Deterioration Of Health Conditions Research Articles

Development of a Multilayer Film Including the Soluble Eggshell Membrane Fraction for the Treatment of Oral Mucosa Lesions

Background/Objectives: Oral diseases causing mucosal lesions are normally treated with local or systemic anti-inflammatory, analgesic and antimicrobial agents. The development of topical formulations, including wound-healing promoters, might speed up the recovery process, improving patients’ quality of life, and reduce the risk of deterioration in health conditions. In this study, a mucoadhesive multilayer film, including a novel biocompatible substance (solubilized eggshell membrane, SESM), was rationally designed. Methods: The SESM preparation procedure was optimized and its biological effects on cell proliferation and inflammation marker gene expression were evaluated in vitro; preformulation studies were conducted to identify the most promising polymers with film-forming properties; then, trilayer films, consisting of an outer layer including chlorhexidine digluconate as a model drug, a supporting layer and a mucoadhesive layer, incorporating SESM, were prepared using the casting method and their mechanical, adhesion and drug release control properties were evaluated. Results: SESM proved to possess a notable wound-healing capacity, inducing a wound closure of 84% in 24 h without inhibiting blood clotting. The films revealed a maximum detachment force from porcine mucosa of approx. 1.7 kPa and maximum in vivo residence time of approx. 200–240 min; finally, they released up to 98% of the loaded drug within 4 h. Conclusions: The formulated trilayer films were found to possess adequate properties, making them potentially suitable for protecting oral lesions and favoring their rapid healing, while releasing antimicrobial substances that might be beneficial in reducing the risk of bacterial infections.

Motivational Factors in Adherence among Elderly with Diabetes and Hypertension

This qualitative study aims to explore the motivational factors in adherence among the elderly with diabetes and hypertension from the perspectives of patients and health professionals in China. Semi-structured face-to-face interviews were conducted. Thematic analysis of the interview transcripts unveiled eight master themes, including vicarious experiences, health beliefs, self-efficacy, feedback on health outcomes, the desire for improved health and longevity, understanding of diseases, perceived personal deterioration in health conditions, external regulation, and support. This study emphasizes the need for comprehensive strategies that align with the motivations of older individuals facing the dual challenges of diabetes and hypertension in China.

Typical fault prediction method for wind turbines based on an improved stacked autoencoder network

Abstract Timely prediction of wind turbine states is valuable for reduction of potential significant losses resulting from deterioration of health condition. To enhance the accuracy of fault diagnosis and early warning, data collected from supervisory control and data acquisition (SCADA) system of wind turbines is graphically processed and used as input for a deep learning mode, which effectively reflects the correlation between the faults of different components of wind turbines and the multi-state information in SCADA data. An improved stacked autoencoder (ISAE) framework is proposed to address the issue of ineffective fault identification due to the scarcity of labeled samples for certain fault types. In the data augmentation module, synthetic samples are generated using SAE to enhance the training data. Another SAE model is trained using the augmented dataset in the data prediction module for future trend prediction. The attribute correlation information is embedded to compensate for the shortcomings of SAE in learning attribute relationships, and the optimal factor parameters are searched using the particle swarm optimization (PSO) algorithm. Finally, the state of wind turbines is predicted using a CNN-based fault diagnosis module. Experimental results demonstrate that the proposed method can effectively predict faults and identify fault types in advance, which is helpful for wind farms to take proactive measures and schedule maintenance plans to avoid significant losses.

Unpacking the role of transport inequalities among older adults for accessing healthcare in Bengaluru, India

ABSTRACT Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of ‘motility’ (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes.

COVID-19 Signs and Symptom Clusters in Long-Term Care Facility Residents: Data from the GeroCovid Observational Study

Background: Long-term care facility (LTCF) residents often present asymptomatic or paucisymptomatic features of SARS-CoV-2 infection. We aimed at investigating signs/symptoms, including their clustering on SARS-CoV-2 infection and mortality rates associated with SARS-CoV-2 infection in LTCF residents. Methods: This is a cohort study of 586 aged ≥ 60 year-old residents at risk of or affected with COVID-19 enrolled in the GeroCovid LTCF network. COVID-19 signs/symptom clusters were identified using cluster analysis. Cluster analyses associated with SARS-CoV-2 infection and mortality were evaluated using logistic regression and Cox proportional hazard models. Results: Cluster 1 symptoms (delirium, fever, low-grade fever, diarrhea, anorexia, cough, increased respiratory rate, sudden deterioration in health conditions, dyspnea, oxygen saturation, and weakness) affected 39.6% of residents and were associated with PCR swab positivity (OR = 7.21, 95%CI 4.78–10.80; p < 0.001). Cluster 1 symptoms were present in deceased COVID-19 residents. Cluster 2 (increased blood pressure, sphincter incontinence) and cluster 3 (new-onset cognitive impairment) affected 20% and 19.8% of residents, respectively. Cluster 3 symptoms were associated with increased mortality (HR = 5.41, 95%CI 1.56–18.8; p = 0.008), while those of Cluster 2 were not associated with mortality (HR = 0.82, 95%CI 0.26–2.56; p = 730). Conclusions: Our study highlights that delirium, fever, and low-grade fever, alone or in clusters should be considered in identifying and predicting the prognosis of SARS-CoV-2 infection in older LTCF patients.

Prediction of changes in the health condition of silver birch (Betula pendula Roth)

Silver birch (Betula pendula Roth.) forms softwooded broadleaved forests in various natural zones. It is widely used in protective afforestation and urban plantings, it is a pioneer species in the clear-cuts and burnt areas. However, the global warming and anthropogenic pressure promote the susceptibility of silver birch to pests and pathogens. 
 The aim of the research was to assess the trends in the health condition dynamics of silver birch stands depending on forest site conditions and the initial health condition of the trees.
 The research was carried out in the 2015-2019 period in the Silver birch forest stands in Kharkiv region in fresh fairly poor forest site conditions (B2), fresh fairly fertile forest site conditions (C2), and fresh fertile forest site conditions (D2). All the stands were 40–45 years old and had a relative density of stocking 0.7–0.8.
 Health condition class was visually assessed for each tree in July of each year according to “Sanitary rules in the forests of Ukraine”. For each group of sample plots, which corresponded to the main types of forest site conditions, the probability of improvement of health condition, deterioration of health condition, and mortality in 2019 was calculated depending on their health condition in 2015.
 In each year of the studies (2015–2019), the health condition of silver birch stands was the worst in fresh fertile site conditions, which was due to the bacterial wet wood disease. In the fresh fertile forest site conditions, no tree of the 4th class of health condition improved it during the 2015–2019 period, and in fresh fairly fertile forest site conditions 27.7% of silver birch trees improved their health condition. In each type of forest site conditions, the probability of mortality in more weakened silver birch specimens is higher. The probability of silver birch mortality of any class of health condition was the highest in the fresh fertile forest site conditions and the lowest in the fresh fairly poor forest site conditions.

Changes In Mental Health, Social Engagement, and Physical Activities During the COVID-19 Pandemic

The current COVID-19 pandemic has profoundly changed our behaviors and health, especially vulnerable community-dwelling older adults. This symposium includes three presentations that evaluated the pandemic’s impacts on mental health, social engagement and physical activity in healthy community-living older adults and those with dementia. Dr. Wenjun Li and his team examined the pandemic impact on mental health and social engagement among relatively healthy older adults residing in suburban and rural neighborhoods in Central Massachusetts, USA. The study reported significant variations in pandemic impacts by sex, age, race, income, living arrangement, and neighborhood housing density, suggesting the pandemic has had disproportionally negative impacts on socially and economically disadvantaged vulnerable older adults. Dr. W. Quin Yow and her team evaluated the impacts of government mandated social distancing and lockdowns on older adults with dementia and their caregivers in Singapore. The study found significant increases in irritability, aggression and hallucinations among older adults with dementia, and possible deterioration of health conditions and heightened moderate level of stress. The results suggest that social distancing may have resulted in negative outcomes in this vulnerable population with dementia and their caregivers. Dr. Ladda Thiamwong reported her team’s efforts on forming an international aging research collaborative to mitigate heath consequences of COVID-19 crisis from the international perspective. The team consists of ten scholars from five countries, including Hong Kong, Nepal, Singapore, Thailand, and the United States. They collect data using combinations of online and face-to-face surveys. Their important findings will be discussed in detail in this symposium.

The lockdown and its consequences-Perspectives and needs of people at increased risk of severe illness from COVID-19 : Results from aqualitative longitudinal study.

BackgroundThere is a lack of knowledge on how people at increased risk of severe illness from Coronavirus disease 2019 (COVID-19) experienced the infection control measures. This study aimed to explore their perspectives and needs during the coronavirus outbreak.MethodsA qualitative longitudinal interview study was conducted in Austria during lockdown due to COVID-19 containment and afterwards. People older than 65 years of age and/or affected by a chronic medical condition participated in individual telephone interviews at two time points. Thematic analysis was used to analyze the data and saturation was defined as no new emerging concepts in at least 10 subsequent interviews.ResultsThematic saturation was reached when 33 individuals (75.8% female, mean age ± standard deviation [SD] 73.7±10.9 years) were included. A total of 44 lower level concepts were extracted and summarized into 6 higher level concepts. They included (i) a general positive attitude toward COVID-19 measures, (ii) challenges of being isolated from the community, (iii) deterioration of health status, (iv) difficulties with measures due to their health condition, (v) lack of physical contact and (vi) lack of information versus overload. Participants suggested environmental adaptations for strengthening resilience in people at increased risk of severe illness from COVID-19.ConclusionStrategies and interventions are needed to support people at risk under pandemic conditions. Their perceptions and needs should be addressed to reduce the potential deterioration of health conditions and ensure well-being even during prolonged periods of crisis.Supplementary InformationThe online version of this article (10.1007/s00508-021-01979-9) contains supplementary material, which is available to authorized users.

The design and implementation of age-related HR practices across firms in institutional contexts: evidence from Thailand

PurposeThis paper aims to examine the design and implementation of age-related human resource (HR) practices across organizations located in the institutional contexts of the under-researched emerging market economy of Thailand.Design/methodology/approachA cross-case analysis of five organizations is conducted across industries. The empirical evidence in this paper draws on semistructured interviews and focus groups with older workers of each organization, semistructured interviews with top managers and/or HR managers of each organization, field visits to each organization located in Bangkok and other provinces in Thailand and a review of archival documents and Web-based resources.FindingsThis paper proposes that firms design and implement various age-related HR practices, including the extension of the retirement age, financial planning facilitation, the bundling of maintenance and the bundling of utilization, to ensure that older workers in their firms maintain their current level of functioning to cope with the problem of skill shortage in the Thai labor market, have sufficient savings after retirement to respond to the “productivist informal security” welfare state regime and return to previous levels of functioning after facing losses in their careers.Research limitations/implicationsDue to the fact that this research is based on case studies of age-related HR practices in five firms across industries in Thailand, the findings may not be generalizable to all other firms across countries. Rather, the aim of this paper is to enrich the discussion regarding the design and implementation of age-related HR practices in organizations. Another limitation of this research is that it does not include firms located in several industries, such as the financial services industry and the education industry. Future research may explore age-related HR practices in organizations located in these industries. Moreover, quantitative studies using large samples of firms across industries might also be useful for fostering an in-depth understanding of the design and implementation of age-related HR practices in organizations.Practical implicationsThis paper provides practical implications for top managers and/or HR managers of firms in Thailand and other emerging market economies. That said, these top managers and/or HR managers can implement age-related HR practices to respond to the problem of skill shortage in the labor market, ensure that older workers have sufficient savings after retirement and help older workers return to previous levels of functioning after facing deterioration in health conditions and/or losses in their careers.Social implicationsThis paper provides policy implications for the government and/or relevant public agencies of Thailand and other emerging market economies that still face a severe skill shortage problem. Older workers who possess tacit knowledge and valuable experience and are still healthy can be considered excellent alternates for firms to help alleviate the skill shortage problem in the labor market. However, firms should implement age-related HR practices to retain this group of employees overtime.Originality/valueThis paper contributes to the literature on comparative institutionalism and human resource management, specifically regarding age-related HR practices, in the following ways. First, this paper examines how firms design and implement age-related HR practices to respond to the country’s macro-level institutions. Additionally, in this paper, the author triangulates the findings from older workers with those from employers to ensure that actual HR practices perceived by older workers are in line with HR practices perceived by top managers and/or HR managers. Moreover, the literature on age-related HR practices has likely overlooked emerging market economies, including the under-researched country of Thailand, because most studies in this area have focused on developed economies. Therefore, the findings in this paper provide an in-depth analysis of the design and implementation of age-related HR practices across firms located in the emerging market economy of Thailand to respond to the national institutional context.

Relationships Between Climatic Variables and Tree-Ring Width of Silver Fir (Abies alba Mill.) in Kozara National Park (Bosnia and Herzegovina)

Silver fir (Abies alba Mill.) is the most common conifer species in Bosnia and Herzegovina. The paper describes the development of a silver fir master tree-ring chronology from Kozara National Park and analyzes the influence of the climate conditions on tree-ring widths. The knowledge concerning the effect of climate on cambium activity and, as a result, on tree growth is of great importance for silviculture, which is particularly complex in terms of deterioration of health condition. Four sites were selected for sampling at Kozara National Park. At each sampling site, 15 dominant trees were drilled with Pressler’s increment borer at breast height. The development of chronology included three steps: i) cross-dating of a series of tree-ring width and checking of their quality using the COFECHA program, ii) data standardization in the ARSTAN program, and iii) master chronology development. Correlation analysis was performed in order to determine the links between tree-ring width and climate (primarily temperature and precipitation). In the 88-year-long master chronology, pointer years analysis identified five positive and nine negative years. Correlation analysis revealed that precipitation had stronger and more significant impact on silver fir radial growth, particularly at the beginning of the growing season, in April and May (r=0.175 and r=0.318, respectively), and in the crucial July−September period (r in the range of 0.143−0.222). The highest negative correlation coefficient with temperature was determined for September of the previous year (r=-0.282) and then for summer months (July and August) of the current year (r=-0.184 and r=-0.272, respectively). In addition, statistically significant correlation between radial growth and the Forestry Aridity Index was determined (r=-0.390). The results of tree-ring width climate analysis obtained in this study are in accordance with other studies carried out in Bosnia and Herzegovina and in the surrounding area.

Evaluation of vernacular and new housing indoor comfort conditions in cold climate – a field survey in eastern Turkey

PurposeThe purpose of this study is to compare vernacular and new houses in terms of indoor occupant satisfaction and thermal and visual comfort in a region with cold climatic conditions. In line with the data obtained, the contribution of passive design techniques to comfort in housing indoor will be revealed.Design/methodology/approachIn this study, the comfort conditions to be provided in a residence were determined and evaluated in Bingol with the help of questionnaires applied on vernacular and new houses. The information gathered from the occupants and the survey study was mainly designed for three purposes: (i) acquiring general information about houses; (ii) acquiring general information about occupants; and (iii) inquiring about the physical comfort satisfaction of the occupants (thermal comfort and visual comfort).FindingsAlthough the average occupant satisfaction in terms of thermal performance in vernacular houses in summer and winter is 3.91, this average is 2.01 for new houses. The average of the general visual comfort of occupants in vernacular houses is 3.59, whereas this rate is 2.63 in new houses. According to the data obtained, occupant satisfaction was higher in vernacular houses than in new houses. In general, the new settlement area is designed and positioned independently of climate and environmental conditions. This situation increases the need to use mechanical systems to provide indoor thermal comfort conditions. The increase in the need for mechanical systems leads to a significant increase in energy expenditures, as well as deterioration of health conditions in places.Research limitations/implicationsTo ensure occupant satisfaction, indoor thermal comfort conditions and healthy environments, vernacular houses should be an example for the design and building of new houses in terms of orientation, environment relations, space dimensions and space usage in accordance with the character of the region and material selection.Originality/valueThere has not been a serious research on bioclimatic, socioeconomic and cultural sustainability of the vernacular architecture of Bingol. Therefore, this region has been preferred as the study area.

Gender and sexual rights: their implications on health and healthcare.

This article is an objective examination of aspects of gender and sexual rights, and their implications in the field of health field, using the methodology of an essay. The first part discusses femicide, highlighting that there are deaths of women due to the fact of being women, which constitute what could be described as the crimes of lèse-humanité or 'femi-genocide'. The second part discusses sexual and gender diversity, with an emphasis on the fragility of the 'right to have rights' expressed in the deterioration in health conditions of the population that is LGBTI (Lesbians, Gays, Bisexuals, Transvestites, Transsexuals and Intersex). Finally, the essay discusses recognition of gender plurality, and the limitations imposed on the rights of non-usual normativebodies bodies; criticism is directed at reiteration of the binary and cisgender normative ethos, which can exacerbate the health vulnerability of people with trans and other non-normative bodies and identities. It is concluded that, in the 30 years' existence of Brazil's Unified Health System (SUS), there have been advances in the political sphere, many of them created by or as a result of social movements, and initiatives that seek to confront femicide and the inadequate assistance available to LGBTI people. In the context of these challenges, it is reiterated that there is a necessary relationship between promotion of health and protection of human rights related to gender and sexuality.

RECREATIONAL INFLUENCE ON THE CONDITION AND STRUCTURE OF FOREST SHELTER BELTS

The influence of recreation of varying intensity on the health condition and structure of forest shelter belts formed by common oak (Quercus robur L.) and green ash (Fraxinus lanceolata Borkh.) is estimated. The long-term impact of recreational pressure on shelterbelts that were identical at the time of creation was evaluated. It was found that the long recreational influence of different intensity leads to a significant decrease in the stocking of the tree stand (by 27.5%), changes in the stand structure, deterioration of health condition (in the S-2 section, the health condition index was І.7 and in the S-1 section, ІІ.3) and a decrease in the average diameter of the trees (by 20.5 %). In addition, such an effect led to a significant reduction in the density, both for advance growth (by 73.5 %) and undergrowth (71.3 %), which ultimately affected the change in the openness of the vertical profile of the shelterbelt. Frequently, uncontrolled burning of refuse and dry grass by recreators provoked the emergence of surface fires and additional weakening of the trees in the stand (the health state of damaged trees fluctuated within the 3-4 category of health condition) as well as partial destruction of the advance growth and undergrowth. Cenomorphic analysis of forest phytocoenoses by Belgard revealed the predominance of ruderants. Sylvants (typical species for the forest) and Pratants (steppe species) are represented by three species and have occurred seldomly.

A medical resource allocation model for serving emergency victims with deteriorating health conditions

Large-scale disasters typically result in a shortage of essential medical resources, and thus it is critical to optimize resource allocation to improve the quality of the relief operations. One important factor that has been largely neglected when optimizing the available medical resources is the deterioration of victims’ health condition in the aftermath of a disaster; e.g., a victim’s health condition could deteriorate from mild to severe if not treated promptly. In this paper, we first present a novel queueing network to model this deterioration in health conditions. Second, we provide both analytical solutions and numerical illustrations for this queueing network. Finally, we formulate two resource allocation models in order to minimize the total expected death rate and total waiting time, respectively. Numerical examples are provided to illustrate the properties of optimal policies.

The Longitudinal Relationship Between Depressive Symptoms and Disability for Older Adults: A Population-Based Study

Although depressive symptoms in older adults are common, their relationship with disability and the influence of disability on the development of depressive symptoms over time is not well understood. This longitudinal study investigates the change trajectories of both depressive symptoms and disability, as well as their associations over time. Participants included 442 community-dwelling older adults living in Taiwan, aged 65 years or older, who completed six waves of survey interviews. Depression was scored with the Short Psychiatric Evaluation Schedule and disability with the instrumental and physical activities of daily living measure during each consecutive data collection wave. The autoregressive latent trajectory model and parallel latent growth curve modeling were adopted for analysis of the data. The autoregressive latent trajectory model highlights that previous depressive symptoms (and disability) significantly contributed to the advancement of more severe depressive symptoms (and disability). This model also indicates that disability significantly contributed to the onset of depressive symptoms and vice versa. The parallel latent growth curve modeling highlights that the disability intercept had significant effects on the depressive symptoms intercept, as did the depressive symptoms on disability. Furthermore, the disability slope had significant effects on the slope of the depressive symptoms. These findings demonstrate that disability is a stronger predictor of depressive symptoms than depressive symptoms are of disability. In addition, the prior existence of a health condition will lead to further deterioration of health conditions and that they often coexist.

Estimaciones acerca de la salud de poblaciones que ocuparon las Sierras Centrales y Planicies Orientales (Córdoba, Argentina) en el Holoceno Tardío: una aproximación desde la antropología dental)

El objetivo de este trabajo es analizar desde una perspectiva bioarqueológica las condiciones generales de salud de las poblaciones humanas que ocuparon la región austral de las Sierras Pampeanas en el Holoceno tardío (ca. 2500-400 años A.P.), particularmente a través del estudio de bioindicadores dentales tales como hipoplasias del esmalte dental, abscesos y pérdidas dentales ante mortem. Se analizó una muestra de 80 individuos adultos de ambos sexos, procedentes de 48 sitios de toda la región. Se calcularon prevalencias por sexo, edad, cronología -Holoceno tardío inicial (ca. 2500-1500 años AP.) y final (ca.1500-400 años AP)-, así como sub-regiones geográficas - Sierras Chicas, Noreste, Noroeste, Llanura extraserrana, Sur y Traslasierra-. Posteriormente, se evaluó si las diferencias observadas eran significativas o no, mediante la aplicación del test de Chi-cuadrado (X2). Los resultados indican que las poblaciones asentadas en la región hacia momentos finales del Holoceno tardío habrían sufrido un deterioro en las condiciones generales de salud, principalmente los individuos adultos jóvenes y medios de toda el área, siendo mayor la intensidad en las sub regiones Noreste y Traslasierra.

A dominance approach to the appraisal of the distribution of well-being across countries

This paper proposes a dominance approach to study inequality of well-being across countries. We consider a class of well-being indices based on the three attributes used in the HDI (Human Development Index). Indices are required to satisfy: preference for egalitarian marginal distributions of income, health and education, ALEP substitution of attributes and priority to poor countries in allocating funds to enhance health and education. We exhibit sufficient conditions for checking dominance over the defined class of well-being indices. We apply our method to country data from 2000 to 2005. The deterioration in health conditions in poor countries is why welfare improvements at the world level cannot be ascertained.

Healers, Healing, and Child Well-being: Ideologies, Institutions, and Health in Latin America and the Caribbean

From Popular Medicine to Medical Populism: Doctors, Healers, and Public Power In Costa Rica, 1800-1940. By Steven Palmer. (Durham, NC: Duke University Press, 2003. Pp. 329. $69.95 cloth, $22.95 paper.) Race, Place, And Medicine: The Idea of the Tropics in Nineteenth-Century Brazilian Medicine. By Julyan G. Peard. (Durham, NC: Duke University Press, 1999. Pp. 315. N.p.) The Tale Of Healer Miguel Perdomo Neira: Medicine, Ideologies, And Power in yhe Nineteenth-Century Andes. By David Sowell. (Wilmington, DE: Scholarly Resources, 2001. Pp. 171. $55.00 cloth, $19.00 paper.) Healing Cultures: Art snd Religion ss Curative Practices in the Caribbean snd its Diaspora. Edited by Margarite Fernández Olmos and Lizabeth Paravisini-Gebert. (New York: Palgrave, 2001. Pp. 236. $45.00 cloth.) The Child in Latin America: Health, Development, and Rights. Edited by Ernest J. Bartell and Alejandro O'Donnell. (Notre Dame, IN: University of Notre Dame Press, 2001. Pp. 378. $50.00 cloth, $22.50 paper.) Minor Omissions: Children in Latin American History and Society. Edited by Tobias Hecht. (Madison: University of Wisconsin Press, 2002. Pp. 277. $45.00 cloth, $21.95 paper.) As scholars from a wide range of disciplines are increasingly discovering, Latin America and the Caribbean provide rich and complex venues in which to examine the worlds of sickness, healing, and healers. Virtually every setting in the region can point to a growing bibliography on themes, including the protean but growing state role in regulating [End Page 176] the public's health; the social cleavages and mutual values revealed during particular epidemics; medical professionalization and the emergence of healing hierarchies; and the political and ideological shaping of medicine, both domestically and internationally. The blossoming of work in this area stems from a variety of factors, ranging from institutional developments—such as the marvelous research and teaching resources at the Casa Oswaldo Cruz in Rio de Janeiro—to the establishment of specialized journals and networks of scholars, to contemporary political concerns about the breakdown of social policies and the deterioration of health conditions across the region, to theoretical and conceptual trends relating to contact and conflict among different healing cultures. The books reviewed in this essay cover several of the most dynamic themes in this literature: the complicated relationship among physicians, competing medical ideologies, and the state; the historic and contemporary vibrancy and demand for a wide array of healers and healing systems; and the health and social conditions of children, past and present. In a previous LARR review essay on this field of inquiry (34, no.3, 1999), Ann Zulawski pointed out that the new generation of scholars of medicine and society in Latin America had invariably rejected an older belief in the enlightened diffusion and progress of Western ideas and practices in the Americas. By aiming their critique at the rise of medical hegemony, however, some of the studies of the 1990s unwittingly repeated the unidirectional diffusion narrative but interpreted it as a form of social control and professional self-interest. In a matter of just a few years, a more finely hued tableau has been painted of places and periods of medical syncretism, of fierce rivalries, and of the coexistence—sometimes uneasy, sometimes happy—of a range of healing cultures. Steven Palmer's From Popular Medicine to Medical Populism: Doctors, Healers, and Public Power in Costa Rica, 1800-1940 is among the finest of these new histories of medical and health institutionalization in Latin America. Beautifully written and drawing from an impressive range of archival sources, journals and newspapers, legal proceedings, and personal reports, he traces the intersecting trajectories of herbalists, empirics, midwives, pharmacists, several grades of doctors, and other healers from colonial times to the launching of Costa Rica's modern exemplar of rapid public health advancement. Palmer's overarching argument is that—although Costa Rica exhibited most of...

Reforms And Performance of the Medical Systems in the Transition States of the Former Soviet Union and Eastern Europe

The States of the former Soviet Union and eastern Europe inherited acute health problems and introduced numerous reforms in their health sectors in the 1990s. In the initial years of transition most countries experienced increases in morbidity and mortality that were caused by deterioration in health conditions (demographic, consumption, social, environmental) and deficiencies in medical systems. The latter were the result of malfunctioning economies, continued low priority status of health, and ineffective health reforms. Although health trends in the East have become more positive in recent years, they are unlikely to converge rapidly with those in western Europe unless health sector institutions in transition countries are allocated more resources and improve their efficiency and effectiveness.

Morbidité, mortalité et réformes du système de santé dans les États en transition de l'ex-U.R.S.S. et de l'Europe de l'Est

The countries of the former Soviet Union and Eastern Europe have experienced increases in morbidity and mortality in both command and transition periods. These adverse trends in health production have been caused both by deterioration in health conditions (demographic, consumption, environmental) and by problems in medical systems and supporting health institutions, such as pharmacies and pharmaceutical industry enterprises. Determinants of the deficiencies in medical care have been the malfunctioning of command and transition economic systems and the continued low priority status of health sectors. Effective reforms of health institutions would result in improvements in the performance of medical systems and national health indicators. However, health sector reforms in most countries in the 1990s have been flawed in design and implementation and have had modest beneficial impacts. Although health trends in the East have become more positive in recent years, they are unlikely to converge rapidly with those in Western Europe unless health sector institutions in transition countries obtain more resources and improve their efficiency and effectiveness.