Adult↗

Climate change and malaria: exploring the risks.

That the enhanced greenhouse effect may prove to influence human health will come as no surprise. One of the potential health consequences is a change in distribution patterns of vector-borne diseases. In tropical countries, such diseases are a major cause of illness and death. One of the most important vector-borne diseases in the world is malaria, which is associated with one of four species of parasite and transmitted by a mosquito vector. Climatic conditions, and temperature in particular, directly influence mosquito development, feeding-frequency and longevity of the mosquito, as well as the time in which the parasite develops inside the mosquito. Other environmental factors such as vegetation and breeding sites are indirectly influenced by climate conditions. In order to assess the impact of an anthropogenic climate change on the transmission of malaria, an integrated assessment model has been developed. In this integrated model, the direct effects of a change in temperature and precipitation on the transmission potential of a mosquito population is assessed by means of the vectorial capacity. The effect of a human-induced climate change on human health is evaluated by assessing the change in malaria prevalence and disease burden. A sustainable development index, which is an aggregate of an environmental pressure indicator, a health indicator and a socio-economic development indicator is introduced and discussed. Such an index can be used to determine whether future projections are sustainable.

Animals↗

Health care for elderly people in developing countries: a case study of Thailand.

The elderly populations of many developing countries are increasing rapidly. These demographic changes are a direct result of the success of socio-economic development that has led to declines in mortality rates at all ages and reductions in fertility. However, an aged population might be expected to suffer with the problems of dependency and disability leading to an increased burden of disease. Adequate disability and life expectancy data are essential for planning health and social policy but are currently insufficient. Making best use of the limited resources available for health care will require an emphasis on training of professional staff and carers, but with integration of health care for elderly people with established health services, particularly the existing primary health care systems. Strategies aimed at developing separate services for elderly people should be avoided because of the high likelihood of producing services of low quality with an inappropriate hospital emphasis.

Aged↗

Economic transition and changing relation between income inequality and mortality in Taiwan: regression analysis.

OBJECTIVE: To examine the changing relation between income inequality and mortality through different stages of economic development in Taiwan. DESIGN: Regression analysis of mortality on income inequality for three index years: 1976, 1985, and 1995. SETTING: 21 counties and cities in Taiwan. MAIN OUTCOME MEASURES: All age mortality and age specific mortality in children under age 5. RESULTS: When median household disposable income was controlled for, the association between income inequality and mortality became stronger in 1995 than in 1976. Especially, the association between income inequality and mortality in children aged under 5, with adjustment for differences in median household disposable income, changed from non-significant in 1976 to highly significant in 1995. In 1995, the level of household income after adjustment for income distribution no longer had a bearing on mortality in children under 5. CONCLUSION: The health of the population is affected more by relative income than by absolute income after a country has changed from a developing to a developed economy.

Adolescent↗

Occupational health research priorities in Malaysia: a Delphi study.

OBJECTIVES: As part of a consultancy project on occupational health, the Delphi method was used to identify research priorities in occupational health in Malaysia. METHODS: Participation was sought from government ministries, industry, and professional organisations, and university departments with an interest in occupational and public health. Two rounds of questionnaires resulted in a final list of priorities, with noticeable differences between participants depending on whether they worked in industry or were from government organisations. RESULTS: The participation rate of 71% (55 of 78) was obtained for the first questionnaire and 76% (72 of 95) for the second questionnaire. The participants identified occupational health problems for specific groups and industries as the top research priority area (ranked as top priority by 25% of participants). Ministry of Health participants placed emphasis on healthcare workers (52% ranking it as top priority), whereas those from industry identified construction and plantation workers as groups, which should be accorded the highest priority. Evaluation of research and services was given a low priority. CONCLUSIONS: The priorities for occupational health determined with the Delphi approach showed differences between Malaysia, a developing country, and findings from similar European studies. This may be expected, as differences exist in stages of economic development, types of industries, occupational activities, and cultural attitudes to occupational health and safety. Chemical poisonings and workplace accidents were accorded a high priority. By contrast with findings from western countries, workplace psychosocial problems and musculoskeletal injuries were deemed less important. There also seemed to be greater emphasis on adopting interventions for identified problems based on experience in other countries rather than the need to evaluate local occupational health provisions.

Delphi Technique↗

Sustainable Cities Programme: a joint UN-HABITAT-UNEP facility on the urban environment with participation of the Dutch government.

The fundamental objective of the Sustainable Cities Programme is to promote environmentally sustainable local development to more fully realize the vital contributions that urban areas make to over-all social and economic development by: (1) enhancing efficiency in the use of local environmental resources, reducing environmental risks, and strengthening application of environmental conventions and agreements with growing regard to the Climate Change Protocol; (2) reducing poverty by promoting more equitable access to resources and environmental services; (3) mobilizing and strengthening local capacities to plan, co-ordinate, and manage sustainable local development in partnership; and (4) combining the complementary strengths of UN-HABITAT, UNEP, and other partners in support of Agenda 21, and the Habitat Agenda sustainable development commitments including improved local environmental governance.

City Planning↗

Health care economics is changing--the law is sure to follow.

Law is intimately related to economics. As the economic relationships in a market change, the legal landscape evolves accordingly. Even if no health care reform is enacted at the federal level, ever-increasing portions of today's managed indemnity sector will convert to plans constraining enrollee choice and seeking to deliver cost-effective care through risk-sharing relationships (both corporate and contractual) with providers. This is inevitable, given employer and federal government pricing demands, and it is changing the face of health care law. If federal reform is enacted and/or the systems adopted in Minnesota, Maryland, Washington, and Florida (to name a few) are replicated elsewhere, the legal concerns of physicians and other providers will shift even more dramatically. In this article, some of the legal fall-out from these economic developments is discussed.

Antitrust Laws↗

The Right to a Just and Peaceful Social and International Order.

Article 28 of the Universal Declaration of Human Rights calls for the establishment of a "social and international order" in which the rights guaranteed by the UDHR "can be fully realized." The social and international order that will be needed for this purpose must be a just and peaceful one. Justice requires equitable economic development and equitable distribution of its benefits; development policies that avoid destruction of the environment; and international respect for the rule of law. Peace requires economic and social justice; abolition of weapons of mass destruction; sharply restricted transfer and use of conventional weapons; and vastly expanded support of nonviolent conflict resolution by the United Nations and other relevant institutions. Health workers, as influential members of civil society, have an important role to play in these efforts.

Journal Article↗

[Diabetes mellitus mortality in the Province of Córdoba: during the 1986-1995 period].

The fact that Diabetes Mellitus has become one of the relevant health problems and is besides an important death cause in the world, has led to investigate mortality as produced by this pathology in the Province of Córdoba during the period 1986/1995. Death register because of Diabetes Mellitus for the whole province(for years 1986-1995) were obtained from the Stadistic Department of the Health Ministry of the Province of Córdoba. Brute and specific rates based on sex and age groups were determined from a total of 6.718 deceased (3,300 males and 3,418 females), evolution of the same and its relation with diverse variables such as instruction level, poor housing and U. B. N.(Unsatisfied Basic Needs). Result showed that death rate increased during the period Studied, 24.42/100,000 being the medium annual rate, with no significative difference between both sexes (P = 0.76 > 0.05). In relation to age, rates raised according to growing age, with prevalence of the masculine, in general from 45 years and onward, except for 1986, 1989 and 1995 years when feminine death rate is greater in the 75 years-old and onward group. With regard to the other variables considered, when comparing them with the social and economic development of each Department in the Province of Córdoba, we could infer that industrialization, urbanization and social and economic evolution of the same have a positive correlation with mortality caused by diabetes.

Adolescent↗

[Present-day socially significant diseases].

The author concludes that only understanding of the close relationship between the level of economic development, high morals of the society, and population health, and implementation of a complex of political, state, and economic measures will lead to the solution of public health problems.

Acquired Immunodeficiency Syndrome↗

[National program of poverty elimination and health of economically active population in Russia].

Effective implementation of actual tasks on social economic development of Russia is certainly determined by significant increasing of health level of laboring people. Death rate of economically active population is an appropriate and highly informative indicator of both population health and society social well-being. Main trend in implementation of program of poverty elimination and in enhancement of national competitive capacity is effective carrying out of public program? Health of laboring population in Russia: 2004 - 2015? with highest possible employers' resource support.

Humans↗