The world economic crisis. Part 1: Repercussions on health.
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The widespread economic crisis has resulted in a fall in living standards in the western hemisphere of over 9% (1981-83) and in Sub-Saharan Africa they have fallen to the level of 1970. Food production in the African countries most seriously affected by drought dropped by 15% between 1981 and 1983. Living standards also fell in some countries in Europe and in some of the poorest countries of Asia. The high cost of fuel, the heavy burden of interest payments and unfavourable terms of trade in Africa and Latin America led to serious unemployment, devaluation of national currencies and formidable austerity policies. While some countries have succeeded in protecting their health services from cuts in public expenditure, in many others cuts in health budgets have been substantial. The effects of the crisis in some countries have amounted to the virtual disintegration of rural health services. There are limited data available to show what has been happening to levels of expenditure on health, but those presented here demonstrate that levels of health expenditure per head have fallen in many countries. The cumulative effects on health of increased poverty, unemployment, underemployment and famine, and the reduced capacity of health services to respond to health problems can be documented with facts for a number of countries in Latin America and Africa. Malnutrition has increased and improvements in infant mortality have been checked or reversed. The economic crisis has placed at risk the health of the most vulnerable. (+info)
Origin of a new Phytophthora pathogen through interspecific hybridization.
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Plant disease epidemics resulting from introductions of exotic fungal plant pathogens are a well known phenomenon. An associated risk-that accelerated pathogen evolution may be occurring as a consequence of genetic exchange between introduced, or introduced and resident, fungal pathogens-is largely unrecognized. This is, in part, because examples of natural, interspecific hybridization in fungi are very rare. Potential evolutionary developments range from the acquisition of new host specificities to emergence of entirely new pathogen taxa. We present evidence from cytological behavior, additive nucleotide bases in repetitive internal transcribed spacer regions of the rRNA-encoding DNA (rDNA), and amplified fragment length polymorphisms of total DNA that a new, aggressive Phytophthora pathogen of alder trees in Europe comprises a range of heteroploid-interspecific hybrids involving a Phytophthora cambivora-like species and an unknown taxon similar to Phytophthora fragariae. The hybrids' marked developmental instabilities, unusual morphological variability, and evidence for recombination in their internal transcribed spacer profiles indicates that they are of recent origin and that their evolution is continuing. The likelihood of such evolutionary events may be increasing as world trade in plants intensifies. However, routine diagnostic procedures currently in use are insufficiently sensitive to allow their detection. (+info)
Patients' priorities with respect to general practice care: an international comparison. European Task Force on Patient Evaluations of General Practice (EUROPEP).
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BACKGROUND AND OBJECTIVES: Improving the sensitivity of general practice to patients' needs demands a good understanding of patients' expectations and priorities in care provision. Insight into differences in expectations of patients in different cultures and health care systems may support decision-making on desirable models for care provision in general practice. An international study was conducted to determine priorities of patients in general practice care: which views do patients in different countries have in common and which views differ? METHODS: Written surveys in general practices in the UK, Norway, Sweden, Denmark, The Netherlands, Germany, Portugal and Israel were performed. Samples of patients from at least 12 practices per country, stratified according to area and type of practice, were included. Patients rated the importance of 38 different aspects of general practice care, selected on the basis of literature analysis, qualitative studies and consensus discussions. Rankings between countries were compared. RESULTS: A total number of 3540 patients (response rate on average 55%) completed the questionnaire. Patients in different countries had many opinions in common. Aspects that got the highest ranking were: getting enough time during the consultation; quick services in case of emergencies; confidentiality of information on patients; telling patients all they want to know about their illness; making patients feel free to talk about their problems; GPs going to courses regularly; and offering preventive services. However, differences between opinions of patients in different countries were also found for some of the selected aspects. A confounding effect of patients' characteristics may have played a role in these differences. DISCUSSION: The study provides information on what patients expect of and value in general practice care. It shows that patients in different cultures and health care systems may have different views on some aspects of care, but most of all that they have many views in common, particularly as far as doctor-patient communication and accessibility of services are concerned. (+info)
Detection of an archaic clone of Staphylococcus aureus with low-level resistance to methicillin in a pediatric hospital in Portugal and in international samples: relics of a formerly widely disseminated strain?
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Close to half of the 878 methicillin-resistant Staphylococcus aureus (MRSA) strains recovered between 1992 and 1997 from the pediatric hospital in Lisbon were bacteria in which antibiotic resistance was limited to beta-lactam antibiotics. The other half were multidrug resistant. The coexistence of MRSA with such unequal antibiotic resistance profiles prompted us to use molecular typing techniques for the characterization of the MRSA strains. Fifty-three strains chosen randomly were typed by a combination of genotypic methods. Over 90% of the MRSA strains belonged to two clones: the most frequent one, designated the "pediatric clone," was reminiscent of historically "early" MRSA: most isolates of this clone were only resistant to beta-lactam antimicrobials and remained susceptible to macrolides, quinolones, clindamycin, spectinomycin, and tetracycline. They showed heterogeneous and low-level resistance to methicillin (MIC, 1.5 to 6 microg/ml), carried the ClaI-mecA polymorph II, were free of the transposon Tn554, and showed macrorestriction pattern D (clonal type II::NH::D). The second major clone was the internationally spread and multiresistant "Iberian" MRSA with homogeneous and high-level resistance to methicillin (MIC, >200 microg/ml) and clonal type I::E::A. Surprisingly, the multidrug-resistant and highly epidemic Iberian MRSA did not replace the much less resistant pediatric clone during the 6 years of surveillance. The pediatric clone was also identified among contemporary MRSA isolates from Poland, Argentina, The United States, and Colombia, and the overwhelming majority of these were also associated with pediatric settings. We propose that the pediatric MRSA strain represents a formerly widely spread archaic clone which survived in some epidemiological settings with relatively limited antimicrobial pressure. (+info)
Fall and rise of Lyme disease and other Ixodes tick-borne infections in North America and Europe.
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Lyme disease is a spirochaetal infection with acute and chronic manifestations. Lyme disease and other infections transmitted by Ixodes species ticks are increasing in temperate and Holarctic regions of the Northern hemisphere. These zoonotic infections are most commonly acquired in suburban residential areas and outdoor recreation areas close to cities. Different enzootic cycles, which include a variety of large and small mammals as well as migratory birds, maintain and distribute in nature the Borrelia species that cause Lyme disease. The rise in cases of Lyme disease and the other Ixodes tick-borne infections is, in part, the consequence of reforestation and the increase in deer populations in developed countries. (+info)
Interspecies transfer of female mitochondrial DNA is coupled with role-reversals and departure from neutrality in the mussel Mytilus trossulus.
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Mussels of the genus Mytilus have distinct and highly diverged male and female mitochondrial DNA (mtDNA) genomes with separate routes of inheritance. Previous studies of European populations of Mytilus trossulus demonstrated that 33% of males are heteroplasmic for a second mtDNA genome of increased length and that hybridization with Mytilus edulis does not block mtDNA introgression, in contrast to reports for American populations. Here, we demonstrate that the female mtDNA type of M. edulis has replaced the resident female mtDNA type of European M. trossulus. This is supported by COIII sequence data indicating that the female mtDNA of European M. trossulus is very similar to that of M. edulis and that in phylogenetic trees, the mtDNAs of these two species cluster together but separately from American M. trossulus sequences, the latter not being disturbed by introgressive hybridization. We also provide evidence that the mtDNA genome of increased length found in heteroplasmic males of European M. trossulus derives from a recent partition of an introgressed M. edulis female type into the male route of transmission. Neutrality tests reveal that European populations of M. trossulus display an excess of replacement polymorphism within the female mtDNA type with respect to conspecific American populations, as well as a significant excess of rare variants, of a similar magnitude to those previously reported for the invading European M. edulis mtDNA. Results are consistent with a nearly neutral model of molecular evolution and suggest that selection acting on European M. trossulus mtDNA is largely independent of the nuclear genetic background. (+info)
Studies of HLA, fertility and mate choice in a human isolate.
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The role of human leukocyte antigen (HLA) genes in pregnancy and in human mate choice has been investigated in the Hutterites, an inbred population of European origins. High-resolution HLA haplotypes were defined by alleles at 16 loci in >1000 Hutterites. Prospective studies of pregnancy outcome previously demonstrated increased fetal loss rates among Hutterite couples matching for HLA-B antigens (P = 0.033) or for the entire 16-locus haplotype (P = 0.002). Among living children of couples matching for HLA-B or for the haplotype, there was a non-significant deficit of children who were heterozygous and compatible with the mother; the number of living children who were compatible and homozygous or incompatible and heterozygous was not different than expectations (HLA-B, P = 0.095; haplotype, P = 0.376). Mate choice among 411 couples was non-random with respect to the HLA haplotype, assessed by a variety of methods (P = 0.020 to <0.001). These combined data indicate a role for HLA region genes in both pregnancy outcome and mate choice, and suggest that selection acting on these genes occurs pre-conceptually as well as during pregnancy. This review outlines previously published studies on HLA, fertility and mate choice in the Hutterites. (+info)
Review of the pharmacoeconomic research on gemcitabine in the treatment of advanced non-small cell lung cancer.
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BACKGROUND: Gemcitabine is a novel nucleoside analogue with unique activity against a range of solid tumors including non-small cell lung cancer (NSCLC) and pancreatic cancer. STUDY DESIGN AND METHODOLOGY: This report reviews a series of retrospective economic evaluations that have taken place over the past 4 years comparing gemcitabine, both as a single agent and in combination therapy, with other treatment modalities for NSCLC in the following countries: United States, Spain, Germany, Sweden, Belgium, Canada, and Italy. These economic evaluations were in the form of simple cost identification, cost minimization, and cost-effectiveness in order to estimate the economic impact of gemcitabine in NSCLC treatment compared with other treatment modalities. RESULTS AND CONCLUSIONS: The results of these retrospective economic evaluations suggest that gemcitabine as monotherapy or in a combination regimen may be cost saving or perhaps even cost effective. This is largely because the chemotherapy can be administered in an outpatient setting and because the side-effect and toxicity profile is lower. This economic advantage assumes equivalent efficacy of gemcitabine and other treatment modalities for treatment of NSCLC. (+info)