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PubMed2006

Tobacco control: present and future.

The history of tobacco control in the twentieth century can be summed up by the phrase 'too little, too late'. The century saw the proliferation of the most deadly form of tobacco use: cigarette smoking. Until the 1970s, no government took serious action to protect its citizens. In fact, probably the most effective global tobacco control 'strategies' to date have not been motivated by health concerns: they have been inaccessible or uneconomic markets for tobacco companies and a cultural taboo on women smoking. Economic development has led to massive increases in male cigarette smoking in developing countries but even now <10% of women in non-Western countries such as China, Russia and India smoke. With 'westernization', this picture is changing. Without drastic action to get current smokers to stop, the annual rate of tobacco-related deaths will grow from 5 million in 2006 to 10 million in 2025. Without further action to prevent take up of smoking, the subsequent death toll will be even higher. The recently enacted World Health Organization (WHO)-initiated Framework Convention on Tobacco Control (FCTC) can mitigate this impending disaster but only if it is implemented according to the spirit and not just the letter of the articles contained therein. Specific tobacco levies in every country should be the primary means of kick-starting the process, with the proceeds being used exclusively to fund other tobacco control initiatives, including product regulation.

Forecasting↗

PubMedDate not supplied

Endemic treponematoses in the Sudan.

Sudan is surrounded by eight countries and has marked movement of population across its borders. At one time yaws and syphilis were important public health problems in the Sudan. Following the wide use of penicillin, both diseases were much reduced in prevalence and were no longer public health problems. However, the extensive population movement and particularly the huge influx of refugees across the border pose important potential hazards. The rapid urbanization and the social and cultural changes that followed economic development affected family ties and community behavior and resulted in a marked increase in the prevalence of sexually transmitted diseases, including syphilis. It is difficult to know the true magnitude of the problem because of the poor health information system and coverage. Improvement of the surveillance system is urgently needed, and more attention needs to be paid to treponemal infections. This entails improvement in health services and training of health personnel.

Animals↗

PubMed2001

Body height, birth cohort and social background in Finland and Sweden.

BACKGROUND: Poor childhood living conditions are associated with short stature. Before the Second World War Finland had much lower living standards than Sweden, but this gap had largely disappeared by the 1970s. Body height differences were examined by birth cohort, economic difficulties in childhood and adult socioeconomic position in Finland and Sweden. METHODS: Two nationally representative data sets were used (n = 7,300 in Finland and n = 4,551 in Sweden). Three indicators of social background were included, i.e. economic difficulties in childhood, education and occupational class. The methods used were direct age-standardisation, index of dissimilarity and regression analysis. RESULTS: In the cohort born in 1920-1929 body height was taller in Sweden (175.8 cm among men and 163.7 cm among women) than in Finland (173.9 and 161.2 cm respectively). Body height by birth cohort increased faster in Finland, with the result that, in the cohort born in 1960-1969, the gap between the countries had narrowed to 0.8 cm among men and 0.3 cm among women. Body height differences by social background were larger in Finland than in Sweden. Socioeconomic body height differences have remained largely stable over the birth cohorts in both countries. CONCLUSIONS: The results suggest that differential economic development is partly seen in the narrowing of body height differences between Finland and Sweden. However, socioeconomic differences in body height have remained largely similar over the birth cohorts studied and between Finland and Sweden.

Adolescent↗

PubMed2006

How do people with cancer wish to be cared for in primary care? Serial discussion groups of patients and carers.

BACKGROUND: In most economically developed countries, patients, their informal and professional carers and policy makers are calling for more care in the community. OBJECTIVES: To involve patients with cancer, and their carers, in designing a framework for providing effective cancer care in primary care. METHODS: Two discussion groups comprising 18 people with current cancer and carers met monthly over a year in the south of Scotland. RESULTS: Patients with cancer and their carers identified five key times in the cancer journey as being especially significant from their perspective: around diagnosis, during treatment, after discharge, at recurrence and the final weeks. At each key time, there were five major issues of concern: information, communication, equity, a holistic approach and patient-centred care. Using these, the group members developed a checklist of recommended interventions for each stage in the illness trajectory and suggested how they might be implemented in primary care. Proactive and ongoing contact, if wished by the patient, was considered the central plank of cancer care in the community. CONCLUSIONS: Patients with cancer and their carers believe that there is an important and unique role for primary care in offering continuity of care and information that is patient-centred and holistic, throughout the cancer trajectory, from first presentation. This study successfully brought patient, carer and professional perspectives to the development of a care framework for primary care.

Adult↗

PubMed2004

Stability and change in the perceived social support of older Taiwanese adults.

OBJECTIVE: The purpose of this study is to examine stability and change in Taiwanese elders' perceptions about the availability of social support and the sociodemographic and cultural factors associated with change. METHODS: This study uses data from four waves of the Survey of Living Status of the Elderly in Taiwan that spans a 10-year period and employs latent growth curve models to examine trajectories of perceived support and the sociocultural factors that may explain variability in baseline levels of support and variability in changes in support as respondents age. RESULT: Perceptions about social support appear to follow a linear trajectory across age, with significant variation in baseline perceptions and in patterns of change in perceived support across the sample. Sociocultural factors primarily explain differences in initial levels of support but also have some effect on changes in support. DISCUSSION: Despite the increasing pressures and demands on adult children's time that are associated with social and economic development, the elderly in Taiwan on average feel supported by their social networks, with the perceived availability of support increasing with age.

Aged↗

PubMed1990

Retirement migration and interstate income transfers.

This paper examines one aspect of the economic impact of elderly migration, the transfer of income from state to state, a concern of policymakers, planners, and researchers. Using 1980 census microdata files it was determined that billions of dollars are transferred between states each year, some states (especially Florida) gaining and others losing. The 1980/1981 Consumer Expenditure Interview Survey was used to estimate the consumption patterns of the typical migrant household. These findings are discussed in the context of state economic development.

Aged↗

PubMed1991

Trend of caesarean section in Italy: an examination of national data 1980-1985.

An Italian nationwide presentation of data concerning the proportion of births by caesarean section (CS) for the period 1980-1985 is presented here. A constant increase in CS was noted, from 11.2% in 1980 to 15.8% in 1985. The increase was observed in all regions while higher rates were noted in northern and central Italy. CS rates are higher in older age groups, in pregnancies from 29th to 35th week of gestation for high and low birthweights and malpresentations. Ecological associations revealed that CS is positively related to economic development and negatively to perinatal and stillbirth rates.

Adult↗

PubMed1980

Hypothesis is lactose a dietary risk factor for ischaemic heart disease?

The prevalence of primary adult lactose malabsorption (LM) in 23 ethnic groups was matched with national data on milk consumption and mortality rates from ischaemic heart disease (IHD). In 6 other ethnic groups prevalence of LM was related to unquantified assessments of milk consumption and frequency of IHD. On the available data, populations with a prevalence of LM over 30%, and whose consumption of milk is low or is largely in low lactose form, have a lower risk of IHD mortality than populations with a prevalence of LM under 30% and a high milk consumption. There is evidence against attributing these findings to genetic linkage between susceptibility to IHD mortality and persistent lactose absorption, or to differences in socio-economic development, cigarette consumption or intake of animal fats. The findings are compatible with an hypothesis that, if the correlation reported previously between milk consumption and IHD mortality is causal, lactose could be the responsible dietary factor.

Animals↗

PubMed2003

Twelve-year changes in vascular risk factors and their associations with mortality in a cohort of 3499 Thais: the Electricity Generating Authority of Thailand Study.

BACKGROUND: Vascular mortality is increasing in economically developing countries such as Thailand but reliable data about the determinants of these changes are few. METHODS: In 1985, male and female employees of the Electricity Generating Authority of Thailand took part in a cardiovascular risk factor survey. In 1997, a follow-up survey was conducted and causes of death were determined for those subjects known to have died. Changes in levels of vascular risk factors over 12 years, and the associations of baseline risk factors with vascular mortality, were calculated. RESULTS: The 1985 survey recruited 3499 volunteers (average age 43 years) of whom 23% were female. In 1997, vital status was determined for 3318 (95%) and 2967 (85%) of the study participants were resurveyed. Mean levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index, total cholesterol and high density lipoprotein (HDL) cholesterol all increased over the 12-year follow-up period. Over the same time, the prevalence of diabetes also rose but the proportion of current smokers decreased. Vascular diseases were the most frequent cause of death during follow-up (n = 46), were positively associated with baseline age, SBP, DBP, smoking, diabetes, male sex, and total cholesterol, and were negatively associated with HDL cholesterol. CONCLUSIONS: Levels of most vascular risk factors worsened over the 12-year period between 1985 and 1997. The associations between baseline risk factor levels and vascular mortality were consistent with those observed in other populations. Interventions that control vascular risk factors have the potential to avert much premature vascular disease in Thailand.

Adult↗

PubMed2004

Health inequalities in Korea: age- and sex-specific educational differences in the 10 leading causes of death.

BACKGROUND: An ideological climate has persisted in Korea that has discouraged public discussion of social inequalities. Thus studies on inequalities in mortality remain undeveloped. This study is to examine age- and cause-specific socioeconomic mortality differentials for both men and women representative of the Korean population. METHODS: Using Korea's 1995 Census and 1995-2000 Death Certificate data, age-, sex-, and education-specific mortality rates were measured, after which education-specific rate ratios, and relative indices of inequality were calculated. RESULTS: Graded educational differentials in mortality were observed among both sexes with higher mortality rates related to lower educational attainment in most causes of death. However, positive associations were identified between education levels and mortality rates with respect to ischaemic heart disease among older males and breast cancer among older females. The magnitude of educational inequality in mortality was not constant across causes and in some cases differed by sex. CONCLUSIONS: The changing relation between educational attainment and mortality rates from ischaemic heart disease and breast cancer likely reflects changes in the social distribution of risk factors that emerged in the process of Korea's rapid economic development. Studies on specific exposures over the life course influencing the occurrence of and survival after specific diseases would help provide a more complete understanding of patterns and trends in socioeconomic mortality differentials in Korea.

Adult↗

PubMed2004

Can we explain why Brazilian babies are becoming lighter?

BACKGROUND: We tried to explain why a marked decrease in birthweight of 122 g occurred over a 15-year period in Ribeirão Preto, Brazil. METHODS: Factors reflecting biological, social, and health care characteristics (infant gender, parity, maternal age, marital status, type of hospital, maternal smoking, preterm birth, small for gestational age [SGA], and prenatal care) were assessed on 6711 newborns in 1978/1979 and 2838 in 1994 using multiple linear regressions. RESULTS: The birthweight distribution shifted to the left and the residual distribution of small preterm babies increased from 1.9% to 3.4%. Only marital status and preterm delivery would have decreased the difference in birthweight over time, explaining for each of them around 30 g of the 122 g. Increasing levels of attendance at antenatal care over time might have decreased the birthweight difference by 40 g. Maternal age and SGA explained little of the decreasing trend. Reductions in maternal smoking would have increased mean birthweight slightly. In stratified analysis the downward trend was more marked among mothers with high education (-202 g) and those delivered by caesarean section (-194 g). After adjusting for all those significant variables mean birthweight was still 74 g (95% CI: -97, -50 g) lower in 1994 than in 1978/1979. CONCLUSION: The trend could be explained in part by factors related to marital status that might reflect dysfunctional families in the Brazilian context and the preterm increase that might be associated with advances in medical technology. The high attendance at antenatal clinics or factors associated with it might have prevented a further decrease in birthweight. Our results may be compatible with the high economic development of Ribeirão Preto within Brazil, together with factors associated with its unfavourable lifestyle.

Adolescent↗

PubMed1994

Celebration of the past: nutrition at USDA.

The knowledge gained in the past 100 years about how nutrients in our foods can affect our health represents a great achievement. This knowledge was essential for the widespread improvements in human health, and the major advances in food production and economic development. USDA and State Experiment Stations were the first scientific organizations in the U.S. to establish a food and nutrition research program and make the results available to people. Human nutrition activities in USDA, initiated by W. O. Atwater in 1894, always have been linked with the nutritive value of foods, human nutritional requirements, the kinds and amounts of foods that Americans consume relative to their needs, and strategies for improving diets and the food supply. Despite recent progress, the science of nutrition is still relatively new, and our knowledge is far from complete. Application of new technologies can be expected to identify the basis for individual differences in nutritional requirements, describe nutrient interactions and define those food constituents needed for healthful diets. Consumers must be given sound research-based information about foods and nutrition, as demand in the market place ultimately determines the foods agriculture and industry produce.

Diet↗

PubMed2002

Africa: addressing growing threats to food security.

Africa remains the only region in the world where the number of hungry people will still be on the increase in 2020, and the number of malnourished children will have increased correspondingly. In this report I have acknowledged the general public policy trends across Africa in terms of macroeconomic policy reforms and political transitions. These welcome trends have to still produce stable nations and economies. Although economic development is the long-term solution to Africa's challenge on hunger and poverty, this will take time. And it follows therefore that African nations have to pursue policies and strategies that promote long-term growth while at the same time offering short-term safety nets for the poorest of the poor. The growth and development strategy will have at its core the need to increase significantly the levels of public-sector investment in agriculture and rural development and to give top priority to the commercialization of smallholder agriculture so as to increase productivity and competitiveness. But food security at the household level is ultimately a balance between availability and access, and in this regard governments need complementary food security policies that increase the probability of food access by the vulnerable groups.

Africa↗

PubMed2004

Breeding for micronutrients in staple food crops from a human nutrition perspective.

Over three billion people are currently micronutrient (i.e. micronutrient elements and vitamins) malnourished, resulting in egregious societal costs including learning disabilities among children, increased morbidity and mortality rates, lower worker productivity, and high healthcare costs, all factors diminishing human potential, felicity, and national economic development. Nutritional deficiencies (e.g. iron, zinc, vitamin A) account for almost two-thirds of the childhood death worldwide. Most of those afflicted are dependent on staple crops for their sustenance. Importantly, these crops can be enriched (i.e. 'biofortified') with micronutrients using plant breeding and/or transgenic strategies, because micronutrient enrichment traits exist within their genomes that can to used for substantially increasing micronutrient levels in these foods without negatively impacting crop productivity. Furthermore, 'proof of concept' studies have been published using transgenic approaches to biofortify staple crops (e.g. high beta-carotene 'golden rice' grain, high ferritin-Fe rice grain, etc). In addition, micronutrient element enrichment of seeds can increase crop yields when sowed to micronutrient-poor soils, assuring their adoption by farmers. Bioavailability issues must be addressed when employing plant breeding and/or transgenic approaches to reduce micronutrient malnutrition. Enhancing substances (e.g. ascorbic acid, S-containing amino acids, etc) that promote micronutrient bioavailability or decreasing antinutrient substances (e.g. phytate, polyphenolics, etc) that inhibit micronutrient bioavailability, are both options that could be pursued, but the latter approach should be used with caution. The world's agricultural community should adopt plant breeding and other genetic technologies to improve human health, and the world's nutrition and health communities should support these efforts. Sustainable solutions to this enormous global problem of 'hidden hunger' will not come without employing agricultural approaches.

Biological Availability↗

PubMed2000

Changing pattern of end-stage renal disease in central and eastern Europe.

BACKGROUND: The epidemiology of end-stage renal disease (ESRD) is changing all over the world. Particularly dramatic changes of the epidemiology of ESRD have occurred in central and eastern Europe (CEE). The aim of the present study was (i) to document the further expansion of renal replacement therapy (RRT) noted in recent years in CEE and (ii) to analyse in some detail treatment modalities and underlying renal conditions. METHODS: Three independent surveys were performed in 1995, 1997 and 1998. Fifteen CEE countries participated. The data were mainly obtained from national registries which are based on centre and patient questionnaires. RESULTS: The data collected from 15 CEE countries document further expansion of RRT in this region. The report includes data on the availability of RRT in Byelorussia, Estonia, and Russia which have become available for the first time. The epidemiology of dialysed patients has changed remarkably. In the majority of countries the number of diabetic patients has increased, most dramatically so in the Czech Republic (31% of all dialysed patients), in the majority of the other countries 10-14%. The number of ESRD patients with the diagnosis of hypertensive nephropathy has also increased and this was accompanied by an increase in proportion of elderly (>65 years) patients, i.e. 46% in the Czech Republic and 12-25% in most other countries. CONCLUSION: Dramatic changes of the availability of RRT treatment have occurred in central and eastern Europe. The proportion of diabetic nephropathy and elderly patients has risen. Large differences in RRT exist between individual CEE countries and this appears mainly dependent on the level of economic development.

Age Distribution↗

PubMed1998

Impacts of global environmental change on future health and health care in tropical countries.

The aggregate human impact on the environment now exceeds the limits of absorption or regeneration of various major biophysical systems, at global and regional levels. The resultant global environmental changes include altered atmospheric composition, widespread land degradation, depletion of fisheries, freshwater shortages, and biodiversity losses. The drive for further social and economic development, plus an unavoidable substantial increase in population size by 2050--especially in less developed countries--will tend to augment these large-scale environmental problems. Disturbances of the Earth's life-support systems (the source of climatic stability, food, freshwater, and robust ecosystems) will affect disproportionately the resource-poor and geographically vulnerable populations in many tropical countries. Ecological disturbances will alter the pattern of various pests and pathogens in plants, livestock and humans. Overall, these large-scale environmental changes are likely to increase the range and seasonality of various (especially vector-borne) infectious diseases, food insecurity, of water stress, and of population displacement with its various adverse health consequences.

Computer Simulation↗

PubMed1989

Asian medical education.

In order to address issues relating to medical education in Asia, consideration must be given to the many differences among Asian countries, including variations in sizes, populations, social and cultural backgrounds, histories, political systems, and stages of economic development. In most Asian countries, poverty is pervasive, and it is usually national in scope. This is often coupled with lack of government commitment to provide health facilities and health care for the entire population. Systems of medical education differ widely and are based mainly on those of the country of colonial domination; hence, the systems may reflect predominantly British, American, Japanese, or Dutch influence, among others. Although most medical schools in Asia have academic disciplines and admission standards similar to those of Western schools, there are sharp differences among countries in faculty salaries, faculty competence, academic standards, adequacy of staffing, and number of medical schools. Underlying conditions and influences that have contributed to the current status of medical education systems in Asia are discussed.

Asia, Southeastern↗

PubMed2002

Forces affecting community involvement of AHCs: perspectives of institutional and faculty leaders.

PURPOSE: To understand the external and internal factors that either facilitated or were barriers to an academic health center's (AHC's) involvement in community-based education, research, and clinical care; community service; and community or economic development activities. METHOD: Eight AHCs in the United States were selected by objective criteria for their significant community involvement. Chief executive officers, vice chancellors, deans, and the individuals responsible for community-based education, research, and community service responded to written surveys. Responses were subjected to quantitative and qualitative analyses. RESULTS: The overall response rate was 79% (n = 91). Public perception, an increased focus on a population health perspective, and an increased call for AHCs to be accountable to local and statewide constituents were cited as the most significant external factors contributing to an AHC's community involvement. Institutional leadership, familiarity with community-based organizations, institutional climate, faculty and student interest, and institutional structures were cited as the most significant internal facilitators of community involvement. Fiscal concerns, competition for community-based training sites, lack of collaboration across health professions schools, and inadequate faculty roles and rewards were viewed as the most significant barriers to community involvement. All respondents reported that their AHCs' orientations towards community service, and community-based teaching, research, and clinical care would increase in the next five years. CONCLUSION: Development of a strategic plan may increase the effectiveness of an institution's community involvement. Central to this plan should be a restructuring of faculty roles and reward polices and an increase in faculty release time to promote community involvement. The importance of involving the community in the planning and implementation of community-campus partnerships should not be underestimated.

Academic Medical Centers↗