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PubMedDate not supplied

[Contribution to studies on the modern health care system in the Republic of Congo: geographical approach].

We carried out a geographic analysis of the modern health care system in the rural areas of Kouilou and Niari (Republic of Congo). Spatial differences in physical (e.g. vegetation, relief) and human (social and demographic profiles) factors must be characterized because they have an effect on the organization and spatial distribution of the health care system. The location of health care structures depended on the structure of the local environment. The health care system seemed primarily to be a component of the economic development determining population distribution in the forest area. In the savannah, it was part of the local administrative framework, the key factor determining the structure of the local space. Health care services were most used in areas with average to large population densities, in which there were the largest number of health care structures. Areas with "marginal" population densities and health care center distributions had the lowest rates of health care use. Health care zones can be defined by considering geographical characteristics and the characteristics of the health care system. This makes health planning (e.g. opening of health centers, improvement of health centers) much easier to undertake.

Congo↗
PubMedDate not supplied

[Helicobacter pylori. I. Morphology, biochemistry, antigenic profile and correlated diseases].

Infection by Helicobacter pylori (HP) occurs all over the world and is related to the socio-economic development of the subject's country of residence and age. Various strains of HP can be identified on the basis of the microbiological characteristics of the bacterium and, in particular, or its antigenic profile, while the virulence factors are responsible for the damage that HP can cause. The virulence factors include components (flagellum and adhesin) and substances produced by bacterium (enzymes and cytotoxins), the most important among which are urease and the cytotoxins, CagA and VacA. It is the association of these virulence factors that is responsible for the different pathologies to which HP-positive subjects are prone. The link between HP and gastritis, peptic ulcer and gastric cancers (adenocarcinoma and lymphoma) is now proven. Whether there is a link between HP and RAP in young children is still a matter for debate; some Authors claim that there is, while others refute it.

Adult↗
PubMed1998

[Viral hepatitis of enteric origin].

Hepatitis viruses of oral-fecal origin are responsible for a high morbidity and mortality throughout the world, even if they never result in chronic hepatitis. Two viruses, the virus of hepatitis A (VHA) and of hepatitis E (VHE) are at present the cause of severe viral hepatitis of enteric origin. Water is the principle vector in the spread of these viruses. However, the epidemiological aspects vary according to the pathogenic agent. VHA is excreted in a highly concentrated form in the feces for a relatively short period of time. Since it resists in an exterior environment, the virus remains infectious for a long time. VHE is excreted for a short period of time and in low concentrations. The viral particles are fragile in vitro and their variability in the environment is little known. The possible reservoir role of certain animals has been envisaged. Epidemics arise especially in countries suffering from poor hygiene and massive water pollution. Hepatitis A should no longer be considered a benign disease of childhood. The progress made in hygiene and economic development in industrialized countries have made contacts with this virus scarce, rendering the populations more receptive to it and epidemics more widespread. When the sickness occurs later in life, infection is more often symptomatic and can be serious, resulting sometimes long-term indisposition. Hepatitis E has a vast distribution throughout the world and manifests itself either in epidemic or endemic-sporadic form in many poor countries. In developed countries, it comes about mostly as a result of imported pathology, even if there exists a "substratum" of infection in these areas. The main clinical aspects, such as we were able to study them in 39 cases of military men from Tchad, Guyana and Somalia, are comparable to those of hepatitis A. The reasons for the particular gravity of symptoms in pregnant women are unknown. These affections have no specific treatment. In the field of prevention, vaccination is at present the best means for hepatitis A prophylaxis. Until a vaccine against hepatitis E is found, prevention depends on hygiene, sanitation measures et distribution of drinking water.

Animals↗
PubMedDate not supplied

The action approach. Integrating a community's needs into the corporate planning process.

With the city of Detroit in turmoil, Mercy Hospitals and Health Services of Detroit (MHHSD) is trying to assimilate the community's unmet needs into the corporate planning process. Through the Community Assessment of Human Needs process, MHHSD identified the needs of the poor in three of Michigan's most impoverished areas. On the basis of these findings, MHHSD collaborated with the Poverty and Social Reform Institute to form the East Side Initiative, a community planning effort to address the community's unmet needs. An advisory group was established to oversee the East Side Initiative's planning process. The East Side Initiative participants met as one group and in smaller groups to focus on specific needs in the areas of healthcare, crime prevention, substance abuse, education, housing, economic development, and family (social) supports. The proposed action plans of each small group have received approval. In the second phase of the East Side Initiative participants will attempt to obtain the necessary resources to implement the groups' proposed actions.

Community-Institutional Relations↗
PubMed1992

Health care challenge in coal mines community.

The present paper depicts salient features of environment and living conditions with the comparison of various diseases prevalent among underground coal miners, surface workers, asbestos mine workers and general population of Jharia-Dhanbad coalfield as conducted by CMRS during the past few years. The investigations on coal miners' community comprise of different morbid conditions with respiratory (22%), Pneumoconiosis (11.6%), Skin (35%), Eye (29%), Intestinal parasitic infestation (44.6%), Anaemia (42%), Immunostatus (V.D.R.L. Positive-19.9%), Status of injuries and Blood pressure, Water-borne diseases, housing facilities and excreta disposal. The paper also includes the analysis of disease pattern obtained from hospital records of two coal mines which depicts 19.1%, 24.7% and 16% members of coal miners' families suffering from disorder with respiratory, gastro-intestinal and fever respectively. With speedy industrialization of the country, the mining of coal resource comes first in the chain of socio-economic development. The speedy human industrial activities are based on 80% steam, metallurgical and thermal electrical energy which hinges on coal wings. The coal has also gradually occupied all the phases of social life, our clothes, books, newspapers, cooking gas, chemical paints, dye stuff, oil phenyl, Benzene, Naphthalene, Coal tar, scents and various types of unaccountable products come out from coal derivatives and pushed to serve in the today's market for our daily exigencies. Every day one finds a new coal based industry is coming up in the area. The coal is utilized in two hundred ways in our various walks of social life.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollution↗
PubMed1997

Long-term care: the Australian experience.

Mainly because of migration of young people, the Australian population is young in comparison with the population of other economically developed countries. Fragmentation and excessive reliance on institutions of care of handicapped and elderly people have led to efforts at coordination of services, quality assurance, and a balance between institutional and community-based services.

Aged↗
PubMed1998

Epidemiologic transition theory and aging: Hispanic populations of North America and the Caribbean.

As the forces of social and economic development combine with epidemiological transitions, population aging will continue to impact world health status and the provision of health services. Epidemiology provides an interdisciplinary link to the traditional study of population change by enhancing the demographic parameters of fertility, life expectancy, and migration, with specific measures of mortality and morbidity in order better to predict the pace and concentration of aging within a population. In this article, the authors examine three theoretical models of epidemiological transition and offer historical (1950-1995) and projection (1995-2050) data for the development patterns in Cuba, Dominican Republic, Puerto Rico, and Mexico. They contrast trends in fertility, life expectancy ratios, and gender differences in these countries with the Hispanic population of the United States. Central to this study are the cause of death statistics presented to identify the model occurring in each country. Shifts in the gender mix at older ages are presented due to the decline in fertility and death associated with childbearing years and the timing of the transition from high mortality to infectious disease to high mortality from chronic and age-related disease.

Aged↗
PubMed1988

Frontier hospitals: endangered species and public policy issue.

Frontier hospitals are the most geographically remote acute care facilities in the United States, and they are rapidly becoming and endangered species. Like other small rural hospitals, especially those under 50 beds, they are experiencing considerable distress and more and more are facing the possibility of closure (American Medical Association 1985; Mullner and McNeil 1986; Van Hook 1985; Cordes and Wright 1985). Frontier hospitals play a key role in acute care, serve an important function in the recruitment and retention of physicians and health personnel, and contribute to the community's economic development. However, the local economy surrounding them may be inadequate to prevent socially undesirable facility closures. Present public policy, which is primarily based on a market approach, is incapable of addressing the problems faced by frontier hospitals. A reexamination of this does not mean that the only other option is to follow the patterns of highly regulated states such as Massachusetts, New York, and Connecticut. United States health care has both competitive (market-driven) and regulatory aspects. Several other options or approaches between the extremes are explored.

Data Collection↗
PubMed1985

The epidemiology of coronary heart disease: a review.

The contribution of epidemiology to the understanding of coronary heart disease (CHD) is described. (1) Descriptive epidemiology has shown the main differences between human populations and the strong association existing between the frequency of the disease and the parameters attesting their levels of socio-economic development. (2) Etiological research has identified the risk factors presumably playing a causal role; it also allows a multifactorial evaluation of risk. A pathogenetic hypothesis has been suggested which proposes a sequence of etiological relationships between the saturated fat content of the diet, the level of serum cholesterol and the development of the disease (Diet Heart Hypothesis). (3) Preventive trials have almost confirmed this hypothesis. The decrease of cholesterol level obtained by diet or drug treatment lowers the risk of the disease, the reduction of the cigarette consumption bringing an additional effect. It has not yet been possible to prove the benefit of an antihypertensive treatment towards the risk of CHD.

Canada↗
PubMed1998

[Management of motor disability in rural Sahelian environment. Experience of the center for rehabilitation and devices in Bogande, Burkina Faso].

The center for rehabilitation and fitting of the disabled in Bogande, Burkina Faso has been in operation since 1992. It was created by a non-governmental organization named Actions de Solidarité Internationale (ASI). The primary goal of the center is to provide support devices to restore upright position and mobility and allow social reinsertion especially for disabled persons between the ages of 0 and 20 years. Approximately one hundred people are treated annually. Treatment is delivered either directly in villages or in dispensaries if the disabled person can be brought in with the assistance of family members or health care workers. This policy has enhanced the quality of information, training, and prevention. Patients with severe disabilities beyond the scope of treatment at the center are contraindicated. The activities of the center have been organized with a view to covering costs. A welding shop has been set up to produce aid devices and provide revenues to pay for some services. The major lessons of this experience involve the need for active recruitment in villages, for contraindicating patients with severe untreatable disability, for developing economically sustainable programs, for training management staff, and for good financial planning. In 4 years of operation, the rehabilitation and fitting center has demonstrated its ability to meet the needs of the disabled in Bogande.

Activities of Daily Living↗
PubMed1998

Epidemiology of human intestinal nematode infections in Wujiang and Pizhou counties, Jiangsu Province, China.

Intestinal nematode infections are considered highly endemic in the Chinese province of Jiangsu. In May 1997, the prevalence of intestinal nematodes infections was determined among all of the inhabitants aged 5 to 65 of the southern Jiangsu village of Yaojiakon (Wujiang County) and the northern Jiangsu village of Jianmiao (Pizhou County). It was determined that the prevalence of ascariasis, trichuriasis and hook worm infection was greatly reduced compared to when it was last measured in 1990. The reduction was noted to be particularly impressive in Yaojiakon village where the prevalence of ascariasis and trichiuriasis fell to 2% and 1.5% respectively. Much of this reduction was attributed to improvements in economic development which have occurred in southern Jiangsu Province at a rapid pace. In contrast, the reduction in nematode infections among villagers living in northern Jiangsu was more modest. The most striking reduction in both villages was in school-aged children who since 1988 have received yearly treatments with anthelminthic drugs. The intensity of nematode infections was investigated for hookworm where 70% of hookworm-infected Yaojiakon villagers were found to harbor light infections (< 400 eggs per gram) compared to 83% of hookworm-infected Jianmiao villagers. Necator americanus was the predominant hookworm in Yaojiakon village (South), whereas Ancylostoma duodenale predominated in Jianmiao village (North). The majority (76%) of hookworm-infected patients developed IgG antibodies against N. americanus antigen, although 20% of uninfected patients living in the village also had circulating antibodies. Intestinal nematode infections continue to be a significant public health problem in Jiangsu Province although their prevalence has decreased since 1990.

Adolescent↗
PubMed1999

Modernization, stress, and blood pressure: new directions in research.

The relationship between modernization and blood pressure has been formally examined in anthropology for some 3 decades. A prominent hypothesis to account for the increase in blood pressure in more modernized (or economically developed) communities is the stressful nature of cultural and social change. Research has progressed from hypothesizing that culture change is stressful to trying to operationalize theoretical models of what it is about culture change that is stressful and in turn relating those more precise variables to blood pressure variability within and between communities. Here, I selectively review the literature on modernization and blood pressure, especially the research literature that explicitly uses models of the stress process to guide that research. The most interesting results have been obtained when the use of the stress model has been informed by careful ethnographic work. This has enabled researchers to adapt models of the stress process to be culturally appropriate in local populations. In addition, incorporating an explicit model of culture, especially one that is sensitive to intracultural diversity, has led to new hypotheses regarding the modification of the effects of stressors by social and cultural context. I conclude with a discussion of recent innovations in ethnographic methods, specifically the cultural consensus model, and the use of those methods in operationalizing relevant variables in culturally appropriate and sensitive ways. The utility of combining these methods in the study of modernization and blood pressure is illustrated by recent research in Brazil.

Blood Pressure↗
PubMed1999

How much global ill health is attributable to environmental factors?

Over the years, estimates have been made of the portions of human mortality and morbidity that can be attributed to environmental factors. Frustratingly, however, even for a single category of disease such as cancer, these estimates have often varied widely. Here we attempt to explain why such efforts have come to such different results in the past and to provide guidance for doing such estimates more consistently in the future to avoid the most important pitfalls. We do so by carefully defining what we mean by the terms "environmental," "ill health," and "attributable." Finally, based on these recommendations, we attempt our own estimate, appropriately qualified according to the many remaining uncertainties. Our estimate is that 25-33% of the global burden of disease can be attributed to environmental risk factors. Children under 5 years of age seem to bear the largest environmental burden, and the portion of disease due to environmental risks seems to decrease with economic development. A summary of these estimates first appeared in the 1997 report, "Health and Environment in Sustainable Development," which was the World Health Organization's contribution to the 5-year anniversary of the Rio Earth Summit. A full explanation of how these estimates were made is first presented here. We end with a call for a program of "strategic epidemiology," which would be designed to fill important gaps in the understanding of major environmental health risks in important population groups worldwide.

Causality↗
PubMed1999

[Epidemiological stratification of malaria in the Comoro archipelago].

In the Comoros Islands, the level of malarial endemicity varies greatly from one island to the other, even though the total area (4 islands) covers less than 2,300 km2 and has a population of some 600,000 people only. The epidemiological stratification is based on the diversity of human and physical characterisation. They both determine the presence and the behaviour as well as the size of the vector's populations. Vectorial dynamics can explain varying levels of endemicity given parasitological indicators and specific morbidity. Analyzing these criteria shows up different epidemiological features and serves as a basic guideline for malaria control. The efficiency of this control depends on the relationships between the intensity and the length of the transmission, in the framework of protection mechanisms; it is of crucial importance for clinical treatment. Further elements are the age of the patient, the season and the geographic situation of the area. Stratification provides explanations for these relationships and helps to define antimalarial programmes adapting to each situation a range of therapeutic and antivectorial methods. The availability and accessibility of anti-malarial medicine is the minimum requirement for reducing mortality: domestic spray insecticides for reducing transmission are effective for several years and should be followed by the use of mosquito nets or curtains impregnated with pyrethrinoids, and in the particular case of Grande Comore, the use of larvivorous fish. As anywhere else, the economic development, which is dependent on political stability, is the essential basis for malaria control.

Age Factors↗
PubMed1999

[A program to detect deficient quality of commercialized drugs].

Defective drugs have been found during the postmarketing phase in various countries, regardless of those nations' level of economic development. This paper proposes guidelines for a program to uncover drug defects in the postmarketing surveillance period. Such a program should be run by a center or service organized for that purpose within the framework of a national drug surveillance system.

Developing Countries↗
PubMed1999

Environmental policy in economies in transition.

Considerable improvement in environmental pollution has been achieved, primarily due to targeted environmental policies rather than general economic developments. Some countries in central and eastern Europe have managed to reduce emissions even after the gross domestic product once again began to increase. Everywhere in the region, however, the cost-effectiveness of environmental spending is questionable. Most countries have established systems of earmarked resource and pollution taxes, which provide a sizable share in financing environmental investment. With stationary sources of pollution brought under increasingly effective control, the environmental problems in central and eastern Europe, and eventually in the newly independent states, will start to resemble those of developed market economies. As more activities become affected by environmental protection measures, cost-effectiveness considerations deserve increased attention.

Cost-Benefit Analysis↗
PubMedDate not supplied

Current extent of disasters in Africa.

The people oFf Africa are exposed to a wide range of disasters that seriously have aggravated the Continent's economic situation. Economic losses and human sufferings from drought, desertification, locust infestation, infectious diseases, epidemics, and armed conflicts are the dominant disasters that the people in the African countries face, and they have rendered the population utterly vulnerable. Disasters have aggravated Africa's economic situation. The cumulative effect of disasters include loss of property, injury, death, mounting food import bills, health hazards, environmental degradation, backward economic development, displaced people, refugees, and nutritional deficiency. Today, 175 million Africans out of a total population of 744 million people (23.5%) are suffering from chronic hunger; this is an increase of 50% from 25 years ago. In many African countries, up to half of the population suffers from absolute poverty. It is projected that Africa will be the only Continent to continue with the current level of poverty for another decade.

Africa↗