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Heavy Burden (heavy + burden)
Selected AbstractsASIA PACIFIC COLUMN: New challenges and opportunities in managing substance abuse in MalaysiaDRUG AND ALCOHOL REVIEW, Issue 5 2006MAHMUD MAZLAN MD Abstract Until recently, Malaysia has lagged behind in the treatment of drug addiction and related disorders, despite experiencing severe drug problems. By the end of 2004, 234 000 heroin users or heroin-dependent individuals had been registered in the official government registry, but other estimates exceed 500 000 for heroin abusers in the country. Amphetamine-type stimulant abuse is also increasing and of considerable public and government concern. Among the population of drug users, HIV and other infectious diseases rates are very high. In the Western Pacific regions, Malaysia has the second highest HIV prevalence (after Vietnam) among adult populations (0.62%) and the highest proportion of HIV cases resulting from injection drug use (76.3%). Drug use and related disorders exert a heavy burden on the country's health care and legal systems. Historically, drug abusers were rehabilitated involuntarily in correctional, rather than health-care, facilities. This primarily criminal treatment approach had limited effectiveness which led to widespread public dissatisfaction and the recent introduction of medical treatments for addiction. Naltrexone was introduced in 1999; buprenorphine was introduced in 2001 and methadone in 2003. Agonist maintenance programmes were embraced rapidly by the medical community in Malaysia. Currently, over 30 000 opiate-dependent patients are treated with agonist maintenance treatments by more than 500 medical practitioners in Malaysia. Despite these recent advances, treatments for amphetamine-type stimulant abuse or dependence are underdeveloped, and diversion of agonist medications is an emerging concern. [source] A THEORY OF THE INFORMAL SECTORECONOMICS & POLITICS, Issue 1 2008YOSHIAKI AZUMA In many countries, especially poor countries, a heavy burden of taxes, fees, bureaucratic hassles, and bribes drives many producers into an informal sector. This paper shows that we can attribute the existence of a large informal sector to the fact that, because productive endowments contain important unobservable components, the state cannot adjust the amounts that it extracts from producers in the formal sector finely according to each producer's endowment. Given this fact, we find that if the endowment of well-endowed producers is sufficiently large relative to poorly endowed producers, or if their number is relatively large, or if the quality of public services is sufficiently low, then the state extracts a large enough amount from producers in the formal sector that poorly endowed producers choose to work in the informal sector. This result obtains both for a proprietary state, which maximizes its own net revenue, and for a hypothetical benevolent state, which would maximize total net output. But, we also find that there exist combinations of the distribution of endowments and the quality of public services such that the policies of a proprietary state, but not the policies of a hypothetical benevolent state, would cause poorly endowed producers to work in the informal sector. [source] Efficacy of four insect repellents against mosquito bites: a double-blind randomized placebo-controlled field study in SenegalFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 5 2009Bernard Uzzan Abstract Insect-borne diseases represent a worldwide threat. In addition to fight against vectors (insecticides) and disease prevention (vaccination against yellow fever, chemoprophylaxis against malaria), insect repellents applied on the skin could help reduce the heavy burden related to these diseases. In a field study performed in Senegal, we compared the efficacy of one skin application between 3 and 4 p.m. of four spray repellents [icaridine 20%, para-menthane-diol (PMD) 20% and 50% and DEET 50%] against placebo, among 100 healthy male and female volunteers experienced with mosquito capture. Double-blind randomized cross-over placebo-controlled study (Latin-square design) during five consecutive nights (7 p.m. to midnight) in two villages was conducted. To avoid residual effect, right or left leg was alternately exposed during consecutive nights and the exposed leg was washed before next night. The statistical model was random and mixed effects anova. All four active repellents provided a significant and similar protection compared with placebo, lasting 8 h. However, there was a non-significant trend for a higher protection by DEET 50% than by PMD 20% (P = 0.07). Duration of protection was similar for all repellents. Their effects were similar among men and women, and against Anopheles or other species. No serious adverse drug reaction was noticed. Using a rigorous methodology and a large number of volunteers, our well-controlled study demonstrated an important and similar protective effect of all four repellents compared with placebo. Such field studies should be required before approval of any newly developed repellent. [source] Youth, AIDS and Rural Livelihoods in Southern AfricaGEOGRAPHY COMPASS (ELECTRONIC), Issue 3 2008Lorraine Van Blerk AIDS, in interaction with other factors, is impacting on the livelihood activities, opportunities and choices of young people in southern Africa. This article explores these linkages firstly by reviewing what is known about the impacts of AIDS on young people, before looking more specifically at how this impinges on their future ability to secure livelihoods. Within the home and family, AIDS often results in youth taking on a heavy burden of responsibilities. This can include caring for sick relatives, helping with chores and taking on paid employment. This burden of care and work can have further impacts on young people's future livelihoods as they find they have reduced access to schooling, potential loss of inheritance and a breakdown in the intergenerational transfer of knowledge, which is especially important for sustained agricultural production. The article ends by suggesting that the sustainable livelihoods approach can be useful for understanding the complexity of the issues surrounding the impacts of AIDS on young people's livelihoods and calls for further research to explore how their access to future sustainable livelihoods in rural southern Africa might be supported. [source] Aspects of tax pertaining to insolvency law in South Africa,INTERNATIONAL INSOLVENCY REVIEW, Issue 3 2005Elzette Muller This paper seeks to briefly analyse the somewhat convoluted provisions contained in South African tax legislation that apply to insolvent entities in South Africa. While South Africa has modern and effective taxation laws, the provisions, when applied to insolvent entities, are often exposed as cumbersome and ineffective. Tax legislation in South Africa does not take proper cognisance of the unique nature of insolvency, often placing a heavy burden on the trustee or liquidator who is required to administer the estate as speedily and effectively as possible. In addition, there are different rules that apply to consumer and corporate insolvency regarding the assessment of income tax pre- and post-liquidation. The recent introduction of a capital gains tax has placed an additional burden on insolvency practitioners, especially considering the lack of clarity as to how these provisions should be applied in practice. Although the Value-Added Tax Act was introduced more than a decade ago, its provisions continue to pose problems for insolvency practitioners during the administration process of insolvent estates. Despite these difficulties, the South African revenue authorities are to be lauded for the sensible manner in which problems are addressed in practice. Copyright © 2005 John Wiley & Sons, Ltd. [source] The socio-economic burden of asthma is substantial in EuropeALLERGY, Issue 1 2008S. Accordini Background: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. Methods: In 1999,2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socio-economic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. Results: The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4,15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1,16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18,4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52,5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63,4.61) and sixfold (RRR = 5.76; 95% CI: 3.25,10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16,3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9,27.1%). Conclusions: The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females. [source] The burden of silicosis, pulmonary tuberculosis and COPD among former Basotho goldminersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 9 2008Brendan V. Girdler-Brown MBChB, FCPHM(SA) Abstract Background The burden of silicosis, pulmonary tuberculosis and COPD is described in 624 South African gold miners 18 months after cessation of work. Methods This was a prevalence study. Questionnaires were administered, and spirometry, chest radiography, tuberculosis investigations, and urine HIV antibody assays were performed. Results Attendance was 80.1% (624/779), mean age 49.4 years, and mean employment duration 25.6 years. Most subjects had had medium (26.5%) or high (65.4%) dust-exposure jobs. Current smoking rate was 35%, with ever smoking 61%. HIV antibodies were detected in the urine in 22.3%. Prevalences were: silicosis 24.6%, past tuberculosis 26%, current tuberculosis 6.2%, airflow obstruction 13.4%, and chronic productive cough 17.7%. Almost 50% of these miners had at least one of these respiratory conditions. Conclusions A heavy burden of silicosis, tuberculosis and COPD was present in this group of former goldminers. Intensification of work place dust control measures and TB and HIV prevention activities are needed on South African gold mines. In labor sending communities investment is needed in silicosis and tuberculosis surveillance as well as HIV treatment and care. Am. J. Ind. Med. 51:640,647, 2008. Published 2008 Wiley-Liss, Inc. [source] Increased nuchal translucency in euploid fetuses,what should we be telling the parents?PRENATAL DIAGNOSIS, Issue 2 2010C.M. Bilardo Abstract Nuchal translucency (NT) measurement between 11 and 14 weeks' gestation is an undisputed marker for aneuploidies. When conventional karyotyping is normal, enlarged NT is a strong marker for adverse pregnancy outcome, associated with miscarriage, intrauterine death, congenital heart defects, and numerous other structural defects and genetic syndromes. The risk of adverse outcome is proportional to the degree of NT enlargement. Although the majority of structural anomalies are amenable to ultrasound detection, unspecified genetic syndromes involving developmental delay may only emerge after birth. Concern over these prenatally undetectable conditions is a heavy burden for parents. However, following detection of enlarged NT the majority of babies with normal detailed ultrasound examination and echocardiography will have an uneventful outcome with no increased risk for developmental delay when compared to the general population. Counseling should emphasize this to help parents restore hope in normal pregnancy outcome and infant development. Copyright © 2010 John Wiley & Sons, Ltd. [source] Management of Neck Metastasis with Carotid Artery Involvement,THE LARYNGOSCOPE, Issue 1 2004Stephen B. Freeman MD Abstract Objectives To demonstrate aggressive management of neck metastasis adherent to the internal or common carotid artery using sound oncologic principles while minimizing the significant risk of complications. Study Design Our 13 year experience of treating patients with recurrent or residual neck metastasis adherent to the internal or common carotid artery was retrospectively reviewed. Methods Angiography was used in patients who demonstrated fixation of the carotid artery on examination or imaging, followed by balloon test occlusion and single photon emission computer tomography (SPECT) scanning. The majority of carotid resections were reconstructed with a vein graft, especially if there was insufficient collateral cerebral circulation. Radical resection of the soft tissue including the carotid artery was performed followed by 15 to 20 Gray of electron beam delivered directly to the deep tissue. More recently, the carotid has been permanently occluded preoperatively, if possible. The assessment of the cerebral circulation and management of the carotid artery were analyzed as was survival, site of recurrence, and complications. Results Fifty-eight charts were reviewed. The majority of patients (41) had their carotid artery reconstructed at time of resection, and the remaining had either the artery ligated or permanently occluded preoperatively. Strokes occurred in 11 patients. The median disease-specific survival was 12 months, with 24% of patients dying from distant metastasis. Conclusions The high risk of complications, loss of life's quality, and mortality must be balanced against the natural history of the disease if left untreated. The decision is a heavy burden for the patient, family, and head and neck surgeon. [source] Advances in the basic and clinical science of migraine,ANNALS OF NEUROLOGY, Issue 5 2009Andrew Charles MD Migraine continues to be an elephant in the room of medicine: massively common and a heavy burden on patients and their healthcare providers, yet the recipient of relatively little attention for research, education, and clinical resources. Its visibility is gradually increasing, however, as advances in genetics, imaging, epidemiology, and pharmacology produce a more definitive understanding of the condition, and identify more specific and effective treatments. Rapid evolution of concepts regarding its prevalence, pathophysiology, and clinical management is leading to growing recognition of migraine as a fundamentally important disorder of the nervous system. Ann Neurol 2009;65:491,498 [source] Malformation of True Bug (Heteroptera): a Phenotype Field Study on the Possible Influence of Artificial Low-Level RadioactivityCHEMISTRY & BIODIVERSITY, Issue 4 2008Cornelia Hesse-Honegger Abstract The results of extensive field studies on the malformation of Western European true bugs (Heteroptera) are reviewed. More than 16,000 individuals were collected over two decades, and subjected to detailed visual inspection. Various types of disturbances were found and illustrated in detail. Depending on country, region, as well as local influences, severe disturbances and high degrees of malformation were noticed, especially in the sphere of nuclear-power installations in Switzerland (Aargau), France (La Hague), and Germany (Gundremmingen). Malformation reached values as high as 22 and 30% for morphological (MD) and total disturbance (TD), respectively. This is far above the values expected for natural populations (ca. 1%) or those determined for true bugs living in biotopes considered as relatively ,intact' (1,3%). A detailed chi-square test of the malformation data obtained for 650 true bugs from 13 collection sites near the nuclear-reprocessing plant La Hague showed a highly significant correlation (p=0.003) between malformation and wind exposure/local topography. Similar observations were made for other study sites. Currently, our data are best rationalized by assuming a direct influence between the release of anthropogenic radionuclides such as tritium (3H), carbon-14 (14C), or iodine-131 (131I), constantly emitted by nuclear-power and nuclear-reprocessing plants, as well as by Chernobyl and bomb-testing fallout, which is rich in caesium-137 (137Cs) and other long-lived noxious isotopes that have entered the food chain. The present work supports the growing evidence that low-level radiation, especially in the form of randomly scattered ,hot' , - and , -particles, mainly transported via aerosols, puts a heavy burden on the biosphere in general, and on true bugs in particular. These insects could, thus, serve as sensitive ,bio-indicators' for future studies. [source] | |||||||||||||