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PubMed1999

Micronutrient malnutrition: policies and programs for control and their implications.

Global progress in social and economic development is occurring, although slowly, in the most needy parts of the nonindustrialized world, where nutritional deficiencies, including micronutrients, remain significant public health problems. Until empowering benefits accrue from development spin-offs, policy guidance for purposeful public health actions can help reduce the unconscionable toll on health and quality of life from micronutrient malnutrition and can interrupt its intergenerational debilitating effects on national development. Narrowly focused control programs including homestead production, plant breeding, fortification, and supplementation are in effect, but in general, they have not been holistically planned and integrated into overall development programs. Such integration is needed to ensure sustainability into the next century. A new paradigm is needed, including a new way of thinking by nutrition scientists and program implementers that includes partnerships with the poor in all aspects of program planning and implementation.

Developing Countries↗
PubMed2000

Health promotion in the city: a review of current practice and future prospects in the United States.

To achieve its health goals, the United States must reduce the disproportionate burden of illness and poor health borne by urban populations. In the 20th century, patterns of immigration and migration, changes in the global economy, increases in income inequality, and more federal support for suburbanization have made it increasingly difficult for cities to protect the health of all residents. In the last 25 years, epidemics of human immunodeficiency virus infections and substance abuse and increases in homelessness, lack of health insurance, rates of violence, and concentrations of certain pollutants have also damaged the health of urban residents. Several common strategies for health promotion are described, and their relevance to the unique characteristics of urban populations is assessed. To identify ways to strengthen health promotion practices in U.S. cities, lessons have been taken from five related fields of endeavor: human rights, church- and faith-based social action, community economic development, youth development, and the new social movements. By integrating lessons from these areas into their practice, public health professionals can help to revitalize the historic mission of public health, contribute to creating healthier cities, and better achieve national health objectives.

Community Participation↗
PubMed2006

[Human resources and their mitigatable imbalances].

In this paper, the policy-sensitive imbalances in the health professional markets are discussed. In Spain, the current staffing levels are still the result of unforeseen demographic and socio-economic developments. In some specialties and areas, there are selective shortages which in all likelihood will become more serious in the coming years due to the objective causes analyzed in this text. We propose a gradual increase in the medical schools numerus clausus and in the number of residents positions, the use of a variety of incentives to attract professionals to specific positions and, particularly, to increase the standing and quality of primary care.

Education, Medical↗
PubMed2001

The future of preventive programs in countries with different systems for dental care.

From 1990 onward the decline of caries has leveled off in economically developed countries and the effectiveness of preventive programs seems to have diminished. The aim of this paper is to consider the future of caries prevention in the light of the studies conducted during the past decade. A shift from population-based prevention to a high-risk strategy has been promoted in countries where caries is strongly polarized. In Finland, however, an intensive preventive program targeted to high-risk individuals had little effect on caries increment, which suggests that the utility of a high-risk strategy is questionable. The relative effects of population-based methods have also decreased during the last decades. Although discontinuation of water fluoridation had no effect on caries in Kuopio, Finland, water fluoridation is still effective in countries with a lower level of basic prevention and a less homogenous social structure. From the standpoint of cost-effectiveness, the use of professionally applied fluoride gels has been questioned in children with a low caries rate, and the same is probably true for fluoride varnishes. In countries with a high caries rate, a low level of basic prevention, and an unorganized dental care system any preventive program seems to be effective. The importance of fluoride toothpastes as a cost-effective and feasible method of fluoride delivery is indisputable and will be so in all countries irrespective of the caries level and dental care systems. Population-based dental health education continues to be important, also in the countries where the caries rate has so far been low.

Adolescent↗
PubMed1999

Insulin-like growth factor-I and binding protein-3 and risk of cancer.

Insulin-like growth factor (IGF)-I is an important mitogen required by some cell types to progress from the G1 phase to the S phase of the cell cycle. IGF binding proteins (IGFBPs) can have opposing actions, in part by binding IGF-I, but also by direct inhibitory effects on target cells. As mitogens and anti-apoptotic agents, IGFs may be important in carcinogenesis, possibly by increasing the risk of cellular transformation by enhancing cell turnover. Indeed, many types of neoplastic cells express or overexpress IGF-I receptors, which stimulate mitogenesis when activated by IGF-I in vitro. In vivo, tissue IGF bioactivity is determined not only by circulating IGF-I and IGFBP levels, but also by local production of IGFs, IGFBPs, and possibly IGFBP proteases that enhance IGF-I availability by cleaving IGFBPs. Because determinants of tissue IGF bioactivity appear to be regulated in parallel with circulating IGF-I level, it is reasonable to hypothesize that the substantial intraindividual variability in circulating levels of IGF-I and IGFBP-3 may be important in determining risk of some cancers. In recent epidemiologic studies, relatively high plasma IGF-I and low IGFBP-3 levels have been independently associated with greater risk of prostate cancer in men, breast cancer among premenopausal women, and colorectal adenoma and cancer in men and women and possibly lung cancer. These include prospective data from the Physicians' Health Study and the Nurses' Health Study. In general, two- to fourfold elevated risks have been observed for prostate cancer in men in the top quartile of IGF-I relative to those in the bottom quartile, and low levels of IGFBP-3 were associated with an approximate doubling of risk. For breast cancer, an association with IGF-I for postmenopausal women was not apparent, but strong associations were observed for premenopausal cases in the Nurses' Health Study. Further study is needed to confirm this subgroup finding in women. Recent data also indicate that high IGF-I and low IGFBP-3 increase risk of colorectal cancer and large or villous adenomas. Of note, for colorectal neoplasia, fourfold elevated risks were observed in men and women with low IGFBP-3, whereas high IGF-I was associated with a doubling of risk. These emerging epidemiologic data indicate that high levels of IGF-I and low levels of IGFBP-3 are associated with an increased risk of at least several types of carcinoma that are common in economically developed countries. Further study is required to determine the clinical relevance of these findings.

Breast Neoplasms↗
PubMed2003

Drinking and its burden in a global perspective: policy considerations and options.

AIMS: To identify the policy implications of the magnitude and characteristics of alcohol consumption and problems, viewed globally, and to summarize conclusions on the effectiveness of the strategies available to policymakers concerned with reducing rates of alcohol problems. DESIGN/METHODS/SETTING: This summative article draws on the findings of the articles preceding it and of reviews of the literature. FINDINGS AND CONCLUSIONS: Overall volume of consumption is the major factor in the prevalence of harms from drinking. Since consumption and associated problems tend to increase with economic development, policymakers in developing economies should be especially aware of the need to develop policies to minimize overall increases in alcohol consumption. Unrecorded consumption is also an important consideration for policy in many parts of the world, and poses difficulties for alcohol control policies. Drinking pattern is also an important contributing factor toward alcohol-related harm. Although some drinking patterns have been shown to produce beneficial health effects, because the net effect of alcohol on coronary disease is negative in most parts of the world, policies that promote abstinence or lower drinking overall may be the safest options. Moreover, sporadic intoxication is common in many parts of the world, and policies are unlikely to change this drinking pattern at least in the short to medium term. At the same time, because injuries comprise a large proportion of the burden of alcohol, it is appropriate to enhance these policies with targeted harm reduction strategies such as drinking and driving countermeasures and interventions focused on reducing alcohol-related violence in specific high-risk settings. Alcohol consumption is a major factor for the global burden of disease and should be considered a public health priority globally, regionally, and nationally for the vast majority of countries in the world. The need for alcohol policy is even stronger when it is taken into consideration that the burden of alcohol estimated in the WHO Global Burden of Disease project includes primarily health problems related to drinking. From the limited evidence available, however, social problems related to drinking seem to impose at least as much burden. Moreover, the burden for both social and health harms fall not only on the drinker, but also on others. There is a broad literature on policy interventions to reduce alcohol problems. Effective strategies include controls over distribution and sale, taxation, drinking-driving countermeasures, brief interventions by health workers or counselors, and selected harm reduction measures. There is a need to develop the growing literature on comparative evaluations of cost-effectiveness of such strategies. In addition, international agreements are needed to support the effectiveness of national strategies.

Alcohol Drinking↗
PubMed2004

Epidemiology of nephrolithiasis today.

The epidemiology of nephrolithiasis differs according to geographical area and socio-economic conditions. In Italy the prevalence of the disease in 1993 was 17.2/1,000 inhabitants, most patients are men and elderly. The relative risk increased in subjects with family history for calculosis, with the tendency to eat protein-rich food and with overweight and body mass index (MBI) >32 kg/m2. Calcium oxalate and/or phosphate stones account for almost 70% of all renal stones observed in economically developed countries.

Adult↗
PubMed1993

Anthropometry in adolescence--secular trends, adoption, ethnic and environmental differences.

A secular trend towards higher final height and earlier pubertal maturation is seen in countries with favourable socio-economic development and higher social classes in countries are also associated with taller height and earlier maturation. Environmental factors, such as nutrition and infections, appear to be the main causes for differences in growth and maturation between ethnic and social groups. Differences in final height are mainly due to prepubertal growth. Studies on immigrant children and children adopted into privileged conditions from developing countries confirm the influence of early growth on subsequent growth. Catch-up growth in adopted children could only partially compensate for early stunting, and in several cases was cut short by early pubertal development. A minority developed very early puberty and eventually very short final height. The optimal rate of catch-up growth, the trigger mechanism for early puberty, and the effect of various types of nutritional intervention need to be studied. The studies reported here indicate the critical importance of optimal intra-uterine, infant and childhood growth as a basis for satisfactory growth during adolescence.

Adolescent↗
PubMed1993

Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. A paradox.

BACKGROUND: For decades, the coronary heart disease (CHD) mortality rate has been four or more times higher in Finland than in France despite comparable intakes of dietary cholesterol and saturated fat. A potential answer to this paradox is provided by this study of 40 countries and the analyses of other nutrients in the diets besides cholesterol and saturated fat. METHODS AND RESULTS: CHD death rates for men aged 55 to 64 years were derived from the World Health Organization annual vital statistics. Dietary intakes were gathered from the Food and Agriculture Organization of the United Nations database. Forty countries at various levels of economic development and 40 dietary variables were investigated, including a lipid score that combined the intakes of cholesterol and saturated fat (Cholesterol-Saturated Fat Index [CSI]). The CSI was significantly and positively related to CHD mortality in the 40 countries. The countries with low CSIs had low CHD death rates. Countries with high CSIs had a wide range of CHD death rates. France, Finland, and other Western industrialized countries had similar CSIs. After adjusting for cholesterol and saturated fat, milk and many components of milk (butterfat, milk protein, calcium from milk, and riboflavin) and total calcium remained positively related to CHD mortality for all 40 countries. There were differences in the consumption of these foods and nutrients in France and Finland. Milk and butterfat (fat from milk, cream, cheese, and butter) consumption was higher in Finland than in France. The consumption of plant foods, recently shown to be protective against CHD (vegetables and vegetable oils containing monounsaturated and polyunsaturated fatty acids), was greater in France than in Finland. CONCLUSIONS: Over the years, France and Finland, with similar intakes of cholesterol and saturated fat, consistently have had very different CHD mortality rates. This paradox may be explained as follows. Given a high intake of cholesterol and saturated fat, the country in which people also consume more plant foods, including small amounts of liquid vegetable oils, and more vegetables (more antioxidants) had lower rates of CHD mortality. On the other hand, milk and butterfat were associated with increased CHD mortality, possibly through their effects on thrombosis as well as on atherosclerosis.

Cholesterol, Dietary↗
PubMed1997

Somatization in cross-cultural perspective: a World Health Organization study in primary care.

OBJECTIVE: The purpose of this study was to examine the phenomenon of somatization in different cultures by determining its frequency and correlates in primary care settings in 14 countries. METHOD: Consecutive primary care patients (N = 25,916) were screened with the 12-item General Health questionnaire, and a stratified sample (N = 5,438) was interviewed with the Composite International Diagnostic Interview. Interviewed patients were also assessed for physical disease burden, self-rated overall health, physician-rated physical health status, number of disability days, and interviewer-rated occupational role functioning. The authors determined center-specific associations with the use of logistic regression analyses in which confounding variables were controlled. RESULTS: ICD-10 defined somatization disorder was relatively uncommon in most primary care settings. A less restrictively defined form was more common. Symptom rates were much higher in South American sites. There was a modest association with low education. Otherwise, frequency of unexplained somatic symptoms did not clearly vary according to geography or level of economic development. Somatizing patients were at elevated risk for self-reported disease burden, negative perception of their health, and comorbid depression and generalized anxiety disorder. Somatization was also commonly associated with disability. Cultures did not differ markedly in the pattern of these associated features. CONCLUSION: Somatization is a common problem in primary care across cultures and is associated with significant problems and disability.

Absenteeism↗
PubMed2001

Mental health in Asia: social improvements and challenges.

Remarkable improvements in economic conditions and a considerable upgrade in the quality of life have been observed in many parts of Asia during the past several decades. At the same time, many mental health challenges face the people of Asia. Various social mental health indexes are reviewed here, with available data from China, Japan, Korea, Singapore, Malaysia, and other Asian societies. The data are compared with data from the United States, Australia in the Pacific Rim, and some other Western countries to examine patterns of similarity or difference between East and West in the process of modernization. Common trends in mental health issues associated with rapid sociocultural change observed in different Asian societies are discussed, as well as the relative shortage of mental health personnel available in many Asian societies. It is emphasized that, in addition to expanding psychiatric services, there is an even more urgent need to promote mental health knowledge and concern through education in the general population. Mental health needs to be cultivated and maintained by social forces and cultural strengths. It is stressed that there is a challenge for Asian people to advance mental health beyond economic development in the 21st century.

Asia↗
PubMed2005

Conformity and change: community effects on female genital cutting in Kenya.

In this article, I analyze women's decisions to have their daughters circumcised based on data from 7,873 women in Kenya collected in the 1998 Kenya Demographic and Health Survey. I use multilevel models to assess the degree to which women s decisions are correlated with the decisions of other women in their community, in addition to studying the effects of socioeconomic characteristics measured at both the individual and community levels. I find some support for modernization theories, which argue that economic development leads to gradual erosion of the practice of female circumcision. However, more community-level variation is explained by the convention hypothesis, which proposes that the prevalence of female circumcision will decline rapidly once parents see that a critical mass of other parents have stopped circumcising their daughters. I also find substantial variation among different ethnic groups in the pace and onset of the decline of female genital cutting.

Adolescent↗
PubMed1998

The evolution of the role of the police with special reference to social support and the mental health statutes.

The role of the police at their formation centred around law enforcement (crime detection and apprehension of criminals) and crime prevention in order to maintain the peace. That role has been changing to keep pace with socio-economic developments. Thus, it has expanded to include the provision of social support. However, law enforcement, crime prevention and provision of social support often overlap. Also, though some studies have shown that much police time is spent on non-crime-fighting activities, other studies have found that lower-rank officers in general see their main role as fighting crime. That apart, the police have always had a role to play under the various mental health statutes: referring mentally disordered people to hospital, retaking absconders from mental hospitals, escorting patients from hospital or prison to court and vice versa, which are all tasks classifiable as provision of social support. Because of the complexity of his work today, the policeman may be described as an 'all-purpose public servant'.

Commitment of Persons with Psychiatric Disorders↗
PubMed1981

A framework for modeling interregional population distribution and economic growth.

"An integrated model is proposed to capture economic and demographic interactions in a system of regions. This model links the interregional economic model of Isard (1960) and the interregional demographic model of Rogers (1975) via functions describing consumption and migration patterns. Migration rates are determined jointly with labor force participation rates and unemployment rates."

Demography↗
PubMedDate not supplied

Opioid consumption in hospitals of the Friuli-Venezia Giulia region: a four-year retrospective study.

AIMS AND BACKGROUND: Opioid consumption for analgesic purposes is considered an important indicator of the quality of cancer pain treatment. Italy's consumption ranks among the lowest in economically developed countries. A lack of systematic education of health care professionals regarding pain control and a sort of "opiophobia" induced by measures designed to control the improper use of drugs have been indicated as possible reasons for this trend. The aim of this study was firstly to evaluate the level of opioid consumption at inpatient institutions (where opioid prescription rules have never been subjected to any restriction) and secondly to survey the attitude of the physicians working in general hospitals and specialized oncology institutions (oncology centers and hospices) towards opioid administration. METHODS: The authors performed a four-year survey (1996-1999) on the consumption of major opioids (morphine, meperidine, buprenorphine, transdermal fentanyl) among all the inpatient institutions (six regional/provincial hospitals, eleven district hospitals, the Aviano Oncology Institute and two hospices) of the Friuli-Venezia Giulia region in North-Eastern Italy. To facilitate data interpretation, all the opioids were converted to milligrams equivalent of oral morphine (mg OME). Data on the number of days of hospitalization of oncological patients in every institution were also collected. RESULTS: The overall consumption of opioids was 9,299,177 mg OME (83.3%) and 1,845,060 mg OME (16.7%) in general hospitals and specialized oncology institutions, respectively. Overall, the number of days of hospitalization of oncological patients was 1,121,142 (87%) and 167,665 (13%) in general hospitals and specialized oncology institutions, respectively. The ratio between the total dosage of mg OME administered and the total number of hospitalization days in general hospitals and specialized oncology institutions was 8.29 mg OME/day and 11 mg OME/day, respectively. CONCLUSIONS: Our data show that in specialized oncology institutions, opioid consumption was proportionally higher than in general hospitals. This result indicates the attitude of the physicians of these institutions towards opioid administration, probably due to the training received on cancer pain treatment, and emphasizes the need to educate all health care workers involved in the management of cancer patients.

Analgesics, Opioid↗
PubMed2007

Building little safe and civilized communities: community crime prevention with Chinese characteristics?

This article describes a community crime prevention program in China, set against a background of rapid economic development, large internal population migration, and increasing crime rates. Traditional social control in China has been transformed to adapt to the new reform era, yet some mechanisms remain intact. Crime prevention measures and strategies resemble those adopted in the West; however, the differences, constituting the so-called Chinese characteristics with community crime prevention are significant.

China↗
PubMed2006

Predicted growth of world urban food waste and methane production.

Landfill gas emissions are one of the largest anthropogenic sources of methane especially because of food waste (FW). To prevent these emissions growing with world population, future FW best management practices need to be evaluated. The objective of this paper was therefore to predict FW production for 2025 if present management practices are maintained, and then, to compare the impact of scenario 1: encouraging people to stay in rural areas and composting 75% of their FW, and; of scenario 2, where in addition to scenario 1, composting or anaerobically digesting 75% of urban FW (UFW). A relationship was established between per capita gross domestic product (GDP) and the population percentage living in urban areas (%UP), as well as production of municipal solid waste (MSW) and UFW. With estimated GDP and population growth per country, %UP and production of MSW and UFW could be predicted for 2025. A relatively accurate (R(2) > 0.85) correlation was found between GDP and %UP, and between GDP and mass of MSW and FW produced. On a global scale, MSW and UFW productions were predicted to increase by 51 and 44%, respectively, from 2005 to 2025. During the same period, and because of its expected economic development, Asia was predicted to experience the largest increase in UFW production, of 278 to 416 Gkg. If present MSW management trends are maintained, landfilled UFW was predicted to increase world CH4 emissions from 34 to 48 Gkg and the landfill share of global anthropogenic emissions from 8 to 10%. In comparison with maintaining present FW management practices, scenario 1 can lower UFW production by 30% and maintain the landfill share of the global anthropogenic emissions at 8%. With scenario 2, the landfill share of global anthropogenic emissions could be further reduced from 8 to 6% and leachate production could be reduced by 40%.

Air Pollutants↗
PubMed2004

Socioeconomic status and health among older adults in rural and urban China.

OBJECTIVE: The association between socioeconomic status (SES) and health, which has proven to be quite robust, is rarely tested in societies where levels of economic development and systems of stratification differ from those in Western developed countries. This article examines associations in rural and urban China. METHOD: Techniques include logit equation estimates of separate and pooled samples. The latter employ interaction terms to test rural and urban effects. Socioeconomic indicators include those more customarily used in these types of studies (e.g., education) and several that are less traditional (e.g., pension eligibility). RESULTS: Results indicate associations exist in China. Bank savings is the strongest predictor. Some unexpected results are also found, including a positive association between socioeconomic status and chronic conditions (e.g., cardiovascular disease) among older adults in urban China. DISCUSSION: Use and access to a health care professional might explain part of this anomaly.

Adult↗