Population growth and economic growth: a reconsideration.
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Demography↗
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Worldwide epidemiology of hepatitis A virus infection.
Patterns of hepatitis A virus (HAV) infection and clinical disease differ worldwide, and correlate with socioeconomic conditions (and hygienic and sanitary conditions) of each geographic area. In least developed countries with very poor sanitary and hygienic conditions, HAV spreads readily, and most persons are infected as young children. Because most persons become infected at an age when HAV infection is often asymptomatic, reported disease rates in these areas are low and outbreaks of disease are rare. In developing countries and some regions of developed countries, sanitary conditions are variable, and transmission can predominate in children, adolescents or adults, depending on the geographic region. Paradoxically, since HAV transmission occurs in these areas in older age groups compared with least developed countries where HAV transmission is highly endemic, reported rates of hepatitis A can be higher. In developed countries, sanitation and hygienic conditions are good, and infection rates in children are generally low. Communitywide epidemics can contribute significantly to the burden of disease, as can occasional day care center and common-source outbreaks. In some areas, disease tends to be among specific risk groups, such as travellers to hepatitis A endemic areas, and intravenous drug users among whom hygienic practices may be poor. As countries develop economically with improvement of sanitary conditions, overall endemicity of HAV infection decreases, and disease patterns may change. As the endemicity of HAV transmission decreases, the reported rate of clinical hepatitis A can increase, due to the shift in the average age of infection to an age when clinical illness is more frequent.
Hepatitis A↗
What has contributed to the change in life expectancy in Italy between 1980 and 1992?
Life expectancy at birth in southern Europe is known to be greater than expected in comparison with levels of economic development. This has been attributed to the 'Mediterranean diet'. There are, however, concerns that this comparative advantage is being lost. This paper examines the factors underlying changing life expectancy in Italy since 1980. The subjects of this analysis are obtained from data on all deaths in Italy between 1980 and 1992. Change in age specific death rates is calculated from selected causes and, using the method developed by Pollard, the contribution of deaths from different causes and at different ages to changing life expectancy at birth is estimated. Between 1980 and 1992, life expectancy at birth increased by 2.70 years for men and 2.75 years for women. Death rates have fallen among children and those over 40. In contrast, death rates have increased among men aged between 20 and 39 and have increased very slightly among women aged 25-29. Falling death rates from ischaemic heart disease are continuing to contribute to increasing life expectancy. Death rates from lung and breast cancer are rising among women but are compensated for by falling death rates from other cancers. Among men, falling death rates from cancer at younger ages are being offset by increases at older ages. The rising death rate among younger men is almost entirely due to AIDS, with accidents also making a small contribution. Life expectancy in Italy has improved throughout the 1980s, largely driven by falling death rates from cardiovascular diseases. Here are, however, some worrying trends, most notably the rising death rate among young men, due almost entirely to AIDS. The changing pattern of mortality has some similarities with Spain, another Mediterranean country, but there are also important differences.
Acquired Immunodeficiency Syndrome↗
Environmental assessment of larvicide use in the onchocerciasis control programme.
The objective of the Onchocerciasis Control Programme (OCP) is to eliminate onchocerciasis as a disease of public importance and as an obstacle to socio-economic development. The OCP was initially based solely on the control of the blackfly vector, Simulium damnosum sensu lato, by insecticide spraying of the breeding sites on river systems, where larval stages develop. Results of monitoring the environmental effects and the process of risk assessment for new insecticides are reviewed. The achievements of this strategy are outlined here by Davide Calamari, Laurent Yameogo, Jean-Marc Hougard and Christian Leveque.
Journal Article↗
Emergency medicine in Vietnam.
The Socialist Republic of Vietnam is one of the poorest countries in the world. Recent economic developments, as the country attempts to start a market economy, have had a profound impact on its health care system. This report describes the state of prehospital and emergency medical care in Vietnam and possibilities for the future.
Emergency Medical Services↗
Hepatitis A shifting epidemiology in the Middle East and Africa.
Data on the endemicity of hepatitis A virus (HAV) infection in Africa and the Middle East are scant, but most of Africa appears to remain a high endemicity region, with the exception of subpopulations in some areas, e.g. White people in South Africa. Saudi Arabia is a model for the Middle East, and is a country in which shifting HAV epidemiology has been documented in recent years, concurrent with the social and economic development that has occurred over the last two decades. Earlier studies generally showed very high prevalence rates, with most people becoming infected in early childhood. Between 1989 and 1995, however, there was a significant fall in the seroprevalence of antibodies to HAV in children up to 12 years old throughout the country except in one region bordering the Yemen. The highest seroprevalence is found in children from rural backgrounds, while the seroprevalences in Bedouin and urban children are similar. Seroprevalence is related to socioeconomic status, being highest in the lowest groups. Similar findings have been reported from other countries in the Middle East. The existence of pockets of high endemicity for HAV infection with surrounding areas shifting towards intermediate endemicity may lead to outbreaks, and widespread vaccination should be considered.
Adolescent↗
Health expenditures in Latin America and the Caribbean.
This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average per capita health expenditure of US$ 162. On average, the countries spent 6.2% of their GDP on health, with the expenditures divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health, along with public health expenditure as a proportion of total health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.
Caribbean Region↗
Using social health insurance to meet policy goals.
Social health insurance, with contributions based on incomes and access to services on need is being considered as an option for health care finance in many countries. The argument in this paper starts from the premise that the choice of health care financing mechanisms should start with a clear focus on policy goals, with different options judged against the extent to which these are met. These are likely to include objectives of access to care for those in need, quality of care, incentives for efficient provision and cost control. Different systems will meet the objectives of mobilising resources, providing insurance against risk and redistribution resources to differing extents. It is argued that a particular problem in health care finance is shifting rights to resources over time. It is also important to be clear about the distinction between affordability of and payment mechanisms for health care. The choice of funding mechanisms may have little effect on other policy goals, such as economic development. However, they may differ in the degree to which they allow specific health policy goals to be met. Different mechanisms for collecting and managing funds, and for paying for services are discussed. The paper concludes with concerns that too much emphasis is placed on structures and not how they work, that a lack of cost control may be a serious risk in developing social health insurance and that it is important to have clear mechanisms for setting priorities if policy goals are to be met.
Cost Allocation↗
Economic growth, biodiversity loss and conservation effort.
This paper investigates the relationship between economic growth, biodiversity loss and efforts to conserve biodiversity using a combination of panel and cross section data. If economic growth is a cause of biodiversity loss through habitat transformation and other means, then we would expect an inverse relationship. But if higher levels of income are associated with increasing real demand for biodiversity conservation, then investment to protect remaining diversity should grow and the rate of biodiversity loss should slow with growth. Initially, economic growth and biodiversity loss are examined within the framework of the environmental Kuznets hypothesis. Biodiversity is represented by predicted species richness, generated for tropical terrestrial biodiversity using a species-area relationship. The environmental Kuznets hypothesis is investigated with reference to comparison of fixed and random effects models to allow the relationship to vary for each country. It is concluded that an environmental Kuznets curve between income and rates of loss of habitat and species does not exist in this case. The role of conservation effort in addressing environmental problems is examined through state protection of land and the regulation of trade in endangered species, two important means of biodiversity conservation. This analysis shows that the extent of government environmental policy increases with economic development. We argue that, although the data are problematic, the implications of these models is that conservation effort can only ever result in a partial deceleration of biodiversity decline partly because protected areas serve multiple functions and are not necessarily designated to protect biodiversity. Nevertheless institutional and policy response components of the income biodiversity relationship are important but are not well captured through cross-country regression analysis.
Animals↗
Can a brain drain be good for growth in the source economy?
"This paper analyzes the interaction between income distribution, human capital accumulation and migration. It shows that when migration is not a certainty, a brain drain may increase average productivity and equality in the source economy even though average productivity is a positive function of past average levels of human capital in an economy. It is also shown how the temporary possibility of emigration may permanently increase the average level of productivity of an economy."
Demography↗
Nitrogen contamination in the Yangtze river system, China.
The data at 570 monitoring stations during 1990 were studied. The results indicate as follows: (i) the contents of nitrogen in the Yangtze mainstream has a raising trend from the upper reaches to the lower reaches; (ii) total nitrogen content at a lot of stations during the middle 1980s is 5-10 times more than that during the 1960s; (iii) seasonal variances of nitrogen content vary with watersheds; and (iv) the difference of nitrogen contamination level is related to the regional population and economic development.
Ammonia↗
Landmarks in burn prevention.
The objective of this paper is to highlight landmarks in burn prevention. Novel strategies in the areas of law and regulation, environmental and consumer product design, and educational programs are identified and discussed. Notwithstanding marked reductions in burn morbidity and mortality, especially in economically developed countries, burn injuries remain an important public health concern throughout the world. More, and more effective, burn prevention programs coupled with renewed efforts to reduce the social and environmental correlates of burn injuries (poverty, overcrowding, family stress, and educational deficits) are needed to further reduce burn incidence and its long-term sequelae.
Accident Prevention↗
Can cardiovascular risk factors explain the association between education and cardiovascular disease in young women?
We sought to explain the observed variation in the relationship between education and cardiovascular disease (CVD) among young women in countries at different stages of economic development. Data comprised 2,478 cases of acute myocardial infarction (AMI) or stroke and 6,819 age-matched controls from Africa, Asia, Eastern Europe, and Latin America. The risks of AMI associated with lower education observed in Eastern Europe and higher education in non-European countries were reduced by 92% in Eastern Europe and totally abolished in non-European countries by adjustment for standard cardiovascular risk factors. The inverse associations between education and stroke risk in the three non-African regions were attenuated by 22, 47, and 60% after adjustment. In Africa, the slight inconsistent trend towards lower stroke risk in less well educated women was unaffected by adjustment. These data suggest that standard risk factors explain a substantial proportion if not all of the difference in AMI risk associated with education but a lesser proportion of educationally linked stroke risk.
Adult↗
Fertility, income distribution and economic growth: theory and cross-country evidence: comments.
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Demography↗
[Acute osteomyelitis in the child with sickle cell disease in a tropical zone: value of oral fluoroquinolones].
AIM: This study was designed to assess the efficacy and the safety of fluoroquinolones in their compassionate use for acute osteomyelitis in children with sickle cell disease in a tropical country. PATIENTS AND METHODS: This study was non comparative, including twelve children (eight SS, three SC and one SEzerothalassemia) treated for acute osteomyelitis with oral ciprofloxacin or ofloxacin because of the following reasons: financial inability to afford conventional parenteral beta-lactams therapy (nine patients), refusal of hospitalization (two patients), and failure of conventional treatment (one patient). RESULTS: The mean age of patients was 9.5 +/- 2.6 years. The long bones were the predominantly site. Salmonella species were present in 75% of cases, followed by other enterobacteriaceae (16.7%), and Staphylococcus aureus (8.3%). Successful outcome occurred in all cases after three to four-weeks of treatment and 45 days of plaster immobilization. Transient bilateral Achilles tendon tendinitis was noted in a five-year-old patient. CONCLUSION: In economically developing countries, oral fluoroquinolones may be a therapeutic alternative for acute osteomyelitis in patients with sickle cell disease particularly in cases of financial hardship or failure with conventional therapy.
Acute Disease↗
Prospective study of pharyngitis: clinical diagnosis and microbiological profile.
A prospective study of pharyngitis was carried out in the general population of twenty-two thousand in a small country town, over a period of ten weeks in the fall of 1984. It has been confirmed that, as in the past clinical diagnosis "streptococcal" and "nonstreptococcal" pharyngitis without microbiological examination is still highly inaccurate. From the clinical and microbiological parameters, the incidence in the period of follow-up was calculated as 7.2 and 12.0 cases per 100 population per year for streptococcal and nonstreptococcal pharyngitis, respectively. These data document the health importance of this disease which is frequently underestimated. The M (by M or OF antigens) typability accounted for 62% of group A strains isolated, the prevailing types being M 1 and M 12. Comparison of M and OF typability of field strains immediately after isolation and three weeks later proved the superiority of an early typing. The accurate identification of prevailing types is essential for the prospect of streptococcal vaccine. In streptococcal pharyngitis cases treated with penicillin, the increase of antistreptolysin O and antideoxyribonuclease B titres was recorded in very few instances during a three week period after the onset of the disease. The examination of patients with nonstreptococcal pharyngitis aimed at detecting the role of some viruses or of M. pneumoniae proved that the etiology by these agents was practically nil in the cases concerned at this particular period of time. This finding suggests focusing interest on a possible role of other pathogens. The morbidity rates of pharyngitis, and the clinical as well as the microbiological data resulting from the study make it urgent to pay further attention to this infection and to attempt to elucidate the missing points in the etiology and diagnosis of this disease which belongs to the bacterial infections most frequently seen in man in economically developed countries.
Antibodies, Bacterial↗
Nutrition and prevention of chronic diseases: a unifying eco-nutritional strategy.
Increasing efforts are being made to address, in public health policy (PHP), both the persistence of nutritional deprivation in economically disadvantaged communities, and the increase in so-called "chronic disease" (abdominal obesity, diabetes, cardiovascular disease, certain cancers, osteoporosis, arthritides, and inflammatory disease) in communities at all stages of economic development. The problems in the "chronic disease" descriptor are that its origins may be as early as conception, rather than during the postnatal lifespan, or even in previous generations; it may appear abruptly or slowly; and it may be amenable to environmental and behavioural intervention well into its course and in older age groups. It is also not necessarily "non-communicable", a qualifier often used for "chronic disease" (chronic non-communicable disease or CNCD) and often has inflammatory features, for example the inflammatory marker C-reactive protein is a predictor of macrovascular disease and ischaemic events can, in part, be prevented in the affected by influenzal vaccination. The nexus between immunodeficiency, inflammatory processes and nutritional status which is characteristic of "infective" and food-borne illness, is also more and more evident in "chronic disease". It may be more helpful to consider "chronic disease" as "eco-disease" with its environmental and behavioural contributors, and to regard that which is clearly nutritionally dependent as "eco-nutritional disease".
Chronic Disease↗
Energy evaluation of forest residues originated from Eucalyptus globulus Labill in Galicia.
The possibility of retrieving the energy contained in forest residues originating from wood exploitation in Galicia (Spain) is evaluated. This study was made on Eucalyptus globulus Labill occupying a forest surface of 240000 ha. This species plays an important role in the economical development of Galicia, as it is the main forest species for production of pulp. Sampling was made over 1999 in seven different zones, three main stations plus four selected for comparison, situated in Galicia. The residues originating from cutting were sorted into three different groups and their calorific values were measured by static bomb calorimetry. These calorific values, close to 7200 kJ kg(-1), make possible the use of this residual biomass as an energy source. Calorific values were measured by static bomb calorimeter in an oxygen atmosphere. Flammability was determined using a standard epiradiator. Simultaneously, some other parameters, elementary chemical composition, heavy metal contents, moisture, density, ash percentage after combustion in the bomb, and main bioclimatic characteristics, were also determined.
Bioelectric Energy Sources↗