Epidemiological Transition Model Research Articles

Navigating Nigeria's Health Landscape: Population Growth and Its Health Implications.

This comprehensive analysis examines the multifaceted impacts of population growth on public health in Nigeria. Drawing parallels with Omran's epidemiological transition model (that focuses on the intricate means that patterns of health and illness are changing, as well as the relationships that exist between these patterns and the sociological, demographic, and economic factors that influence them) and referencing experiences from Chile and Ceylon. The study highlights a substantial rise in Nigeria's population causing a double burden of infectious and non-communicable diseases, leading to higher morbidity, and mortality rates, increased healthcare costs, decreased productivity, and health inequalities, posing significant challenges to the country's healthcare system. Furthermore, the correlation between low education levels and health outcomes underscores the importance of addressing systemic deficiencies in Nigeria's educational sector. The article emphasizes the urgent need for strategic interventions to mitigate the adverse effects of population growth on health. Recommendations include revitalizing primary healthcare centers, fostering public-private partnerships to enhance healthcare accessibility, leveraging technological advancements like telemedicine, and promoting initiatives to improve nutrition and environmental sustainability. Moreover, prioritizing education on reproductive health and family planning emerges as a crucial strategy to manage population growth sustainably. In conclusion, the article underscores the imperative for collaborative efforts across sectors to navigate Nigeria's evolving health landscape amidst increasing population growth. By implementing targeted policies and interventions, Nigeria can strive toward achieving universal health coverage, enhancing health outcomes, and ultimately raising the standard of living for its populace.

ON EPIDEMIOLOGICAL TRANSITION MODEL OF THE EBOLA VIRUS IN FRACTIONAL SENSE

ON EPIDEMIOLOGICAL TRANSITION MODEL OF THE EBOLA VIRUS IN FRACTIONAL SENSE

The Phenomenon of Epidemiological Transition in Health and the Necessity to Update

The epidemiological transition is a global shift from communicable diseases to non-communicable diseases and injuries, impacting health and demographic indicators. The four-stage demographic transition model illustrates the evolution of population dynamics, with the epidemiological transition model overlaying disease patterns. Egypt-born demographer Omran classified transitions into “Classic,” “Accelerated,” and “Delayed” models, emphasizing the interplay between mortality decline, fertility, and healthcare demands. The Global Burden of Disease (GBD) assesses causes of deaths, disabilities, and risk factors, revealing a shift from communicable to non-communicable diseases worldwide. In India, a significant portion of the population faces a rising burden of non-communicable diseases, particularly ischemic heart disease, chronic obstructive pulmonary disease, and stroke. Health transitions in diseases, demography, donor assistance, and domestic financing in India have implications for the healthcare system. Epidemiological transition levels (ETL) vary across states, affecting vulnerable populations like the elderly and urban women. Challenges arise from a double burden of disease, emphasizing the need for comprehensive policies, awareness, and improved accessibility. Risk factors like malnutrition, air pollution, and high blood pressure contribute to the disease burden. It is concluded by advocating for tailored interventions, utilizing the socio-ecological model, and emphasizing the importance of ongoing research in addressing emerging health challenges.

Epidemiological transition and the dual burden of communicable and noncommunicable diseases in Zimbabwe

Background: The epidemiological transition model, coined by Abdel Omran in 1971, building on the demographic transition theory developed by Frank Notestein in 1945, has been largely credited for describing epidemiological situations both globally and nationally in many parts of the world. However, owing to its origins in the United States of America (USA), scholars critique the model's applicability to various geographical, socioeconomic, and epidemiological contexts, which are diversely different from the USA and vary from region to region. It was imperative to test the applicability of this model in sub-Saharan Africa (SSA), particularly Zimbabwe to ascertain versatility in describing epidemiological transitions, predicting population health status and whether the assumption of a shift from communicable diseases (CDs) to noncommunicable diseases (NCDs) could be confirmed in a low-income developing nation focusing on Zimbabwe. Methods: The study was a retrospective document review case study, using the existing framework of the epidemiological transition model, as a guiding principle, applying the model to describe the demographic and epidemiological circumstances prevailing within Zimbabwe. The researcher reviewed, compared, analyzed, and described the existing literature on population dynamics and epidemiological profile of the country for the period 1990–2020. Results: The epidemiological transition model attempts to describe the changes in epidemiological circumstances both at national and global scales. The model presumes a shift in CDs to NCDs. However, many scholars question the applicability of the model to diverse contexts, particularly within the SSA context. The Zimbabwean case was considered in light to its rising population growth, dual burden characterized by a high burden of communicable and rising NCDs. Findings from this study indicate that NCDs are on the rise in Zimbabwe. However, owing to a high burden of CDs, a dual disease burden model is the best fit to explain the epidemiological transition currently obtaining within Zimbabwe. Conclusions: Consequentially, funding streams targeting CDs should take heed of the currently obtaining epidemiological situation in the country and respond by challenging funding to public health interventions with a view to address the rising NCDs. Further, public health authorities should craft Public health policies that create supporting environments conducive for the populace to fight NCDs. Informed by the Ottawa charter, reorientation of health services to ensure more health systems responsiveness in the face of emerging NCDs is imperative. In addition, developing interpersonal skills for individuals to be able to act against NCD's risk behaviors and factors is key; at the same time, strengthening community action by capacitating community health workers to address risk behaviors and factors associated with NCDs at community level is imperative. Finally, the inadequacy of the epidemiological transition model inadvertently challenges epidemiologists to step up efforts to review, refine, and extend the model to suit SSA countries like Zimbabwe and elsewhere countries in similar circumstances.

How interdisciplinary research at the crossroad between socio-cultural anthropology, nutritional and physical activity physiology can help addressing the obesity epidemic

• Biological, behavioral and eco-anthropological factors contribute to weight gain. • Interdisciplinary research is needed to assess the respective role of these factors. • Pre-industrial populations who are ongoing transitions are an excellent study model. • Longitudinal studies tracking these populations are therefore needed. Despite large global initiatives to manage obesity, its prevalence reaches pandemic levels. A potential reason is that the complex interactions between biological, behavioral, and socio-ecological factors and their respective role in the regulation of body weight (BW) and fat mass are still not well understood. Our view is that as long as physical activity (PA) is above a certain level, diet, genes and other factors play a role, but their contribution is less pronounced. However, PA levels below a certain threshold uncouple energy intake and energy needs, and impair metabolic control, thus promoting long-term excessive BW and fat mass gain. Technological advances of the past centuries have most likely decreased PA below this threshold in our societies. The epidemiological transition model summarizes the changes in lifestyle, diet and PA that initiated the onset of obesity in Westernized countries. We believe that to identify which factors pose the greatest risk for excessive BW gain, scientists need to study lifestyles, diet, PA and the metabolism of pre-industrial populations, who are undergoing this transition, in a comprehensive metabolic, behavioral and socio-anthropological approach. Here we are presenting the related state-of-the-arts, current gaps in knowledge and future directions. Malgré les programmes de santé publique mis en place à travers le monde, la prévalence de l’obésité atteint des niveaux pandémiques. Une des raisons possibles est que les interactions complexes entre les facteurs biologiques, comportementaux et socio-écologiques, ainsi que leur rôle respectif dans la régulation du poids corporel et de la masse grasse ne sont toujours pas bien compris. Notre groupe de recherche souscrit à l’hypothèse selon laquelle tant que l’activité physique est supérieure à un certain niveau, le rôle de l’alimentation, des gènes et des autres facteurs reste. En revanche, dès que le niveau d’activité physique passe en dessous d’une certaine valeur seuil, les apports énergétiques et les besoins énergétiques sont découplés, et le contrôle métabolique altéré. L’ensemble de ces changements favorise une prise de poids et de masse grasse excessive à long terme. Les progrès technologiques de ces derniers siècles ont très probablement fait baisser l’activité physique en dessous de ce seuil dans nos sociétés occidentales. Le modèle de la transition épidémiologique résume les changements de l’alimentation, de l’activité physique et de la culture ou modes de vie qui ont déclenché l’apparition de l’obésité. Nous pensons que pour identifier les facteurs qui présentent le plus grand risque pour une prise de poids excessive, les scientifiques doivent étudier le métabolisme, l’alimentation, l’activité physique et le mode de vie des populations préindustrielles. Nous présentons ici un modèle de travail expliquant comment les facteurs proximaux et distaux contribuent à une prise de poids, et les lacunes actuelles dans les connaissances et les orientations futures.

Candidemia in the intensive care unit: A 12-year retrospective cohort study in Reunion Island

ObjectivesWe aimed to describe the epidemiology of Candida bloodstream infection in an intensive care unit (ICU) in Reunion Island. MethodsWe performed a retrospective cohort study and evaluated 63 candidemia episodes, which occurred between January 2004 and December 2015 in the ICU of a University Hospital in St-Pierre. ResultsThe incidence rate of candidemia in the ICU was estimated at 7.6%. Candida albicans was the most common yeast pathogen species recovered (54%), followed by Candida glabrata (17%), Candida tropicalis (12%) and Candida parapsilosis (10%). Between 2012 and 2015, we also observed a modification of antifungal use. ConclusionThe epidemiology of candidemia in Reunion Island is characterized by the predominance of Candida albicans and by the relative importance of Candida tropicalis. This pattern corresponds to a model of epidemiological transition between the one usually observed in tropical areas and the one observed in temperate countries.

Are my Values Different from Yours? The Value of Coronary Artery Disease Invasive Care in Brazil

Coronary Artery Disease (CAD) has been consistently associated with the leading cause of death and disability in most western industrialized countries since the mid-1950s. Although it still has a major impact on the health of society in these countries, CAD rates have considerably decreased in recent decades. There are significant differences in the prevalence of CAD, as different world regions face varying stages of this epidemic. An epidemiological transition model for cardiovascular disease describes a series of stages starting from [...]

Epidemiological Status in Selected States of India: Causes of Death Analysis

Epidemiological Status in Selected States of India: Causes of Death AnalysisAbstract Number:1768 Rahul Koli* Rahul Koli* IIPS,India, India, E-mail Address: [email protected] Search for more papers by this author AbstractEpidemiological Status in selected states of India: Causes of death analysis Name of author: Rahul Koli1 PhD Scholar,IIPS,Mumbai,India. India has experienced important improvements in its health situation in recent decades, but the health gap between different community and within state is still a significant problem. India now finds itself in the half way of third stage of epidemiological transition model, as the country is definitely struggling with a triple health burden.Objectives To understand and explore the differential in epidemiological status among selected states of India To assess the sex differentials in leading causes of death in selected states Methodology The data has been taken from ‘Medical certification of causes of Death’ for five states i.e. Andhra Pradesh, Karnataka, Maharashtra, Manipur and Delhi. The present study classifies the different causes of death clubbed taking into consideration the nature of cause of death in three broad groups – communicable diseases, non- communicable diseases and other causes of death. The age group is taken as ,<1,1-4,5-14,15-24,25- 34,35-44,45-54,55-64,65-69,70+. Result andConclusion The states like Karnataka, Andhra Pradesh, and Delhi are having more than 50 years of life expectancy, decrease in IMR value and communicable disease, which can be a possible indication that these states are in the halfway of third stage of epidemiological transition, which was given by Omran in 1971. But the states like Maharashtra and Manipur the situation is quite different compared to other states, in these two states life expectancy is higher with lower IMR and deaths due to non-communicable disease is more than 60% but in recent years there is possibility of re-emergence of infectious and parasitic disease made a huge contribution to the increase of communicable deaths. All states are under double burden of disease of communicable and non- communicable, while Delhi is under triple burden of disease.

Modelos conceptuales y paradigmas en salud pública

The epidemiological transition model proposed by Omhran at the beginning of the 1970s (decreased fecundity rate and increased life expectancy), together with modifications in lifestyles and diet, showed increased mortality due to chronically degenerative causes. This essay thus discusses and makes a comparative analysis of some currents of thought, taking as its common thread an analysis of epidemiological change identified in different eras or stages and relationships with some public health models or conceptual frameworks. Discussing public health paradigms leads to a historical recapitulation of conceptual models ranging from magical-religious conceptions to ecological and socio-medical models. M. Susser proposed 3 eras in this discipline's evolution in his speech on the future of the epidemiology. The epidemiological changes analysed through different approaches constitute elements of analysis that all models discussed in this essay include to delimit the contributions and variables so determining them.

Further evidence for epidemiological transition hypothesis for elderly suicides.

:Background:A developmental model of epidemiological transition for elderly suicide rates with four sequential stages has been developed to simultaneously explain cross-national variations in elderly suicide rates, trends over time for elderly suicide rates and age-associated trends in suicides rates reported in the literature. This model was supported by demonstration of a curvilinear (inverted U-shaped curve) relationship between elderly suicide rates and socio-economic status fitting the quadratic equation Y = A + BX - CX2 (where Y is the suicide rate, X is the socio-economic status and A,B, and C are constants) in both sexes. However, this relationship was derived from a cross-sectional study and, therefore, only an association can be inferred. One way to substantiate this further would be to examine the above curvilinear relationship between suicide rates and socio-economic status in a series of younger age-bands because a large part of the epidemiological transition hypothesis was contingent upon the impact of socio-economic status, through a series of mechanisms, on life expectancy. It was hypothesized that the curvilinear (inverted U-shaped curve) relationship between suicide rates and socio-economic status would be absent in younger age-bands and may be present in the younger age-bands closer to the older age-bands (i.e. 45-54 years and 55-64 years).Methods:The curvilinear relationship between suicide rates in five age-bands 15-24 years to 55-64 years in both sexes and gross national domestic product (GDP), a measure of socio-economic status, fitting the above quadratic equation was examined with curve estimation regression model using data from the World Health Organization.Results:In males in the age-bands 35-44 years, 45-54 years and 55-64 years there was a statistically significant curvilinear (inverted U-shaped curve) relationship with GDP and fitted the quadratic equation Y = A + BX - CX2; this relationship was absent in males in the age-bands 15-24 years and 25-34 years. In females in the age-bands 45-54 years and 55-64 years there was a statistically significant curvilinear with GDP (inverted U-shaped curve) and fitted the quadratic equation Y = A + BX - CX2; this relationship was absent in females in the age-bands 15-24 years, 25-34 years and 35-44 years.Conclusions:Although caution should be exercised in accepting the model of the epidemiological transition hypothesis for elderly suicide rates because it had been generated from cross-sectional data using an ecological design, the findings of the current study of suicide rates in younger age-bands provide support for this hypothesis.

The changing disease-scape in the third epidemiological transition.

The epidemiological transition model describes the changing relationship between humans and their diseases. The first transition occurred with the shift to agriculture about 10,000 YBP, resulting in a pattern of infectious and nutritional diseases still evident today. In the last two centuries, some populations have undergone a second transition, characterized by a decline in infectious disease and rise in degenerative disease. We are now in the throes of a third epidemiological transition, in which a resurgence of familiar infections is accompanied by an array of novel diseases, all of which have the potential to spread rapidly due to globalization.

Mortalidad por cáncer infantil en Chile: Modelo de transición epidemiológica en la infancia

ABSTRACT Pediatric cancer mortality in Chile. Model of epidemiological transition in infancy Background: The process of demographic and epidemiological transition that occurred in Chile during thesecond half of the 20 th century has been broadly described, with special emphasis in adults diseases. Objective: Characterize the process of epidemiological transition in infancy, using as model a disease thataffects exclusively this age group (i.e. childhood cancer). Method: The trend of childhood cancer mortalityrate and its proportion of deaths in relation to other diseases was analyzed for the period 1960-2000. Results: Childhood cancer mortality rate reduced 41.4% between 1960 and 2000 (5.8 to 3.4/100 000 childrenyounger than 15-years old), mainly as a consequence of important advances in technology and publichealth organization. On the contrary, childhood cancer proportion of deaths increased 11-fold during thesame period of time (4 to 43/1 000 children younger than 15 years-old), mainly as a consequence ofreduction in transmittable diseases and malnutrition mortality rates.

Health in China and India: A cross-country comparison in a context of rapid globalisation

China and India are similarly huge nations currently experiencing rapid economic growth, urbanisation and widening inequalities between rich and poor. They are dissimilar in terms of their political regimes, policies for population growth and ethnic composition and heterogeneity. This review compares health and health care in China and India within the framework of the epidemiological transition model and against the backdrop of globalisation. We identify similarities and differences in health situation. In general, for both countries, infectious diseases of the past sit alongside emerging infectious diseases and chronic illnesses associated with ageing societies, although the burden of infectious diseases is much higher in India. Whilst globalisation contributes to widening inequalities in health and health care in both countries – particularly with respect to increasing disparities between urban and rural areas and between rich and poor – there is evidence that local circumstances are important, especially with respect to the structure and financing of health care and the implementation of health policy. For example, India has huge problems providing even rudimentary health care to its large population of urban slum dwellers whilst China is struggling to re-establish universal rural health insurance. In terms of funding access to health care, the Chinese state has traditionally supported most costs, whereas private insurance has always played a major role in India, although recent changes in China have seen the burgeoning of private health care payments. China has, arguably, had more success than India in improving population health, although recent reforms have severely impacted upon the ability of the Chinese health care system to operate effectively. Both countries are experiencing a decline in the amount of government funding for health care and this is a major issue that must be addressed.

The importance of the socioeconomic status of countries for mental disorders in old age: development of an epidemiological transition model

The prevalence of a disorder is a function of the incidence of the disorder and the duration of the illness (which may remit spontaneously, by treatment or death). The socioeconomic status of societies may influence the incidence and duration of mental illnesses in old age by influencing life expectancy and availability of appropriate healthcare services and treatments (Suh and Shah, 2001). The relationship between a proxy measure of the socioeconomic status (per capita gross national domestic product (GDP)) and (i) the life expectancy, (ii) child mortality rates and (iii) proxy measures of the quality and quantity of available healthcare services (the proportion of GDP spent on health, per capita expenditure on health and child mortality rates) was examined. The WHO website (www.who.int/countries/en/) provided data on these variables for 191 of the 192 countries for the year 2002. The inter-correlations between all the measured variables were examined using Pearson's correlation coefficient. Because of highly significant inter-correlations between all these variables, multiple linear regression analysis, with the Enter method, was undertaken with per capita GDP as the dependent variable, and all the variables that were significantly correlated with per capita GDP on univariate analysis as the independent variables.

Cancer incidence in Martinique: a model of epidemiological transition

In this paper, we present data from the Martinique Cancer Registry for the period 1981-2000 and interpret cancer incidence trends in the light of risk factor patterns. In Martinique, cancer data are available from 1981. The sources of information are represented by insurance records, medical evacuations, hospitals and laboratory files. We performed a Mantel-Haenszel chi test stratified on age in order to assess time trends and to compare incidence rates between men and women over the whole period. A total of 8992 incidents of cancer cases were recorded during the last 20 years among men and 6832 in women. (The overall age-standardized incidence rate is 222 per 10 person-years for men and 145 per 10 person-years for women.) The most common cancers are prostate cancer in men (104 per 10 person-years) and breast cancer in women (42 per 10 person-years). Except for thyroid and salivary gland cancer, men experienced higher incidence rates for all other cancers. Incidence of prostate cancer in men, breast cancer in women and colorectal cancer in both sexes strongly increased between 1981-1990 and 1991-2000, whereas no significant variation was observed for that of all digestive cancers together. Among women, cervical cancer incidence strongly decreased. These results demonstrate that Martinique tends to have the same cancer risk profile as France Mainland with, however, higher incidence rates for cervical, stomach and prostate cancer. Changes in lifestyle and greater accessibility to diagnostic and therapeutic procedures, in particular screening, have strongly contributed to the 'epidemiological transition' observed.

Transición epidemiológica: la otra cara de la moneda

The model of epidemiological transition proposed by Omram explains the changes in disease patterns in communities. In societies with a high level of development this model has been complemented with the study of the post transition process. In this context, the emergence of allergic diseases, asthma and subsequently, of autoimmune diseases, has reached worrisome proportions in some countries, and no model can explain these changes. The hygiene theory supported by Strachan gives a reasonable explanation to this phenomenon. It postulates that the reduction of early exposure to biological agents, along with an improvement of sanitation conditions, immunizations and medical therapies, causes an asymmetrical immunological response, favoring the expression of Th2 response. The hygiene theory does not fully explain by itself what is happening in developed countries and it is not universally accepted. Chile is experiencing an epidemiological transition from a high burden of infectious diseases to a growing prevalence of non communicable diseases. In a previous similar setting in developed countries, there is some evidence to suspect that asthma, allergic and autoimmune diseases are becoming part of the epidemiological situation of Chile.

Changing health in China: re-evaluating the epidemiological transition model

This paper reviews the changing health situation in China, which has shown remarkable improvement in the 50 years since the founding of the People’s Republic of China (PRC) in 1949. At first sight this improving health situation follows the classical epidemiological transition model. Just three decades ago health in China was characterised by high rates of infectious disease and early mortality (diseases of poverty) in a mainly peasant society. More recently infectious disease rates have decreased, with corresponding and extended morbidity and mortality associated with an aging population in a rapidly urbanising society. This process has given rise to new health problems, including chronic and degenerative diseases (diseases of affluence). Nonetheless, while there is some validity in the application of the epidemiological transition concept, further analysis demonstrates that China faces a new epidemiological phase, characterised by increasing life expectancy and diseases of affluence coupled with the emergence and re-emergence of infectious diseases. We demonstrate that China’s state policy plays a major role in defining the parameters of health in a Chinese context. We conclude that, today, China is faced with a new set of health issues, including the impact of smoking, hypertension, the health effects of environmental pollution and the rise of HIV/AIDS; however, state policy remains vital to the health of China’s vast population. The challenge for policy is to maintain health reform whilst tackling the problems associated with rapid urbanisation, widening social and spatial inequalities and the emergence of HIV/AIDS and other infectious diseases.

Epidemiological transition: Model or illusion? A look at the problem of health in Mexico

This paper discusses the validity of the epidemiological transition model to interpret changes in the structure of mortality and morbidity. Epistemological and political questions are posed. The case of Mexico is used to illustrate the limitations its use imposes on understanding the constellation of components explaining the epidemiological profile, and the problems involved in designing a public health policy on the basis of this sort of misinterpretation. It is suggested that the illusory certainty of a pre-determined destiny distorts the prospective that would enable to construct scenarios; what is actually happening remains hidden by the model and health policies are designed without adequate parameters for evaluating their effective impact. We conclude with some remarks on the usefulness of constructing alternative forms of interpretation for understanding changes in the epidemiological profile, one of the most important inputs for designing better policies to face the challenges posed by health care and dealing with illness in modern-day societies.

Book Review

Bowling , A. Research Methods in Health: Investigating Health and Health Services . Buckingham : Open University Press , 2002 , £22.50 , xiv + 486pp . ISBN 0335206433 (pbk) . I welcomed the opportunity to read this book as I was aware of, but not familiar with, the first edition. The book has the laudable and ambitious aim of providing a comprehensive overview of the theory and practice of health services research for ‘students and researchers of health and health services, health professionals and policy-makers’. It begins with a section on the scope of health services research before dealing briefly with the philosophy and principles of research. The remaining three sections cover the practicalities of quantitative and qualitative methods. The first two sections were disappointing. A challenge faced by health professionals and policy makers who are interested in research, and one alluded to by the author in the preface, is coming to grips with sociological and psychological jargon. Sections 1 and 2 do little to this address this. Throughout, there are numerous examples of repetition and lack of clarity. For example, when discussing Parsons’ Sick Role, the author states: ‘The sick role is functional for society because the individual is permitted to break the rules, but only if the obligations (which are functional for society) are met’. A similar lack of clarity is seen in relation to the use of the word ‘paradigm’. It is adequately defined on page 119 but is used elsewhere to indicate a type of psychological study and in the glossary to mean ‘a set of ideas (hypotheses) about the phenomenon under enquiry’. In addition, new terms, such as ‘epidemiological transition model’, are introduced without explanation and there are several unsubstantiated and unlikely statements, such as: ‘those on lower incomes … have further to travel to health care facilities’. A further weakness of the earlier sections is the uncritical inclusion of dated literature, like that relating to gender and illness behaviour. Although this provides the reader with a broad historical perspective of the theories and concepts discussed, it would be more useful for the target audience if the literature had been reviewed more critically in order to highlight the important contemporary debates, especially in a second edition. Of the six chapters in the first section, only Chapter 4, on health economics, stood out as being clear, concise and informative. Unfortunately, lack of clarity also pervaded the last section of the book. For example, statements such as, ‘Qualitative methods are less obtrusive than quantitative methods’ are made without explanation. This statement would obviously not be true if comparing a short postal questionnaire with an in-depth interview. In addition, some statements suggest a more fundamental lack of understanding of qualitative research. For instance, it is implied that relatively small samples are used in qualitative studies because of the prohibitive cost of collecting and analysing qualitative data, and that small samples lead to ‘questionable representativeness of the data’. The author then suggests that ‘The [qualitative] sample . . . could, in theory, be randomly selected to satisfy generalisability, although given the small numbers usually required, the chances of the sample being representative of a wider population of interest are usually slim’. Throughout the book, reading was made difficult and irritating by frequent graphical errors (e.g. Friedson instead of Freidson), by grammatical errors (e.g. ethical committees instead of ethics committees) and by sloppy writing (e.g.‘men have higher mortality patterns [it should be “rates”] than women’). Of the chapters in sections 3 and 4, some of the later, more practical ones provided straightforward advice on how to go about specific aspects of research. The chapters dealing with questionnaire design and preparation of quantitative data for coding and analysis were particularly clear and comprehensive. There is no question that an all-encompassing text on health services research is desirable in principle. After reading this book, however, I question whether such a text can be successfully written by a single author. The value of the book is that it indicates the diversity and scope of health services research. However, by aiming at comprehensive coverage, it fails adequately to explain many of the important concepts relating to the theory and practice of research. I would certainly recommend that students and health professionals refer to the chapters on practical aspects of quantitative research. However, until a clearer and more accurate text is written, I will continue to use and recommend the many excellent specialist books and articles on specific aspects of health services research.

Aspects geographiques de la mortalite en Polynesie Francaise

The fast pace of social and economic changes which have occurred in French Polynesia over the last 30 years, have made this territory a choice ground for studying trends in mortality by revealing a fast and outstanding epidemiological transition. However, the breakdown of the population in small scattered human groups raises the statistical problem of measuring mortality. The crude mortality rate has decreased steadily from 17.5/1000 in 1945-1949 to 5.3/1000 over the last five years. However, the various infant mortality rate, in spite of their decline, is still exceeding those of Metropolitan France. The contrasted trends in the causes of mortality provides a means to classify French Polynesia in the group of small fast developing countries but still ranks it far behind its 'reference models' such as Metropolitan France or the developed countries in the South Pacific, Australia and New Zealand. Moreover, there are significant regional disparities which still exist between Tahiti and the outlying archipelagoes, mainly among causes of death. As a whole, distant islands remain significantly more affected by deaths resulting from infectious and parasitic diseases, in line with the model of epidemiological transition, where as the islands of Tahiti with 70% of the total population appears as a place of cumulation of infectious and degenerative diseases, in particular of overloading and cultural problems. The centre/periphery opposition between a metropolitan country and an overseas territory repeats itself at the local level between urban and rural environments.