Process Of Epidemiological Transition Research Articles

Public health in Kosovo after five difficult years of independence

Kosovo is undergoing a rapid process of transformation to an independent state,which was formally proclaimed in 2008, after almost a decade under United Nationsadministration. Regarding the health status, five years after independence, compared with other European countries, post-war transitional Kosovo is still characterized by higher mortality rates including traditional public health problems pertinent to infant mortality and maternal deaths. In parallel, however, Kosovo is undergoing a rapid process of epidemiological transition characterized by an aging trend which is inevitably coupled with high cardiovascular and cancer mortality and morbidity along with an excess mortality in external causes of death and injuries among the adult population. Adoption of the new Health Law in December 2012 by the Kosovo Assembly aims the transition from centralized health care system established under emergency conditions of the post-war period towards a contemporary modern health care system with a clear purchaser-provider split based on a high transparency and accountability of the health care providers and their contractors. The health care reform, leading eventually to significant changes within the health sector in Kosovo, consists of two main pillars: (i) structural and functional reorganization of the health care system through establishment of Kosovo Health Service (an autonomous and non-for-profit public enterprise at central level of the health care sector), and; (ii) establishment for the first time of the public health insurance system with a Health Insurance Fund as its main body. Nevertheless, five years after declaration of independence, Kosovo, the newest state in Europe consisting of the youngest population, is currently facing a particularly difficult socioeconomic and political transition and is additionally struggling and mainstreaming all energies and efforts in order to get full international recognition.

Estado nutricional y condiciones de vida de niños y jóvenes rurales de Tucumán, Argentina

Introducción: El objetivo del trabajo fue analizar el estado nutricional, las condiciones sociales, económicas y ambientales y los estilos de vida de escolares que residen en zonas rurales de Famaillá.Material y métodos: Se realizó un estudio observacional transversal en escolares de 10,0 a 15,9 años de edad, de ambos sexos, residentes en zonas rurales del departamento de Famaillá, Tucumán. Se efectuaron mediciones de peso y talla y para estimar el estado nutricional se calcularon los indicadores de IMC/Edad y Talla/Edad. Se utilizaron las tablas de referencia de la Organización Mundial de la Salud (OMS). Las condiciones socioeconómicas, ambientales y de estilo de vida se analizaron mediante un cuestionario que fue respondido por los escolares.Resultados: Sobre 356 escolares (196 varones y 163 mujeres), el 54,2% presentó estado nutricional adecuado; 5,6% desnutrición (3,9% Baja Talla/Edad y 1,7% Bajo IMC/Edad) y 40,1% exceso de peso (21,3% sobrepeso y 18,8% obesidad). Los resultados informaron que el consumo predominante fueron grasas saturadas, harinas refinadas y azúcares a través de panificados, bebidas azucaradas y golosinas, seguido por frutas, carnes y yogur. El 72,5% de los escolares realizaba ejercicio físico semanal y el 67,7% no superaba las 3 horas diarias frente a las pantallas de televisión y computadora.Conclusiones: La desnutrición, particularmente el retardo lineal del crecimiento, constituye una problemática vigente y coexiste con incrementos acelerados de sobrepeso y obesidad en los ámbitos rurales de Tucumán. Se reafirma la condición epidémica del exceso ponderal. Estos resultados permiten evidenciar que los procesos de transición nutricional y epidemiológica impactan negativamente en los ámbitos rurales, cuyas carencias socioeconómicas y ambientales agravan la problemática de salud pública, en una mirada prospectiva. Sin embargo, existen factores protectores en la alimentación y el estilo de vida que podrían utilizarse en la elaboración de estrategias sanitarias para mejorar el estado nutricional de estas poblaciones.

Unequal burden of mortality from gastric cancer in Brazil and its regions, 2000-2015.

Gastric cancer (GC) is an important cause of morbidity and mortality worldwide. However, population-based data on GC mortality dynamics in low and middle income countries are scarce. We analyzed GC mortality in Brazil based on all GC-related deaths registered 2000-2015. A total of 17,374,134 deaths were recorded, with GC identified in 214,808 (1.24%) cases-203,941 (94.9%) as underlying cause, and 10,867 (5.1%) as associated cause of death. Adjusted rates for age and sex was 6.85 deaths/100,000 inhabitants [95% confidence interval (CI) 6.73-6.97]. The highest mortality rates were found in males [10.00; rate ratio (RR) 1.85; 95% CI 1.78-1.91; p < 0.0001] and patients ≥ 45years of age (24.98; RR 3.79; 95% CI 3.55-4.05; p < 0.0001). The South (7.56; RR 1.62; 95% CI 1.50-1.76; p < 0.0001) and Southeast (7.36; RR 1.59; 95% CI 1.48-1.71; p < 0.0001) regions had the highest regional rates. Spatial and spatiotemporal high-risk mortality areas in 2004-2007 were located mainly in the South, Southeast, and Central-West regions. After 2008, the Northeast region became a high-risk area, especially Ceará State. GC remains a significant public health problem with high mortality burden and unequal distribution in Brazilian states. The new patterns in poorer regions and the high risk in some specific populations show a clear process of epidemiological transition over time. There is a need to strengthen nationwide epidemiological monitoring, surveillance, prevention, and control for GC in the country.

Effects of age-period and cohort on mortality due to ovarian cancer in Brazil and its regions

This article sought to evaluate the effects of age, period and birth cohort (APC) on the temporal evolution of mortality due to ovarian cancer in Brazil and its regions from 1980 to 2014. This is an ecological, time-trend study using APC models with a Baysean approach and INLA (Integrated Nested Laplace Approximations) deterministic method for parameter inference. Mortality data and population data were obtained from the Brazilian Health Informatics Department. Rates of mortality due to ovarian cancer, according to geographical region, were standardized using the direct method, after correcting deaths for undefined causes and incomplete cancer diagnosis. In the period we studied, Brazil had 4.91 deaths due to ovarian cancer per 100,000 women, the Southern (5.66) and Southeastern regions (5.70) had higher rates per 100,000 women and the Northern region had the lowest rate (3.13/100,000 women). In all regions, there was a progressive increase in mortality as ages advanced. The multivariate best fit APC model showed positive risk of death in the Central and Northeast between 2010-2014 and, beginning in 1995-1999, in the South. We also observed a positive and significant risk of death for older cohorts in the South and Southeast and a reduced risk for younger cohorts. The inverse was opposed in the Northern and Northeastern regions. The data shows a heterogeneous pattern in the temporal evolution of mortality due to ovarian cancer in the Brazilian geographical regions, which may be related to the distinct demographic and epidemiological transition processes experienced in these regions.

Cardiovascular risk factors with an emphasis on hypertension in the Mura Indians from Amazonia

BackgroundThe Brazilian indigenous population is currently undergoing a process of epidemiological transition regarding the occurrence of communicable diseases, malnutrition and non-communicable chronic diseases. Chronic non-infectious diseases are the most common causes of death worldwide, and hypertension is one of the main cardiovascular risk factors. Thus, the main objective of this paper was to evaluate the prevalence of cardiovascular risk factors, with an emphasis on hypertension, in the Mura Indians living in the municipality of Autazes in the northern Brazilian state of Amazonas.MethodsThis cross-sectional study was conducted among 455 natives (57.8% women, 42.2 ± 16.7 years) selected by simple random sampling. Sociodemographic variables, habits and lifestyles, anthropometric data, fasting glycaemia and lipid profiles were evaluated. Blood pressure was measured with a validated automatic device. Values of p ≤ 0.05 were considered significant.ResultsThe prevalence of hypertension was 26.6%. The other cardiovascular risk factors were as follows: increased waist-hip ratio (85.1%); increased neck circumference (60.2%); increased waist circumference (48.6%); overweight (57.1%); physical inactivity (52.7%); use of alcoholic beverages (40.2%); high total cholesterol (27.5%); increased triglycerides (23.5%); smoking (20.4%); and diabetes mellitus (3.0%). In relation to non-hypertensive individuals, indigenous hypertensive individuals were (p ≤ 0.05) older and had a higher proportion of individuals living with partners and individuals who were retired, as well as a lower level of schooling and higher family income. The indigenous people living in urban areas had a higher prevalence of hypertension than did those living in rural areas. In relation to habits and lifestyles, hypertensive Indians had a lower prevalence of smoking, higher frequency of the use of animal fat during meal preparation, lower frequency of vegetable oil use and lower frequency of salt addition to already-prepared meals. An assessment of anthropometric variables and laboratory markers showed that the hypertensive indigenous individuals had higher values of body mass index, neck circumference, waist circumference, visceral fat, Conicity Index, and body fat than did the non-hypertensive individuals.ConclusionThe prevalence of hypertension and other important cardiovascular risk factors in the Mura Indians was high. This finding is probably due to the adoption of inappropriate habits and lifestyles.

Health Systems Readiness to Manage the Hypertension Epidemic in Primary Health Care Facilities in the Western Cape, South Africa: A Study Protocol.

BackgroundDeveloping countries are undergoing a process of epidemiological transition from infectious to noncommunicable diseases, described by the United Nations Secretary General Ban Ki-Moon as ‘‘a public health emergency in slow motion.” One of the most prevalent in sub-Saharan Africa is hypertension, which is a complex chronic condition often referred to as a “silent killer” and key contributor to the development of cardiovascular and cerebrovascular diseases. Hypertensive patients in this setting are estimated to increase from 74.7 million in 2008 to 125.5 million in 2025, a 68% increase. However, there is an important gap between emerging high-level policies and recommendations, and the near-absence of practical guidance and experience delivering long-term medical care for noncommunicable diseases within resource-limited health systems.ObjectiveTo address this gap, our study will consist of field investigations to determine the minimum health systems requirements to ensure successful delivery of antihypertensive medications when scaling-up interventions to control the hypertension epidemic.MethodsA cross-sectional analytic study will be conducted in the Western Cape using a mixed-method approach with two semistructured interview guides. The first will be for health professionals involved in the care of hypertensive patients within at least 6 community health centers (3 urban and 3 rural) to understand the challenges associated with their care. The second will be to map and assess the current supply chain management system of antihypertensive medications by interviewing key informants at different levels of the processes. Finally, modeling and simulation tools will be used to understand how to estimate minimum numbers of health workers required at each supply chain interval to ensure successful delivery of medications when scaling-up interventions.ResultsFunding for the study was secured through a Doctoral Research Award in October 2014 from the International Development Research Centre (IDRC). The study is currently in the data analysis phase and results are expected during the first half of 2016.ConclusionsThis investigation will highlight the detailed processes in place for the care of hypertensive patients in primary health care facilities, and thus also identify the challenges. It will also describe the drug supply chain management systems in place and identify their strengths and weaknesses. The findings, along with the estimates from modeling and simulation, will inform the health system minimum requirements to scale-up interventions to manage and control the hypertension epidemic in the Western Cape province of South Africa.

Evaluation factors for determining the quality of life of physically independent elderly

Introduction: Brazil has experienced an epidemiological transition process, characterized by an aging population, with a rise in chronic diseases and reduction in infectious diseases. In this context, aging brings about the presence of multimorbidities and the use of multiple drugs associated with a worse quality of life of those people. Objectives: To analyze the determinants of quality of life in physically independent elderly. Method: Cross-sectional study of 498 elderly physically independent, divided into three groups according to the presence of comorbidities: I) Control group: no comorbidities; II) Group comorbidities: &lt;3 comorbidities; and III) multimorbidities Group: ≥ 3 comorbidities and were also stratified on the use of medications in: I) Control group: non-medicated; II) medicated Group: &lt;3 drugs; and III) polymedicated Group: ≥ 3 drugs. Structured questionnaires were applied to survey data on socio-demographic characteristics, history of comorbidities and medication use, as well as the SF-36 questionnaire as a quality of life assessment method. Results: Statistically significant differences were found in the quality of life regarding gender, educational level, economic status and multimorbidities. The results show that in elderly populations there is inequality in non-white races and among women in matters regarding access to health services. These groups show bigger probability to have more serious chronic conditions and a bad perception of health and quality of life. It is also very clear that in third world countries, a lot of elderly live in poverty having difficulties in the area of health, a major challenge to the implementation of public policies for the care of those people. Lastly, the results make it evident that the aging process has a direct relationship to the amount of installed diseases and increased use of medications. Conclusion: As much as the results showed that the decline of quality of life in physically independent elderly is related to the presence of multimorbidities and high medication intake, researchers state that people can age with a good quality of life if they opt for a successful aging process where significant activities gain space along with daily actions.

Magnitudes y tendencias de la desnutrición en la niñez argentina durante la primera década del siglo XXI

En este artículo se presentan las principales magnitudes y tendencias que caracterizan a la desnutrición en la niñez argentina en los primeros años del siglo XXI. Para abordar este problema se elaboró un indicador denominado Tasa Integral de Mortalidad por Desnutrición en la Niñez (TIMDN); se trata de un indicador de mortalidad que incluye tanto las causas directas de desnutrición (Kwashiorkor, marasmo, etc.) como aquellas asociadas a este problema, muchas veces contributarias al cuadro nutricional. Se destacan entre estas causas las patologías infecciosas, diarreas, sarampión, parasitismo, bronquiolitis, neumonía, entre otras. El análisis multi-escala diacrónico y sincrónico permitió detectar brechas, asimetrías y comportamientos diferenciados tanto en la escala provincial como regional. En efecto, pudo observarse que, mientras la tasa nacional disminuyó, operaron diferentes comportamientos tanto regionales, con distintas magnitudes y tendencias, como provinciales, con algunos casos incluso de estancamiento y aumento de la desnutrición; esto resulta contrario a lo operado en el marco nacional y relacionado con un proceso de contra-transición epidemiológica señalado para el caso argentino. Con los resultados hallados se espera colaborar en la ejecución de políticas públicas específicas para aminorar y/o erradicar el problema de la desnutrición en las provincias argentinas, atendiendo a las especificidades que le son propias en cada territorio.

Public Health in Kosovo after five difficult years of independance

Kosovo is undergoing a rapid process of transformation to an independent state, which was formally proclaimed in 2008, after almost a decade under United Nations administration. Regarding the health status, five years after independence, compared with other European countries, post-war transitional Kosovo is still characterized by higher mortality rates including traditional public health problems pertinent to infant mortality and maternal deaths. In parallel, however, Kosovo is undergoing a rapid process of epidemiological transition characterized by an aging trend which is inevitably coupled with high cardiovascular and cancer mortality and morbidity along with an excess mortality in external causes of death and injuries among the adult population. Adoption of the new Health Law in December 2012 by the Kosovo Assembly aims the transition from centralized health care system established under emergency conditions of the post-war period towards a contemporary modern health care system with a clear purchaser-provider split based on a high transparency and accountability of the health care providers and their contractors. The health care reform, leading eventually to significant changes within the health sector in Kosovo, consists of two main pillars: (i) structural and functional reorganization of the health care system through establishment of Kosovo Health Service (an autonomous and non-for-profit public enterprise at central level of the health care sector), and; (ii) establishment for the first time of the public health insurance system with a Health Insurance Fund as its main body. Nevertheless, five years after declaration of independence, Kosovo, the newest state in Europe consisting of the youngest population, is currently facing a particularly difficult socioeconomic and political transition and is additionally struggling and mainstreaming all energies and efforts in order to get full international recognition.

Divisão do trabalho odontológico em perspectiva: desafio de interpretar as competências dos técnicos

Com mais de cem anos de história, a divisão do trabalho odontológico é um processo afeto a princípios distintos, às vezes antagônicos: o profissional (social) e o administrativo (técnico/econômico). As circunstâncias geradas pelo dinamismo histórico desses princípios contendores recursivamente redefinem as possibilidades de sua operação. No Brasil de hoje, o brutal excedente de cirurgiões-dentistas na composição de força de trabalho odontológico tem gerado anomalias no processo de profissionalização da odontologia brasileira; ineficácia e injustiças no processo de racionalização e expansão da divisão de trabalho (trabalho em equipe) no Sistema Único de Saúde, em particular na atenção básica orientada pela Estratégia Saúde da Família; e a perpetuação de disputas interpretativas sobre os instrumentos normativos do ordenamento jurídico, tal como a lei n. 11.889/2008 que regulamenta as profissões de técnico em saúde bucal e de auxiliar em saúde bucal. Tudo isso são elementos cruciais para o futuro da organização de oferta de saúde bucal na atenção básica, bem como a disposição futura da força de trabalho no processo de transição epidemiológica em curso no país, hoje ainda excludente.

P2-348 Avoidable mortality in elderly people: using the Brazilian avoidable causes of death classification in three Brazilian cities (2003–2007)

Population ageing is observed throughout the world, especially in developing countries where this growth is even faster. Ageing leads to the overlapping of non-communicable diseases (NCDs) and transmitted diseases (TDs)...

Distúrbios metabólicos em doenças infecciosas emergentes e negligenciadas

The gradual and progressive replacement of infectious and parasitic by chronic diseases as causes of morbidity and mortality, characterizing the process of epidemiological transition hasn't been observed in various populations, especially in underdeveloped or developing countries characterizing a superposition of these profiles (incomplete transition). Besides the increased prevalence of metabolic disorders, various infectious diseases remain endemic in several regions, such as leprosy, tuberculosis, leishmaniasis, viral hepatitis, among others, as well as emerging diseases in recent decades, as HIV infection/Aids. In this context, more attention has been given to the occurrence of metabolic disturbances in the recent years, mainly from the observation of a high incidence of metabolic disorders associated with HIV infection/Aids, and its therapy with antiretroviral drugs. This review addresses clinical and epidemiological aspects of metabolic disturbances reported in some infectious and parasitic diseases with worldwide and local (Brazil) relevance, as well as possible mechanisms and factors involved in these associations.

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.

Morbidity and mortality in Brazilian municipalities: a multilevel study of the association between socioeconomic and healthcare indicators

Socioeconomic and healthcare indicators are major determinants of health outcomes. The impact of social and healthcare inequalities on Brazilian morbidity and mortality indicators is of concern but it is not well studied. A multilevel ecological study was performed in order to investigate the association between a set of socioeconomic and healthcare indicators and five morbidity and mortality outcomes. Datasets were presented at three hierarchical levels: local (lower level), regional (intermediate level) and state (higher level). A Poisson regression model was estimated for each outcome with random intercept and fixed regression coefficients for independent variables at the three levels. The magnitude of outcome variability at intermediate and higher levels was assessed for all models. All outcomes were associated with both socioeconomic and healthcare variables, with predominance of associations at the local level. General and high-complexity healthcare infrastructures were directly associated with indicators related to later stages of the demographic and epidemiological transition process. A mild effect on morbidity and mortality related to political voting patterns was found at the local level. Healthcare conditions and socioeconomic indicators are associated with health outcomes in a complex way at the local level in Brazil, but part of the variability of health outcomes is related to factors operating at higher levels. Some possible interaction effects and cross-sectional design limitations of this study must be considered.

Prevalence of obesity in Iran

Recent descriptive studies suggest that Iran has geared in the nutrition and epidemiological transition processes. Therefore, while the problems of undernutrition (e.g. growth retardation and micronutrient deficiencies) still exist, the burden of overweight/obesity and diet-related chronic diseases is increasing. The prevalence of overweight (body mass index > or = 85th reference percentiles) among urban 15-39 and 40-69 year olds is estimated at about 22% and 40% respectively. Corresponding values in rural areas are 16% and 26%. The transition seems faster among female population at national level. There are however, great differences between different provinces. Urgent preventive strategies are needed to simultaneously tackle both forms of malnutrition in the country.

Tuberculosis is still a major cause of cervical lymphadenopathies in adults from developing countries.

To establish the frequency of infectious aetiology in Mexican adult patients with cervical lymphadenopathies (CLAs), 87 consecutive patients with enlarged cervical lymphatic nodes, HIV negative and without anti-tuberculous treatment, were selected from a tertiary-level speciality concentration hospital. Histopathological studies, investigation of acid-fast bacilli, cultures in Löwenstein Jensen and Mycobacterium growth indicator tube (MGIT) media, and in-house polymerase chain reaction (PCR) with IS6110-based primers for Mycobacterium tuberculosis complex were performed in resected lymphatic nodes. Non-infectious aetiology corresponded to 45 cases (52 %). Tuberculosis was suspected in 42 cases (48%) by histology and confirmed positive results were obtained by staining in 8 (19%), by culture in 23 (55%), and by PCR in 34 (81 %) patients. All were confirmed after therapeutic success. In addition to the epidemiological transition process occurring in Mexico, tuberculosis remains an important cause of CLA. Histopathology with confirmatory studies including PCR can detect tuberculous aetiology.

Intra-urban mortality differentials in Belo Horizonte, Minas Gerais State, Brazil, 1994: revisiting the debate on demographic and epidemiological transitions

Demographic and epidemiological transition models have seldom been debated within the Brazilian scientific community. This study aims to critically review the studies based on such transition models, analyzing their contributions and limitations for health research in Brazilian cities. Data from the city of Belo Horizonte were used to illustrate the theoretical issues raised in this paper. A total of 10,558 death certificates from 1994 were classified according to underlying cause of death and place of residence (75 geographical areas). Areas were classified according to the proportion of heads of households with low formal education. Population age structures and age- and sex-adjusted mortality rates in the areas were compared. Mortality rates indicate that Belo Horizonte is experiencing a multiple and unequal epidemiological transition process. In the poorer areas, infectious diseases have been replaced by homicides as cause of death in adulthood. The findings suggest that large Brazilian cities have mortality patterns that vary according to social and economic differentials.

Ambiocontrol as a primary factor of health

This paper is based upon the results of two research projects that took place in very dissimilar places and contexts, at different situations in the epidemiological transition process, but lead to some important common conclusions. In both studies, a geo-systemic or socio-spatial classificatory model was first constructed, comprising a series of environmental (independent) variables. Second, this model was used to reveal, measure, and try to explain the health disparities existing in the area under study, as measured by certain health indicators (dependent variables). Two socio-spatial models were constructed. The first used 26 environmental variables, measured in the 78 municipios of Puerto Rico. The dependent variables were mortality rates. The second employed 28 environmental variables, measured in the 32 community health department territories (DSCs) of Québec. The dependent variables were physical and mental health indices. The most significant common conclusion of these studies is that the socio-economic level per se, or its classical principal defining elements (income, education level) are not the main determinants of the observed health disparities. A certain stability in the physical and social environment, the person's sense of understanding of his environment and of control over the course and setting of his own life (what is called ambiocontrol) that is induced by this stability appear to be the most important determinants of health. On the other hand, centrality, complexity and instability of the environment are the most pathogenic characteristics of the milieu.

Brazil is getting older: demographic changes and epidemiological challenges

Population ageing is currently a phenomenon not only in developed countries but also in third world countries. In this paper the features of a population's ageing and the process of epidemiological transition are discussed along with the worldwide changes in age-structure. Population statistics in Brazil and the characteristics of the elderly population are presented and analysed in the light of recent changes. The Brazilian elderly population is also discussed, particularly the issues relating to the social cost of the aged population, its urban and rural distribution, the elderly by sex, marital status and level of schooling, and emphasis is given to the imbalance of the sexes and the consequences of it for women.