High-income European Countries Research Articles

Early identification and intervention services for children with autism in Vietnam.

In high income countries in Europe and North America, early identification and intervention for autism spectrum disorders (ASD) have been linked to improved long-term outcomes. However, in most low and middle income countries (LMIC) little is known about use or availability of such services, which limits the ability of policy and development planning. The purpose of the present study was assess the use of ASD services in Vietnam, an Asian LMIC, in order to identify areas within the field that should be specifically targeted to improve ASD services in Vietnam. Surveys were conducted in six different cities across Vietnam with 90 parents/caregivers of children with ASD, 115 professionals working with children with ASD, and 10 directors of agencies providing ASD services. Parents/caregivers' survey assessed demographics and information regarding their child's symptoms and services the child received. Professionals' survey assessed their demographic and professional background, the ASD services they provide, and their perspective on the quality of ASD services at their agency. Directors' survey included these same questions as well as additional questions regarding the operation of the agency. Early identification and intervention ASD services are available in Vietnam, at least in major cities. However, there is a lack of well-trained professionals, the tools used for evaluation and diagnosis are limited, outdated and unstandardized, and the quality of services is questionable. Most importantly, a scientific evidence base for services is absent, and the country lacks an official governmental policy for supporting children with ASD. Research directly assessing the quality of ASD services in Vietnam is needed. Most centrally, efforts at facilitating governmental policy and support advocacy are needed to increase the likelihood that families and children with ASD will receive appropriate and effective services.

Using mixed methods to build knowledge of refugee mental health

Mixed methods research, which combines elements of qualitative and quantitative research approaches, should be well suited to studying refugee mental health.However, thishas not yet been adequatelydiscussed nordemonstratedwithin the existingscienti¢c literature.This paper aims to begin to ¢ll this gap and describes how mixed methods have been used in refugee mental health research. Twenty-nine articles from the health and social sciences literature were systematically reviewed with a focus on study designs and key ¢ndings.The studies reviewed were mostly conducted in high income countries inEurope, Australia, and North America.The mixed methods studies largely involved surveys and interviews, and the designs were mostly sequential and explanatory. The key mixed methods ¢ndings were in the domains of loss of connection, loss of status, lack of adequate services and resilience. Onemixedmethods research example, which studied protective resources among adolescent refugees in US resettlement, is oiered to illustrate some advantages of mixed methods data collection and analysis.There is, however, a need for further research on refugee mental health which takes advantage of the full spectrum of mixed methods designs to address priority needs and questions, especially involving resilience and resilience focused interventions.

Incidence of traumatic spinal cord injury worldwide: a systematic review

Traumatic spinal cord injuries (TSCI) are among the most devastating conditions in developed and developing countries, which can be prevented. The situation of TSCI around the world is not well understood which complicates the preventive policy decision making in fight against TSCI. This study was aimed to gather the available information about incidence of TSCI around the world. A systematic search strategy was designed and run in Medline and EMBASE, along with extensive grey literature search, personal communications, website searching, and reference checking of related papers. Overall, 133 resources including 101 papers, 17 trauma registries, 6 conference proceedings, 5 books, 2 theses and 2 personal communication data were retrieved. Data were found for 41 individual countries. The incidence of TSCI ranges from 3.6 to 195.4 patients per million around the world. Australia, Canada, US, and high-income European countries have various valuable reports of TSCI, while African and Asian countries lack the appropriate epidemiologic data on TSCI. Data of epidemiologic information in TSCI are available for 41 countries of the world, which are mostly European and high-income countries. Researches and efforts should be made to gather information in developing and low-income countries to plan appropriate cost-effective preventive strategies in fight against TSCI.

Problems of world debt

This paper analyzes the problem of world debt of high-income European countries in the euro zone, the U.S., Japan and the BRIC countries with a lower level of debt as special reference to the amount of Serbia's debt to GDP ratio. Level of indebtedness occurs with increasing trade deficit and capital inflows. The ratio of debt to GDP is an important indicator. Countries with lower credit ratings have to take credits with high interest rates. But high public debt as a phenomenon has also occurred in most developed countries. A debt crisis occurs as a consequence when a country is not able to repay its debt anymore with a high inflation rate. Sustainability of public finances is in direct correlation with the level of debt in a country, its credit rating and credit risk.

Improved Nonhuman Animal Welfare Is Related More to Income Equality Than It Is to Income

The link between nonhuman animal welfare, income, and income inequality (Gini coefficient) was tested using consumption of animal products, laws protecting animals on the farm from the worst abuses, and animals used in experimentation as indicators. Experimentation on all animals and on rodents significantly increased in high-income European countries, although there was some evidence that the increase in experimentation on cats and dogs started to flatten out for the highest income countries. Consumption of all flesh products in high-income countries declined in more equal societies. More equal high-income countries also had stricter regulations protecting animals, although the same correlation was not seen between U.S. states. In New Zealand, there was some evidence that testing on cats and dogs declined during years when equality was improving. The results provide little evidence for a Kuznets effect of income on animal welfare, with the possible exception of companion animal treatment. They do, however, suggest that greater equality can be a predictor for better treatment of animals. Previous research has strongly suggested that social conditions for humans improve with greater equality. The same may be true for nonhuman animals. Alternatively, conditions conducive to improving human income equality may also lead to better animal welfare outcomes.

Foundation Activities To Improve Health Around The World

Foundation Activities To Improve Health Around The World

Trends in hypertension prevalence (1990–2005) and mean blood pressure (1975–2005) in Portugal: a systematic review

Aims. We aimed to describe the temporal trends of the mean blood pressure and prevalence of hypertension in studies that evaluated Portuguese adults. Methods. Pubmed was searched and 42 eligible studies were identified. Reference screening and data extraction were conducted independently by two researchers. We fitted linear regression models to compute ecological estimates of hypertension prevalence and mean blood pressure, adjusting for sex, age and significant interaction terms. Results. Between 1990 and 2005, the prevalence of hypertension defined as blood pressure ≥140/90 mmHg and/or drug treatment remained approximately constant in young adults and decreased in middle-aged and older adults, whereas the prevalence of self-reported hypertension increased 0.4% per year (95% confidence interval 0.1–0.7) overall. Between 1975 and 2005, mean systolic and diastolic blood pressures decreased in middle-aged and older adults, reaching a 32-mmHg decrease in systolic blood pressure among women at average age 70. Conclusion. The trends in the last decades show a decrease in blood pressure levels, probably attributable to increasing awareness and a higher treatment proportion. Although this absolute trend in blood pressure parallels the observed in other high income European countries, Portugal maintains its position above the mean levels in other Western settings.

A pearl study analysis of national neonatal, early neonatal, late neonatal, and corrected Neonatal Mortality Rates in the state of Qatar during 2011: A comparison with World Health Statistics 2011 and Qatar′s historic data over a period of 36 years (1975-2011)

Objective:To prospectively ascertain Qatar's national Neonatal Mortality Rate (NMR), Early Neonatal Mortality Rate (ENMR), and Late Neonatal Mortality Rate (LNMR) during 2011, compare it with recent data from high-income countries, and analyze trends in Qatar's NMR's between 1975 and 2011 using historic data.Study Design:A National prospective cohort-study.Materials and Methods:National data on live births and neonatal mortality was collected from all public and private maternity facilities in Qatar (1st January-December 31st 2011) and compared with historical neonatal mortality data (1975-2010) ascertained from the database of maternity and neonatal units of Women's Hospital and annual reports of Hamad Medical Corporation. For inter country comparison, country data of 2009 was extracted from World Health Statistics 2011 (WHO) and the European Perinatal Health report (2008).Results:A total of 20583 live births were recorded during the study period. Qatar's national NMR during 2011 was 4.95, ENMR 2.7, LNMR 2.2, and cNMR 3.33. Between 1975 and 2011, Qatar's population increased by 10-fold, number of deliveries by 7.2 folds while relative risk of NMR decreased by 87% (RR 0.13, 95% CI 0.10-0.18, P<0.001), ENMR by 91% (RR 0.09, 95% CI 0.06-0.12, P<0.001) and LNMR by 58% (RR 0.42, 95% CI 0.23-0.74, P=0.002). The comparable ranges of neonatal mortality rates from selected high-income West European countries are: NMR: 2-5.7, ENMR 1.5-3.8, and LNMR 0.5-1.9.Conclusions:The neonatal survival in the State of Qatar has significantly improved between 1975 and 2011. The improvement has been more marked in ENMR than LNMR. Qatar's current neonatal mortality rates are comparable to most high-income West European countries. An in-depth research to assess the correlates and determinants of neonatal mortality in Qatar is indicated.

Pharmaceutical policies in European countries in response to the global financial crisis

Objective: The objective of this paper is to analyze which pharmaceutical policies European countries applied during the global financial crisis.Methods: We undertook a survey with officials from public authorities for pharmaceutical pricing and reimbursement of 33 European countries represented in the PPRI (Pharmaceutical Pricing and Reimbursement Information) network based on a questionnaire. The survey was launched in September 2010 and repeated in February 2011 to obtain updated information.Results: During the survey period from January 2010 to February 2011, 89 measures were identified in 23 of the 33 countries surveyed which were implemented to contain public medicines expenditure. Price reductions, changes in the co-payments, in the VAT rates on medicines and in the distribution margins were among the most common measures. More than a dozen countries reported measures under discussion or planned, for the remaining year 2011 and beyond. The largest number of measures were implemented in Iceland, the Baltic states (Estonia, Latvia, Lithuania), Greece, Spain and Portugal, which were hit by the crisis at different times.Conclusions: Cost-containment has been an issue for high-income countries in Europe – no matter if hit by the crisis or not. In recent months, changes in pharmaceutical policies were reported from 23 European countries. Measures which can be implemented rather swiftly (e.g. price cuts, changes in co-payments and VAT rates on medicines) were among the most frequent measures. While the “crisis countries” (e.g. Baltic states, Greece, Spain) reacted with a bundle of measures, reforms in other countries (e.g. Poland, Germany) were not directly linked to the crisis, but also aimed at containing public spending. Since further reforms are under way, we recommend that the monitoring exercise is continued.

Prevalence of anxiety and its correlates among older adults in Latin America, India and China: cross-cultural study

BackgroundAnxiety is a common mental disorder among older people who live in the Western world, yet little is known about its prevalence in low- and middle-income countries.AimsWe investigated the prevalence of anxiety and its correlates among older adults in low- and middle-income countries with diverse cultures.MethodCross-sectional surveys of all residents aged 65 or over (n = 15 021) in 11 catchment sites in 7 countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru) were carried out as part of the 10/66 collaboration. Anxiety was measured by using the Geriatric Mental State Examination (GMS) and the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) diagnostic algorithm.ResultsThe age- and gender-standardised prevalence of anxiety varied greatly across sites, ranging from 0.1% (95% CI 0.0–0.3) in rural China to 9.6% (95% CI 6.2–13.1) in urban Peru. Urban centres had higher estimates of anxiety than their rural counterparts with adjusted (age, gender and site) odds ratios of 2.9 (95% CI 1.7–5.3). Age, gender, socioeconomic status and comorbid physical illnesses were all associated with a GMS/AGECAT diagnosis of anxiety, and so was disability (World Health Organization Disability Assessment Schedule II).ConclusionsAnxiety is common in Latin America. Estimates from this region are similar to the ones from high-income European countries found in the literature. As demographic change will occur more rapidly in these countries, further research exploring the mental health of older people in developing areas is vital, with the inclusion of other specific anxiety disorders, along with evidence for strategies for supporting those with these disorders.

Health technology assessment in Europe: Communicating and applying lessons learned from high-income countries to middle-income countries

Continuous innovation and research in health result in the development of new medical technologies. Such technologies demonstrate varying levels of costs and effectiveness, with some producing benefits at comparable or lower costs while others result in higher levels of health expenditure. European health systems are constrained by limited resources, and health managers and policymakers face choices regarding what new technologies to fund. Such decisions are increasingly supported by health technology assessment (HTA). While formal HTA agencies and networks are predominant in high-income European countries, they rarely exist in middle-income European countries. This is despite the fact that such countries have a greater need for the evidence base and cost-effectiveness of new health technologies to guide funding decisions due to lower levels of resources as well as increasing pressures from pharmaceutical and health-technology companies. High-income European countries should therefore provide technical assistance and support for their middle-income counterparts to institutionalise HTA in health policy-making across Europe.

Differences in citation rates by country of origin for papers published in top-ranked medical journals: do they reflect inequalities in access to publication?

BackgroundThe acceptance of a paper in a top-ranked journal depends on the importance of the study, and should not depend on its country of origin. If the papers' citation rate...

Children’s medicines – a global problem

It is appropriate that the first Drug Therapy section of the Archives of Disease in Childhood , which incorporates Paediatric and Perinatal Drug Therapy (PPDT) ,1 includes papers from three...

Disease burden of psoriatic arthritis compared to rheumatoid arthritis, Hungarian experiment

The objectives of this study were to assess the costs of psoriatic arthritis (PsA) in Hungary and to identify key cost drivers among demographic and clinical variables and to compare cost-of-illness of PsA and rheumatoid arthritis (RA). Cross-sectional retrospective survey of 183 consecutive patients from eight rheumatology centres was conducted. Mean direct medical, direct non medical, indirect and total costs were 1,876, 794, 2,904 and 5,574 euros/patient/year, respectively. Total costs were in significant linear relationship with health assessment questionnaire score and psoriatic area severity index. Costs of RA were higher in all domains than of PsA. Our study was the first from the Eastern European region that provides cost-of-illness data on PsA. Our study revealed that functional status and severity of skin symptoms were the key cost drivers. The costs of PsA in Hungary were lower than in the high-income European countries.

Determinants of U.S. Exports to China

This paper examines U.S. goods trade with China, focusing on the performance of exports. Throughout the analysis, we explore whether U.S. trade is unusual by contrasting it with trade from Japan and the EU-15.1 The issue is examined from three perspectives: the commodity composition of exports, the role of multinational corporations (MNCs), and the determinants of trade as specified in a formal “gravity model.” As an initial point of departure, we show that the commodity composition of U.S. exports to China is similar to the pattern of exports to the world as a whole, and that the operations of U.S. MNCs have only minor implications for trade with China. Consequently, we emphasize the estimation of a set of “gravity equations” that explore the role of market size and distance from the United States. Distance exerts a surprisingly large effect on trade. Finally, although exports to China may be a small share of U.S. GDP, they are relatively substantial compared to U.S. exports to other countries. In other words, the measure of U.S. trade performance in China is distorted by the low level of its exports to all countries. We present evidence that the United States underperforms as an exporter relative to a peer group of high-income European countries and Japan.

Political commitment to CO2 capture and storage: evidence from government RD&amp;D budgets

For CO2 capture and storage (CCS) to succeed as a mitigation strategy, political commitment is one of several prerequisites. This article offers an appraisal of political commitment to a CCS strategy among high-income countries in Europe and North America: Which governments are committed, and what particular interests and concerns do they seek to accommodate by supporting CCS? In order to answer these questions, new data are reported on government CCS research, development and demonstration (RD&D) budgets. RD&D budgets divided by GDP is used as an indicator of political commitment, and explanations are sought for cross-national differences. The analysis shows that fossil fuels reserves and extraction within a country has a very strong bearing on funding levels. Likely explanations include the potential for combining CCS with enhanced resource recovery. All large economies (population >50 million) have a funding program. The smaller states that provide funding (Norway, Canada, the Netherlands) have the highest funding levels relative to GDP. These findings suggest that high-income petroleum producing countries are likely to be leaders in promoting CCS and a favorable regulatory environment. The fact that all large, high-income countries in the two regions now display some interest in CCS further improves its political outlook.

Implementation of the Bangkok Charter on Health Promotion in a Globalized World: experience and challenges of selected high income countries in Europe

Implementation of the Bangkok Charter on Health Promotion in a Globalized World: experience and challenges of selected high income countries in Europe