Prevalence Of Specific Diseases Research Articles

Epidemiology of Viral Infectious Diseases Reported in Saudi Arabia.

Efficient epidemiological monitoring of virus diseases is crucial in evaluating general public health, the prevalence of specific diseases, the pattern of spread, and implementing preventative and control strategies into action. This study analyzed data obtained from the Field Epidemiology Program (FETP) which is part of the Ministry of Health (MOH) in Saudi Arabia, which contained reported cases of infectious diseases over four years, from January 2018 to December 2021, to investigate and highlight the significant trend and incidence rate for each viral infectious disease. Of the reported viral infectious diseases, hepatitis B and C, dengue fever (DF), influenza, chickenpox, and measles were the highest reported viral cases over four years. For the aforementioned diseases, males were often more susceptible to viral infections than females. Except for DF, this viral infection was more common in Saudi citizens. Viral illnesses like hand, foot, and mouth disease were less prevalent, while neurological viral disorders such as acute flaccid paralysis were rarely detected. There was an overall reduction in viral cases recorded during 2020-2021, which may be attributed to the implementation of preventive measures during the Coronavirus Disease 2019 (COVID-19) pandemic or an underreporting of cases during the lockdown of that time. The prevalence of these common viral infections in the Saudi population suggests that understanding the mechanisms influencing changes in these viruses, methods of transmission, and the burden of these diseases is a priority for health policy. This understanding is necessary to develop effective intervention and preventive strategies.

Reduction of adverse outcome due to COVID-19 infection in a high-risk population: evaluation of an informative intervention through active call by General Practitioners

currently, individuals at risk of adverse outcomes for COVID-19 can access to vaccination and pharmacological interventions. But, during the first epidemic wave, there were no treatments or therapeutic strategies available to reduce adverse outcomes in patients at risk. to assess the impact of an intervention at 15-month follow-up developed by the Agency for Health Protection of the Metropolitan Area of Milan (ATS Milan) based on telephone triage and consultation by the General Practitioners (GPs) for patient with high-risk for adverse outcomes. intervention on population. a total of 127,292 patients in the ATS aged ≥70 years and with comorbidities associated with an increased risk of dying from COVID-19 infection were identified. Using a specific information system, patients were assigned to their GPs for telephone triage and consultation. GPs inform them about the risks of the disease, non-pharmacological prevention measures, and precautions in contacts with family members and other persons. No specific clinical intervention was carried out, only an information/training intervention was performed. by the end of May 2020, 48.613 patients had been contacted and 78.679 had not been contacted. Hazard Ratios (HRs) of infection hospitalisation and death at 3 and 15 months were estimated using Cox regression models adjusted by confounder. no differences in gender, age class distribution, prevalence of specific diseases, and Charlson Index were found between the two groups (treated such as called patients and not called). Called patients had a higher propensity for influenza and antipneumococcal vaccination and have more comorbidities and greater access to pharmacological therapies. Non-called patients have a greater risk for COVID-19 infection: HR was 3.88 (95%CI 3.48-4.33) at 3 months and 1.28 (95%CI 1.23-1.33) at 15 months; for COVID-19 hospitalization HR was 2.66 (95%CI 2.39-2,95) at 3 months and 1.31 (95%CI 1.25-1.37) at 15 months; for overall mortality HR was 2,52 (95%CI 2.35-2:72) at 3 months and 1.23 (95%CI 1.19-1.27) at 15 months. the results of this study show a reduction in hospitalization and deaths and support, in case of pandemic events, the implementation of new care strategies based on adapted stratification systems in order to protect the population's health. This study presents some limits: it is not randomized; a selection bias is present (called patients were those most in contact with the GPs); the intervention is indication-based (on march 2020, the actual benefit of protection and distancing for high-risk groups was unclear), and the adjustment is not able to fully control for confounding. However, this study points out the importance to develop information systems and improve methods to best protect the health of the population in setting of territorial epidemiology.

FLEXIBILITY IN PRIMARY HEALTH CARE DESIGN IN MARGINAL AREAS

This research focuses on the analysis of Primary Health Care facilities located in rural areas. The health facility for primary care is the minimum unit of a complex system since it can be extended and implemented with other services and functions in the future. The most helpful method to develop the basic health unit in a small hospital will mainly depend on the nature of the expertise area, the living conditions of the community and its particular needs, and the prevalence of specific diseases and socio-cultural conditions. This study adopted a mixed-methods focused on analyzing the literature review of the principles of flexibility and evaluating the design of ten international primary care facilities. The factors that influence the design of the architectural space have been analyzed under three macro requirements: expansibility, versatility, reversibility. These macro aspects have been investigated in three criteria relating to form, space, and structure. The intersection of each case study with the three requirements of expansibility, versatility, and reversibility highlighted the flexibility requirements met. The expansibility requirement was not achieved, as the buildings analyzed were designed as finished units with no possibility of extension in the future. Therefore, it is necessary to pay more attention to the architecture of the primary health care facilities during the planning and design phase to accommodate changing needs. Only an integrated approach can make steady progress on social and health care conditions improving community’s needs in marginal areas.

FLEXIBILITY IN PRIMARY HEALTH CARE DESIGN IN MARGINAL AREAS

This research focuses on the analysis of Primary Health Care facilities located in rural areas. The health facility for primary care is the minimum unit of a complex system since it can be extended and implemented with other services and functions in the future. The most helpful method to develop the basic health unit in a small hospital will mainly depend on the nature of the expertise area, the living conditions of the community and its particular needs, and the prevalence of specific diseases and socio-cultural conditions. This study adopted a mixed-methods focused on analyzing the literature review of the principles of flexibility and evaluating the design of ten international primary care facilities. The factors that influence the design of the architectural space have been analyzed under three macro requirements: expansibility, versatility, reversibility. These macro aspects have been investigated in three criteria relating to form, space, and structure. The intersection of each case study with the three requirements of expansibility, versatility, and reversibility highlighted the flexibility requirements met. The expansibility requirement was not achieved, as the buildings analyzed were designed as finished units with no possibility of extension in the future. Therefore, it is necessary to pay more attention to the architecture of the primary health care facilities during the planning and design phase to accommodate changing needs. Only an integrated approach can make steady progress on social and health care conditions improving community’s needs in marginal areas.

Mortality and Morbidity Among Persons Deprived of Liberty During the COVID-19 Pandemic in Brazil.

Health EquityVol. 5, No. 1 Letter to the EditorOpen AccessCreative Commons licenseMortality and Morbidity Among Persons Deprived of Liberty During the COVID-19 Pandemic in BrazilMatheus Lins-Rocha, Liliane Lins-Kusterer, José Menezes, and Ailton MeloMatheus Lins-Rocha*Address correspondence to: Matheus Lins-Rocha, ML, Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Rua Doutor Augusto Viana, S/N—Canela, Salvador 40110-060, Brazil, E-mail Address: matheuslins@linselins.com.brhttps://orcid.org/0000-0002-8682-0901Postgraduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil.Postgraduate Program in Law, Governance and Public Policy, Salvador University—UNIFACS, Salvador, Brazil.Search for more papers by this author, Liliane Lins-Kustererhttps://orcid.org/0000-0003-3736-0002Postgraduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil.Search for more papers by this author, José Menezeshttps://orcid.org/0000-0001-7839-7931Postgraduate Program in Law, Governance and Public Policy, Salvador University—UNIFACS, Salvador, Brazil.Search for more papers by this author, and Ailton Melohttps://orcid.org/0000-0001-7457-0573Postgraduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil.Search for more papers by this authorPublished Online:20 Aug 2021https://doi.org/10.1089/heq.2021.0057AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Dear Editor:In Brazil, persons deprived of liberty (PDL) have a high risk of COVID-19 infection due to the overcrowded and deficiently ventilated cells, restricted access to basic sanitation, and a lack of health units.1 Brazilian health services in prisons should be distributed according to the prison population and organized following the national primary care model, achieving the universality of the Unified Health System and guaranteeing the constitutional right to health for prisoners.2 Brazilian prisons present considerable challenges for the implementation of preventive health policies. A recent ecological study evaluated the five Brazilian macro-regions, including the Federal District. Results showed 14 spatial risk clusters for COVID-19 among PDL, and the highest-risk cluster was in the Federal District.1The health of PDL is not an object of great concern by society. The provision of specialized health services has declined during the COVID-19 pandemic in Brazil. In this context, a similar or even worse situation is expected to occur concerning the health of Brazilian prisoners. We compared general morbidity and mortality of prisoners in the State of Bahia, Brazil, in the second half of 2019 and the first half of 2020.A retrospective study analyzed data from the Brazilian Penitentiary statistical information system (INFOPEN),3 for the State of Bahia, Brazil, concerning periods before (second half of 2019) and at the beginning of (first half of 2020) the COVID-19 pandemic. Prevalence of specific diseases and mortality rates for the two semesters were compared by using the OpenEpi tool (www.OpenEpi.com).4Comparing the two semesters, the prevalence of other causes of illness increased substantially among men (13.1 times) and women (5.98 times). A decrease (29%) in the prevalence of tuberculosis among men was also observed. Mortality by criminal causes and suicide increased 7.92 and 3.17 times among men, comparing semesters before and during the COVID-19 pandemic. Women accounted for 2.8% and 3.3% of the prisoners' total populations, in the first half of 2019 and 2020, respectively. There was only one case of death in the first half of 2020 (Table 1).Table 1. Prevalence (per 10,000) of Diseases and Mortality (per 100,000) per Cause in Persons Deprived of Liberty According to Sex and Semester, State of Bahia, BrazilDisease/sex2019 (second half)2020 (first half)PR (2020.1/2019.2)95% CInPrevalencenPrevalenceMale (n=14,687)Male (n=13,911) Hepatitis5940.26848.91.210.85–1.72 HIV155105.5145104.20.980.78–1.23 Syphilis422287.3374268.90.930.81–1.07 Tuberculosis169115.111582.70.710.57–0.91 Others96.111280.513.16.67–25.90Female (n=421)Female (n=469) Hepatitis247.5121.30.450.04–4.93 HIV10237.510213.20.900.38–2.13 Syphilis18427.525533.01.250.69–2.25 Tuberculosis247.500.0—— Others371.320426.45.981.79–20.0Cause2019 (second half) (n=14,687)2020 (first half) (n=13,911)MRR (2020.1/2019.2)95% CInMortalitynMortalityMale Health causes854.514100.61.850.77–4.40 Suicide213.6643.13.170.64–15.70 Criminal427.230215.77.922.80–22.47 Unknown427.2321.60.790.18–3.54 Total18122.653381.03.111.82–5.30Source: Sistema de Informações do Departamento Penitenciário Nacional, 2019.MRR, mortality rate ratio; PR, prevalence ratio..A report issued by the Catholic Church in Brazil entitled The Pandemic of Torture in Prison, published by the Prison Ministry Office of the Bishops' Conference of Brazil, registered 90 complaints of ill treatment. The complaints included physical abuse, humiliating treatments, deprivations, and violations of the constitutional right to health care in PDL.5,6 Most of the complaints were ignored by judiciary authorities. Of the 90 reported complaints, only 8 were followed by an investigation.6The advent of the COVID-19 pandemic was associated with changes in disease prevalence and mortality among PDL in the State of Bahia penitentiary system. We emphasize the increase of violent deaths, reflecting the stressful situation of the inmates. Public Policies for PDL need to be effective in reducing the number of crimes or enabling the reintegration of prisoners into society. They should also include health accessibility, and guarantee constitutional humans rights, preventing violence and torture.

Determinants of General Health Status and Specific Diseases of Elderly Women and Men: A Longitudinal Analysis for Western and Eastern Germany

We used the panel data of the German Life Expectancy Survey (LES) for analysing the impactof specific life conditions on the gender-specific health outcome of respondents aged 60+ atfollow-up over a period of 13 years (for western Germany) and 7 years (for eastern Germany)respectively. For western Germany we extended the analysis by additional information aboutlife course experiences with unemployment, smoking behaviour, reproduction history andmigration background. We analysed self-rated general health as well as the self-reportedabsence and prevalence of specific diseases which are directly related to the main causes ofdeath and disabilities. Moreover, we analysed death and attrition as competing risks atfollow-up in order to control for selection effects to the health outcome. The analysis wasseparated by sex to account for gender-specific life conditions. The results confirm existingknowledge regarding socioeconomic differences and offer insights into the influence of healthlifestyles, in particular sports activity and smoking history. Further, associations were foundbetween the earlier presence of diseases and the health condition at follow-up. Genderdifferences in health outcomes are partly explained by the higher mortality of males and thehigher number of non-respondents among females. The study extends the knowledge aboutrisk factors for health in Germany by a longitudinal approach and emphasises the importanceof earlier life stage intervention to reduce disease-specific risk factors.

Emerging trends in childhood blindness and ocular morbidity in India: the Pavagada Pediatric Eye Disease Study 2

To discuss the aims, methods, and results of a population-based cross-sectional prevalence survey of children ≤15 years, in South India and compare it with a study conducted earlier, in the same area. We also discuss the changing trends in the domain of childhood blindness in India. A population-based cross-sectional prevalence survey of children ≤15 years, in Pavagada and Madhugiri taluks of Tumkur district in Karnataka state in south India, was conducted in 2 phases. One trained medical-social-worker and one field-investigator identified eligible children and brought them to a makeshift clinic in the village school, where they were examined by an ophthalmologist. Children with minor problems were treated on the field and those with major conditions were referred to the pediatric ophthalmologist in the tertiary hospital. The prevalence of specific diseases were calculated in percentages. The prevalence of childhood ocular morbidity (COM) was 6.54%. Refractive errors (2.77%) constituted the major cause of COM. The prevalence of blindness (best corrected visual acuity of <3/60 in the better eye) was 0.09%. Whole-globe anomalies (25%) and uveal coloboma (25%) constituted the main cause of blindness. A major proportion of the blindness was due to unavoidable causes. Unlike several earlier studies, corneal blindness is no longer the main cause of blindness. This shows that there is a changing trend in the pattern of childhood blindness in India. The current data demonstrate the need for low vision rehabilitative services and a review of public health strategy in India.

Chang Gung Research Database: A multi-institutional database consisting of original medical records

BackgroundThe Chang Gung Research Database (CGRD) is a de-identified database derived from original medical records of Chang Gung Memorial Hospital (CGMH), which comprises seven medical institutes located from the northeast to southern regions of Taiwan. The volume of medical services performed in CGMH is large, and clinical and scientific studies based on the CGRD are reported to be of high quality. However, the CGRD as a useful database for research has not been analyzed before. The objective of the study was to analyze the CGRD with regard to its characteristics and coverage of Taiwan's population. MethodsWe performed a nationwide cohort study using population-based data from the Taiwan National Health Insurance Research Database (NHIRD). All patients who had any medical record of outpatient visits or admission between January 1, 1997, and December 31, 2010, were included, and the sex ratio, age distribution, socioeconomic status, urbanicity, severity of illness, prevalence of specific disease, and coverage of the CGRD were analyzed. ResultsThe sex ratio, age distribution, socioeconomic status, and urbanicity of the population of the CGRD are different from those of Taiwan NHIRD and medical centers in Taiwan (all the pairwise p < 0.05). The severity of comorbidities, and prevalence of specific diseases of the population of the CGRD are significantly higher than those of Taiwan NHIRD and medical centers in Taiwan for both outpatient and inpatient samples (all the pairwise p < 0.05). The overall coverage of the CGRD was 21.2% for outpatients and 12.4% for inpatients. The disease-specific coverage of the CGRD was 27–34% for outpatients and 14–21% for inpatients. ConclusionsThe CGRD is a multi-institutional, original medical record-based research database with high overall and disease-specific coverage of Taiwan. The population of the CGRD has significantly higher severity of comorbidities, and prevalence of specific diseases than those of Taiwan NHIRD and medical centers in Taiwan.

Insights into Population Health Management Through Disease Diagnoses Networks

The increasing availability of electronic health care records has provided remarkable progress in the field of population health. In particular the identification of disease risk factors has flourished under the surge of available data. Researchers can now access patient data across a broad range of demographics and geographic locations. Utilizing this Big healthcare data researchers have been able to empirically identify specific high-risk conditions found within differing populations. However to date the majority of studies approached the issue from the top down, focusing on the prevalence of specific diseases within a population. Through our work we demonstrate the power of addressing this issue bottom-up by identifying specifically which diseases are higher-risk for a specific population. In this work we demonstrate that network-based analysis can present a foundation to identify pairs of diagnoses that differentiate across population segments. We provide a case study highlighting differences between high and low income individuals in the United States. This work is particularly valuable when addressing population health management within resource-constrained environments such as community health programs where it can be used to provide insight and resource planning into targeted care for the population served.

Bedside Education Will Be More Important than Now in the Age of Artificial Intelligence

The birth of the scientific revolution, brought forth by Vesalius and Copernicus in 1543, marked the beginning of a new age. However, the changes such as treatment effectiveness, survival rate, prevalence of specific diseases, etc. had not yet become clear during the 16th century. In the early 17th century, Boerhaave emphasized bedside teaching and practice. His attitude influenced numerous students and educators, so many medical students visited hospital wards where he worked. From the late 18th to 19th centuries, Jenner’s smallpox vaccination, Pasteur’s anthrax and rabies vaccinations, and Koch’s four postulates used to detect pathogens were developed using the scientific research method, which initiated big changes for medicine. Flexner, credited for reporting the new medical education system, adopted scientific medicine. He believed medical students must study basic medical science since it could be the foundation of clinical medicine and lead to a revolution in the field. He proposed a new medical curriculum composed of two-years of basic medicine and two-years of clinical medicine, which has been used more than 100 years. During the late 20th century, bedside teaching rounds decreased gradually as scientific medicine has become popular. Many medical educators in many articles have proposed bedside education as an effective method for medical learning. Despite the advent of the age of artificial intelligence and the changing of medical environments in the near future, bedside education will be more useful and important for medical students, educators, and patients as it is a traditional method and essential for patients who desire a more personal approach.

Incidence and effects of diseases in sheep in Uttar Pradesh

The present study was undertaken to analyze the incidence and effects of diseases in Sheep. The prevalence of specific diseases (42.0%) (FMD 11.7% and HS 30.30%) were more prominent followed by parasitic diseases (18%) digestive diseases (18%) and respiratory diseases (18.0%). while reproductive and other diseases (enterotoxaemia, skin infections) were also prevalent at lower morbidity rate (2.0%) in the study area. Lambs were highly affected by parasitic diseases (41.67%). In young stocks the highest proportional morbidity rate was observed due to digestive diseases (26.32%) while in adults other diseases (4.0%) had high morbidity. Males were affected more by specific diseases (48.72%) followed by parasitic diseases (23.08%). But in females, highest proportional morbidity rate was observed due to respiratory diseases (22.95%). The highest mortality was due to specific diseases (41.86%) followed by parasitic diseases (20.93%) and digestive diseases (20.93%). The analysis of the data on the effect of disease on wool yield in sheep did not reveal any significant difference in wool reduction due to pasturellosis and circling diseases. Overall wool reduction due to both diseases was (44.88%) but pasturellosis had higher effect (44.94%) than circling disease (44.76%) on wool production in sheep.

Childhood Health: Trends and Consequences over the Life Course

This article first documents evidence on the changing prevalence of childhood physical and mental health problems, focusing on the development of childhood health conditions in the United States. Authors Liam Delaney and James Smith present evidence on the changing prevalence of childhood chronic conditions over time using recalled data as well as contemporaneous accounts of these childhood health problems. The raw data from both sources show sharp increases in the prevalence of most childhood physical health problems (such as asthma, allergies, respiratory problems, and migraines) over time. However, inferring trends is difficult because such data are also consistent with improved detection of childhood disease, and many of the causes of childhood disease have not worsened over time. Conclusions about rapidly rising rates of childhood physical health problems over time are premature at best, especially concerning the magnitude of trends. Documenting real changes in the prevalence of specific diseases is a high-priority research topic. In contrast, the evidence is much stronger that childhood mental health problems are becoming worse. The authors next present new evidence on the effects of early childhood physical and mental problems on health and economic status in adulthood. They find that both childhood physical and mental health problems contribute significantly to poorer adult health. However, they also find that childhood mental health problems have much larger impacts than do childhood physical health problems on four critical areas of socioeconomic status as an adult: education, weeks worked per year, individual earnings, and family income. Finally, the authors examine evidence regarding the efficacy of early mental health treatment for children in terms of promoting good health later on. Existing studies suggest that a combination of cognitive behavioral therapy and medication appears to be effective in the treatment of both anxiety and depression in children. However, much more research is needed on the efficacy of these childhood interventions into adulthood. Clinical trials have been too short to evaluate the long-term impacts of various forms of treatment, and these impacts are definitively long term.

Medical therapy of pericardial diseases

The treatment of pericardial diseases is largely empirical because of the relative lack of randomized trials compared with other cardiovascular diseases. The main forms of pericardial diseases that can be encountered in the clinical setting include acute and recurrent pericarditis, pericardial effusion with or without cardiac tamponade, and constrictive pericarditis. Medical treatment should be targeted at the cause of the disease as much as possible. However, the cause of pericardial diseases may be varied and depends on the prevalence of specific diseases (especially tuberculosis). The search for an etiology is often inconclusive, and most cases are classified as idiopathic in developed countries where tuberculosis is relatively rare, whereas a tuberculous etiology is often presumed in developing countries where tuberculosis is endemic. The aim of the present article is to review current medical therapy for pericardial diseases, highlighting recent significant advances in clinical research, ongoing challenges and unmet needs. Following a probabilistic approach, the most common causes are considered (idiopathic, viral, tuberculous, purulent, connective tissue diseases and neoplastic pericardial disease). In this article, the therapy of idiopathic and more common forms of infectious pericarditis (viral and bacterial) is reviewed.

Quantitative health impact assessment modelling

Health Impact Assessment (HIA) is spreading as a tool for policy and decision making. An important stage of HIA is to predict the future health consequences of implementing a potential decision in order to raise the level of knowledge for making the final decision. This journal published an editorial on HIA in November 2008 [1]. This editorial expanded the issue with the quantitative approach to HIA – in some parts of the international literature also called public health models. Long before the concept of HIA was established and the first practical guidance was published [2] and a state-of-the-art book printed [3], activities with the purpose of developing public health models were in progress for making scenarios of the future health effects of changing exposure to determinants of health and with a focus on health improvement interventions. Because of increasing computational ability simple causal models have been succeeded by models handling more complex causality webs. Some methods are based on dynamic micro-simulation techniques and model, for instance, individual life courses where shifts between states (e.g. unexposed, exposed, healthy, ill and dead) operate by transition probabilities. Generally, the use of these models is limited because of scarce data. Other models operate on aggregated data and are often restricted as to their ability to handle different topics. Typically, the models include input data such as prevalence of exposure to risk factors, incidence or prevalence of specific diseases, death rates and estimates from epidemiological studies on the association between risk factors and diseases or death. Because of the aim of evaluating the future consequences of health promotion interventions the models also include parameters of latency and lag time and data on the demographic evolution. Complementary to quantifying reduction in disease incidence or number of deaths or quantifying life years gained by health promotion interventions, summary measures of population health have been introduced in order to facilitate comparisons between various health states and across different population strata or to make comparisons between policies involving different fields easier. Thus, quality-adjusted life years (QALYs) is a composite measure of health-related quality of life developed by health economists and originally used with the purpose of comparing the health outcome of different medical therapies or interventions on patients suffering from the same specific disease, or to compare health care or therapeutic outcomes for patients suffering from different diseases. Summary measures of population health such as QALYs and health expectancy (i.e. average lifetime in a specific state of health) are increasingly important measures incorporating and summing up knowledge from different epidemiological evidence and with the characteristic feature to comprehend the possibility of comparisons between various population groups [4,5]. Disabilityadjusted life years (DALYs) is another popular indicator that combines mortality and disability. DALYs has been extensively used in the global burden of disease studies [6]. Diseases of the circulatory system are still highly frequent (despite many years of decline), and during the last three decades there has been a lot of focus on epidemiological research on these deceases and on

„Sind Reiche gesünder?”

The aim of this study was to determine representative nationwide data on differences in the prevalence of specific diseases between socioeconomic groups. The "First National Health Survey for the Federal Republic of Germany" was conducted from October 1997 to March 1999 in the form of a standardized cross-sectional questionnaire study. The data were elicited about the 35 most common diseases and socioeconomic status. The net sample was made up of a total of 7125 persons aged 18 to 79. A significantly higher prevalence in subjects of lower socioeconomic status was identified for typical orthopaedic diseases as well as for hypertension, chronic bronchitis, gastric and vascular disease. The most apparent socioeconomic difference to the detriment of socially deprived subjects was identified for addiction disease and diabetes. In contrast, numerous allergic diseases such as food allergies, urticaria, and allergic diseases of the respiratory tract and eyes were approximately twice as common among members of higher socioeconomic groups. Various gastrointestinal and renal diseases (hepatitis, gastritis, pyelonephritis) were also more common in higher socioeconomic groups. These socioeconomic differences were still apparent after adjustment for age and gender. This study provides representative socioeconomic group-specific prevalence data on a total of 35 clinical entities for the Federal Republic of Germany. Although the self-reporting involved in large epidemiological studies of this kind is associated with a certain amount of bias, it is nonetheless clear that the frequently cited "socioeconomic gradient", i. e., a higher disease prevalence among lower socioeconomic groups, seems not to apply for numerous disease entities; for which the association seems to be in the opposite direction. This phenomenon requires explanation.

Pharmacoepidemiology in developing countries--what can ISPE do?

Rational use of drugs and drug safety monitoring have become matters of life and death throughout the world during the last decades. These issues are of even greater concern in developing countries because of their limited economic resources their less than ideal health conditions their large populations which make any control programme difficult and their high prevalence of specific diseases. In developed countries pharmacoepidemiology has the potential whether as an academic or a service discipline to fill the gap between basic pharmacology science and its application to practice in populations. Unfortunately most developing countries have failed to recognize pharmacoepidemiology as a service specialty and have neglected its potential contribution to the solution of major health care problems. As a result pharmacoepidemiology studies are sporadic and rare in this part of the world - a multifaceted problem which will be discussed below. (excerpt)

Obstetric and gynecological care for Third World women

The particular characteristics required for women's health care in the Third World are compared with these in developed countries. Women of the Third World present a different prevalence of specific diseases and give less attention to symptoms and to preventive measures. The health system is usually not well adapted to respond to these problems. Examples of the differences between the needs of health care of Third World women and those of developed countries are taken from certain aspects of pre-natal care, from the prevention of cancer of the cervix and from family planning. A critical analysis of the prevalent characteristics of women's care in the Third World was undertaken. As a result some basic points to be considered in the implementation of women's health care for the Third World were proposed: (1) avoid the uncritical simple replication of developed country's models; (2) application of a larger proportion of the resources to primary health care; (3) a more aggressive attitude to improve preventive measures; (4) efforts to maintain a continuous and non-sporadic contact between the health system and the target population; (5) greater attention to reference and contra-reference to improve the integration of the various levels of the health system; (6) delegation of functions from physicians to paramedical personnel; (7) emphasis on health education, both formal and in the day-to-day contact between health agents and target population.