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While demographic changes in future decades should expand the need for subspecialists in reconstructive pelvic surgery and urogynecology, managed care will probably limit access of patients to specialists in this field. Much of the evaluation and treatment for women with prolapse and incontinence will be provided by primary care providers.
Epidemics of Cardiovascular Disease (CVD) are presently occuring or accelerating in developing countries, as epidemiologic transition accompanies socio-economic and demographic changes. Hypertension, a major risk factor for coronary and cerebrovascular disease, needs effective programmes for prevention, recognition and control. Strategically, hypertension control is ideally suited to be the initial component of an integrated CVD control programme which has to be implemented in the developing countries. Primary prevention, through a population based lifestyle linked programme, as well as cost-effective methods of detection and management are synergestically complementary approaches. The existing health care infrastructure needs to be reoriented to meet the emerging challenge of CVD, while empowering the community through health education.
The discrepancy between the potential and the reality of productive aging is very substantial. We have to deal with a structural gap. The individual productivity of aging is much more developed than the options of society for productive aging. Two ways of overcome the structural discrepancy are discussed. First options for post-retiremental activities are described. They follow the aim to enrich the role activities of elderly people by job options and honorary work. Second the model "Aktion 55" is discussed as an innovative initiative for new post-retirement activities. Future interventions have to follow demographic changes by developing age-integrated social roles and to leave age-differentiated activities and roles.
Therapy of coronary artery disease in elderly patients will gain in importance due to the demographic changes in industrialized societies. In our own institution 6.5% of all dilated patients were over 70 years of age in 1989, compared to 17.5% in 1995. Elderly patients were more likely to be women and to have unstable angina or multivessel disease. Primary success rates in elderly and younger patients are comparable. The current 3-year survival rate of 84 patients > or = 70 years of age is 92.9%. Long-term follow-up is primarily influenced by non-cardiac comorbidity. In conclusion, percutaneous transluminal coronary angioplasty (PTCA) results in a symptomatic improvement in elderly patients with single-vessel and most patients with multivessel disease.
A significant geographical correlation (r = 0.719) was found between the logarithm of effective size (InNe) and heterozygosity level (H) in populations under the assumption of the Hardy-Weinberg equilibrium. The area of highest positive correlation was positioned meridionally between the Ob and Yenisei rivers, from the Arctic coast of Taimyr Peninsula to eastern Sayans and the southern Cis-Baikal region, i.e., in the same region where the highest distribution density of mean Ne values was found. Two additional areas of high correlations were found on the northern Black Sea coast and in the lower Lena river region. Analysis and mapping of correlation ratios eta H/lnNe2 and eta lnNe/H2 revealed that effective size substantially influenced heterozygosity level (as could be expected in the case of an intense gene drift), and heterozygosity level influenced effective size to the same extent. The latter relationship indicated an intense adaptation, and changes in diversity of the gene pool caused substantial demographic changes. However, this might be accounted for by direct gene migration into a population prevailing over reverse migration, i.e., mechanical population growth prevailing over natural growth.
The United Arab Emirates has witnessed extensive social and economic development during the past 2 decades. Significant demographic changes have also taken place mainly as a result of the continuous flow of expatriates. The development of the health care delivery system resulted in the reduction of the infant mortality rate by 25% (10.93 per thousand live births by 1992), but the perinatal mortality rate has remained almost unchanged. Although maternal and child health care has improved dramatically, its limited impact on perinatal mortality can be attributed to underutilization of maternal health centers, absence of screening programs for mothers at high risk, absence of regionalization of perinatal care centers, poor maternal and neonatal transport facilities, absence of effective referral and cooperation and interaction between hospitals and health centers, the limited number of nursing and medical staff, and, finally, underutilization of available information to support and enhance research. The national perinatal mortality survey may address and seek appropriate solutions to such problems.
OBJECTIVE: Interpretive analysis of epidemiological, clinical trials and practice pattern data for cardiovascular risk reduction in the contemporary setting of unprecedented demographic changes. DATA SOURCES: Literature review and audit results of the Clinical Quality Improvement Network (CQIN). DATA SYNTHESIS: Coronary artery disease (CAD) is the largest single cause of death in Canada. CAD is age-related and the population is rapidly ageing, a combination that threatens an epidemic of future CAD events. Epidemiological data demonstrate a direct relation of CAD risk and serum cholesterol levels and no threshold cholesterol level below which there is no CAD risk. The epidemiological data also suggest CAD risk can be reduced by lowering serum cholesterol and this hypothesis has now been incontrovertibly confirmed by repeated randomized clinical trials. Most recently, reduction of all-cause mortality with cholesterol-lowering therapy in high risk subjects has also been confirmed. Despite the overwhelming trials and epidemiological evidence, CQIN effectiveness analyses reveal far from optimal risk assessment and management practices among high risk patients. CONCLUSIONS: Serum cholesterol is directly related to CAD risk. Reduction of cholesterol reduces CAD, and all-cause, mortality in high risk patients. There is a large window of opportunity to improve lipid-lowering practices, and patient outcomes, for the most deadly diseases in our society.
This study examines the genetic impact of the Great Famine (1846-1851) on the regional genetic structure of Ireland. The Great Famine resulted in a rapid decrease in population size throughout Ireland in a short period of time, increasing the possibility of genetic drift. Our study is based on migration and anthropometric data collected originally in the 1930s from 7211 adult Irish males. These data were subdivided into three time periods defined by year of birth: 1861-1880, 1881-1900, and 1901-1920. Within each time period the data were further subdivided into six geographic regions of Ireland. Estimates of Wright's FST were calculated from parent-offspring migration data and from 17 anthropometric variables (10 head measures, 7 body measures). Over time, the average population size decreased, but average rates of migration increased. The estimates of FST at equilibrium from migration matrix analysis suggest that the net effect of these opposite effects is a reduction in among-group variation. Closer examination shows that within each time period the rate of convergence to equilibrium is slow, meaning that the expected levels of genetic homogeneity revealed from migration matrix analysis are not likely to be seen over short intervals of time. Estimates of FST from anthropometric data show either relatively little change in microdifferentiation or some increase, depending on which variables are analyzed. Investigation of a simple model of demographic and genetic change shows that, given the demographic changes in post-Famine Ireland, FST could in theory increase, decrease, or remain the same over short intervals of time. Overall, the Great Famine appears to have had minimal impact on the genetic structure of Ireland on a regional level. Comparison with studies focusing on local genetic structure shows the opposite. It appears that the level of genetic impact depends strongly on the level of analysis; local populations are affected to a greater extent by demographic shifts than regional populations. We also provide formulas for the standard errors of FST from metric traits and related statistics.
Because of major worldwide demographic changes, many Latin American children are frequently adopted in the U.S. This article presents an overview of the historical and contemporary circumstances and controversies surrounding intercountry adoptions (ICAs), and a review of possible risk factors for later child or adolescent maladjustment. Although a number of follow-up studies indicate a 70-80% positive outcome, some ICAs end in painful family-child disruptions. There is, therefore, a growing need for bilingual/bicultural mental health services to improve the initial adjustment process and to facilitate a positive long-term outcome. These services are especially needed when the child is older at arrival and the adopting family lives in a mostly homogeneous community. Suggested prearrival, arrival, and follow-up interventions with the family, the child, and the school are described. A case illustration of the interventions offered to a U.S. family and their recently adopted Latin American child is provided.
The aim of this article is to examine the performance of screening for fetal Down syndrome (DS) in the context of demographic variation in time and place, using population and fertility data for several European countries. Two screening approaches are distinguished: one on the basis of maternal serum screening with human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) in combination with maternal age, and one on the basis of maternal age only. Screening performance, as measured by detection and false-positive ratios, is shown to be the result of the screening approach chosen and of the demographic characteristics of the population under consideration. A proper distinction between these two determinants of DS screening performance should be made, in order to distinguish between an improvement in screening performance that is brought about by a new screening approach and an improvement that is brought about by demographic change. We recommend that measures of DS screening performance be standardized for demographic variation. The methodology and demographic data presented in this article can be used for this purpose.
Demographic changes have forced gerontologists to focus attention on the gender based character of population ageing. Ageing is likely to become a 'gender issue' with a large number of women surviving into very old age in almost all the countries of the world. Elderly women, especially in Third World countries like India, face several jeopardizes. They are likely to be illiterate or poorly educated, unlikely to be employed, most likely to be widowed and dependent on others, and they suffer from malnutrition and disabilitating symptoms as well as report higher psychological distress. The vulnerability of the ageing women, special types of problems they are likely to encounter over the life span, and factors that marginalise them need to be better understood. There is no clear awareness as yet, of the potential contribution of ageing women to the development process as ageing women are stereotypically perceived as burdens on the national economy. Strategies addressed to ensure health and well-being of older women need to be developed.
The long-term fall in household size in the United States is discussed within the framework of the aging of the population, continuing as the effects of fertility and mortality decline accumulate. Using distributions of households by size from U.S. census data 1790-1970 and a components of change analysis on primary individuals for 1950-1974, household changes are related to demographic change for the periods 1790-1900, 1900-1950, and 1950-1974. Fertility and mortality declines have unambiguous impact on household size until the increases in primary individuals begin. But these, too, have a theoretically interesting, if indirect relationship to population structure.
As more persons with Alzheimer disease are diagnosed earlier in the disease progression, their perspectives, values, and preferences warrant closer attention from clinicians, service planners and providers, and the research community. Demographic changes suggest that more persons with early-stage Alzheimer disease will be living alone. Their treatment, housing, and service preferences, as well as values about desirable health, mental health, and cognitive and functional outcomes may differ from those of their concerned families. Clinicians and researchers must identify relevant domains of life quality from the perspective of the person with dementia and develop individually sensitive, reliable, and valid instruments to assess, monitor, and evaluate outcomes of care and services.
Demographic changes are dramatically increasing the importance of dementia disorders, and among them Alzheimer's disease (AD), which accounts for over 50% of age-associated dementias. Early diagnosis is important in order to detect reversible disorders and, on the other hand, to exploit newly available treatment options as soon as possible. For detection of dementia and differential diagnosis a two-step approach is advocated. Screening is carried out by the primary care physician, who refers the patient for differential diagnosis and thorough workup to a specialist or specialized institution, such as a memory clinic. Patient management is, as usual in geriatric medicine, a multidisciplinary task. The new therapeutic options make early diagnosis mandatory to ensure optimum benefit for the patient in Alzheimer's disease, which today can be diagnosed with sufficient accuracy. Vascular dementia, which is second to AD in frequency of occurrence, can best be prevented and treated by vigorous management of cardiovascular risk factors. In addition to drug treatment, psychotherapeutic approaches (particularly milieu therapy) help to keep patients in their accustomed setting for much longer and to alleviate the caregivers' burden.
Due to the demographic changes in Chile, where preventable causes of death are being controlled and congenital malformations arise as an important cause of morbidity and mortality during infancy, of pathological pregnancies and reproductive alterations, medical genetics is becoming increasingly important. Using data from an inquiry that was answered by thirteen medical genetics centers in the country, this article reviews the history of the discipline in Chile, the available resources, the existent services, the main problems found and their eventual solutions, genetics teaching and the research that is being conducted.
The paper summarizes the answers to given questions and the lecture held on the occasion of a hearing of the Enquete-Kommission "Demographic change" of the German Parliament. The subject was the problem of cost-effectiveness of rehabilitation measures. The position of geriatric rehabilitation in Germany as an established and efficient method is described. The indication for rehabilitation must be correctly and individually determined, and the treatment should be available to patients in all communities.
The population in sub-Saharan Africa is growing faster than increases in food production, resulting in a net decrease in food production per capita. The Food and Agriculture Organization has stated that there is a "risk of widespread hunger" which could be prevented by "effective planning of water resources". However, the potential effects of such schemes on the human population are often inadequately assessed and the effect of large dams on human health is not clear. The potential risk to human health of water resources was emphasized a few years ago but no effective preventive programs were implemented, probably because of inadequate availability of information and lack of awareness. The effects on health of "large" water resource projects are not uniform within a population. Decision-makers have tended to focus on the positive effects, to obtain support for their plans. These include: 1) improvement in the well-being of the population (safe water more readily available, new infrastructure, better access to health care) and 2) increases in the food supply (more vegetables and fish available due to irrigation). Thus, there has been a logical expectation that more, better quality food will become available as a result of these schemes, whereas in fact, health and nutrition has often worsened, particularly in young children. Most of the diseases associated with water resource management are communicable, including diseases directly related to the presence of large quantities of water, such as: malaria, which increases in incidence immediately after the building of the dam, after which a new balance develops between the human population and the parasites, schistosomiasis, the disease which increases most in response to the building of dams, particularly in its most severe gastrointestinal form, diarrhea, as water is a major means of dissemination for many organisms, including those causing digestive tract infections and gastroenteritis (amebiasis, salmonellosis, cholera), due to poor sanitation, other parasitic infections, such as onchocerciasis and trypanosomiasis, which should be monitored as they may also threaten the population. Other communicable diseases may appear or increase in incidence with the influx of migrants to the irrigated area. Sexually-transmitted diseases and HIV infection are a particular problem. The large numbers of insects (mosquitoes, blackflies) may also have harmful effects on populations adapting to the new environment. These effects are related to each other and to the environmental changes. New types of food affect people's feeding habits and generate new sources of income. However, they may also lead to new and higher expenditure. There are also likely to be major socio-demographic changes associated with changes in reproductive behavior and women's activities. The location and nature of new homes and infrastructure (e.g. schools, health centers, roads) also contribute to the success or failure of the dam project. There are many constraints to be considered and a more comprehensive approach to the problem is required. Health and nutritional status may be used as simple indicators of the ability of the population to adapt to a new environment. This makes it possible to construct a causal model to identify the most effective and relevant areas of intervention. Health and nutrition issues are of vital importance and scientific findings should be used in decision-making processes for planning future large dam schemes.
The demographic and academic profiles of first-year classes entering the three allopathic medical schools in Florida (UM, UF, and USF) between 1990 and 1996 have been summarized. In general, the high academic standards for admission (high GPAs and MCAT scores) have been maintained, and in some cases, increased. The percentages of women admitted to the first-year classes at UM and UF have increased in recent years, and the number of women enrolled in MD programs in Florida has increased by 26% since 1990. At the University of Miami, the student body has reached gender parity. There also has been a marked shift in the ethnicity of medical students in the state of Florida. Non-hispanic white students have decreased by 9% to 64.4% of the total population. Black students and hispanic students have made modest gains, and now constitute 7.4% and 11.5% of the population, respectively. Asian students have made the largest gain (6.4%), now making up 15.8% of all Florida medical students. In contrast, there has been no sustained increase in the overall number of underrepresented minority students admitted to first-year classes despite national programs and institutional commitments to do so. These changes have not occurred just at Florida medical schools. They parallel far broader national trends resulting from a dramatic increase in the number of medical school applicants and demographic changes in the applicant pool.