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Undernutrition among Honduran children 12-71 months old.

In 1996, the Ministry of Health of Honduras conducted a national micronutrient survey that included anthropometric measurements to determine the nutrition status of children 12-71 months old. Among the 1,744 children who participated, 38% of them were stunted, including 14% who were severely stunted; 24% were underweight, of which 4% were severely underweight; and 1% were wasted, of which 0.1% were severely wasted. The country can be divided into three groupings based on the level of stunting and underweight: 1) lowest prevalence: Tegucigalpa, San Pedro Sula, and medium cities; 2) medium prevalence: other urban areas, the rural north, and the rural south; and 3) highest prevalence: the rural west. Using logistic regression analysis, the important determinants of stunting were found to be: mother/caretaker's and father's schooling, source of water, the dominion (geographic location and strata) in which the child lived, and the "possession score" for ownership of such items as a radio, television, refrigerator, stereo system, and electric iron. The predictors for underweight were micronutrient status, diarrhea, maternal/caretaker's schooling, type of toilet, and possession score. Historical data indicate that the national prevalence of chronic undernutrition has changed little over the last 10 years despite the number of national food and nutrition plans implemented and the significant improvements in health services. It is possible that these positive interventions have been offset by the slow progress in economic development. Future nutrition interventions should take into account household-level perceived needs and priorities in order to set realistic nutrition targets.

Age Factors↗

[Mortality from cardiovascular diseases in three Brazilian states from 1980 through 2002].

OBJECTIVE: To evaluate and compare adult mortality from diseases of the circulatory system (CDs), especially ischemic heart disease (IHD) and cerebrovascular disease (CVD), from 1980 through 2002 in the Brazilian states of Rio de Janeiro, Rio Grande do Sul, and São Paulo and their capital cities (respectively Rio de Janeiro, Porto Alegre, and São Paulo), taking into account the impact of deaths due to ill-defined causes on mortality rates. METHOD: We estimated mortality rates (crude and adjusted by age and sex) from CDs overall and from IHD and CVD among individuals aged 20 years or older. These rates were weighted with a portion of the deaths from ill-defined or unknown causes, in the same proportion as deaths from CDs, IHD, and CVD in relation to deaths overall, excluding deaths from ill-defined causes. Using linear regression models, we also estimated the mean values of and annual differences in the weighted adjusted mortality rates. The reference population was that of the state of Rio de Janeiro in 2000. RESULTS: The annual decline in the weighted adjusted mortality rates from CDs ranged from -13.1 per 100,000 individuals in the state of Rio de Janeiro to -8.7 per 100,000 in the city of São Paulo. For IHD, the annual declines were greatest in the city of Rio de Janeiro (-5.0 per 100,000) and the state of Rio de Janeiro (-4.5 per 100,000), and smallest in the state of Rio Grande do Sul (-2.8 per 100,000) and the city of São Paulo (-2.7 per 100,000). With CVD, the range that was found extended from -6.5 per 100,000 in the state of Rio de Janeiro to -2.9 per 100,000 in the city of Porto Alegre. CONCLUSION: The decreases in weighted adjusted mortality rates from CDs, IHD, and CVD occurred after 1980, so it is unlikely that the declines resulted from controlling risk factors or from the practice of myocardial revascularization. The decreases might be related to a period of strong economic development preceding the declines, which translated into improved living conditions and reduced exposure to infections in the perinatal period and childhood.

Adult↗

[Economic impact of dengue and dengue hemorrhagic fever in the State of Zulia, Venezuela, 1997-2003].

OBJECTIVES: To determine the direct and indirect costs of medical care provided to cases of dengue and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) between 1997 and 2003 in Zulia State, Venezuela. METHODS: The total number of patients with dengue and DHF/DSS was obtained from records belonging to the Regional Epidemiology Office of the state of Zulia and from reports of cases that were confirmed in the Virology Section of Dr. Americo Negrette's Clinical Research Institute, Zulia University, Maracaibo, Venezuela, between 1 January 1997 and 31 December 2003. Direct costs included the cost of emergency medical care for all cases and hospital costs for cases with DHF/DSS (cost per bed-day and laboratory expenses). The costs connected to absence from work among patients over 15 years of age and mothers who accompanied their children under 15 years of age comprised the indirect costs, which were adjusted for the proportion of men and women in the labor force. Calculations were based on the minimum yearly wage, and results were given in United States dollars, converted according to each year's average exchange rate. RESULTS: During the study period, 33,857 cases of dengue and DHF/DSS were seen. Of them, 30 251 (89.35%) were cases of dengue, and 3606 (10.65%) were cases of DHF/DSS. Six cases of DHF/DSS died (lethality rate: 0.2 per 100 cases of DHF/DSS). Direct costs were 474,251.70 US dollars; of these costs, 132,042.30 US dollars were spent on emergency medical care and 342,209.40 US dollars on the hospital costs of DHF/DSS cases. Indirect costs were 873,825.84 US dollars and comprised 64.8% of overall expenditures (1 ,48,077.54 US dollars) connected to this disease during the study years. CONCLUSIONS: This is the first study on the economic impact of dengue in the state of Zulia and in Venezuela. In spite of some limitations, results show that dengue is an important public health problem that causes great expense because of temporary absenteeism from work and that undermines regional and national economic development.

Adolescent↗

Distance from roads and cities as a predictor of habitat loss and fragmentation in the caatinga vegetation of Brazil.

Roads and cities represent huge sources of degradation for adjacent ecosystems regarding nutrient cycling, energy, water flow and species composition. In this study we test the hypothesis that distance from roads and cities is associated with habitat loss and fragmentation in the caatinga vegetation--a dry forest to scrub vegetation that covers ca. 736,000 km2 of northeast Brazil. The study site comprised a 2,828.8 km2 piece (64 km x 44.2 km) of Xingó region (09 degrees 36'S, 37 degrees 50'W), which is located between the States of Alagoas and Sergipe. Based on satellite imagery we mapped the remaining vegetation, 145 km of paved roads and the seven small-sized cities set in the study site. A positive correlation was found between the combined distance from roads and cities and the percentage of remaining vegetation as it dropped from 18% at 12 km distant to 5.9% at 1 km distant from cities and roads. Thus, remaining vegetation was reduced by one third near cities and roads. A positive correlation was also found between distance from cities and roads and the percentage of fragments larger than 200 ha, which ranged from 3.6% (within 3 km distance class) to 23.3% (15 km distance class) of all fragments. Our results suggest a road/city-effect zone of 12 to 15 km width, over which habitat loss and fragmentation extend throughout the caatinga vegetation. These findings should be considered in the regional polices for biodiversity conservation and economic development of the caatinga region.

Brazil↗

Emerging or re-emerging bacterial zoonotic diseases: bartonellosis, leptospirosis, Lyme borreliosis, plague.

There are a whole series of emerging and re-emerging zoonotic diseases present in the Northern Hemisphere and the author describes four of them, namely, bartonellosis, leptospirosis, Lyme borreliosis and plague. Reasons for the emergence or re-emergence of such diseases are not clear, but factors such as human demographics, economic development and land use, international travel and commerce, and microbial adaptation, are thought to be involved. Control of emerging and re-emerging diseases has become a major challenge for the international community and it is important to disseminate information about diagnosis and control capabilities, particularly to people working in public health.

Animals↗

Contextual influences on the use of health facilities for childbirth in Africa.

OBJECTIVES: Previous studies of maternal health-seeking behavior focused on individual- and household-level factors. We examined community-level influences on the decision to deliver a child in a health facility across 6 African countries. METHODS: Demographic and Health Survey data were linked with contextual data, and multilevel models were fitted to identify the determinants of childbirth in a health facility in the 6 countries. RESULTS: We found strong community-level influences on a woman's decision to deliver her child in a health facility. Several pathways of influence between the community and individual were identified. CONCLUSIONS: Community economic development, the climate of female autonomy, service provision, and fertility preferences all exert an influence on a woman's decision to seek care during labor, but significant community variation remains unexplained.

Adolescent↗

Determinants of community-based coverage: periodic vitamin A supplementation. Aceh Study Group.

Factors related to preschool child receipt of vitamin A during the first year of a semi-annual vitamin A capsule delivery program were investigated in 229 villages in Aceh, Indonesia. Coverage was higher in villages which were more rural and less economically developed. Highest performance was achieved by village distributors who represented the local status quo in this rural area (farmers, or non-farmers with minimum education) rather than more upwardly mobile, highly educated residents. Household or child-level characteristics were not associated with coverage. This information may be useful for planning direct service programs in the community.

Agriculture↗

Socioeconomic differences in cervical cancer: two case-control studies in Colombia and Spain.

OBJECTIVES: This study examined the causes of socioeconomic differences in invasive cervical cancer in two countries that differ substantially in cervical cancer incidence and economic development. METHODS: Data were derived from two case-control studies carried out in Spain and Colombia; there were 373 case subjects, 387 control subjects, and 425 husbands interviewed with a structured questionnaire. Exfoliated cells were obtained from cervical or penile scrapes and tested for human papillomavirus (HPV) DNA. RESULTS: Relative to better educated women, women with low educational levels in both countries reported fewer Pap smears and had a higher prevalence of HPV DNA. The prevalence ratio of HPV DNA across educational strata was twofold in Spain and fourfold in Colombia. In both countries, husbands of poorly educated women reported higher use of prostitutes than husbands of better educated women. In Colombia, 30% of husbands of poorly educated women harbored HPV DNA, compared with 10% of husbands of better educated women. CONCLUSIONS: Socioeconomic differences in invasive cervical cancer could be partly explained by differences in the prevalence of HPV DNA and by a lower use of preventive care.

Adult↗

Person and place: the compounding effects of race/ethnicity and rurality on health.

Rural racial/ethnic minorities constitute a forgotten population. The limited research addressing rural Black, Hispanic, and American Indian/Alaska Native populations suggests that disparities in health and in health care access found among rural racial/ethnic minority populations are generally more severe than those among urban racial/ethnic minorities. We suggest that disparities must be understood as both collective and contextual phenomena. Rural racial/ethnic minority disparities in part stem from the aggregation of disadvantaged individuals in rural areas. Disparities also emerge from a context of limited educational and economic opportunity. Linking public health planning to the education and economic development sectors will reduce racial/ethnic minority disparities while increasing overall well-being in rural communities.

Ethnicity↗

An assessment of stream water quality of the Rio San Juan, Nuevo Leon, Mexico, 1995-1996.

Good water quality of the Rio San Juan is critical for economic development of northeastern Mexico. However, water quality of the river has rapidly degraded during the last few decades. Societal concerns include indications of contamination problems and increased water diversions for agriculture, residential, and industrial water supplies. Eight sampling sites were selected along the river where water samples were collected monthly for 10 mo (October 1995-July 1996). The concentration of heavy metals and chemical constituents and measurements of bacteriological and physical parameters were determined on water samples. In addition, river discharge was recorded. Constituent concentrations in 18.7% of all samples exceeded at least one water quality standard. In particular, concentrations of fecal and total coliform bacteria, sulfate, detergent, dissolved solids, Al, Ba, Cr, Fe, and Cd, exceeded several water quality standards. Pollution showed spatial and temporal variations and trends. These variations were statistically explained by spatial and temporal changes of constituent inputs and discharge. Samples collected from the site upstream of El Cuchillo reservoir had large constituent concentrations when discharge was small; this reservoir supplies domestic and industrial water to the city of Monterrey.

Enterobacteriaceae↗

Social class and all-cause mortality in an urban population of North India.

BACKGROUND: There is a rapid emergence of cardiovascular disease in India with economic development, leading to an increase in mortality due to these diseases. The exact causes of death in India, however, are not known. SUBJECTS AND METHODS: We studied randomly selected death records from 2222 (1385 men and 837 women) victims, aged 25-64 years, out of 3034 death records during 1999-2001 at the Municipal Corporation, Moradabad. All the families of these victims could be contacted individually to find out the causes of death, by scientists/doctors-administered pre-tested verbal autopsy questionnaires, completed with the help of spouses and local treating doctors practising in the concerned lane. Social classes were assessed by a questionnaire based on attributes of per capita income, occupation, education, housing and ownership of consumer luxury items in the household. RESULTS: Causes of mortality included infectious diseases (41.1%, n = 915) such as tuberculosis, pneumonia, chronic obstructive pulmonary disease, diarrhea/dysentery, hepatitis B, and inflammatory brain infections as the commonest causes of death in the urban population of North India. The second most common causes of death were circulatory diseases (29.1%, n = 646), including heart attacks (10.0%), strokes (7.8%), valvular heart disease (7.2%, n = 160), sudden cardiac death, and inflammatory cardiac disease (each 2.0%, n = 44). Malignant neoplasm (5.8%, n = 131), injury (14.0%, n = 313), including accidents, fire and falls, and poisonings were also quite common causes of death. Miscellaneous causes of death were noted in 9.1% (n = 202) death records, including diabetes mellitus (2.2%, n = 49), suicides (1.8%, n = 41), congenital anomalies (1.0, n = 37), dental caries infections (1.9, n = 42), and burns (1.3%, n = 33). Pregnancy and perinatal causes (0.72%, n = 15) were not commonly recorded in our study. Circulatory diseases as the cause of mortality were statistically significantly more common among higher social classes (1-3) than in lower social classes (4 and 5) whose members died more often due to infections. Heart attacks, strokes, hypertension, diabetes and obesity were statistically significantly more common among higher social classes (1-3) as compared to classes 3 and 4, but tobacco intake showed only minor differences among various classes. CONCLUSIONS: This study indicates that circulatory diseases, injury and malignant diseases have become the major causes of death in India, after infections. Members of social classes 1-3 died more often due to circulatory diseases and members in lower social classes died more often due to infections. Urbanization with rapid changes in diet and lifestyle in various social classes, and possibly aging of the population seem to be responsible for the double burden of diseases, related to under- and over-nutrition, causing death in a developing economy. Monitoring of blood pressure and heart rate around the clock for 7 days, with data analysed chronobiologically can detect abnormal circadian patterns associated with a large increase in cardiovascular disease risk, greater than hypertension itself, allowing the institution of prophylactic treatment. Such prehabilitation may be particularly useful to curb the increasing burden of cardiovascular diseases in both developed and developing countries.

Adult↗

Management of obesity in the elderly: special considerations.

Over the last few decades, there has been an unprecedented increase in the prevalence of obesity, especially in economically developed countries. Furthermore, it is becoming an increasingly recognized health problem in the elderly. The precise mechanisms underlying increased adiposity in the elderly are not known. Aging is associated with a host of biologic changes that limit the ability of the individual to regulate energy homeostasis. Thus, it is likely that older individuals may be more likely to develop the two extremes of the spectrum of nutritional abnormalities, namely malnutrition and increased adiposity. These nutritional abnormalities are associated with significant morbidity and mortality. Current guidelines define overweight as a body mass index (BMI) of 25-29.9 kg/m2 and obesity as a BMI of 30 kg/m2 or more. However, the optimal BMI may be different in older individuals. Management strategies should attempt to optimize the nutritional status of older individuals. Age per se cannot be used as a justification for denying medical management of obesity to elderly individuals. Individualized programs with the goal of achieving modest weight reduction in obese patients are likely to result in immediate (e.g. alleviation of arthritic pains and reduction of glucose intolerance) and possibly long-term (e.g. reduction in cardiovascular risk) healthcare benefits. Management should emphasize lifestyle modifications, while the use of pharmacologic agents such as sibutramine and orlistat should be reserved for select groups of patients who do not respond to lifestyle modification.

Aged↗

Global health care and neurosurgeons.

The contributions that neurosurgeons can make to global health are discussed in the context of the author's clinical and research experience, his views on priorities and equity in research and economic development, and the state of health care in developed and developing countries. Ideas for establishing a new paradigm of health care for all are proposed, as well as more general interventions on behalf of human rights and peace. Neurosurgeons, other medical professionals, and those who are concerned about these global issues are urged to work in concert to remove inequalities in health care both locally and globally.

Delivery of Health Care↗

Globalization and global health.

Along with the positive or negative consequences of the globalization of health, we can consider global health as a goal, responding to human rights and to common interests. History tells us that after the "microbial unification" of the world, which began in 1492, over three centuries elapsed before the recognition of common risks and attempts to cope with them in a cross-boundary effort. In the 19th and 20th centuries, the struggle against epidemics united countries, world health became a common goal, and considerable results were achieved. However, in recent decades the notion of health as a cornerstone of economic development has been replaced by the idea that public health and health services are an obstacle to the wealth of nations. Meanwhile, new common threats are growing: among them, the exacerbation of old infections and emergence of new ones, the impact of environmental changes, drug traffic on a world scale, and destructive and self-destructive violence. New and stronger empirical motives relate the interests of peoples to universal rights and to global health. The author concludes with some proposals for policies.

Conservation of Natural Resources↗

Child poverty in rich countries, 2005, Part II.

Protecting children from the sharpest edges of poverty during their years of growth and formation is both the mark of a civilized society and a means of addressing some of the evident problems that affect the quality of life in the economically developed nations. The proportion of children living in poverty has risen in a majority of the world's developed economies over the past decade. This report asks what is driving poverty rates upwards and why some OECD countries are doing a much better job than others in protecting children at risk.

Adolescent↗

From ex-patient alternatives to consumer options: consequences of consumerism for psychiatric consumers and the ex-patient movement.

The psychiatric consumer movement in the United States evolved out of the political activism of a small group of antipsychiatry "ex-patients" (former patients) early in the 1970s. The shift in the movement from radical opposition to the medical model to viewing the latter as a possible choice in treatment occurred gradually under a series of social and political changes (e.g., deinstitutionalization), responses to those changes (e.g., the Community Support Program of the National Institute of Mental Health), and the involvement of new actors on the scene (e.g., the National Alliance for the Mentally Ill, a family consumer movement). This article traces the evolution of the psychiatric consumer movement up to the early 1990s in the light of these larger social, political, and economic developments. The author then considers the consequences of that evolution for both consumers and the ex-patient movement in the context of the unique nature of consumerism in the United States and the more recent restructuring of mental health services under managed care.

Commitment of Persons with Psychiatric Disorders↗

Understanding women, health, and social change: the case of South Korea.

Since the 1960s, South Korea has experienced rapid economic development and an improvement in the health of its population. During this period there have been marked increases in women's educational and occupational opportunities. But despite these improvements, women still suffer higher levels of gender discrimination than their counterparts in many other countries at similar stages of development. Most dramatically, there are still high levels of sex-selective abortion. Women have lower socioeconomic status than men, and their lives are markedly restricted by the cultural values associated with Confucianism. This article explores the effects of these factors on women's health. Despite their greater longevity, South Korean women still report higher rates of morbidity and distress than men. This can be compared with the "gender paradox" in health reported in many developed countries during the 1970s and 1980s. More detailed research is needed on the factors influencing the health of South Korean women and on related trends in other newly industrializing Asian societies.

Adolescent↗

Modernization and status change among aged men and women.

This study investigates the differences between the relationship between elderly occupational status and modernization for men and women. Consonant with previous findings, it finds that economic development is associated with relative losses of elderly men in professional and technical occupations. Augmenting those findings, however, it finds an even stronger association between development and such losses for women. In accounting for the differences, several explanations are advanced and tested, using data from fifty-one nations.

Aged↗