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Occupational exposures to carcinogens in developing countries.

There have been very few studies of exposure to occupational carcinogens in developing countries, and even fewer studies of the health consequences of such exposures. However, all industrial chemicals, occupations and industrial processes classified by the International Agency for Research on Cancer (IARC) as Group 1 or Group 2A (carcinogenic or possibly carcinogenic to humans) have been described in developing countries, and there is growing concern that the health impact of many chemicals used in the developing world has been underestimated. In all regions a very large workforce is employed in the construction industry, in which substantial exposure to asbestos may occur, and there has been a rapid increase in production in countries such as Brazil and India. There is, for instance, a similar pattern for tyre production with a large increase in production in developing countries in the 1980s. Thus, the number of workers in industries entailing a carcinogenic risk is increasing in developing countries, partly as a result of the transfer of hazardous industry from industrialized countries. There is much that could be achieved in the prevention of occupational cancer in developing countries, and there have been a number of successful initiatives. However, the greatest progress in the prevention of occupational cancer in developing countries is most likely to come from political and economic changes.

Carcinogens↗

Blueprint for integrating nurse extenders in critical care.

As more and more hospitals use the techniques of work restructuring to reduce their operating budget, no nursing department can escape change. Intensive care units can effectively and economically change skill mix by using a design that incorporates essential staff input and a structured educational program. Implementing a Patient Care Specialty Technician role in critical care serves as a driving force to control costs while maintaining quality care and patient satisfaction.

Cost Control↗

[Social and psychological aspects of the war in Bosnia and Herzegovina 1992-1993].

Every war is the deepest compassion of political fightings turned out with weapon in purpose of biological, economic, social, political and culture destroying of people. This aggression has all these components. Aggressors are Serbia and Monte Negro, and Croatia, and extreme Serbs and Croats living in Bosnia and Herzegovina, and their purpose is the destroying of Bosnian State, and its division into ethnic rules, and making great Serbia and Croatia. This inormal dirty war (war against the civilians, there are no two armies, genocid war, destroying one population) makes injuries, illnesses. It makes hard social economic changes, which change the whole life of the population, making striking changes of spirit and life of people. The most important fact which the people have in war is fear for own family and social survival. Main characteristics of the war is the horrible violence: killing people, raping, kidnapping and torturing in the concentration camps, robbing everything that worth, and making people refugees. This is the war against the civilisation. The last consequences of all these are deep emotional changes in people and groups, and this is the biggest social and medical problem of the community. That is the theme of this project.

Bosnia and Herzegovina↗

Opportunities for women through reproductive choice.

Women around the world hope for the future--for better lives for themselves, education and prosperity for their children, and security for their families. A broad array of social and economic changes is necessary to overcome the poverty, lack of education, and limited control over their own lives that often keep women's hopes from coming true. But women can take an important step forward when they make their own reproductive choices--about marriage, sex, childbearing, and contraception.

Contraceptive Agents, Female↗

Historical recollections of freeze-drying.

The history of freeze-drying is surprisingly recent. Although Altmann used freeze-drying for the preparation of histological sections as early as 1890, his technique went unnoticed for over 40 years. Shackell independently rediscovered the technique in 1909 for the preservation of biologicals. The industrial applications of freeze-drying do not appear to have been appreciated prior to the patients of Tival in 1927 and Elser in 1934, rapidly followed by the important contributions of Flosdorf in the United States and Greaves in England who were largely responsible for making large scale applications of freeze-drying possible. Stimulated particularly by a series of symposia in England and the United States and the renowned courses on freeze-drying organized by Rey in France, the atmosphere in the 1950s and early 60s was one of optimism for the future of freeze-drying, particularly in its application to food stuffs. Many of the dreams of that time remain unfulfilled, largely because of the higher costs of quality processing. Nevertheless, although the optimism may have somewhat dimmed, the promise remains, and economic changes in the future may well stimulate another surge in development.

Freeze Drying↗

Health in the central and eastern countries of the WHO European Region: an overview.

The enormous social, political and economic changes that began in the CCEE/NIS in the late 1980s included the revelation and public discussion of a widening health gap between these countries and the other Member States of the European Region. The continuing economic problems and their effects on health increase the urgency of the need for assistance from the international community. Diverging trends in life expectancy became evident in the mid-1970s, and the gap continued to widen in the 1980s for all major causes of death, particularly cardiovascular diseases. The situation is worse in the NIS than in the CCEE, and worst in the central Asian countries. In 1990, the worst infant mortality rate in these countries was eight times the best rate elsewhere in the Region. Non-mortality data, while patchy, confirm the indications given by mortality data. There is no single reason for the health gap, but contributory factors include the increasing prevalence of major risk factors in lifestyles and the environment, and the low efficiency and effectiveness of health care systems. The current situation and short-term prospects are mixed, but the negative trends in mortality and morbidity patterns are likely to continue for some time. While the worst health problems of the transition period in the CCEE/NIS could largely have been avoided, there is no doubt that economizing on health today will exact large costs tomorrow.

Europe↗

Low birthweight in Thailand: 1982.

Birthweight is sensitive index of social and economic change. The objectives of this study are to establish baseline birthweight, per cent of low birthweight and to determine maternal characteristics on LBW among Thai mothers. The study was based on data from birth records which was collected in 1982. The total number of samples used was 28,952. The lowest mean birthweight occurred in the North and Northeastern regions. These two regions had a mean birthweight of less than 3,000 g. The incidence of LBW was highest in the North at 12.8 per cent. The per cent of birthweight showed the highest with maternal age less than 20 years or parity equal to zero. Unskilled workers showed the highest per cent of LBW in the Northeast, North and the East and housewives in the West and South and farmers in the North.

Humans↗

[Ongoing problems of road signs in transportation control].

The diagnosis and evaluation of causes of traffic accidents frequently calls for effective mutual collaboration of forensic medical officers and transport psychologists. Both scientific disciplines participate in prevention of traffic injuries as regards theoretical arguments and practical provisions. The Bratislava Institute of Forensic Medicine, based on many years of professional and practical experience, participates in the elaboration of principles of risk-free transport of urban and non-urban traffic as well as in preventive provisions and suggestions for conditions of traffic the field. Due to social and economic changes they will be faced in future with more complicated traffic problems/safety of pedestrians--children, old people. In transport man adapts, due to biological laws, with greater difficulties to technical signs of controlled traffic which assumes rapid, immediate and inevitable reactions. Transport safety cannot be resolved unless within prevention a radical solution will be found for the risk of alcoholism, toxicomania, ever increasing speed of vehicles and greater traffic density.

Accidents, Traffic↗

[Paths of food hygiene in Poland].

Varying economic conditions and management systems in different countries have determined the foundation of legal regulations for sanitary food control. The legal system in Poland in the years 1795-1928 was subject to the laws of three partitioning powers: Prussia, Russia and the Austro-Hungarian Empire. On March 28, 1928, the President of Poland passed three decrees equivalent to acts which had a significant impact on sanitary food control. The decrees took into account the following issues: animal protection, food products inspection and evaluation of slaughter animals and meat. For the people of Poland, who in the first half of the 20th century lived within the boundaries drawn by the partitioners, it was important that the legal systems had been based on German law, regarded the best possible at that time. Although the decrees were based on Prussian and Austrian regulations, the infrastructure of food production, of food trade and hygiene in Poland until 1945 was built on the Russian administrative foundation (2/3 of Polish territory) (Fig. 1). After World War II, the economic system established in Poland was subordinate to Soviet rules. This included food manufacturing plants as well as the system of food control. In 1989 Poland came through deep political and economic changes, but the legal system has remained the same. However, there are disputes about the scope between the National Hygiene Inspectors (PIS) operating under the Ministry of Health and Veterinary Hygiene Inspectors (WIS) subject to Woivod's Office.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Characteristic features of HIV/AIDS in the Czech Republic.

First laboratory proved HIV infections in the Czech Republic were diagnosed in a homosexual couple in autumn of 1985. Total number of detected HIV+ cases reached 143 persons by the end of 1992 (132 men and 11 women), of that 31 cases were classified as fully blown AIDS (21 already died). Out of these 143 HIV+ cases, 93 (65.0%) are represented by homo/bisexuals, 10 (7.0%) by heterosexuals, 16 (11.2%) by haemophiliacs, 14 (9.8%) by blood recipients, 1 (0.7%) by IVDU and 9 (6.3%) by unknown transmission category. Approx. 2.1 mil. of tests have been done as routine screening of donated blood. Only 5 cases (0.0002%) of HIV positivity have been found in this group. All HIV positive blood recipients (30 cases) were infected before the mandatory HIV testing of blood supply has been introduced in 1987 (14 out of 16 HIV+ haemophiliacs were infected by imported clotting products). The twins born in 1990 to mother infected by contaminated blood in 1984, were declared at the age of 30 months as HIV free, with all laboratory tests (serology, virus cultivation, PCR) negative. The cummulative infection rate of HIV antibody in 1986-1992 reached 13.8 per million inhabitants. It may be concluded that slow steady increase in the number of reported HIV/AIDS cases has been registered during the whole follow-up period. The authors are aware that relatively low prevalence of HIV infection in the Czech Republic may change dramatically in consequences of recent deep social, political and economical changes in the country.

Acquired Immunodeficiency Syndrome↗

[The Free Trade Agreement and environmental health in Mexico].

This work offers an overview of the state of the art and future state of environmental health in our country from a viewpoint of the impact of the commercial opening established in the Free Trade Agreement among Mexico, the USA, and Canada. In the first section of this work, we analyze the expected economic changes resulting from the implementation of the FTA and foretells the way in which those changes will influence the present environmental and epidemiologic profiles of this country in the medium and long term. The main changes predicted by the analysis are, in the epidemiologic context, the acceleration of the transference of occupational, consumption, environmental and population risks, characteristic of industrialized countries, to the country's polarized epidemiologic profile; and, in the environmental context, a transition consisting of a broadening and composition of the spectrum of pollutants, including and important lagging of bacteriologic control. The second section offers an analysis of the predicted response capacity facing the new environmental risk dynamics in the country, encompassing regulation, normativeness and enforcement of environmental and consumer protection, as well as obstacles found in health services to the implementation of surveillance, detection and treatment of health damages caused by environmental factors. The analysis of the organized social response to these problems discloses a relative flexibility of the normativeness and enforcement functions in comparison with our northern neighbors, a paramount factor for the possible transference of environmental risks, as well as the informational and research deficiency about environmental issues, basic elements for sustaining environmental health in the country, aiming at speeding up the development and transference of technologies for prevention, detection and management of environmental risks in the country, drawing upon the systematization of our experience and that of our neighbors. This speeding process ought to match, in the medium term, the velocity of risk transference produced by the commercial opening. In this way, the commercial integration of North America will become a favorable context for the development of the environmental health infrastructure of the country.

Canada↗

Family patterns and primary prevention of family violence.

Although services for victims and treatment programs for batterers have priority in efforts to ameliorate family violence, primary prevention programs are also essential. The importance of primary prevention lies not only in the suffering which can avoided, but also because it is unlikely that sufficient treatment resources can be allocated to match the magnitude of the problem. The latter point is illustrated by the results of a study of nationally representative samples of 2,143 families (studied in 1975) and 6,002 families (studied in 1985). These studies show that a minimum of 16% of American couples experienced an assault during the year of the study, and that about 40% of these involved severely violent acts, such as kicking, biting, punching, choking, and attacks with weapons. These studies also identified risk factors that can serve as the focus for primary prevention, for example, early marriage, male dominance in the family and use of physical punishment. Educational and therapeutic efforts, and economic changes, which encourage equality and which teach the skills necessary for an equal relationship, can help prevent family violence.

Child↗

Preschool children. Need and use of dental services.

There have been major decreases in dental diseases, but many youngsters are still in need of care, especially low-income and medically compromised children. Additionally, family structure and economic changes are placing children at increased risk for dental diseases. Although there is a progressive increase in the use of services, many children don't have insurance coverage and do not receive preventive and restorative dental care. The preschool years are a foundation period for children, but many continue to receive an uncertain start.

Child, Preschool↗

[Graduate education financing. An indispensable review in the modernization of health education in universities].

Due to the social and economical changes in the Chilean university and health systems in the last decades, the traditional financing model of the Faculty of Medicine and postgraduate training programs became obsolete. The progressive reduction of the fiscal budget has forced the search of alternate financing sources. The payment of specialization is, at the present moment, an obliged, inappropriate and without compensation subsidy of the universities to the public and private health system, that profit of training professionals and to the specialists that acquire skills that will increase their earnings. Equable financing systems should be established in which the direct beneficiaries, institutions or individuals, would pay the expenses. A national scholarship fund or deferred credits seem reasonable alternatives that should be promptly established to allow the survival of university postgraduate training programs.

Chile↗

[Changes in the cardiovascular risk indicators in adolescents between 1980 and 1991].

The aim of this study was to evaluate the trends of indicators of cardiovascular risk (smoking, physical activity, cholesterol, triglycerides...) in adolescents between 14 and 18 years of age. The data was recensed at the Centre of Preventive Medicine of Vandoeuvre-lès-Nancy which was responsible for periodic Social Security health check-ups in 6,974 adolescents in 1980, 1984, 1988 and 1991. The analysis of the trends of the indicators of cardiovascular risk took into consideration the socio-economic changes of the population recruited during this period and the long-term analytical variations of biochemical parameters. Globally, between 1980 and 1991, there was a decrease in the percentage of smokers (21.8% to 13.5%) which was more marked in boys than in girls, an increase in physical activities (46.9% to 57.5%), a linear reduction in serum cholesterol (4.65 mmol/l to 4.33 mmol/l in boys, and 4.94 mmol/l to 4.72 mmol/l in girls), and no significant changes in serum triglycerides. These results confirm those reported by others and are encouraging for cardiovascular disease prevention and should be confirmed in adults groups.

Adolescent↗

[Evaluation of dietary changes during a 10 year observation period of the local Pol-MONICA population in Warsaw with regard to risk of cardiovascular diseases].

In the frame of the Warsaw Pol-MONICA Project three population screenings were performed in randomly selected 35-64 year men and women in 1984 (2571 participants), in 1988 (1397) and 1993 (1485). Twenty-four-hour dietary recalls were used for assessment of nutritional value of daily food ration and food products consumption. Statistical analyses was performed by linear regression method (SAS REG procedure). Substantial changes in food consumption pattern were noted during 10 years, particularly in the last 4 years. In 1993 participants of both sexes consumed significantly less cereals, butter, eggs (trend p < 0.01) and more fats of vegetable origin (trend p < 0.01). This changes reflected in nutritional values of daily food ration from 1984 to 1993: dietary cholesterol decreased from 630 mg to 433 mg in men and from 447 to 284 in women, percent of energy from saturated fatty acids decreased from 15.7% to 14.7% in men and from 15.9% to 13.9% in women, percent of energy from polyunsaturated fatty acids increased from 4.1% to 5.4% and from 4.3% to 5.5% respectively. Above mentioned changes resulted in a significant reduction of atherogenicity level of diet as expressed by Keys score. A period covered by the study was a period of economical changes in Poland associated with an introduction of a free food-market. Changes in food consumption and nutrient intake reflect the mixture of industry, mass communication patterns, and commercial advertising.

Adult↗

Internal migration in China, 1950-1988.

This paper examines the long-term patterns of migration within China between 1950 and 1988. The analysis uses data from China's 1988 2/1,000 Fertility and Birth Control Survey, which asks respondents about their most recent interprovincial move. The results suggest that long-term migration patterns can be explained by political and economic changes in China. We argue that the approaches we introduce can offer significant insight into long-term migration patterns for countries where historical data on migration are unavailable or unreliable.

China↗

[The epidemiological characteristics of Sonne and Flexner dysentery in St. Petersburg in 1953-1994].

In connection with the growth of mortality in Flexner's dysentery observed since 1991 and a rise in morbidity in this infection since 1993 the data on the registered cases of Shigella flexneri and Shigella sonnei infections in St. Petersburg for the period of 1953-1994 were analyzed. In the 60-80s the specific features of the epidemic process was determined by S. sonnei infection which constituted up to 90% of all documented cases of dysentery. Flexner's dysentery lost the character of a mass epidemic disease in the 60s, but in the 70s became again capable of epidemic spread, which was testified by annual seasonal rises producing a half of all cases registered per annum and two rises with peaks in 1975 and 1984. In 1991-1992 the tenfold rise of morbidity in Flexner's dysentery took place in the presence of a common level of morbidity of Shigella infections. In 1993-1994 an essential change in the etiological structures of Shigella infections was observed: morbidity in Flexner's dysentery rose 6 times and morbidity in Sonne dysentery dropped 3 times, which was probably due to socio-economical changes in the living conditions of the population during recent years.

Adult↗