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PubMed1995

HIV risk behaviors but absence of infection among drug users in detoxification centers outside Yunnan province, China, 1993.

OBJECTIVES: To date, HIV spread in China has occurred principally among injecting drug users (IDU) in remote border regions of Yunnan province. We therefore sought to better understand the risks for and prevalence of HIV infection among drug users in parts of China outside Yunnan province. METHODS: A behavioral survey of drug use and AIDS-related knowledge was conducted among all consenting drug users who entered treatment from 1 November to 31 December 1993 in seven provincial drug detoxification centers outside Yunnan province. After giving verbal informed consent, all drug users were tested for HIV. RESULTS: Of the 1293 study participants, 207 (16%) reported injecting drugs. The proportion of IDU among all drug users varied widely by region, from 1% in Sha'anxi and Gansu provinces in the northwest region to 58% in Guangxi province in the south. IDU were more likely than non-IDU to be single and unemployed or self-employed, but did not differ in other demographic aspects. Among all drug users, 2% reported sharing needles without cleaning equipment, while 5% shared with some cleaning. Although 1060 (82%) drug users had heard of AIDS and most knew about its sexual (79%), parenteral (77%), and perinatal (60%) modes of transmission, many had misconceptions about its spread by casual contact. Of the 207 IDU tested for HIV, none were HIV-positive (95% confidence interval, 0--1.4). CONCLUSION: The absence of HIV infections detected in this study suggests that the prevalence of HIV is currently low among IDU in China outside the Yunnan province. However, the behavior of these IDU puts them at high risk for HIV infection. Prevention efforts are needed to prevent the spread of HIV among IDU throughout China and to avoid the experience of neighboring countries in Asia.

Adolescent↗
PubMed2000

Expanding the range of interventions to reduce HIV among adolescents.

OBJECTIVE: Structural interventions are identified to reduce adolescents' HIV risk. METHOD: The goals, strategies, approaches, and delivery sites of adolescent HIV prevention programs are reviewed. RESULTS: In addition to reducing sexual activity and substance use, HIV prevention programs may also reduce adolescents' HIV risk by: decreasing poverty; ensuring access to HIV testing, healthcare, general social skills training, and employment opportunities; and requiring community service for students. Adolescent HIV prevention programs do not currently utilize diverse modalities (computers, videotapes, television, telephone groups, computerized telephones) or sites (parents' workplaces, religious organizations, self-help networks, primary healthcare clinics) for delivering interventions. Diversifying current approaches to HIV prevention include: economic development programs; mandating delivery of programs at key developmental milestones (e.g. childbirth, marriage) and settings (school-based clinics, condom availability programs); securing changes in legislative and funding policies through ballot initiatives or lawsuits; and privatizing prevention activities. CONCLUSIONS: To implement structural HIV interventions for adolescents requires researchers to shift their community norms regarding the value of innovation, adopt designs other than randomized controlled trials, expand their theoretical models, and adopt strategies used by lawyers, private enterprise, and lobbyists.

Adolescent↗
PubMed1989

Child psychiatry in Japan.

Japanese society strongly influences the mode of presentation of child mental health problems, both in terms of protective factors and pressures inherent in Japanese child-rearing practices. Recent changes in society associated with Japan's rapid economic development are affecting the mental health of children and families. Currently there is concern about levels of school refusal, bullying, suicidal behavior, and delinquency.

Child↗
PubMedDate not supplied

Epidemiological study of self-inflicted burns in Tehran, Iran.

Self-inflicted burns have been considered a serious mental health problem throughout the world and especially in economically developing countries. The aim of this study was to identify the epidemiologic features and current etiological factors of suicide by burning in Tehran, Iran, to develop effective prevention programs. Over a period of 2 years from March 1997 to March 1999, of the 1,236 patients aged 14 years and older who were admitted to Tohid Burn Center in Tehran, Iran, 110 (8.9%) had attempted suicide by self-immolation. The median age was 25 years (range: 14-68 years) and the median extent of the burns was 71% TBSA (range: 20-100%). Forty-eight patients had a previous psychiatric diagnosis (43.6%). Depression was the most common psychiatric diagnosis by history. The method most commonly used was a flame with the addition of a flammable liquid (frequently kerosene). Also, most of the patients (70%) were of a low socioeconomic class. Overall, self-inflicted burns should be considered an increasing mental health problem in our society. Therefore, it is necessary to implement prevention programs and strategies to reduce the incidence rate of this problem.

Adolescent↗
PubMed2002

Nurse practitioners and traditional healers: an alliance of mutual respect in the art and science of health practices.

The indigenous people of Hawaii have had difficulty adapting to the Western diet and stressful lifestyle of today's mixed cultural and economic development. This has left a health toll of high rates of diabetes, hypertension, hypercholesterolemia, cardiovascular problems, asthma, and obesity. To promote a healthy lifestyle and promote the U.S. Department of Health and Human Services (DHHS) goal of 100% access to health care and 0% disparity (no one will be denied health care), nurse practitioner/traditional Hawaiian healing clinics have been placed in community settings, which are known to community people and comfortable to access. These clinics provide health care to uninsured and underinsured people in an atmosphere that assures respect for the culture and the health needs. This pilot study examines the perceptions of 30 residents of Hawaii and the type of provider sought. Seventy-five percent of the respondents were generally satisfied with the health care received from both Hawaiian and Western care providers. Back and neck problems and injuries were associated with the use of Hawaiian therapies and appeared to reflect chronic conditions. Western health care is sought for predominantly acute conditions (infections, allergies, and upper respiratory conditions) and for diabetes and hypertension.

Acute Disease↗
PubMed2004

Worldwide prevalence of hypertension: a systematic review.

PURPOSE: To examine the prevalence and the level of awareness, treatment and control of hypertension in different world regions. STUDY SELECTION: A literature search of the MEDLINE database, using the Medical Subject Headings prevalence, hypertension, blood pressure and cross-sectional studies, was conducted. Published studies, which reported the prevalence of hypertension and were conducted in representative population samples, were included in the review. The search was restricted to studies published from January 1980 through July 2003. DATA EXTRACTION: All data were extracted independently by two investigators using a standardized protocol and data collection form. RESULTS: The reported prevalence of hypertension varied around the world, with the lowest prevalence in rural India (3.4% in men and 6.8% in women) and the highest prevalence in Poland (68.9% in men and 72.5% in women). Awareness of hypertension was reported for 46% of the studies and varied from 25.2% in Korea to 75% in Barbados; treatment varied from 10.7% in Mexico to 66% in Barbados and control (blood pressure < 140/90 mmHg while on antihypertensive medication) varied from 5.4% in Korea to 58% in Barbados. CONCLUSION: Hypertension is an important public health challenge in both economically developing and developed countries. Significant numbers of individuals with hypertension are unaware of their condition and, among those with diagnosed hypertension, treatment is frequently inadequate. Measures are required at a population level to prevent the development of hypertension and to improve awareness, treatment and control of hypertension in the community.

Awareness↗
PubMedDate not supplied

Lifestyle incongruity and adult blood pressure in Western Samoa.

OBJECTIVE: The effects of lifestyle incongruity on blood pressure were tested in a cross-sectional study of 711 modernizing adult men and women, ages 25 to 64 years, residing in nine villages throughout Western Samoa. METHODS: Lifestyle incongruity (LI) was conceptualized as the mismatch between a 21-item material possessions and lifestyle scale and an eight-part occupational rank score. LI was measured by the arithmetic difference between the standardized distributions of lifestyle and occupation. Blood pressure (BP) was measured three times in the seated position, averaged and adjusted for body mass. Sex-stratified analyses were performed and adjusted BP was regressed on LI, age, and socioeconomic rank. RESULTS: In men systolic BP was associated (p < .01) with incongruity between material way of life and occupation. Men with higher occupation scores than lifestyle scores had significantly higher systolic BP. This association was stronger and significant for both systolic and diastolic BP among young (<40 years) men and all men from the more economically developed island. On the other hand, among older women diastolic BP was significantly (p < .01) higher among those whose material lifestyles exceeded their occupational class. CONCLUSIONS: The results in men, especially the young group, suggest two explanations: 1) financial demands from the extended family on young men with better paying jobs may reduce material consumption and produce psychosocial stress; 2) upward socioeconomic mobility marked by good jobs but a lag in material lifestyle may represent work stress. The results in older women support the suggestion of earlier studies that excess material consumption for enhancement of social prestige (living beyond ones' means) leads to stress and elevations in BP.

Adult↗
PubMed1977

Mammary tuberculosis: a rare modern disease.

Tuberculosis of the breast has become a rare disease since the advent of antituberculous chemotherapy. The incidence of tuberculous mastitis at Vanderbilt Hospital for the last two decades was 0.025% of surgically treated breast disease. This probably reflects its prevalence in economically developed parts of the world. The pathologic diagnosis of mammary tuberculosis may be difficult. The only diagnostic proof is the demonstration of tubercle bacilli by microscopic smear of culture. Numerous cases have been incorrectly reported as mammary tuberculosis because of nonadherence to this criterion. Definite guidelines for treating breast tuberculosis are not available and may never become so because of its rarity. Drug therapy has been successful and should be tried in all cases. Adequate surgical removal is inevitably corrective of the local disease. Surgically treated patients should receive antituberculous drugs before and after their operations.

Adult↗
PubMed1999

Equal dependence of the high prevalence of health problems on age and family income in rural southern areas.

BACKGROUND: People who have periods of low family income are at risk for increased health problems in the future, even if they present a similar clinical picture before the reduction in family income. The association between low income and health status was studied in residents of an area with relatively low-average family income and with a historically unstable economy. METHODS: We surveyed a stratified, clustered sample of residents of Johnson County, Tennessee, using a structured interview. The responses were analyzed in conjunction with national and regional data (National Health Interview Survey). RESULTS: Residents of the geographic area under study had a markedly higher prevalence of self-reported health problems than either the national average or rural areas in the southeast United States. The higher prevalence was accounted for by the combination of age and family income, which had equal effects on health status, but not by age differences alone. CONCLUSIONS: Family income and economic development are critically important to improving community health. Sensible capitation rates in managed care arrangements can be obtained only if the income distribution of an insured population is considered along with their age, sex, and physical health status.

Adolescent↗
PubMed2004

Trends in childhood cancer incidence and mortality in Catalonia, Spain, 1975-1998.

Childhood cancer mortality has sharply declined in most economically developed countries over the last years, whereas no substantial changes in the incidence have been observed. In Catalonia (Spain), childhood cancer mortality showed a considerable decline until 1992, but incidence trends have not been analysed in this population. To assess both recent incidence and mortality trends in this population, we analysed childhood (0-14 years) cancer data from the population-based Tarragona Cancer Registry and from the Mortality Registry of Catalonia (Spain) from 1980 to 1998. All cancer mortality decreased by -2.6% annually in boys (95% confidence interval, 95% CI -3.7, -1.6) and -3.7% in girls (95% CI -4.9, -2.5). Mortality due to leukaemia decreased annually -3.0% in boys (95% CI -4.7, -1.4) and -4.4% in girls (95% CI -6.3, -2.4). Mortality for brain tumours showed a reduction of -3.2% in boys (95% CI -5.5, -0.9) and of -4.4% in girls (95% CI -6.3, -2.4). No significant trend in incidence rates, either in boys or in girls, was observed (annual per cent of change for all cancers -0.5%, 95% CI -3.5, 2.7, in boys and 1.7%, 95% CI -1.9, 5.5, in girls). These results suggest an improvement in both childhood cancer diagnosis and treatment, which may explain current higher childhood cancer survival rates.

Adolescent↗
PubMed2003

Cardiovascular risk factor levels in urban and rural Thailand--The International Collaborative Study of Cardiovascular Disease in Asia (InterASIA).

BACKGROUND: Vascular mortality is increasing in economically developing countries but reliable data about the determinants of cardiovascular disease are few. The International Collaborative Study of Cardiovascular Disease in Asia (InterASIA) was designed to obtain precise estimates of cardiovascular risk factor levels in the adult population of Thailand. DESIGN: A complex sample survey. METHODS: Data from a structured questionnaire, brief physical examination and a blood sample were collected from 5305 individuals aged 35 years or older (response rate 68%). Mean risk factor levels were calculated for eight groups defined by age and sex in 18 representative urban and rural areas of Thailand. Population risk factor levels were calculated by applying sampling weights derived from the 2000 Thai Census and allowing for the complex sampling design. RESULTS: The estimated mean (standard error) population blood pressure was 120/76 (0.7/0.5) mmHg, mean serum total cholesterol was 5.2 (0.06) mmol/l, mean body mass index was 24 (0.2) kg/m2, mean fasting plasma glucose was 5.6 (0.06) mmol/l, the proportion with diabetes 9.6 (1)% and the proportion of current smokers was 25 (3)%. There were estimated to be 5.1 (0.5) million individuals with high blood pressure, 4.4 (0.4) million with high total cholesterol, 8.9 (0.8) million overweight or obese, 2.4 (0.2) million with diabetes and 6.2 (0.9) million current smokers. Mean levels of all major risk factors, except smoking, were worse in urban compared with rural areas. However, except for total cholesterol, the absolute numbers of individuals with abnormal risk factor levels were highest in rural areas. CONCLUSION: Absolute levels of cardiovascular risk factors in Thailand are high. Effective risk factor control strategies that target both rural and urban areas of Thailand have the potential to avert much premature cardiovascular disease.

Adult↗
PubMed2005

Preparing for the next influenza pandemic: lessons from multinational data.

BACKGROUND: In the past decade, avian influenza has made several incursions of increasing scope and virulence into humans. The likelihood of another pandemic is increasing with time. In work recently published, influenza was found to be the principal cause of the increase in mortality in the United States during the winter months. In a companion report, the U.S. national vaccination program was shown to have increased coverage of high risk groups 5-fold from 1980 to 1999, but excess mortality did not decline in any elderly age group. The Multinational Influenza Seasonal Mortality Study has assembled and has begun to mine mortality data from many countries. Early results indicate that the U.S. results extend to other economically developed countries and probably worldwide. RESULTS: The Multinational Influenza Seasonal Mortality Study data extend the observations of others that there were heralding events that provided advance warning for all of the pandemics of the 20th century. Moreover, in the first year of emergence of A(H3N2) viruses, the 1968-1969 pandemic produced little excess mortality outside of North America. It appears that there were at least 2 variants of the pandemic virus, differing at 1 or more internal gene loci, and that the more virulent form emerged as dominant in the second pandemic season. CONCLUSIONS: Integrating these findings, it seems clear that the influenza control strategy now used in about 50 countries is less than optimal. While it is likely that there will be more time to react in the pandemic season than previously imagined, an enhancement of the historical strategy is clearly indicated. Furthermore, the vaccine shortage that is presently inevitable suggests that a departure from the historical strategy if calamitous ineffectiveness is to be avoided.

Aged↗
PubMed2003

Freshwater for resilience: a shift in thinking.

Humanity shapes freshwater flows and biosphere dynamics from a local to a global scale. Successful management of target resources in the short term tends to alienate the social and economic development process from its ultimate dependence on the life-supporting environment. Freshwater becomes transformed into a resource for optimal management in development, neglecting the multiple functions of freshwater in dynamic landscapes and its fundamental role as the bloodstream of the biosphere. The current tension of these differences in worldview is exemplified through the recent development of modern aquaculture contrasted with examples of catchment-based stewardship of freshwater flows in dynamic landscapes. In particular, the social and institutional dimension of catchment management is highlighted and features of social-ecological systems for resilience building are presented. It is concluded that this broader view of freshwater provides the foundation for hydrosolidarity.

Aquaculture↗
PubMed2005

Gloom and doom? The future of marine capture fisheries.

Predicting global fisheries is a high-order challenge but predictions have been made and updates are needed. Past forecasts, present trends and perspectives of key parameters of the fisheries--including potential harvest, state of stocks, supply and demand, trade, fishing technology and governance--are reviewed in detail, as the basis for new forecasts and forecasting performance assessment. The future of marine capture fisheries will be conditioned by the political, social and economic evolution of the world within which they operate. Consequently, recent global scenarios for the future world are reviewed, with the emphasis on fisheries. The main driving forces (e.g. global economic development, demography, environment, public awareness, information technology, energy, ethics) including aquaculture are described. Outlooks are provided for each aspect of the fishery sector. The conclusion puts these elements in perspective and offers the authors' personal interpretation of the possible future pathway of fisheries, the uncertainty about it and the still unanswered questions of direct relevance in shaping that future.

Animals↗
PubMed2001

The environmental consequences of altered nitrogen cycling resulting from industrial activity, agricultural production, and population growth in China.

Human activities exerted very little effect on nitrogen (N) cycling in China before 1949. Between 1949 and 1999, however, rapid economic development and population growth led to dramatic changes in anthropogenic reactive N, inputted recycling N, N flux on land, N2O emission, and NH3 volatilization. Consequently, these changes have had a tremendous impact on the environment in China. In the current study, we estimated the amount of atmospheric wet N deposition and N transportation into water bodies from the watersheds and major valleys in China. Additionally, we addressed issues on leaching and accumulation of NO3- in the farmland under different climate zones, land use, and cropping systems as well as the potential influence of NO3- on underground water in China.

Agriculture↗
PubMed1998

The Northridge earthquake: community-based approaches to unmet recovery needs.

The 1994 Northridge, California earthquake has proven to be one of the most costly disasters in United States history. Federal and state assistance programmes received some 681,000 applications from victims for various forms of relief. In spite of the flow of US$11 billion in federal assistance into Los Angeles and Ventura counties, many victims have failed to obtain adequate relief. These unmet needs relate to the vulnerability of particular class and ethnic groups. In response to unmet needs, a number of non-governmental organisations (NGOs) have become involved in the recovery process. This paper, based on evidence collected from hundreds of in-depth interviews with the people involved, examines the activities of several community-based organisations (CBOs) and other NGOs as they have attempted to assist vulnerable people with unmet post-disaster needs. We discuss two small ethnically diverse communities in Ventura County, on the periphery of the Los Angeles metropolitan region. The earthquake and resultant disaster declaration provided an opportunity for local government and NGOs to acquire federal resources not normally available for economic development. At the same time the earthquake created political openings in which longer-term issues of community development could be addressed by various local stakeholders. A key issue in recovery has been the availability of affordable housing for those on low incomes, particularly Latinos, the elderly and farm workers. We discuss the successes and limitations of CBOs and NGOs as mechanisms for dealing with vulnerable populations, unmet needs and recovery issues in the two communities.

California↗
PubMed2000

Internal displacement in Burma.

The internal displacement of populations in Burma is not a new phenomenon. Displacement is caused by numerous factors. Not all of it is due to outright violence, but much is a consequence of misguided social and economic development initiatives. Efforts to consolidate the state by assimilating populations in government-controlled areas by military authorities on the one hand, while brokering cease-fires with non-state actors on the other, has uprooted civilian populations throughout the country. Very few areas in which internally displaced persons (IDPs) are found are not facing social turmoil within a climate of impunity. Humanitarian access to IDP populations remains extremely problematic. While relatively little information has been collected, assistance has been focused on targeting accessible groups. International concern within Burma has couched the problems of displacement within general development modalities, while international attention along its borders has sought to contain displacement. With the exception of several recent initiatives, few approaches have gone beyond assistance and engaged in the prevention or protection of the displaced.

Altruism↗