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PubMed2003

Trends in coronary artery disease and associated risk factors in sub-Saharan Africans.

It has been suggested that the prevalence of coronary artery disease (CAD) is steadily increasing in sub-Saharan Africa. To address this issue, we conducted a Medline search of English language articles on cardiovascular diseases-and specifically CAD in Africa- from 1966 to 1997. The prevalence of CAD and related complications is relatively low in most regions in Africa compared to that obtained in the economically developed countries, although the situation is rapidly changing due to trends in urbanization, changes in lifestyle, acquisition of technology and the increasing numbers of tertiary care institutions. There are variations in reported prevalence rates within the different regions, but there is an upward trend in all the regions of the sub-Saharan Africa. This trend is believed to be related to the increasing frequencies of CAD risk factors in the subcontinent.

Adolescent↗
PubMed2004

Prevalence, awareness, treatment and control of hypertension in North America, North Africa and Asia.

Results from national surveys of prevalence, awareness, treatment and control provide the most meaningful basis for assessing the burden of hypertension in the community. National surveys conducted in a variety of countries in North America, Europe, Australia, Asia and Africa have identified a strikingly similar relationship between age and blood pressure (BP), with a progressive and steep increase in systolic BP throughout adult life and a less steep increase in diastolic BP from adolescence until the fifth or sixth decade. In most countries surveyed, there was a high prevalence of hypertension. Approximately, one quarter of all adults in the United States and Egypt had hypertension (systolic BP>/=140 mmHg or diastolic BP>/=90 mmHg or use of antihypertensive medication) in national surveys conducted in 1988-1991 and 1991-1993, respectively. The corresponding percentage was somewhat lower (14.4%) for adults surveyed in China during 1991, but temporal trends indicate that the prevalence of hypertension is increasing rapidly in that country. In the 1988-1991 national survey, more than 25% of US adults were unaware of their diagnosis, only 55% were being treated with antihypertensive medication and only 29% were on antihypertensive medication with a systolic/diastolic BP >140/90 mmHg. The situation was much worse in Egypt and China, with only 8% and <5% of adults with hypertension, respectively, being treated with antihypertensive medication and having a systolic/diastolic BP <140/90 mmHg. These survey results underscore the fact that hypertension is highly prevalent, poorly treated and controlled, and an escalating health challenge in economically developing countries.

Africa, Northern↗
PubMed2003

Familial and environmental determinants for wheezing and asthma in a case-control study of school children in Palestine.

BACKGROUND: Our prevalence study on Palestinian school children aged 6-12 years showed lower rates for asthma and asthma symptoms than economically developed and industrialized countries. Reasons for such differences are largely unknown, and could possibly be related to different environmental and lifestyle factors. OBJECTIVE: To investigate familial, early life exposures and indoor environmental determinants for asthma in children in Palestine. METHODS: From the population of our previous study, a group of 273 children with wheeze in the past 12 months (of whom 99 children had physician-diagnosed asthma) were matched with an equal number of non-wheezing controls. This case-control study involved a parental questionnaire; skin prick testing (SPT) with mixed house dust mites, cat and dog dander, mixed grass, mixed trees pollen, Alternaria tenuis, olive tree and cockroach extracts; and serum for total and specific IgE for the same eight allergens. RESULTS: Paternal asthma and maternal hayfever significantly tripled the risk for their children to have wheezing. Previous diagnoses of bronchial allergy, bronchitis, pneumonia, or whooping cough, and positive SPT for house dust mites and cockroaches were significantly more likely among wheezing and asthmatic children than controls. Specific IgE levels for house dust mites and cat allergens showed significantly higher risk for reported wheezing. After adjustment for several environmental and sociodemographic factors using multivariate logistic regression analysis, paternal asthma, maternal hayfever, damp houses, cat and cockroach SPT positivity proved to be strong predictors for wheezing symptoms. CONCLUSION: Our study confirmed that familial 'atopic' diseases are significant predictors of childhood asthma in Palestinian children. Moreover, indoor environment such as presence of cats and domestic moulds also appear to play a role. Our findings are consistent with studies in Canada, New Zealand, Estonia and Sweden, and show promise to explore further gene-environment interaction in the genesis of asthma.

Air Pollution, Indoor↗
PubMed2003

Verocytoxigenic Escherichia coli in animal faeces, manures and slurries.

Animal wastes and effluents from farming operations, including manures and slurries, are frequently applied as fertilizer to land used for crop or silage production and cattle grazing. It is well documented that potentially harmful pathogens including verocytoxigenic Escherichia coli (VTEC) are shed in animal faeces and there is growing concern in many countries about the number of sporadic and outbreak cases of VTEC attributable to direct contact with faecal material either as a result of handling contaminated mud in fields or ingestion of produce grown in contaminated manures or slurries. VTEC has been detected in the faeces of ruminant and non-ruminant farmed animals, wild animals, domestic pets and birds and the pathogen appears to be well adapted to survive in animal faeces and can persist for extended periods ranging from several weeks to many months. Because of this persistence these materials are important as potential vehicles for transmission within herds, farms, the fresh food chain and the wider environment. Appropriate handling of bovine faeces is necessary to control spread of this pathogen and to limit the significant risks of human infection. It may be necessary to hold manure/slurry for extended periods prior to spreading on farmland, or for use in the production of food crops, particularly foods that are to be consumed in the raw or minimally processed state. Alternatively, it may be necessary to apply processes such as composting, heat drying or digestion which can expedite the decline of pathogens including VTEC in manures. However, there is a need for research work to develop economical and practical systems for treatment of manures and slurries. The risk from direct contact with faecal material at farms and petting zoos is also recognized and many public health authorities have put forward measures for strict practices to limit the risk of infection, particularly for young children visiting these environments.

Animals↗
PubMed1996

Malaria control and fever management in Henan Province, China, 1992.

Henan Province, which once had the highest malaria prevalence in China, had only 318 reported cases in 1992. Our purpose was to investigate this late 'consolidation phase' of malaria control in Henan with reference to malaria surveillance. We conducted a questionnaire survey of village doctors in Shang Shi Qiao Township during the transmission period of 1992. Of the 732 recorded fever cases, 16 were probable malaria cases by clinical and treatment response criteria, but only one received a full course of antimalarials. Of the 732 patients, 61% had fever every day, 37% went for treatment the first day, 52% waited 2-3 days and 10% waited longer. One hundred and twenty-eight patients took self-medication before seeing the doctor. Blood examination was carried out in 526 (71%) fever cases but only four were positive, all for Plasmodium vivax. Our findings highlight problems relating to patient behaviour and motivation of village doctors, malaria treatment, surveillance and microscopy, rural migration, economic development and malaria transmission. All need to be considered for reforming the malaria control strategy in Henan Province.

Adolescent↗
PubMed2002

Socioeconomic status and the prevalence of coronary heart disease risk factors.

South Asian countries have a high prevalence of coronary heart disease (CHD) in line with their economic development. India, in particular, has a high burden of CHD. Hence, the aim of the present study was to assess the prevalence of CHD risk factors in a semiurban population of Andhra Pradesh, India, in different socioeconomic status (SES) groups. Information was collected on socioeconomic status, physical activity, cigarette smoking, body mass, blood pressure (BP) and serum lipid profiles among a healthy sample of 440 men and 210 women with an age range of 20-70 years. Mean levels of serum cholesterol (SC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC) and skinfold ratio were found to be higher among women, whereas triglycerides (TG), systolic BP and diastolic BP were higher in men. No statistically significant differences in body mass index (BMI) or pulse rate were observed between the sexes. In men, a significant positive rank correlation (rho = P < 0.05) was observed between SES and SC, TG, systolic and diastolic BP, pulse rate and BMI, but in women, the same trend was found only with SC, TG, skinfold ratio and age. The prevalence (age standardized to the world population of Segi, 95% CI) of obesity was 14.37% (11.06-17.68), hypertension 13.13% (9.11-17.15), hypercholesterolemia 18.56% (13.88-23.24), hypertriglyceridemia 45.98% (36.47-55.49) and low HDLC 31.01% (24.25-37.77). In both sexes, the prevalence of hypercholesterolemia, hypertriglyceridemia and sedentary life style increased among higher SES groups (P < 0.05). Also, an increase in the level of social class was positively associated with mean levels of serum cholesterol and triglycerides in both men and women. The results demonstrate that higher SES groups have greater prevalence of CHD risk factors than lower SES groups. Preventive measures are required to reduce the risk factors among higher SES groups.

Adult↗
PubMed2002

Dietary fat plays a major role in obesity: no.

The percentage of dietary energy from fat has been suggested to be an important determinant of body fat, and this presumed effect has been invoked to justify the general promotion of low-fat diets. Dietary fat and the prevalence of obesity are lower in poor countries than in affluent countries. However, these contrasts are seriously confounded by differences in physical activity and food availability; within areas of similar economic development, per capita intake of fat and the prevalence of obesity have not been positively correlated. Randomized trials are the preferable method for evaluating the effect of dietary fat on adiposity because they avoid problems of confounding that are difficult to control in other studies. In short-term trials, a small reduction in body weight is typically seen in individuals randomized to diets with a lower percentage of calories from fat. In a meta-analysis of these trials, it was estimated that a decrease in 10% of energy from fat would reduce weight by 16 g d-1, which would correspond to a 9-kg weight loss by 18 months. However, compensatory mechanisms appear to operate because in trials lasting one year or longer, fat consumption within the range of 18-40% of energy has consistently had little, if any, effect on body fatness. Moreover, within the United States (US), a substantial decline in the percentage of energy from fat during the last two decades has corresponded with a massive increase in obesity, and similar trends are occurring in other affluent countries. Diets high in fat do not account for the high prevalence of excess body fat in Western countries; reductions in the percentage of energy from fat will have no important benefits and could further exacerbate this problem. The emphasis on total fat reduction has been a serious distraction in efforts to control obesity and improve health in general.

Adaptation, Physiological↗
PubMed2002

Onchocerciasis in West Africa after 2002: a challenge to take up.

Initially planned for a 20 year life time, the Onchocerciasis Control Programme in West Africa (OCP) will have finally continued its activities for nearly three decades (vector control alone from 1975 to 1989, then vector control and/or therapeutic treatment until 2002). Although onchocerciasis is no longer a problem of public health importance nor an obstacle to socio-economic development in the OCP area, the control of this filariasis is not over because OCP never aimed at eradication, neither of the parasite (Onchocerca volvulus), nor of its vector (Simulium damnosum s.l.). In 2003, the eleven Participating countries of OCP will take over the responsibility of carrying out the residual activities of monitoring and the control of this disease. This mission is of great importance because any recrudescence of the transmission could lead in the long run to the reappearance of the clinical signs of onchocerciasis, if not its most serious manifestations. For epidemiological and operational reasons, and given the disparity in national health policies and infrastructures, the capacities of the countries to take over the residual activities of monitoring and control of onchocerciasis are very unequal. Indeed, the interventions to be carried out are very different from one country to another and the process of integrating the residual activities into the national health systems is not taking place at the same pace. This inequality among the countries vis-a-vis the challenges to be met does not, however, prejudge the epidemiological situation after 2002 whose evolution will also depend on the effectiveness of the provisions made before that date by OCP, then after 2002, by the Regional Office for Africa of the World Health Organization which is currently setting up a sub-regional multidisease surveillance centre.

Africa, Western↗
PubMedDate not supplied

Important emerging bacterial zoonotic infections affecting the immunocompromised.

The immunocompromised are at particular risk for infection with zoonotic diseases. Persons can be temporarily immunocompromised due to pregnancy or developmental stage (i.e. infants); longer-term or permanent states of immunosuppression can occur as a result of immunosuppressive treatment following cancer or organ transplant, or from infectious diseases, such as AIDS. The focus of this review article is on emerging bacterial zoonotic diseases that are of particular concern among the immunocompromised. Factors that affect disease emergence can include factors such as human demographics and behavior; technology and industry; economic development and land use; international travel and commerce; microbial adaptation and change; and breakdown of public health measures. The immunocompromised need to take precautions when engaging in seemingly normal activities such as food preparation; caring for companion animals; and recreational or occupational activities. The immunocompromised are not only more susceptible to infection, but often suffer more serious sequelae as a result of infection. This review article provides an overview of the major foodborne, respiratory, and vector-borne bacterial pathogens that affect the immunocompromised. The major categories of immunodeficiency are described. In addition, measures that can be taken to prevent infection, including the role of health education, are discussed.

Animals↗
PubMedDate not supplied

Commentary: Problematic issues in cultural comparisons.

This commentary offers a critique of cross-cultural comparisons of health care systems between the United States and less economically developed nations. Two main issues are discussed: the abuse of power in such comparisons and the reluctance of nurses from the United States to address conditions of suffering in their own country. Recommendations are given to increase sensitivity of nurses.

Attitude of Health Personnel↗
PubMed2001

[The future of social medicine from the practical viewpoint].

Within the German statutory health care system the practice of sociomedicine as an applied health science is mainly related to individual aspects of theinsured persons. Combining factors due to medical and socio-economical developments it plays an important integrative role as so to say a lawyer of the patients. Furthermore, practical sociomedicine must provide consultant services to support the social insurance in the sphere of shaping the health care system. Profound knowledge on the required level must be acquired by graduate studies and can be deepened by well-planned continuing medical education. Professionalism in providing services and fulfillment of legal obligations can be achieved by standardisation of social medical procedures, scientific orientation towards public health aspects, appropriate methods of delivering medical knowledge, use of information systems, refinement of co-operation, quality management, social medical controlling, application of modern planning and control concepts as well as model leadership.

Case Management↗
PubMed2002

Controlling tuberculosis in India.

BACKGROUND: Tuberculosis kills nearly 500,000 people in India each year. Until recently, less than half of patients with tuberculosis received an accurate diagnosis, and less than half of those received effective treatment. METHODS: We analyzed the effects of new policies introduced in 1993 that have resulted in increased resources, improved laboratory-based diagnosis, direct observation of treatment, and the use of standardized antituberculosis regimens and reporting methods. RESULTS: By September 2001, more than 200,000 health workers had been trained, and 436 million people (more than 40 percent of the entire population) had access to services. About 3.4 million patients had been evaluated for tuberculosis, and nearly 800,000 had received treatment, with a success rate greater than 80 percent. More than half of all those treated in the past 8 years were treated in the past 12 months. CONCLUSIONS: India's tuberculosis-control program has been successful in improving access to care, the quality of diagnosis, and the likelihood of successful treatment. We estimate that the improved program has prevented 200,000 deaths, with indirect savings of more than $400 million--more than eight times the cost of implementation. It will be a substantial challenge to sustain and expand the program, given the country's level of economic development, limited primary health care system, and large and mostly unregulated private health care system, as well as the dual threats of the human immunodeficiency virus and multidrug-resistant tuberculosis.

Communicable Disease Control↗
PubMed2005

Major causes of death among men and women in China.

BACKGROUND: With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China. METHODS: Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent. RESULTS: We documented 20,033 deaths in 1,239,191 person-years of follow-up. The mortality from all causes was 1480.1 per 100,000 person-years among men and 1190.2 per 100,000 person-years among women. The five leading causes of death were malignant neoplasms (mortality, 374.1 per 100,000 person-years), diseases of the heart (319.1), cerebrovascular disease (310.5), accidents (54.0), and infectious diseases (50.5) among men and diseases of the heart (268.5), cerebrovascular disease (242.3), malignant neoplasms (214.1), pneumonia and influenza (45.9), and infectious diseases (35.3) among women. The multivariate-adjusted relative risk of death and the population attributable risk for preventable risk factors were as follows: hypertension, 1.48 (95 percent confidence interval, 1.44 to 1.53) and 11.7 percent, respectively; cigarette smoking, 1.23 (95 percent confidence interval, 1.18 to 1.27) and 7.9 percent; physical inactivity, 1.20 (95 percent confidence interval, 1.16 to 1.24) and 6.8 percent; and underweight (body-mass index [the weight in kilograms divided by the square of the height in meters] below 18.5), 1.47 (95 percent confidence interval, 1.42 to 1.53) and 5.2 percent. CONCLUSIONS: Vascular disease and cancer have become the leading causes of death among Chinese adults. Our findings suggest that control of hypertension, smoking cessation, increased physical activity, and improved nutrition should be important strategies for reducing the burden of premature death among adults in China.

Adult↗
PubMed1987

On the size distribution of cities: an economic interpretation of the Pareto coefficient.

"Both the hierarchy and the stochastic models of size distribution of cities are analyzed in order to explain the Pareto coefficient by economic variables. In hierarchy models, it is found that the rate of variation in the productivity of cities and that in the probability of emergence of cities can explain the Pareto coefficient. In stochastic models, the productivity of cities is found to explain the Pareto coefficient. New city-size distribution functions, in which the Pareto coefficient is decomposed by economic variables, are estimated."

Demography↗
PubMed2005

Traditional v. modified dietary patterns and their influence on adolescents' nutritional profile.

Korea has experienced exceptionally rapid economic developments. Even though the country has managed to maintain aspects of its traditional diet, dietary habits are changing, especially among adolescents. This study was carried out to identify prevailing dietary patterns among Korean adolescents and to compare the nutrient intakes and dietary behaviours between the patterns. A 3 d diet record, collected from 671 Korean adolescents aged 12-14 years in Seoul, Korea, was assessed. By cluster analysis, subjects were classified into a modified (69.9 %) and a traditional (30.1 %) dietary pattern group. The modified group consumed more bread, noodles, cookies and pizza/hamburgers compared with the traditional group, which consumed mainly rice and kimchi (fermented cabbage). The modified group had significantly higher intakes of all nutrients. It had a higher total daily energy intake (7719 kJ), a higher daily energy intake from fat (29.8 %) and a higher cholesterol intake (326 mg/d), compared with the traditional group (6686 kJ, 24.8 % and 244 mg/d, respectively). The modified group was more likely to consume fast foods, fried foods and carbonated beverages even though they consumed more fresh fruits and milk, while the traditional group was more likely to have a rice-based diet and not to skip breakfast. These results suggest that monitoring dietary behaviours of adolescents, especially in a society experiencing a nutrition transition, is necessary in order to identify both negative and positive changes in respect of risk factors for nutrition-related chronic diseases as well as for undernutrition.

Adolescent↗
PubMed2001

Impact of climatic and other environmental changes on food production and population health in the coming decades.

World population will reach an estimated nine billion by 2050. Given this factor and continued economic development in today's low-income countries, the total global demand for food will increase approximately threefold over the coming half-century. Meanwhile, against this background, newly-occurring global environmental changes such as climate change are anticipated to affect food production. Other incipient large-scale environmental changes likely to affect food production include stratospheric O3 depletion, the accelerating loss of biodiversity (with knock-on effects on crop and livestock pest species) and the perturbation of several of the great elemental cycles of N and S. The ways in which these various environmental influences affect the production of food (crops and livestock on land, and wild and cultivated fisheries) are complex and interactive. Uncertainties therefore persist about how global climate change is likely to affect world and regional food production. On balance, recent modelling-based estimates indicate that, in the medium to longer term, if not over the next several decades, climate change is likely to affect crop yields adversely, especially in food-insecure regions. The prospect of increased climatic variability further increases the risks to future food production. Given these possible though uncertain adverse impacts of climatic and other environmental changes on world food production, there is a need to apply the Precautionary Principle. There are finite, and increasingly evident, limits to agro-ecosystems and to wild fisheries. Our capacity to maintain food supplies for an increasingly large and increasingly expectant world population will depend on maximising the efficiency and sustainability of production methods, incorporating socially-beneficial genetic biotechnologies, and taking pre-emptive action to minimise detrimental ecologically-damaging global environmental changes.

Agriculture↗
PubMed2003

Evidence v. rights-based decision making for nutrition.

The need for an evidence base for human nutrition action is analysed in the context of human rights. Over the last 50 years the twin tracks of development, economical needs based and normative rights based, have come progressively closer in terms of goals and objectives, even if they do maintain different orientations and origins. The international human rights machinery is described, together with those parts that are of relevance to the right to food and nutrition. The role of the State in respecting, protecting and facilitating these rights is further described. The evidence base for the benefit of nutrition interventions during the fetal and infant period to the health and well-being of populations throughout life's course is briefly reviewed, and reasons why such a large body of evidence has not been acted upon are discussed. The power of nutrition is in prevention more than cure, and the prevention of nutritional deficiency is best suited to radical population-wide strategies rather than high-risk strategies targeted at individuals. The population-wide distribution of benefits of nutrition is in congruence with universality of human rights. In the UK much remains to be done to ensure that food and nutrition rights are realised, especially during the critical period of fetal and infant growth. What role the Nutrition Society might play in the realisation of these rights, including the creation of a robust evidence base for nutrition action, is further discussed.

Child Nutritional Physiological Phenomena↗
PubMed1979

The epidemiology of schistosomiasis in the vicinity of Lake Sibaya, with a note on other areas of Tongaland (Natal, South Africa).

The epidemiology of human and bovine schistosomiasis in the Lake Sibaya area of Tongaland, South Africa, an undeveloped rural environment, is discussed. The mean prevalence of Schistosoma haematobium infection is 72%, but S. mansoni is absent; possible reasons for this are given and the different types of water habitat are shown to play different roles in transmission. Fear of crocodiles and hippopotami is important because villagers are compelled to use for domestic purposes, the smaller, shallower habitats, where Bulinus (Ph.) globosus occurs but not Biomphalaria pfeifferi, rather than the deeper, larger ones where both snails are found. This discontinuous distribution of B. pfeifferi in the deeper sites, due to the high temperatures in spring, is viewed in relation to local climatic conditions. A human population influx, such as would result from the economic development of Tongaland, would cause not only a decline in crocodile and hippopotamus populations, and thus encourage human contact with the deeper waterbodies, but would favour the introduction of S. mansoni into at least some of these habitats. A similar prevalence pattern of human schistosomiasis exists over the remainder of Tongaland and the lowlands of southern and central Mozambique. The mean prevalence of Schistosoma mattheei in Tongaland cattle is 42% and although data are not available a comparable percentage seems likely in Mozambique.

Adolescent↗