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PubMed2004

Eating, drinking and being depressed: the social, cultural and psychological context of alcohol consumption and nutrition in a Brazilian community.

Much has been written about the socioeconomic distribution of nutritional status, both in more economically developed, and in developing nations. In general, persons of lower socioeconomic status suffer adverse consequences of poor nutritional status, although these consequences can vary depending on the level of development, i.e. in more developed countries the problem tends to be one of over-nutrition and obesity, while in developing countries the problem tends to be one of under-nutrition and nutritional deficiencies. In this paper, we explore the socioeconomic distribution of dietary intake in a Brazilian city, in an area that in some ways is neither prototypically developed or underdeveloped. The analysis presented here was stimulated by the surprising observation of no socioeconomic differences in total caloric intake in the context of extreme differences in income distribution. Further examination showed that socioeconomic differences in total caloric intake appeared after controlling for alcohol intake. A complete analysis of the data suggests that lower income leads to lower cultural consonance, which in turn leads to higher depression, higher alcohol intake, and higher total caloric intake. In this model, alcohol ingestion can be seen as both a psychological and nutritional adaptive strategy to economic, social and cultural marginality in a highly stratified society.

Adult↗
PubMed2006

Developing health-related quality-of-life instruments for use in Asia: the issues.

About half of the world's population live in Asia. Mandarin (the official language of China), Hindi and Japanese are among the ten languages spoken by the largest number of primary speakers. The numbers of Tamil and Malay speakers are expected to grow rapidly in the next few decades. Most health-related quality-of-life (HR-QOL) instruments currently used in Asia are translations and/or adaptations of instruments developed in North America and Western Europe. We illustrate and discuss several major issues in the development of HR-QOL instruments for use in Asia. We have seen insufficient quality in translation and semantic equivalence, which is not a uniquely Asian problem. This problem will be alleviated by putting recently proposed guidelines for translation and adaptation of patient-reported outcomes into practice and formally conducting equivalence studies. For copyright or other reasons it is rare to see major adaptations, such as exclusion of a domain in the original instrument or inclusion of a new domain, made to existing instruments. Evidence is limited and mixed as to whether there are differences in the concepts of HR-QOL between Asian and North American/Western European cultures that are important enough to justify such major adaptations, or the development of indigenous instruments, as opposed to the translation/adaptation of existing instruments. There are substantial cultural differences concerning what questions are appropriate to ask and answer. Many HR-QOL instruments are designed for self-completion. This mode of administration is often not feasible in Asia because of low literacy rates and the presence of many different regional languages. Alternative administration methods and analytic strategies that allow for pooling data collected by different modes are needed. The availability of HR-QOL instruments in various Asian countries seems to reflect the status of economic development of the countries rather than their disease burden. For instance, many important HR-QOL instruments are available in Japanese but not in Hindi or Tamil.

Asia↗
PubMed1998

What works? Success stories in Type 2 diabetes mellitus.

The increasing prevalence of Type 2 diabetes mellitus has made diabetes a major public health problem worldwide. Healthcare systems are faced with the major challenge of developing innovative approaches to improving the prevention of diabetes and associated complications, particularly in populations undergoing rapid cultural development. Examples of community-based primary prevention projects in two Native communities in Canada that have high incidences of diabetes are reviewed. These projects are notable for the active participation of the communities, the collaborative relationship that was established between the communities and the researchers, and the way that traditional native culture and beliefs were incorporated into the intervention design. This phenomenon has impacted on the success of the projects and has enhanced their long-term sustainability.

Canada↗
PubMedDate not supplied

Breast cancer in limited-resource countries: health care systems and public policy.

As the largest cancer killer of women around the globe, breast cancer adversely impacts countries at all levels of economic development. Despite major advances in the early detection, diagnosis, and treatment of breast cancer, health care ministries face multitiered challenges to create and support health care programs that can improve breast cancer outcomes. In addition to the financial and organizational problems inherent in any health care system, breast health programs are hindered by a lack of recognition of cancer as a public health priority, trained health care personnel shortages and migration, public and health care provider educational deficits, and social barriers that impede patient entry into early detection and cancer treatment programs. No perfect health care system exists, even in the wealthiest countries. Based on inevitable economic and practical constraints, all health care systems are compelled to make trade-offs among four factors: access to care, scope of service, quality of care, and cost containment. Given these trade-offs, guidelines can define stratified approaches by which economically realistic incremental improvements can be sequentially implemented within the context of resource constraints to improve breast health care. Disease-specific "vertical" programs warrant "horizontal" integration with existing health care systems in limited-resource countries. The Breast Health Global Initiative (BHGI) Health Care Systems and Public Policy Panel defined a stratified framework outlining recommended breast health care interventions for each of four incremental levels of resources (basic, limited, enhanced, and maximal). Reallocation of existing resources and integration of a breast health care program with existing programs and infrastructure can potentially improve outcomes in a cost-sensitive manner. This adaptable framework can be used as a tool by policymakers for program planning and research design to make best use of available resources to improve breast health care in a given limited-resource setting.

Breast Neoplasms↗
PubMed2005

Contraceptive issues of youth and adolescents in developing countries: highlights from the Philippines and other Asian countries.

This article highlights contraceptive issues in Asia, home to some 700 million adolescents. It starts with a description of the socio-cultural milieu of adolescents in South and Southeast Asia, their knowledge and use of contraceptives, the myriad barriers to access, and the many innovative programs to broaden contraceptive availability. The reproductive health needs of adolescents in poor countries cannot be solved by merely supplying them with contraceptives--these needs can only be fully addressed in the context of gender equality, poverty alleviation and the conviction that investing in the reproductive health of adolescents is a most urgent priority. Investing in the reproductive health of adolescents will have an impact not only on birth and abortion rates, maternal health, and the spread of STI/HIV but also on the demographics and economic development of the region--and beyond.

Adolescent↗
PubMed2001

A new integrated program for natural product development and the value of an ethnomedical approach.

There is a need for less expensive alternative therapies, especially in the treatment of chronic illnesses. This presentation addresses the issues inherent in the use of natural products in a drug-discovery or development program and reviews a model program developed by the U.S. National Institutes of Health (NIH) and administered by the Fogarty International Center at the NIH. Eighty percent (80%) of the world's population relies on medicinal plants for their primary health care. The World Health Organization has been promoting traditional medicine as a source of less expensive, comprehensive medical care, especially in developing countries. Natural products have also been successful in drug development. Over 50% of the best-selling pharmaceuticals in use today are derived from natural products. In a natural-product drug development program, it is the diversity of the natural products that is especially interesting. Thanks to technologic advances, now is a good time to be looking for new drugs in the natural-product arena. But there are major hurdles to overcome in a natural-products development program, namely, time-to-lead, supply, and ownership. Time-to-lead is complex because most natural products are mixtures or crude extracts. It can be very difficult to isolate the active principles and elucidate their structures. The difficulty of obtaining sufficient supply is often given as a reason for not becoming involved in natural-product drug development or discovery. This presentation details some ways these seeming hurdles can be overcome. The concept of ownership has changed dramatically in recent years. Until recently, genetic resources were considered to belong to no one and to therefore be the heritage of everyone. The United Nations Convention on Biodiversity and the meetings in Rio de Janeiro in 1992, redefined biodiversity ownership. Genetic biodiversity has a potential value and belongs to the country of origin. The International Conservation of Biodiversity Groups (ICBGs) was founded in 1992 to address such issues. This presentation discusses the importance of integrating efforts in conservation, economic development, and drug development into one program. The presentation details a collaboration that includes an ICBG based at the Walter Reed Army Institute of Research and its four partner organizations and discusses the associated programs the collaboration has underway.

Bioethics↗
PubMed1983

Dracunculiasis: an eradicable scourge.

As an incapacitating disease which has a direct negative effect on the self-sufficiency of rural populations in parts of Asia and Africa, dracunculiasis is a serious, but neglected, hindrance to economic development. It is the only communicable disease that is transmitted solely by drinking contaminated water. Several intervention measures have been shown to be effective in reducing or interrupting transmission, the most effective of which is provision of safe drinking water. Its vulnerability to well planned control measures has been demonstrated in India, the Ivory Coast, Nigeria, the Soviet Union, and elsewhere. The International Drinking Water Supply and Sanitation Decade (1981-1990) presents an unparalleled opportunity to eradicate dracunculiasis, and linking the Decade and an effort to eradicate dracunculiasis would be mutually beneficial. Additional epidemiologic studies to document further the economic impact of the disease on affected populations, the changes in incidence which result when effective interventions are made, and the role of subgroups in affected villages as transmitters of the infection, would be very useful in the struggle to eradicate another scourge of mankind.

Africa↗
PubMed1989

Family and socialization in cross-cultural perspective: a model of change.

I have attempted to cover some aspects of the rather disjointed interdisciplinary field of family and socialization from a cross-cultural perspective. The coverage has necessarily been incomplete and selective, focusing mainly on intergenerational family interactions along the dependence/independence dimension, working toward a model of family change. I started out with an observation that psychology has not concerned itself much with holistic study of the family or the complex socialization process, especially within a cross-cultural perspective, even though some of the main models of person-environment relations at its disposal are appropriate for such study. With the recently increasing acceptance and use of the ecological and contextual models in coverging interdisciplinary approaches, the time may be ripe for cross-cultural theorizing on the family and socialization. The contextual approach to socially defined meaning is a key in such an endeavor to develop a thorough understanding of family diversity. Such an approach goes beyond simple description of cross-cultural differences and explains what meanings are attributed to events and how similar behaviors may be given different meanings in different contexts or how apparently contrasting behaviors may carry common meanings and lead to common outcomes. Family diversity in parental beliefs and values, parent-child interactions, and social class and family types can be better understood with such a contextual approach, where structural-functional links between underlying causes and behavioral outcomes are sought. Macro-level explanations such as industrialization, economic development models, and political/religious ideologies are often proposed to explain human diversity. What seem to be lacking are psychological models with cross-cultural validity that can tackle both human diversity and commonality. The (inter)dependence/independence dimension of human (family) relations is proposed as a psychological parameter that is independent of socioeconomic development levels and such and that has the potential to be the basis of a psychological explanation. There appears to be systematic cross-cultural variation along this dimension, and a number of assumptions prevail about shifts on this dimension through both time and space. The main assumption of unidirectional change toward the Western ideal-typical model of human (family) independence is challenged by much conflicting evidence including that on the American family. Some of the findings of the cross-cultural Value of Children Study also throw light on this issue, so that material and emotional interdependencies can be differentiated. I next proposed a heuristic model of family change comprising three ideal-typical patterns.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2001

Honduras: Caribbean Coast.

The coast of Honduras, Central America, represents the southern end of the Mesoamerican Barrier Reef System, although its marine resources are less extensive and studied than nearby Belize and Mexico. However, the coastal zone contains mainland reef formations, mangroves, wetlands, seagrass beds and extensive fringing reefs around its offshore islands, and has a key role in the economy of the country. Like most tropical areas, this complex of benthic habitats experiences limited annual variation in climatic and oceanographic conditions but seasonal and occasional conditions, particularly coral bleaching and hurricanes, are important influences. The effects of stochastic factors on the country's coral reefs were clearly demonstrated during 1998 when Honduras experienced a major hurricane and bleaching event. Any natural or anthropogenic impacts on reef health will inevitably affect other countries in Latin America, and vice versa, since the marine resources are linked via currents and the functioning of the system transcends political boundaries. Much further work on, for example, movement of larvae and transfer of pollutants is required to delineate the full extent of these links. Anthropogenic impacts, largely driven by the increasing population and proportion of people living in coastal areas, are numerous and include key factors such as agricultural run-off, over-fishing, urban and industrial pollution (particularly sewage) and infrastructure development. Many of these threats act synergistically and, for example, poor watershed management via shifting cultivation, increases sedimentation and pesticide run-off onto coral reefs, which increases stress to corals already affected by decreasing water quality and coral bleaching. Threats from agriculture and fishing are particularly significant because of the size of both industries. The desire to generate urgently required revenue within Honduras has also led to increased tourism which provides an overarching stress to marine resources since most tourists spend time in the coastal zone. Hence the last decade has seen a dramatic increase in coastal development, a greater requirement for sewage treatment and more demand for freshwater, particularly in the Bay Islands. Although coastal zone management is relatively recent in Honduras, it is gaining momentum from both large-scale initiatives, such as the Ministry of Tourism's 'Bay Islands Environmental Management Project', and national and international NGO projects. For example, a series of marine protected areas and legislative regulations have been established, but management capacity, enforcement and monitoring are limited by funding, expertise and training. Existing and future initiatives, supported by increased political will and environmental awareness of stakeholders, are vital for the long-term economic development of the country.

Animals↗
PubMed2005

Healthcare infrastructure, contraceptive use and infant mortality in Uttar Pradesh, India.

This paper analyzes data on approximately 30,000 women from a survey in Uttar Pradesh in 1995 together with the data from surveys of public and private providers of healthcare and family planning services. A framework was developed for analyzing the effects of quality of services on utilization, and for understanding the gradual evolution of the healthcare infrastructure. The empirical results from logistic regressions for use of female sterilization and IUD showed significant effects of quality of services in government and private hospitals, and of socioeconomic variables such as education, caste, and an index of household possessions. Secondly, models for infant mortality of children born in the preceding 3-year period showed significant effects of socioeconomic variables, quality of healthcare services and birth spacing. Lastly, analysis of data at a more aggregated (Primary Sampling Unit) level indicated differential effects of economic development on the quality of services available in the public and private facilities.

Adult↗
PubMed1997

Lacrimal surgery at St John, Jerusalem.

Lacrimal surgery forms a prominent component of a general ophthalmic surgeon's workload at the St. John Ophthalmic Hospital, Jerusalem. The hospital caters for the Palestinian community of East Jerusalem, the West Bank and Gaza, the combined population totaling approximately 2.2 million. The area is under-developed economically and, in addition, the ongoing political conflict, the Intifada, makes the provision of health care difficult. Nonetheless the St. John Ophthalmic Hospital provides a level of surgical care which is notable for the fact that it is consistent and high. Advanced, obstructive lacrimal disease is endemic in the region; in 1993/94 256 operations were performed for lacrimal obstruction at the St John Ophthalmic Hospital. Lacrimal disease on the West Bank and Gaza Strip is the result of well defined causes which have not been previously documented. This paper proves that conventional lacrimal surgery is successful in relieving advanced lacrimal obstruction in the developing community.

Adolescent↗
PubMed1994

Editorial.

Explore the source record for details and available documents.

Demography↗