The burden of disease from undernutrition and overnutrition in countries undergoing rapid nutrition transition: a view from Brazil.
(25/96)
On the basis of 3 comparable population-based surveys conducted in Brazil, we identified clear changes in the relative magnitude of women's undernutrition and overnutrition. In 1975, there were almost 2 cases of underweight to 1 case of obesity, whereas in 1997, there were more than 2 cases of obesity to 1 case of underweight. In 1997, Brazilian low-income women were significantly more susceptible than high-income women to both underweight and obesity. (+info)
Ageing populations and childhood infections: the potential impact on epidemic patterns and morbidity.
(26/96)
BACKGROUND: Population decline, arising from below replacement fertility and possibly giving rise to substantial changes in age distribution, is a feature of many industrialized developed countries; Italy is one of the most notable European examples. The potential influence of this phenomenon on prevalence of chronic non-infectious disease is well known, but little attention to date has been paid to the impact on severe disease due to childhood infections in those cases where control is insufficient to achieve elimination. METHODS: A transmission dynamics model incorporating realistic demography is used to investigate the possible impact of population decline and ageing and suboptimal vaccination uptake on the age distribution of incidence of measles infection and of consequent mortality. Data from Italy is used to parameterize the model. RESULTS: Population ageing in the absence of vaccination is shown to reduce per capita incidence of infection but also to increase average and upper quartile ages at infection. The effect is substantially enhanced by significantly suboptimal vaccination uptake, when disease-induced mortality has, for a period, the potential to exceed that in the absence of vaccination. CONCLUSIONS: Although a substantially increased burden from chronic non-infectious disease has frequently been proposed as a consequence of population decline, there is also potential for an increase in morbidity and mortality from measles and other childhood infectious diseases, particularly where vaccine uptake is substantially below the optimum. Rubella is highlighted as a particular cause for concern. This work also has implications for less-developed countries. (+info)
Rethinking the relationship between medicine and media: two examples from Croatia.
(27/96)
The communication between medicine and media is an important component within the complex process of changes in post-communist transition countries. It reflects not only organizational and legislative state of the society but its cultural adaptability and character. In that respect, media communication could be a tool for shifting the existing attitudes to innovative evaluation of physician's responsibility. Adapting to the democratic society necessitates more effective communication and improvement of all components of communication process: medicine, media, and the public sphere. Existing communication strategies in Croatia were recognized as inefficient and proved damaging for the health care system and society in general. As a demonstration, two representative examples were analyzed in this paper: the case of deaths related to Baxter dialyzers, and the case of pediatric cardiac surgery at the Zagreb University Hospital Center. The cases illustrate the lack of communication within the medical profession and physicians with the executive government, and the public. There is a great need for more effective communication and skillful professionals in transition countries. The future concept of the communication should be characterized by contextual and "cross-talk' approach. (+info)
Nutrition transition in west Sumatra, Indonesia.
(28/96)
Indonesia, like many developing countries, is experiencing a rapid urbanisation characterised by double burden of disease in which non communicable diseases become more prevalent while infectious diseases remain undefeated. This report describes the nutrition transition which occurred to Indonesia after economic transformation in 1966, based on information gathered from published reports. The major sources of information used in this paper were: a) a series of Indonesian National Socio-Economic Surveys (SUSENAS) conducted regularly by Central Bureau of Statistics (which provided a coherent picture of the nutrition transition in Indonesia) and b) data collected from two relatively smaller surveys conducted in West Sumatra (which demonstrated the changes in food and nutrient intakes over the period 1983-1999). It was found that while Indonesia had a rapid economic growth since 1970s, major dietary changes included an increase in expenditure for meat, eggs, milk and prepared food, and a fall in expenditure in cereal products. Nutrient proportions had changed from carbohydrate to fat and protein but the proportions remained close to the ideal ratio. There was also a dramatic shift in causes of death from infectious to chronic diseases. It is concluded that the nutrition transition in Indonesia is similar to patterns in other developing countries. Although fat consumption increased slightly, there is movement to maintain the traditional diet. (+info)
A window of opportunity for the transformation of national mental health policy in Turkey following two major earthquakes.
(29/96)
Striking at the nation's highly populated industrial heartlands, two massive earthquakes in 1999 killed over 25,000 people in Turkey. The economic cost and the humanitarian magnitude of the disaster were unprecedented in the country's history. The crisis also underscored a major flaw in the organization of mental health services in the provinces that were left out of the 1961 reforms that aimed to make basic health services available nationwide. In describing the chronology of the earthquakes and the ensuing national and international response, this article explains how the public and governmental experience of the earthquakes has created a window of opportunity, and perhaps the political will, for significant reform. There is an urgent need to integrate mental health and general health services, and to strengthen mental health services in the country's 81 disparate provinces. As Turkey continues her rapid transformation in terms of greater urbanization, higher levels of public education, and economic and constitutional reforms associated with its projected entry into the European Union, there have also been growing demands for better, and more equitably distributed, health care. A legacy of the earthquakes is that they exposed the need for Turkey to create a coherent, clearly articulated national mental health policy. (+info)
Syphilis as a social disease: experience from the post-communist transition period in Estonia.
(30/96)
Increased incidence of sexually transmitted diseases (STD) and radical social changes have taken place at the same time in Estonia. Our aim was to study the trends in syphilis incidence, selected sociodemographic factors and health status indicators during the economic transition. Associations were estimated by the ordinary least square regression method for change in and actual values of syphilis and tuberculosis incidence rate (IR), percentage of non-ethnic Estonians and urban population, homicides rate, unemployment rate and, birth rate. The analysis was performed by counties at three different time periods. Syphilis IR significantly correlated with the proportion of non-ethnic Estonians, urban population, tuberculosis IR and birth rate. Change of syphilis IR correlated significantly with concurrent changes in unemployment rate and tuberculosis IR. Our findings support the theory that syphilis is a social disease, thus emphasizing the importance of social factors in the occurrence of STDs. (+info)
A look at the (near) future based on the (recent) past - how our patients have changed and how they will change.
(31/96)
Remedies for dental diseases have been in use for as long as 4,000 years, and various materials and methods have been used over the millennia. Dentistry continues to change in response to changes in the age distribution, origins, financial means and health of the population, as well as to changes within the profession itself. The Canadian population is very unevenly distributed geographically and ethnically. Furthermore, it is aging rapidly and life expectancy is increasing. Although the average income of Canadians has increased, the increase was unevenly distributed, and the gap between rich and poor continues to expand. There has been a steady rise in the number of Canadians with dental insurance, although the proportion of the population with insurance varies from one province to another. Not surprisingly, people with dental insurance compared to those without are more frequent users of dental services. The rate of caries attack has diminished in industrialized countries, but people are keeping their teeth longer, so caries will remain a significant public health problem, particularly among elderly people. In addition, smoking tobacco is strongly associated with periodontal disease; thus, there should be more action within the dental community in support of smoking cessation programs. The composition of the dental care community is also changing. The ratios of dentists and dental hygienists to the population have increased, the services offered by dental technicians have expanded greatly, and the services offered by denturists have also increased as these services gain more widespread acceptance. Use of dental services in Canada remains reasonably broad; however, denture-wearers continue to regard uncomfortable dentures as a normal part of aging. The pattern of uneven distribution of disease and access to service remains the major challenge facing the dental profession. (+info)
Lithuanian health care in transitional state: ethical problems.
(32/96)
BACKGROUND: Throughout the economic and political reforms in post-communist countries, significant changes have also occurred in public morality. One of the tasks of the Lithuanian health policy is to create mechanisms for strengthening the significance of ethical considerations in the decision-making processes concerning health care of individuals and groups of individuals, as well as considering the positions of physicians and the health care system itself in a general way. Thus, health care ethics could be analyzed at two levels: the micro level (the ethics of doctor-patient relationships) and the macro level (the ethics of health policy-making, which can be realized by applying the principles of equal access, reasonable quality, affordable care and shared responsibilities). To date, the first level remains dominant, but the need arises for our attention to refocus now from the micro level to the patterns of managing and delivering care, managing the health care resources, and conducting business practices. DISCUSSION: In attempting to increase the efficiency of health services in Lithuania, a common strategy has been in place for the last fifteen years. Decentralization and privatization have been implemented as part of its policy to achieve greater efficiency. Although decentralization in theory is supposed to improve efficiency, in practice the reform of decentralization has still to be completely implemented in Lithuania. Debates on health policy in Lithuania also include the issue of private versus public health care. Although the approach of private health care is changing in a positive way, it is obvious that reduced access to health services is the most vulnerable aspect. In the Lithuanian Health Program adopted in July 1998, the target of equity was stressed, stating that by 2010, differences in health and health care between various socio-economic groups should be reduced by 25%. SUMMARY: The restructuring of health care system in Lithuania should be based on a balance between decentralization and centralization, and between public and private health care sectors. Successful transition requires a balanced role of the government. Today it is obvious in Lithuania that continuous encouragement to make sacrifices was not enough to induce the system to function well, and in an ethical manner. (+info)