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PubMed2002

An overview of changing agendas in health sector reforms.

This paper discusses health sector reforms and what they have meant for sexual and reproductive health advocacy in low-income countries. Beginning in the late 1980s, it outlines the main macro-economic shifts and policy trends which affect countries dependent on external aid and the main health sector reforms taking place. It then considers the implications of successive macro-economic and reform agendas for reproductive and sexual health advocacy. International debate today is focused on the conditions necessary for socio-economic development and the role of governments in these, and how to improve the performance of health sector bureaucracies and delivery systems. A critical challenge is how to re-negotiate the policy and financial space for sexual and reproductive health services within national health systems and at international level. Advocacy for sexual and reproductive health has to tread the line between a vision of reproductive health for all and action on priority conditions, which means articulating an informed view on needs and priorities. In pressing for greater funding for reproductive health, advocates need to find an appropriate balance between concern with health systems strengthening and service delivery and programmes, and create alliances with progressive health sector reformers.

Africa South of the Sahara↗
PubMed2004

Women's autonomy, education and employment in Oman and their influence on contraceptive use.

Since 1970 political and economic changes have brought about great improvements in health and education in Oman, and since 1994 the government has provided free contraceptives to all married couples in primary health care centres. Despite rapid socio-economic development, the fertility rate was 4.2 in 2001. The aim of this study was to define baseline data on ever-married women's empowerment in Oman from a national study in 2000, analyse the correlates of women's empowerment and the effect of empowerment on unmet need for contraception. Two indicators of empowerment were used: women's involvement in decision-making and freedom of movement. Bivariate analysis was used to link these measures and their proxies, education and employment status, with use of a family planning method. Education was a key indicator of women's status. Unmet contraceptive need for women exposed to pregnancy was nearly 25%, but decreased significantly with educational level and paid employment. While empowered women were more likely to use contraception, women's education was a better predictor of "met need" than autonomy, as traditional factors and community influence remain strong. For nearly half the 1,830 women in the study, the husband decided whether contraception was used. Fewer than 1% were using contraception before their first child as women are expected to have a child within the first year of marriage.

Adult↗
PubMed2004

Abortion patterns and reported sex ratios at birth in rural Yunnan, China.

High sex ratio at birth due to son preference has been known in China historically, but it was thought this phenomenon would diminish with modernisation. The aim of this study was to investigate abortion decisions and reported sex ratios at birth in the context of successive family planning policies in Huaning County, Yunnan Province, in China. Abortion patterns and reported sex ratios at birth of a random sample of 1,336 women aged 15-64 were analysed for the period 1980--2000, in relation to parity and sex of previous children. There was a mole bias in the abortion pattern during the 1980s, but by the end of the 1990s most pregnancies of women with two children were being terminated. Sex ratio at birth rose from 107 in 1984--87 to 110 between 1988--2000 in Huaning. While women's reproductive decisions were influenced by son preference over the whole period, the means used to ensure a son differed with changing family planning policies. We conclude that rising sex ratios in the context of falling fertility and modernisation is an alarming socio-demographic issue, which defies historical experience. Assumptions that discrimination against girls would diminish with economic development and female education have proven simplistic. Action is urgently needed to reduce and mitigate the effects of discrimination against girls.

Abortion, Legal↗
PubMed1998

Experience with a new human skin equivalent for healing venous leg ulcers.

Leg ulcers affect about 650,000 adults each year and in every setting--rural, urban, and both economically developed and impoverished areas. Both the physical and the psychologic aspects of treatment present challenges to the caregiver. The nurse must be aware of new techniques for treatment and be able to educate patients about potential modalities for healing. A human skin equivalent, Apligraf, will soon be available for treatment of these wounds. The results of controlled, multicenter studies indicate that human skin equivalent interacts with the patient's own cells, responds to individual wound characteristics, and promotes healing. The nursing professional can readily master the application technique and will find that this tissue-engineered skin product offers a new approach to wound management.

Adult↗
PubMed2003

COMPARE radiology: creating an interactive Web-based training program for radiology with multimedia authoring software.

RATIONALE AND OBJECTIVES: Computer-based training has two primary benefits: Content can be presented interactively, and students can choose the time, place, and pace of learning. As a subject of medical education, radiology lends itself particularly well to computer-based training because of its highly visual content. To improve the efficiency of radiology training at their institution, the authors decided to create an interactive Web-based training site. MATERIALS AND METHODS: Working with a group of medical students knowledgeable in multimedia authoring, the authors used authoring software to create "COMPARE Radiology," an interactive training program that follows the modality-based structure of the undergraduate curriculum for radiology at the University of Erlangen-Nuremberg, Erlangen, Germany, and at medical schools worldwide. RESULTS: The Web-based program offers cases and exercises in radiographic anatomy at different selectable levels of difficulty, allowing users to test and build their knowledge of radiology. Pathologic images are initially presented without any further information. Additional information (patient history, laboratory results, reports from other imaging studies, and normal images for comparison) can be retrieved selectively and successively. Further information regarding the diagnosis and pathologic findings can be found by following links to external Web sites. The COMPARE Radiology program content is extended and updated regularly. The program is subject to internal peer review and can be evaluated by the user online. CONCLUSION: The authors' experience shows that a highly interactive Web-based training program for radiology, tailored to the requirements of the target group, can be developed economically by a team of medical students using an advanced storing system, with the guidance of a radiologist and without the help of professionally trained computer experts.

Computer-Assisted Instruction↗
PubMed2001

Asthma mortality in Uruguay, 1984-1998.

BACKGROUND: Asthma mortality rates have increased worldwide during the past several years despite the increased availability of new and effective medications. Few studies show reliable data from Latin American countries. OBJECTIVE: To determine asthma mortality rates from 1984 to 1998 and to relate mortality to sales of asthma medications. METHODS: We conducted a retrospective epidemiologic study in the total population of Uruguay. Data were obtained from the Department of Statistics of the Ministry of Public Health. Trends in mortality rates were analyzed using linear regression procedures. Spearman rank correlations were used to relate mortality rates to sales of asthma medications. RESULTS: The mean overall mortality rate was 5.10 per 100,000 during the period 1984 to 1998, (range 6.08 to 3.39) and showed a decreasing trend (P = 0.001). During the period 1995 to 1998, a more pronounced decrease was observed (mean mortality rate, 4.10 per 100,000). In the 5- to 34-year-old age group the mean mortality rate was 0.43 (range 0.65 to 0.13). Similarly, the mortality rate in this age group decreased particularly in the 1994 to 1998 period (mean 0.19; P = 0.005). Finally, the mortality rate was inversely correlated with sales of inhaled corticosteroids; for the overall mortality rate, p = -0.71, P = 0.003; for 5- to 34-year-old age group, p = -0.63, P = 0.01. CONCLUSIONS: Although mortality attributable to asthma seems to be decreasing, the overall mortality rate is still high compared with more economically developed countries. A more pronounced decrease in asthma mortality has been seen in the 5- to 34-year-old group. At present, Uruguay is a Latin American country with a low rate of asthma mortality. This is probably related to the use of new therapies to treat asthma.

Adolescent↗
PubMed2002

Aiming to eliminate tsetse from Africa.

The problem of tsetse-transmitted trypanosomiasis occurs only in sub-Saharan Africa, where it represents a major constraint to socio-economic development. The East African form of sleeping sickness, caused by Trypanosoma brucei rhodensiense, is an acute and fatal disease, whereas the West African form, caused by Trypanosoma brucei gambiense, is generally more chronic and debilitating. The African governments have developed a new initiative, known as the Pan African Tsetse and Trypanosomiasis Eradication Campaign, which seeks to employ an area-wide approach and appropriate fly suppression methods to eradicate tsetse from areas of tsetse infestation, at a time, to ultimately create tsetse-free zones.

Africa South of the Sahara↗
PubMed2001

The evolution of the family planning programme and its role in influencing fertility change in Kenya.

Kenya was one of the first sub-Saharan countries to enter the fertility transition, and analysts have suggested various explanations for this. This paper examines the growth in contraceptive availability in Kenya by looking at the Kenya family planning programme and its association with the fertility transition. This is of critical programmatic importance because the fertility transition is not yet underway in many sub-Saharan countries. Policymakers will find the information from this study helpful in evaluating the efficacy of current programmes and replicating the Kenyan programme in areas where fertility decline has not yet occurred. For researchers, the study attempts to highlight some of the major factors driving Kenya's fertility decline, apart from the conventional arguments about social and economic development.

Adolescent↗
PubMed2006

The beneficial helminth parasite?

There is unequivocal evidence that parasites influence the immune activity of their hosts, and many of the classical examples of this are drawn from assessment of helminth infections of their mammalian hosts. Thus, helminth infections can impact on the induction or course of other diseases that the host might be subjected to. Epidemiological studies demonstrate that world regions with high rates of helminth infections consistently have reduced incidences of autoimmune and other allergic/inflammatory-type conditions. Here I review and assess the possible ways by which helminth infections can block or modulate concomitant disease processes. There is much to be learned from careful analysis of immuno-regulation in helminth-infected rodents and from an understanding of the immune status of acutely and chronically infected humans. The ultimate reward from this type of investigation will likely be a more comprehensive knowledge of immunity, novel ways to intervene in the immune response to alleviate autoimmune and allergic diseases (growing concerns in economically developed areas), and perhaps the development of helminth therapy for patients suffering from specific inflammatory, autoimmune or allergic disorders.

Animals↗
PubMed1994

A developmental study of the acquisition of colour terms in Setswana.

We report a study of the acquisition of colour terms by speakers of Setswana, the language of Botswana in Southern Africa. This was carried out as a test of Berlin & Kay's theory of colour term universals, on a language with less than the maximum complement of eleven basic colour terms, and in order to document changes in Setswana under the impact of economic development. Seventy-seven five- to nine-year-olds were studied on two colour tasks: elicited lists and colour naming. In general the data were consistent with Berlin & Kay's theory: the rank order of frequency of correct use of colour terms was similar to the order of the Berlin & Kay hierarchy; and primary colour terms were offered more frequently and were more likely to be used correctly than secondary colour terms. The use of English colour terms was prevalent, especially amongst the younger groups, but they functioned as substitutes for Setswana terms, rather than as a means to fill the vacant basic colour term slots.

Age Factors↗
PubMed2001

Modeling of fugitive dust emission for construction sand and gravel processing plant.

Due to rapid economic development in Taiwan, a large quantity of construction sand and gravel is needed to support domestic civil construction projects. However, a construction sand and gravel processing plant is often a major source of air pollution, due to its associated fugitive dust emission. To predict the amount of fugitive dust emitted from this kind of processing plant, a semiempirical model was developed in this study. This model was developed on the basis of the actual dust emission data (i.e., total suspended particulate, TSP) and four on-site operating parameters (i.e., wind speed (u), soil moisture (M), soil silt content (s), and number (N) of trucks) measured at a construction sand and gravel processing plant. On the basis of the on-site measured data and an SAS nonlinear regression program, the expression of this model is E = 0.011.u2.653.M-1.875.s0.060.N0.896, where E is the amount (kg/ton) of dust emitted during the production of each ton of gravel and sand. This model can serve as a facile tool for predicting the fugitive dust emission from a construction sand and gravel processing plant.

Air Pollution↗
PubMed2003

Research issues in sustainable consumption: toward an analytical framework for materials and the environment.

We define key research questions as a stimulus to research in the area of industrial ecology. The first group of questions addresses analytical support for green engineering and environmental policy. They relate to (i) tools for green engineering, (ii) improvements in life cycle assessment, (iii) aggregation of environmental impacts, and (iv) effectiveness of a range of innovative policy approaches. The second group of questions addresses the dynamics of technology, economics, and environmental impacts. They relate to (v) the environmental impacts of material and energy consumption, (vi) the potential for material efficiency, (vii) the relation of technological and economic development to changes in consumption patterns, and (viii) the potential for technology to overcome environmental impacts and constraints. Altogether, the questions create an intellectual agenda for industrial ecology and integrate the technological and social aspects of sustainability.

Conservation of Energy Resources↗
PubMed1997

Bioactive labdane diterpenoids from Renealmia alpinia collected in the Suriname rainforest.

The preservation of tropical rainforests is an important goal both for the intrinsic value of their cultural and biological diversity as well as for the well-being of the peoples who make these forests their home. In addition, tropical forests are potential sources of new pharmaceutical products that can only be found by chemical prospecting in Nature's genetically encoded combinatorial library. As part of an effort to integrate biodiversity conservation and drug discovery with economic development, we have initiated a collaborative program to discover potential pharmaceuticals in the rainforest of Suriname. The plant Renealmia alpinia (Zingiberaceae) was selected for investigation based on its ethnomedical use as a febrifuge, but testing in the yeast Sc-7 assay gave a positive response, indicative of cytotoxic activity. Using this bioassay, the two new labdane diterpense, 11-hydroxy-8(17),12(E)-labdadien-15,-16-dial 11,15-hemiacetal (1) and 16-oxo-8(17),12(E)-labdadien-15-oic acid (2), and the known diterpene, 8(17),12(E)-labdadien-15,16-dial (3), have been isolated. Their structures were elucidated by 1D and 2D NMR techniques (DEPT, COSY, HETCOR, HMBC, and NOESY) and IR, UV, and MS spectra, and the absolute stereochemistry of 1 was established by CD spectroscopy and by the formation and NMR analysis of alpha-methoxyphenylacetyl esters. The hemiacetal 1 was cytotoxic to M109 cells, with an IC50 value of 2.6 micrograms/mL.

Animals↗
PubMed1999

Fat, fatigue and the feminine: the changing cultural experience of women in Hong Kong.

This paper seeks to demonstrate that rapid economic development in Hong Kong has transformed not only social structures but also Chinese women's subjectivity and bodily experience, thereby producing new forms of identity, aesthetics and aspirations, in addition to novel patterns of distress. Evidence is assembled to show that women's being-thin-yet-feeling-fat and being-active-yet-feeling-tired reflect not so much psychopathology as transformation in embodied moral experience. Because such normative experiences are grounded in the conflicting demands of production and reproduction that recent social transformations have brought to bear on women's lives, "fat" and "fatigue" can be said to embody what it is to become a woman in contemporary Hong Kong.

Adipose Tissue↗
PubMed1998

Intergenerational living arrangements in Turkey.

Despite the growing research on the living arrangements of elderly we know very little about intergenerational relations in Turkey. This research is a step towards this goal. The purpose is to assess whether urbanization and economic development at the aggregate level and modernity and secularism at the individual level result in a decline in coresiding and living nearby older family members in Turkey. Results obtained using multinomial logistic estimates are supportive of the hypotheses. There is a significant variation in coresidence and in the reasons for coresiding with older family members by regional development, urbanization, individual modernity and religiosity.

Journal Article↗
PubMed2001

Aging in a tiger welfare regime: the single elderly in Hong Kong.

This paper explores the coping strategies of the low income single elderly in Hong Kong, which are divided into several broad types: government-orientated (public services); market-orientated; community-orientated; and individually-orientated (practically speaking self restraint and denial). It highlights this group's reliance on the government, which not only provides housing, medical care and other services, but is also a major source of income support, although support levels are seriously inadequate. Yet the highly differentiated nature of Hong Kong's market economy provides single elders with ways to supplement inadequate public provision, by entering into low paid, menial work, and purchasing consumption necessities and accessing affordable housing in the informal sector--notably those segments of Hong Kong's increasingly sophisticated economy that are a throwback to leaner, meaner times. This case study also highlights the extent to which the community sector is undeveloped in Hong Kong. In spite of Hong Kong's wealth and level of economic development the prognosis for this group is not good.

Journal Article↗
PubMed2002

Harnessing heredity in Gilded Age America: middle class mores and industrial breeding in a cultural context.

By investigating the practices and beliefs of Gilded Age trotting horse breeders, this article demonstrates the relationship between industrial economic development and the growth of genetic reasoning in the United States. As most historians of biology already know, E. H. Harriman, Leland Stanford, and John D. Rockefeller not only transformed American business practice, they donated heavily to institutions that promoted eugenic research programs. What is not widely known, however, is that these same industrialists were accomplished trotting horse breeders with well-developed theories of inheritance. The article that follows uses these theories to place the rise of eugenic and genetic research into the context of the rapid development of industry in post Civil War America. Specifically, the study identifies how functional utility as defined through the narrow concerns of industrial practices were privileged over form and pedigree in American horse breeding. Even more importantly, this article suggests that the continuity established between the practices of the industrial philanthropists and the scientific research institutions that they established occurred at two levels: through the values privileged by the development of the dynamics of a mass society and through the tools used to process the large amounts of information necessary to understand breeding patterns in slow breeding organisms.

Animals↗
PubMed2002

Growth and mortality in sheep and goats under high tsetse challenge in Kenya.

Trypanosomosis is a major impediment to livestock production and economic development in those areas of Africa where it is endemic. Although small ruminants appear to perform better than cattle in various agro-ecological zones, the importance of trypanosomosis has not been extensively investigated in these livestock. This study was designed to investigate the prevalence of trypanosomosis in sheep and goats in an endemic area and to evaluate the performance of different breeds under high tsetse challenge and the potential role of chemoprophylaxis in the control of the disease. The results showed that tsetse flies feed readily on small ruminants, and that these animals are susceptible to trypanosomosis. The Small East African goats acquired fewer infections than the Black Head Persian and Dorper sheep used in the study. In both sheep and goats, chemoprophylaxis with isometamidium chloride (Samorin, Rhone Merieux, Annecy, France) was protective, resulting in fewer infections and higher body weight gain. Trypanosomosis caused anaemia in both sheep and goats, and animals whose PCV fell below 15% rarely recovered, even with trypanocidal drug treatment. The peak transmission period was between 1 and 3 months after the peak tsetse fly density, which raises the possibility of effective strategic prophylaxis.

Anemia↗