Reaching a stationary global population: what we have learnt, and what we must do.
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Adult↗
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Getting a Grip on Arthritis: an educational intervention for the diagnosis and treatment of arthritis in primary care.
OBJECTIVE: To evaluate a community-based educational intervention designed to improve the diagnosis and treatment of arthritis in primary care. METHODS: The educational intervention, entitled "Getting a Grip on Arthritis", consisted of a 2-day workshop and followup reinforcement activities for healthcare providers (providers) and was supported by a toolkit of written materials for providers and clients. The content of the intervention was designed around 10 arthritis best practices derived from published arthritis guidelines. Five community health centers (CHC) participated as intervention sites and 2 as control sites. Intervention impact was determined through a mailed survey to clients with arthritis. Primary outcome analysis compared responses to questions about arthritis best practices between intervention and control sites at baseline and followup. RESULTS: The workshop was attended by 21 multidisciplinary providers from intervention CHC. At baseline, 423 of 624 eligible and consenting clients completed the survey and 376 of 593 completed the followup survey. At followup clients in the intervention group reported significantly higher referrals to The Arthritis Society therapy program, and were more often provided information on type of arthritis, medications and their side effects, disease management strategies, and arthritis community resources. CONCLUSION: This demonstration project is one of the first to show changes in the management of arthritis in a primary care setting. This project has recently received funding from Health Canada's Primary Health Care Transition Fund for implementation across Canada and is expected to provide a template for use in other chronic diseases.
Aged↗
Population momentum expresses population aging.
Population momentum and population aging occur when an initially growing population experiences a reduction in fertility to replacement level. Conceptually and empirically, momentum and aging express the same change, albeit on different scales. Fundamentally, they are two manifestations of the underlying process of demographic transformation. We consider three measures of aging over the transition to stationarity: the increase in mean population age, the decrease in the proportion under age 30, and the increase in the proportion over age 65. The three measures of aging are highly correlated, though the relationship to momentum is weakest for the increase in the proportion over age 65. We find that momentum is linearly related to aging. In both model and actual populations, a one-year increase in mean age translates into about 4.5% more population growth. The population below age 30 does not grow over the transition to stationarity and the ratio of initial to ultimate proportions under age 30 is virtually identical to momentum.
Adolescent↗
Using standardized methods for research on HIV and injecting drug use in developing/transitional countries: case study from the WHO Drug Injection Study Phase II.
BACKGROUND: Successful cross-national research requires methods that are both standardized across sites and adaptable to local conditions. We report on the development and implementation of the methodology underlying the survey component of the WHO Drug Injection Study Phase II--a multi-site study of risk behavior and HIV seroprevalence among Injecting Drug Users (IDUs). METHODS: Standardized operational guidelines were developed by the Survey Coordinating Center in collaboration with the WHO Project Officer and participating site Investigators. Throughout the duration of the study, survey implementation at the local level was monitored by the Coordinating Center. Surveys were conducted in 12 different cities. Prior rapid assessment conducted in 10 cities provided insight into local context and guided survey implementation. Where possible, subjects were recruited both from drug abuse treatment centers and via street outreach. While emphasis was on IDUs, non-injectors were also recruited in cities with substantial non-injecting use of injectable drugs. A structured interview and HIV counseling/testing were administered. RESULTS: Over 5,000 subjects were recruited. Subjects were recruited from both drug treatment and street outreach in 10 cities. Non-injectors were recruited in nine cities. Prior rapid assessment identified suitable recruitment areas, reduced drug users' distrust of survey staff, and revealed site-specific risk behaviors. Centralized survey coordination facilitated local questionnaire modification within a core structure, standardized data collection protocols, uniform database structure, and cross-site analyses. Major site-specific problems included: questionnaire translation difficulties; locating affordable HIV-testing facilities; recruitment from drug treatment due to limited/selective treatment infrastructure; access to specific sub-groups of drug users in the community, particularly females or higher income groups; security problems for users and interviewers, hostility from local drug dealers; and interference by local service providers. CONCLUSION: Rapid assessment proved invaluable in paving the way for the survey. Central coordination of data collection is crucial. While fully standardized methods may be a research ideal, local circumstances may require substantial adaptation of the methods to achieve meaningful local representation. Allowance for understanding of local context may increase rather than decrease the generalizability of the data.
Adult↗
Ageing, care dependency, and care for older people in Egypt: a review of the literature.
AIMS: The purpose of this study was to gain an overview of the current situation of ageing and elderly care in Egypt and to consider the ensuing socio-economical problems, which provide the framework for the provision of care. BACKGROUND: Recent discussions about demographic transition in developing countries suggest a change in their age group composition. Possible implications of this development for nursing care require closer examination. METHOD: Literature about ageing and elderly care in Egypt of the period from 1980-2004 was researched and reviewed. RESULTS: Despite the scarcity of literature and the lack of precision in many cases, it is possible to outline an overall development. Ageing is a slowly emerging phenomenon in Egypt contributing to a change in the country's age group composition. The ensuing care dependency appears to become a problem especially for lower and middle class members due to economical restrictions and life-style changes. In relation to the need, there is a shortage of care-providing institutions. Furthermore, geriatric homes seem to differ in their quality according to the residents' social status. CONCLUSION: The existing types of geriatric homes will serve as prototypes for future development. There is however, a need for additional homecare services to reduce care givers' strain in the families.
Age Distribution↗
Transition of young people with respiratory diseases to adult health care.
As many more young people with chronic health conditions survive well into adulthood, transition of affected young people from paediatric to adult health care is increasingly becoming the expected standard of care. Despite this, there is still little objective or long-term evidence to guide the development or deployment of developmentally appropriate transition processes or to define the precise manner in which the transfer of care should take place. Nevertheless, certain principles of transition have now received nearly universal endorsement. In this paper, the rationale for transition is discussed, practical strategies for transition are described, the existing evidence base supporting transition is reviewed and limitations in our knowledge are outlined. Ultimately, a carefully planned transition to adult health care should improve self-reliance, enhance autonomy and independence and support young people in attaining their maximum potential and meaningful adult lives.
Adolescent↗
Human resources for health in Palestine: a policy analysis. Part II. The process of policy formulation and implementation.
This article is the presentation of part II of the analysis aiming at providing an insight and better understanding of human resources for health development within a conflicting and transitional context. This part focuses on the human resources for health (HRH) policy development in Palestine taking into consideration the critical elements in policy formulation and implementation, such as sound data based policy and planning, key stakeholders, role and implications of international cooperation. Moreover, it examines recent progress of HRH policy and constraints for implementation. Part I addresses the current situation and recent developments in HRH in Palestine.
Arabs↗
Market transition, educational disparities, and family strategies in rural China: new evidence on gender stratification and development.
Two theoretical perspectives have dominated debates about the impact of development on gender stratification: modernization theory, which argues that gender inequalities decline with economic growth, and the "women in development" perspective, which argues that development may initially widen gender gaps. Analyzing cross-sectional surveys and time-series data from China, this article indicates the relevance of both perspectives: while girls' educational opportunities were clearly more responsive than boys' to better household economic circumstances, the era of market transition in the late 1970s and early 1980s failed to accelerate and, in fact, may have temporarily slowed progress toward gender equity.
China↗
Cardiovascular mortality in Korea: a country experiencing epidemiologic transition.
BACKGROUND: The pattern of morbidity and mortality of cardiovascular disease (CVD) changes with epidemiologic transition. An understanding of this pattern in rapidly developing countries might provide important clues for the understanding of the epidemiological trends in CVD mortality. The objective of this paper was to address the changing pattern of CVD mortality in Korea during the period 1984-1999, and to examine the significant changes in associated major risk factors for CVD over a similar period. METHODS: For the purpose of this study, three main categories in CVD were reviewed: hypertensive heart disease, ischaemic heart disease, and cerebrovascular disease (stroke). The analyses of mortality were based on nationwide mortality data published by the National Statistical Office from 1984 to 1999. All the mortality rates were adjusted for age using the direct method. Changes in major CVD risk factors (blood pressure, cigarette smoking, serum total cholesterol and diet) were also reviewed during similar periods. FINDINGS: During the 15-year period investigated, the age-adjusted mortality from CVD decreased markedly. It decreased by 57% in males (from 172.2 to 73.0/100,000) and 48% in females (from 135.5 to 70.2/100,000). The age-adjusted mortality from stroke decreased while the proportion of ischaemic strokes among total stroke deaths increased. The proportion increased about 5.2 times in men and 4.9 times in women. The age-adjusted mortality from hypertensive heart disease decreased markedly. It decreased by 92% in men (from 51.6 to 4.1/100,000) and 84% in women (from 34.1 to 5.3/100,000). Also the age-adjusted mortality from ischaemic heart disease increased significantly. In 1999, the rates for men and women were 11.9 and 7.5/100,000, respectively. These rates were 3.8 and 3.6 times higher than the rates in 1984 for men and women, respectively. The changes of CVD risk factors in Korea observed during a similar period were a decrease in hypertension prevalence, although still present at a high level, an increase in serum total cholesterol level and intake of total fat along with a high, although decreasing, prevalence of cigarette smoking. INTERPRETATION: The mortality changes in Korea are consistent with the change that occurs during the transition from the age of receding pandemics to the age of degenerative and man-made diseases. This study has indicated that the change of CVD mortality was closely associated with the change in CVD risk factors. In order to avert the ongoing epidemic of CVD in developing countries, prevention and treatment of modifiable risk factors must become a high health priority.
Adult↗
The burden of disease from undernutrition and overnutrition in countries undergoing rapid nutrition transition: a view from Brazil.
On the basis of 3 comparable population-based surveys conducted in Brazil, we identified clear changes in the relative magnitude of women's undernutrition and overnutrition. In 1975, there were almost 2 cases of underweight to 1 case of obesity, whereas in 1997, there were more than 2 cases of obesity to 1 case of underweight. In 1997, Brazilian low-income women were significantly more susceptible than high-income women to both underweight and obesity.
Adult↗
Social determinants of birthweight and length of gestation in Estonia during the transition to democracy.
BACKGROUND: To investigate social variation in birthweight and length of gestation in Estonia in the period of transition to a democracy and market economy. METHODS: All live births resulting from singleton pregnancies reported to the Estonian Medical Birth Registry in 1992-1997 (n = 84, 629) were studied with respect to social variation in birthweight and preterm delivery (<37 weeks gestation). The results were adjusted for maternal age, parity, education, nationality, marital status, smoking in pregnancy, sex of the infant (and gestational age). RESULTS: Between 1992 and 1997, mean birthweight increased from 3,465g to 3,497g (P < 0.001) and the preterm rate fell from 5.8% to 5.1% (P = 0.001). Maternal education, marital status and nationality were all independently related to the mean birthweight and the risk of preterm birth. The mean difference in birthweight between children of mothers with basic and university education was 87 g (95% CI : 74-100). Children born to mothers of non-Estonian compared to Estonian nationality were on average 77 g lighter (95% CI: 70-84). While the effect of nationality and marital status on birthweight was relatively stable during the study period, differences in birth outcome by maternal education became stronger. CONCLUSIONS: The mean birthweight increased and the preterm rate decreased in Estonia as a whole during the transition. However, the improvements were not shared equally by all social groups. An increase in variation in birthweight by maternal education was particularly notable.
Adolescent↗
[National public health information system].
Information production and its communication being a key public health activity, developing modern information systems is a precondition for its fulfilling these assignments. A national public health information system (NPHIS) is a set of human resources combined with computing and communication technologies. It enables data linkage and data coverage as well as undertaking information production and dissemination in an effective, standardized and safe way. The Croatian Institute of Public Health LAN/WAN modules are under development. Health Safety System, Health Workers Registry, and Digital Library are among the Institute's developmental priorities. Communication between NPHIS participants would unfold over the Internet by using every relevant data protection method. Web technology-based applications would be run on special servers. Between individual applications, use would be made of the transaction module of communication through an exchange of the HL7 standard-based xml messages. In the conditions of transition, the health system must make an optimal use of the resources, which is not feasible without applying modern information and communication technologies.
Croatia↗
Epidemiology as discourse: the politics of development institutions in the Epidemiological Profile of El Salvador.
STUDY OBJECTIVE: To determine the ways in which institutions devoted to international development influence epidemiological studies. DESIGN: This article takes a descriptive epidemiological study of El Salvador, Epidemiological Profile, conducted in 1994 by the US Agency for International Development, as a case study. The methods include discourse analysis in order to uncover the ideological basis of the report and its characteristics as a discourse of development. SETTING: El Salvador. RESULTS: The Epidemiological Profile theoretical basis, the epidemiological transition theory, embodies the ethnocentrism of a "colonizer's model of the world." This report follows the logic of a discourse of development by depoliticising development, creating abnormalities, and relying on the development consulting industry. The epidemiological transition theory serves as an ideology that legitimises and dissimulates the international order. CONCLUSIONS: Even descriptive epidemiological assessments or epidemiological profiles are imbued with theoretical assumptions shaped by the institutional setting under which epidemiological investigations are conducted.
Confounding Factors, Epidemiologic↗
Nutrition transition in west Sumatra, Indonesia.
Indonesia, like many developing countries, is experiencing a rapid urbanisation characterised by double burden of disease in which non communicable diseases become more prevalent while infectious diseases remain undefeated. This report describes the nutrition transition which occurred to Indonesia after economic transformation in 1966, based on information gathered from published reports. The major sources of information used in this paper were: a) a series of Indonesian National Socio-Economic Surveys (SUSENAS) conducted regularly by Central Bureau of Statistics (which provided a coherent picture of the nutrition transition in Indonesia) and b) data collected from two relatively smaller surveys conducted in West Sumatra (which demonstrated the changes in food and nutrient intakes over the period 1983-1999). It was found that while Indonesia had a rapid economic growth since 1970s, major dietary changes included an increase in expenditure for meat, eggs, milk and prepared food, and a fall in expenditure in cereal products. Nutrient proportions had changed from carbohydrate to fat and protein but the proportions remained close to the ideal ratio. There was also a dramatic shift in causes of death from infectious to chronic diseases. It is concluded that the nutrition transition in Indonesia is similar to patterns in other developing countries. Although fat consumption increased slightly, there is movement to maintain the traditional diet.
Adolescent↗
Pharmacoeconomic analysis of adjuvant therapy with exemestane, anastrozole, letrozole or tamoxifen in postmenopausal women with operable and estrogen receptor-positive breast cancer.
OBJECTIVE: To compare the efficiency of adjuvant therapy with aromatase inhibitors or with tamoxifen in postmenopausal women with operable breast cancer and positive estrogen receptors. MATERIAL AND METHODS: A cost-utility analysis was performed based on a Markov model, from the Spanish National Health Care System perspective, comparing the treatment with exemestane (EXE: 25 mg/day) or tamoxifen (TAM: 20 mg/day) after 2-3 years of monotherapy with TAM; anastrozole (ANA, 1 mg/day) or TAM (20 mg/day) without previous TAM therapy; and letrozole (LET: 2.5 mg/day) or placebo after 5 years of monotherapy with TAM. The follow-up of a hypothetical cohort of women starting treatment at 63 years of age was simulated during 10 and 20 years. The probabilities of transition between health states and quality adjusted life years (QALYs) were obtained from the literature, and the unit costs (euro corresponding to 2004) from a Spanish database. RESULTS: After 10 and 20 years of follow-up, more QALYs per patient would be gained with the EXE scheme (0.230-0.286 and 0.566-0.708, respectively) than with ANA (0.114 and 0.285) and LET (0.176 and 0.474). The cost of gaining one QALY was lower with the EXE scheme (50,801-62,522 euro and 28,849- 35,371 euro, respectively) than with ANA (104,272 euro and 62,477 euro) and LET (91,210 euro and 49,460 euro). The result was stable for the cost per life-year gained (LYG) and in the sensitivity analysis. CONCLUSIONS: The EXE scheme after TAM is more cost-effective than the ANA and LET schemes.
Anastrozole↗
[Epidemiological transition: the other side of the coin].
The model of epidemiological transition proposed by Omram explains the changes in disease patterns in communities. In societies with a high level of development this model has been complemented with the study of the post transition process. In this context, the emergence of allergic diseases, asthma and subsequently, of autoimmune diseases, has reached worrisome proportions in some countries, and no model can explain these changes. The hygiene theory supported by Strachan gives a reasonable explanation to this phenomenon. It postulates that the reduction of early exposure to biological agents, along with an improvement of sanitation conditions, immunizations and medical therapies, causes an asymmetrical immunological response, favoring the expression of Th2 response. The hygiene theory does not fully explain by itself what is happening in developed countries and it is not universally accepted. Chile is experiencing an epidemiological transition from a high burden of infectious diseases to a growing prevalence of non communicable diseases. In a previous similar setting in developed countries, there is some evidence to suspect that asthma, allergic and autoimmune diseases are becoming part of the epidemiological situation of Chile.
Chile↗
[Comparison of quality of life of schizophrenic patients in different forms of psychiatric care].
Health related quality of life and severity of psychopathological symptoms were evaluated in 90 patients with schizophrenia, hospitalized in a psychiatric ward in a day hospital or followed by the therapist in a community care center. No statistical differences were found in the quality of life evaluation between patients from all three settings. The quality of life did not correlate with the severity of schizophrenic symptoms. Older patients and those more frequently hospitalized were more pessimistic in evaluation of their quality of life. Health status transition, as compared to the situation one year before, correlated inversely with patients' age. Male patients as well as patients from schizophrenic families evaluated their quality of life as worse.
Adult↗
Cause-specific mortality trends in The Netherlands, 1875-1992: a formal analysis of the epidemiologic transition.
BACKGROUND: The objective of this study is to produce a detailed yet robust description of the epidemiologic transition in The Netherlands. METHODS: National mortality data on sex, age, cause of death and calendar year (1875-1992) were extracted from official publications. For the entire period, 27 causes of death could be distinguished, while 65 causes (nested within the 27) could be studied from 1901 onwards. Cluster analysis was used to determine groups of causes of death with similar trend curves over a period of time with respect to age- and sex-standardized mortality rates. RESULTS: With respect to the 27 causes, three important clusters were found: (1) infectious diseases which declined rapidly in the late 19th century (e.g. typhoid fever), (2) infectious diseases which showed a less precipitous decline (e.g. respiratory tuberculosis), and (3) non-infectious diseases which showed an increasing trend during most of the period 1875-1992 (e.g. cancer). The 65 causes provided more detail. Seven important clusters were found: four consisted mainly of infectious diseases, including a new cluster that declined rapidly after the Second World War (WW2) (e.g. acute bronchitis/influenza) and a new cluster showing an increasing trend in the 1920s and 1930s before declining in the years thereafter (e.g. appendicitis). Three clusters mainly contained non-infectious diseases, including a new one that declined from 1900 onwards (e.g. cancer of the stomach) and a new one that increased until WW2 but declined thereafter (e.g. chronic rheumatic heart disease). CONCLUSIONS: The results suggest that the conventional interpretation of the epidemiologic transition, which assumes a uniform decline of infectious diseases and a uniform increase of non-infectious diseases, needs to be modified.
Adolescent↗