By Region (by + region)

Distribution by Scientific Domains

Selected Abstracts

Increasing prevalence of diabetes mellitus in Oman

J. A. Al-Lawati
Abstract Aims To determine the prevalence of diabetes mellitus and impairedfasting glucose by age, gender, and by region and compare resultswith the 1991 survey; and estimate previously undiagnosed diabetesmellitus in the Omani population. Methods Cross-sectional survey containing a probability random sample of5838 Omani adults aged , 20 years. Diabetesand impaired fasting glucose (IFG) were assessed by fasting venous plasmaglucose using 1999 World Health Organization's diagnosticcriteria (normoglycaemia < 6.1 mmol/l, IFG , 6.1 but < 7 mmol/l,and diabetes , 7 mmol/l). The 1991 surveywas reanalysed using the same diagnostic criteria, and results werecompared. Results In 2000, the age-adjusted prevalence of diabetes among Omanis aged30,64 years reached 16.1% (95% confidenceinterval (CI) 14.7,17.4) compared with 12.2% (95% CI11.0,13.4) in 1991. IFG was found among 7.1% (95% CI6.2,8.1) of males and 5.1% (95% CI 4.4,6.0)of females. Generally, diabetes was more common in urban then ruralregions. Only one-third of diabetic subjects knew that they haddiabetes. Nearly half of the study population had a body mass index > 25 kg/m2. Conclusions The prevalence of diabetes is high in Oman and has increasedover the past decade. The high rate of abnormal fasting glucosetogether with high rates of overweight and obesity in the population makeit likely that diabetes will continue to be a major health problem inOman. Primary prevention programmes are urgently needed to counteract majorrisk factors that promote the development of diabetes. Diabet. Med. 19, 954,957 (2002) [source]

Regional Income Inequality and International Trade

Julie A. Silva
Abstract: This study investigates the effects of trade on income inequality across regions in the United States. Using both structural and price-based measures of regional trade involvement, we evaluate the effects of trade on inequality within and across states, the metropolitan and nonmetropolitan portions of the states, and the major census regions. Across all states and metropolitan and nonmetropolitan areas, we found that trade affects inequality primarily via import and export prices. In contrast to our expectations, however, a weaker dollar,more expensive imports and cheaper exports,is associated with the worsening of a state's position relative to other states and greater inequality within the state. Across the census regions, both our price and orientation measures had significant effects, but the direction of these effects varied by region. Whereas many regions benefited from cheaper imports, states in regions that are traditionally home to low-wage sectors, including the Southeast and South Central regions, were made relatively worse off by lower import prices and by greater orientation toward import-competing goods. Our findings reinforce notions about the uneven impacts of globalization and suggest that policy measures are needed to ensure that both the benefits and costs of involvement in international trade are shared across regions. [source]

Mortgage credit conditions in the UK

John Muellbauer
It is widely perceived that credit conditions for UK consumers, particularly in the mortgage market, have been radically liberalized since the 1970s. The implications for the housing market and consumer spending have been important. This article by John Muellbauer draws on a 1997 paper by the author which examined data from the Survey of Mortgage Lenders to learn, from information about loan-to-value ratios of first-time buyers, classified by region, about changes in mortgage credit conditions. By controlling for economic and demographic influences on credit conditions, a single time-varying index of mortgage credit conditions was extracted from these SML data. This index rises in the 1980s, peaking towards the end of the decade. It retraces part of its rise in the early 1990s before rising again by 1995 to a level not far below the previous peak. The article considers whether more recent data suggest a further liberalisation of mortgage credit conditions. It draws on joint research with others to discuss possible implications for consumer spending, house prices, the volume of property transactions and mortgage defaults. [source]

Sampling and analytical plus subsampling variance components for five soil indicators observed at regional scale

B. G. Rawlins
Summary When comparing soil baseline measurements with resampled values there are four main sources of error. These are: i) location (errors in relocating the sample site), ii) sampling errors (representing the site with a sample of material) iii) subsampling error (selecting material for analysis) and iv) analytical error (error in laboratory measurements). In general we cannot separate the subsampling and analytical sources of error (since we always analyse a different subsample of a specimen), so in this paper we combine these two sources into subsampling plus analytical error. More information is required on the relative magnitudes of location and sampling errors for the design of effective resampling strategies to monitor changes in soil indicators. Recently completed soil surveys of the UK with widely differing soils included a duplicate site and subsampling protocol to quantify ii), and the sum of iii) and iv) above. Sampling variances are estimated from measurements on duplicate samples , two samples collected on a support of side length 20 m separated by a short distance (21 m). Analytical and subsampling variances are estimated from analyses of two subsamples from each duplicate site. After accounting for variation caused by region, parent material class and land use, we undertook a nested analysis of data from 196 duplicate sites across three regions to estimate the relative magnitude of medium-scale (between sites), sampling and subsampling plus analytical variance components, for five topsoil indicators: total metal concentrations of copper (Cu), nickel (Ni) and zinc (Zn), soil pH and soil organic carbon (SOC) content. The variance components for each indicator diminish by about an order of magnitude from medium-scale, to sampling, to analytical plus subsampling. Each of the three fixed effects (parent material, land use and region) were statistically significant for each of the five indicators. The most effective way to minimise the overall uncertainty of our observations at sample sites is to reduce the sampling variance. [source]

Blister rust and western forest biodiversity: ecology, values and outlook for white pines

FOREST PATHOLOGY, Issue 3-4 2010
D. F. Tomback
Summary Eight white pine species are widely distributed among the forests of western Canada and the United States. The different forest communities with these species contribute biodiversity to the western landscape. The trees themselves provide various ecosystem services, including wildlife habitat and watershed protection. White pine communities range in elevation from lower to upper treeline, in successional stage from seral to climax, and in stand type from krummholz to closed-canopy forest. Many white pine species are moderately to strongly fire-dependent for regeneration; several species are extreme stress tolerators and persistent on harsh sites. Among the white pines are the oldest-living trees, the world's largest pines, species dependent on birds for seed dispersal, species important for grizzly bear habitat and species of high commercial timber value. The principal threats to white pine populations are blister rust (Cronartium ribicola, pathogen), fire suppression, succession, mountain pine beetle and climate change. Severe population declines in several white pine species are attributed to losses caused by these factors acting either alone or together, and sometimes in concert with logging and other land-use changes. The importance and particular interactions of these threats vary by region and species. For example, many northern and western populations of whitebark pine are seriously declining from a combination of mountain pine beetle outbreaks and severe blister rust infestations. As whitebark pines provide many keystone services on high-elevation sites, their loss would impact forest composition and structure, succession, biodiversity, and ecosystem services. Although there are serious challenges to science-based management and conservation (especially in remote American wilderness areas), prompt and effective intervention promoting regeneration of blister rust-resistant white pines could mitigate these severe impacts. [source]

Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update

Jennifer S. Smith
Abstract Data on human papillomavirus (HPV) type distribution in invasive and pre-invasive cervical cancer is essential to predict the future impact of HPV16/18 vaccines and HPV-based screening tests. A meta-analyses of HPV type distribution in invasive cervical cancer (ICC) and high-grade squamous intraepithelial lesions (HSIL) identified a total of 14,595 and 7,094 cases, respectively. In ICC, HPV16 was the most common, and HPV18 the second most common, type in all continents. Combined HPV16/18 prevalence among ICC cases was slightly higher in Europe, North America and Australia (74,77%) than in Africa, Asia and South/Central America (65,70%). The next most common HPV types were the same in each continent, namely HPV31, 33, 35, 45, 52 and 58, although their relative importance differed somewhat by region. HPV18 was significantly more prevalent in adeno/adenosquamous carcinoma than in squamous cell carcinoma, with the reverse being true for HPV16, 31, 33, 52 and 58. Among HSIL cases, HPV16/18 prevalence was 52%. However, HPV 16, 18 and 45 were significantly under-represented, and other high-risk HPV types significantly over-represented in HSIL compared to ICC, suggesting differences in type-specific risks for progression. Data on HPV-typed ICC and HSIL cases were particularly scarce from large regions of Africa and Central Asia. © 2007 Wiley-Liss, Inc. [source]

MRI white matter hyperintensities, 1H-MR spectroscopy and cognitive function in geriatric depression: a comparison of early- and late-onset cases

Tetsuhito Murata
Abstract Background and Objectives Geriatric depression is often thought to differ from that at other times of adulthood. Recently, several studies have shown that the incidence of white matter hyperintense lessions identified by brain MRI is higher in patients with geriatric depression than in healthy elderly subjects, but a consensus has not yet been reached on the relationship between the severity of white matter lesions and either cognitive impairment or depressive symptoms. Method Forty-seven patients aged 50 to 75 years with major depression were divided into two groups based on age at onset of depression: early-onset (<,50 years) group (20 patients; mean age, 62.7,±,6.7) and late-onset (,50 years) group (27 patients; mean age, 65.6,±,5.4). The severity of hyperintense white matter lesions on MRI was classified by region, then a proton magnetic resonance spectroscopy (1H-MRS) focusing on the white matter of the frontal lobes, multidimensional neuropsychological tests and evaluation of depressive symptoms were conducted. Results The severity of the deep white matter lesions, the deterioration of cognitive function related to subcortical/frontal brain system and clinician-rated depressive symptoms were all more pronounced in the late-onset group compared with those in the early-onset group. It was further observed that the more severe the deep white matter lesions, the lower the levels of N-acetylaspartate/creatine. With the age of onset as the covariate, the patients with moderate deep white matter lesions had more pronounced cognitive impairment and clinician-rated depressive symptoms than those with none and/or mild lesions. Conclusion These results suggest that subcortical/frontal type cognitive impairment and the persistence of depressive symptoms in geriatric depression is related to moderate deep white matter lesions more often complicated in the late-onset group. The 1H-MRS findings were suggested to be a useful indicator of neuronal/axonal loss in the white matter of the frontal lobes which precedes cognitive impairment. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Selenium Content of Venison, Squirrel, and Beef Purchased or Produced in Ohio, a Low Selenium Region of the United States

D.H. HolbenArticle first published online: 20 JUL 200
ABSTRACT: The selenium (Se) content (AOAC fluorometric method) of: 1) raw and cooked venison, squirrel, and beef from a low selenium region of the United States and 2) nonregion-raised beef was assessed and compared by region, species, and gender. For both raw and cooked meats, the Se content of venison was not different from region-raised beef (p > .05), and their contents were generally less than squirrel, which was less than nonregion-raised beef (p < .05). Gender and age did not influence Se content of the meats. Field-dressed weight did not affect Se content of deer, and antler size did not impact Se content of meat from male deer. [source]

Dental Caries Status and Need for Dental Treatment of Pennsylvania Public School Children in Grades 1,3, 9, and 11

Robert J. Weyant DMD
ABSTRACT Objectives: This cross-sectional study was designed to determine the caries status and provide a general evaluation of the level of dental treatment need of Pennsylvania public school children in grades 1, 3, 9, and 11 on a statewide and regional basis. Methods: Between September 1998 and May 2000, caries status and treatment need were assessed using a school-based dental examination, performed on a representative sample (n=6,040) of public school children in grades 1, 3, 9, and 11 (age range=6 to 21 years). Children's caries status in the primary and permanent dentition was assessed. Need for treatment was scored on a three-level categorical scale,no treatment need identified, routine treatment need, and urgent treatment need,and was based on the presence and severity of caries and other oral conditions. Population estimates of the prevalence of untreated dental caries, DMFT and dft scores, and treatment need were calculated by grade and geographically, using the six Pennsylvania health districts and the cities of Pittsburgh and Philadelphia. The inequality of caries distribution in the population was assessed for both permanent and primary caries using Lorenz curves and Gini coefficients. Results: Dental caries has remained highly prevalent among Pennsylvania's public school children. Caries levels varied considerably by health districts and city. Urgent treatment needs were significant and also varied by health district and city. Conclusions: Dental caries remains the most prevalent disease affecting Pennsylvania's schoolchildren. Caries status varies significantly by region of the state, suggesting that environmental, social, and demographic contextual factors may be important determinants of disease prevalence. [source]


Nick Polaschek RN
SUMMARY Background: Given increasing demand for renal replacement therapy, this study sought to identify of key workforce issues facing dialysis units, based on a "snapshot" of the current workforce. Methods: A web-based survey of all dialysis unit managers in Australia and New Zealand, in October 2008, about their workforce. Results: A significant minority of dialysis staff in most regions were not registered nurses. Many renal registered nurses worked part-time. Staff/patient ratios in dialysis units varied significantly by region, reflecting the relative prevalence of home therapies. Most dialysis units were generally adequately staffed. The proportion of registered nurses with specific renal qualifications varied significantly by region. Conclusion: The changing character of the workforce in the dialysis unit in the future will require clarification of the relationships between different categories of dialysis staff. Specialty education for nurses needs to be oriented to equipping staff to be effective in their changing work environment. [source]

Travelers' Diarrhea in Children Visiting Tropical Countries

Filipe Glória Silva MD
We studied a group of 174 Portuguese children (aged 2 mo,16 y) who mostly traveled to tropical Portuguese-speaking countries and found an attack rate of 21.8% for travelers' diarrhea, much lower than previously described. We also showed that African rate analysis by region may hide significant differences between countries. [source]

Fatal Injuries of US Citizens Abroad

Clare E. Guse MS
Background US citizens are increasingly traveling, working, and studying abroad as well as retiring abroad. The objective of this study was to describe the type and scope of injury deaths among US citizens abroad and to compare injury death proportions by region to those in the United States. Methods A cross-sectional design using reports of US citizen deaths abroad for 1998, 2000, and 2002 on file at the US State Department was employed. The main outcome measures were the frequencies of injury deaths and proportional mortality ratios (PMRs) comparing deaths abroad to deaths in the United States. Results Two thousand eleven injury deaths were reported in the 3 years, comprising 13% of all deaths. The overall age-adjusted PMR for injury fatalities abroad compared to the United States was 1.6 (95% confidence interval 1.6,1.7). The highest age-adjusted PMRs for motor vehicle crashes were found in Africa (2.7) and Southeast Asia (1.6). The proportion of drowning deaths was elevated in all regions abroad. Conclusions Injuries occur at a higher proportion abroad than in the United States. Motor vehicle crash and drowning fatalities are of particular concern. Improved data quality and surveillance of deaths would help government agencies create more evidence-based country advisories. [source]

Primates in traditional folk medicine: a world overview

MAMMAL REVIEW, Issue 2 2010
Rômulo R. N. ALVES
ABSTRACT 1Almost 50% of primate species are in danger of becoming extinct, according to the criteria of the International Union for Conservation of Nature (IUCN) Red List of Threatened Species. This is partly because of their consumption by humans. The reasons for hunting vary by region. One pretext is the medicinal or magical value of products derived from these animals. 2In this paper, we provide an overview of the global use of primates in traditional folk medicines as well as identifying the species used as remedies associated with folk beliefs. Some important questions relating to the conservation of primates are addressed. 3Our results revealed that at least 101 species of primates, which belong to 38 genera and 10 families, were used in traditional folk practices and in magic,religious rituals throughout the world. 4Of the 101 species of primates recorded in our review, 12 species were classified as Critically Endangered, 23 as Endangered, 22 as Vulnerable, seven as Near Threatened, 36 as Least Concern and one as Data Deficient in the IUCN Red List. All species were also included in The Convention on International Trade in Endangered Species of Wild Fauna and Flora Appendices I or II, although the reasons for their inclusion were not necessarily related to their medicinal use. 5The widespread utilization of primates in traditional medicine is evidence of the importance of understanding such uses in the context of primate conservation as well as the need for considering socio-cultural factors when establishing management plans concerning the sustainable use of these mammals. [source]

A multilevel model for the study of breastfeeding determinants in Brazil

Daniela Wenzel
Abstract The benefits of breastfeeding for the children's health have been highlighted in many studies. The innovative aspect of the present study lies in its use of a multilevel model, a technique that has rarely been applied to studies on breastfeeding. The data reported were collected from a larger study, the Family Budget Survey-Pesquisa de Orçamentos Familiares, carried out between 2002 and 2003 in Brazil that involved a sample of 48 470 households. A representative national sample of 1477 infants aged 0,6 months was used. The statistical analysis was performed using a multilevel model, with two levels grouped by region. In Brazil, breastfeeding prevalence was 58%. The factors that bore a negative influence on breastfeeding were over four residents living in the same household [odds ratio (OR) = 0.68, 90% confidence interval (CI) = 0.51,0.89] and mothers aged 30 years or more (OR = 0.68, 90% CI = 0.53,0.89). The factors that positively influenced breastfeeding were the following: higher socio-economic levels (OR = 1.37, 90% CI = 1.01,1.88), families with over two infants under 5 years (OR = 1.25, 90% CI = 1.00,1.58) and being a resident in rural areas (OR = 1.25, 90% CI = 1.00,1.58). Although majority of the mothers was aware of the value of maternal milk and breastfed their babies, the prevalence of breastfeeding remains lower than the rate advised by the World Health Organization, and the number of residents living in the same household along with mothers aged 30 years or older were both factors associated with early cessation of infant breastfeeding before 6 months. [source]

Plasma folate status and dietary folate intake among Chinese women of childbearing age

Yaling Zhao
Abstract Maternal folic acid deficiency is an underlying risk for neural tube defects (NTDs). China has one of the highest prevalences of NTDs, and the prevalence rates of NTDs vary by region. We characterized plasma folate level and dietary folate intake among Chinese women of childbearing age by region (North and South, East and West, urban and rural) to provide evidence for establishing policy to prevent NTDs. A total of 1003 women of childbearing age from five provinces in China were interviewed. Fasting blood samples were collected. Plasma folate concentrations were determined by a microbiological assay. Dietary intake data were collected using a 24-h recall. Both the plasma folate concentrations and dietary folate intake of women in the South (25.9 nmol L,1 and 211.0 µg day,1) were higher than those of women in the North (13.3 nmol L,1 and 189.2 µg day,1). In the North, plasma folate concentrations and dietary folate intake of women in rural areas were lower than those of women in urban areas, whereas, in the South, an opposite pattern was observed. No difference was found between women in the East and West, in either the North or South regions. Plasma folate and dietary folate intake among Chinese women of childbearing age were suboptimal and varied by region. Different folic acid supplementation approaches and dosage should be undertaken to improve folate status of women in different areas. Particular attention should be paid to women in the North, especially in northern rural areas. [source]

Influences of study design and location on the relationship between particulate matter air pollution and birthweight

Jennifer D. Parker
Summary A large number of studies have identified a relationship between particulate matter air pollution and birthweight. Although reported associations are small and varied, they have been identified in studies from places around the world. Exposure assignment, covariates and study inclusion criteria vary among studies. To examine the effect of these and other study characteristics on associations between particulate matter and birthweight, US birth records for singletons delivered at 40 weeks gestation in 2001,03 during the months of March, June, September and December were linked to quarterly estimates of pollution exposure, both particulate matter exposure and exposure to multiple pollutants, by county of residence and month of birth. Annual, 9-month and trimester-specific exposures were assigned. Among births linked to particulate matter exposure there was a small association between coarse particle exposure and birthweight (beta ,13 g per 10 µg/m3 increase [95% CI ,18.3 g, ,7.6 g]) after controlling for maternal factors; this association was attenuated slightly and remained statistically significant after further adjustment for contextual factors, year of birth, region, or urban,rural status. The associations were slightly weaker among births linked to multiple pollutant exposure than among births linked to just particulate matter exposure. The association varied markedly by region, ranging from a decrement of 43 g per 10 µg/m3[95% CI ,58.6 g, ,27.6 g] in the north-west to a null association in the south-west. Trimester findings were smaller, yet remained significant and varied regionally. The association between fine particle exposure and birthweight varied considerably, with an overall small positive association that became null after control for region. This study found that wide regional differences in association may contribute to the varied published findings. The association between coarse particle exposure and birthweight appeared robust, if small; fine particles had no overall association with birthweight. [source]

Bronchiectasis in children: Orphan disease or persistent problem?,

Charles W. Callahan DO
Abstract More than a decade ago, bronchiectasis unrelated to cystic fibrosis was termed an "orphan disease", because it had become an uncommon clinical entity among children in the developed world. Bronchiectasis is more common among children in lower socioeconomic classes and in developing countries, presumably due to more frequent and recurrent respiratory infections, environmental airway irritants, poor immunization rates, and malnutrition. Reports from the Southern Pacific and from Alaska Native children reveal persistently high rates of childhood bronchiectasis. Better epidemiologic data throughout the world are needed to reassess the importance of this condition. The pathophysiology includes airway inflammation, mucus production, and regional airway obstruction, yet the reasons why some children develop bronchiectasis while other do not is unclear. The coexistence of asthma with bronchiectasis is associated with more severe disease, yet the impact of asthma therapy in children with both disorders has not been studied. Similarly, the pattern of antibiotic use for children with bronchiectasis varies by region with little data to justify one particular approach. It may be that public health measures aimed at improving living conditions for children and prevention of respiratory infections with antiviral vaccines will have more impact on childhood bronchiectasis than medical treatments in the future. Pediatr Pulmonol. 2002; 33:492,496. © 2002 Wiley-Liss, Inc. [source]

Geographical differences in physiques of male youth of age 18,20 years in China

Shang Lei
Three national surveys on the physical status of 18-, 19-, and 20-year-old male candidates for military service were carried out in six geographic regions of China in 1955, 1974, and 2001. Data from these surveys for 72,000 individuals were compared by region, by time, and by age, and estimates of incremental changes by decade were made. Overall, at all time points, males in the north and northeast areas were larger and heavier than males in the southwest. Similarly, the proportion of males in the north and northeast who were overweight was greater than in the other areas. The proportion classified as "thin" was highest in the south, southwest, and northwest, reaching 42.6% in the northwest. When urban and rural areas were compared, the mean value of every measure in every region was higher for urban youth, with all but two comparisons reaching significance (P<0.05). Differences of chest circumference among age groups were significant, as were differences in height, weight, and body mass index for 18-year-olds compared to 20-year-olds. Overall, height increments per decade were greatest for males in the southwest (average of age groups 1.79 cm, 1974 to 2001) and least in the northeast (1.08), indicating some tendency toward convergence over time. Weight increments per decade over the same time were greatest in north China (1.37 kg) and least in the northwest region (0.58 kg). Am. J. Hum. Biol. 18:141,148, 2006. © 2005 Wiley-Liss, Inc. [source]

The Evolution of the Centre-right and the State of Scottish Conservatism

Michael Dyer
This article considers the decline of Scottish Conservatism, 1951,97. The statistical data indicate that 91 percent of the variance in Tory support is accounted for by an underlying negative trend against time, that similar patterns appear when the data is disaggregated by region, and that short-term fluctuations have been more in conformity with English results than is conventionally understood. The process of generational change is seen as a waning of the cultural conditions which produced the centre-right coalition that dominated Scottish politics, 1931,64, and its fragmentation into Conservatism, Liberalism, and Scottish Nationalism. The changed circumstances are not seen as peculiarly Scottish, but the consequences for Scottish Conservatism of an evolution affecting the centre-right across the United Kingdom. [source]

Using Repayment Data to Test Across Models of Joint Liability Lending,

Christian Ahlin
Theories rationalising joint liability lending are rich in implications for repayment rates. We exploit this fact to test four diverse models. We show that the models' repayment implications do not always coincide. For example, higher correlation of output and borrowers' ability to act cooperatively can raise or lower repayment, depending on the model. Data from Thai borrowing groups suggest that repayment is affected negatively by the joint liability rate (ceteris paribus) and social ties, and positively by the strength of local sanctions and correlated returns. Further, the relative fit of the adverse selection versus informal sanctions models varies by region. [source]

Identifying educational influentials for formal and informal continuing medical education in the province of British Columbia

Dr. Stefan Grzybowski MD, FCFP Director of Research, MCI SC
Abstract Background: The objective of this study was to identify physicians in the province of British Columbia (BC) who are perceived by their colleagues to be the most educationally influential. Methods: A cross-sectional study using a previously validated survey tool was mailed to a randomly selected sample of 2300 BC registered primary care physicians. Follow-up mailings were sent to nonresponders. Results: The survey response rate was 53%. A list of 375 educationally influential physicians (Els) was proportionately determined and tabulated by region. Implications: The top 5% of provincial Els were identified to serve as a resource for formal and informal continuing medical education (CME). Their names will be brought forward in response to selected requests for CME speakers. [source]

Systematic Evaluation of Pancreas Allograft Quality, Outcomes and Geographic Variation in Utilization

D. A. Axelrod
Pancreas allograft acceptance is markedly more selective than other solid organs. The number of pancreata recovered is insufficient to meet the demand for pancreas transplants (PTx), particularly for patients awaiting simultaneous kidney-pancreas (SPK) transplant. Development of a pancreas donor risk index (PDRI) to identify factors associated with an increased risk of allograft failure in the context of SPK, pancreas after kidney (PAK) or pancreas transplant alone (PTA), and to assess variation in allograft utilization by geography and center volume was undertaken. Retrospective analysis of all PTx performed from 2000 to 2006 (n = 9401) was performed using Cox regression controlling for donor and recipient characteristics. Ten donor variables and one transplant factor (ischemia time) were subsequently combined into the PDRI. Increased PDRI was associated with a significant, graded reduction in 1-year pancreas graft survival. Recipients of PTAs or PAKs whose organs came from donors with an elevated PDRI (1.57,2.11) experienced a lower rate of 1-year graft survival (77%) compared with SPK transplant recipients (88%). Pancreas allograft acceptance varied significantly by region particularly for PAK/PTA transplants (p < 0.0001). This analysis demonstrates the potential value of the PDRI to inform organ acceptance and potentially improve the utilization of higher risk organs in appropriate clinical settings. [source]

A Global Review of New Social Risks and Responses for Children and their Families

Shirley Gatenio Gabel
Given global demographic and social trends, the need for new policy and program responses is essential. This article identifies and describes new and traditional social risks affecting children and their families in both industrialized and developing countries by region. Traditional risks continue in the developing as well as the industrialized countries but the extent and scale are very different and the problems are far more severe in developing countries. In addition, new risks are now evident and new policy responses are emerging. Attention to the new risks is increasing, with growing investment in services and policies facilitating the reconciliation of work and family life and non-traditional families. The citizens of many developing countries experience new risks as well, but their capacity to confront and address these risks is also more limited. [source]

Public Health Conditions and Policies in the Asia Pacific region

Dennis A. Ahlburg
Health has improved dramatically in Asia over the last 40 years. Infant mortality dropped over 60 per cent and life expectancy increased by 40 per cent. Despite these gains, health outcomes remain relatively low in many Asian countries, and vary tremendously by region, income level and demographic group. Little progress has been made, for example, in decreasing maternal mortality. Asia is experiencing an epidemiological transition from a high burden of communicable diseases to a high burden of non-communicable diseases. The pace of this transition varies across countries, and some countries will experience increasing incidence of non-communicable diseases before the level of communicable diseases has decreased. Ill-health imposes a heavy economic cost: HIV/AIDS may reduce economic growth in some countries. As incomes and expectations rise, the demand for health care also rises and one of the greatest challenges facing Asia is how to provide and finance this care. [source]

Recent trends in the use of radical prostatectomy in England: the epidemiology of diffusion

S.E. Oliver
OBJECTIVE To describe recent trends in the use of radical prostatectomy (RP) in England, as there is currently no consensus on the most effective treatment for localized prostate cancer, although RP is the treatment of choice among urological surgeons for men aged < 70 years. METHODS Routine data were assessed to establish the number of RPs performed in England in 1991,99. Age-standardized operation rates were compared by region and socio-economic group, and the geographical spread of use mapped. RESULTS The number of RPs performed annually increased nearly 20-fold between 1991 and 1999. Rates of surgery were greatest in the London National Health Service (NHS) regions and lowest in the Trent region. Outside London, the risk of surgery in a NHS hospital was significantly greater for men living in the least deprived areas; in London this trend was reversed. CONCLUSION Rapid increases in the use of RP showed marked regional variations, most likely related to access to prostate-specific antigen testing and the location of surgeons able to carry out radical surgery. By 1999, a third of procedures were still being undertaken in ,low-volume' hospitals, with implications for the quality of care and outcomes. Crucially, these developments occurred in the absence of robust information about the effectiveness of RP. Recent funding of a randomized trial of treatment options in this area is welcome, but wider questions remain about the timing of the evaluation of surgical technologies. [source]

Prostate cancer incidence among American Indian and Alaska Native men, US, 1999,2004,,§

CANCER, Issue S5 2008
Jeffrey A. Henderson MD
Abstract BACKGROUND. American Indian and Alaska Native (AI/AN) men experience lower incidence of prostate cancer than other race/ethnic populations in the US, but racial misclassification of AI/AN men threatens the validity of these estimates. To the authors' knowledge, little is known concerning prostate-specific antigen (PSA) testing in AI/AN men. METHODS. The authors linked cancer registry data with Indian Health Service enrollment records to improve race classification. Analyses comparing cancer incidence rates and stage at diagnosis for AI/AN and non-Hispanic white (NHW) men for 6 geographic regions focused on counties known to have less race misclassification. The authors also used Behavioral Risk Factors Surveillance System data to characterize PSA testing in AI/AN men. RESULTS. Prostate cancer incidence rates were generally lower in AI/AN than in NHW men for all regions combined (rate ratio of 0.68). However, regional variation was noted among AI/AN men, with incidence rates (per 100,000 population) ranging from 65.7 in the Southwest to 174.5 on the Northern Plains. The rate of distant stage disease was somewhat higher among AI/AN (7.8) than NHW (6.2) men. Nationally, AI/AN men were less likely than NHW men to have undergone recent PSA testing (48.4% vs 58.0%), with prominent regional variation in screening rates noted. CONCLUSIONS. Prostate cancer incidence rates and the proportion of men with recent PSA testing were lower for AI/AN men than for NHW men. However, incident rates and rate of distant stage varied by region more for AI/AN than for NHW. Further research is needed among AI/AN men to evaluate strategies for better understanding the causes of the regional variation in prostate cancer incidence. Cancer 2008;113(5 suppl):1203,12. Published 2008 by the American Cancer Society. [source]

The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI

K. E. Schwab
Abstract Objective, The National Institute for Clinical Excellence (NICE) has recommended laparoscopic resection as an alternative to open surgery for patients with colorectal cancer. The aim of this study was to evaluate the current uptake of laparoscopic colorectal surgery in Great Britain and Ireland. Method, A questionnaire was distributed to members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) regarding their current surgical practice. Results were analysed individually, by region, and nationwide. Results, Information was received on 436 consultants (in 155 replies), of whom 233 (53%) perform laparoscopic colorectal procedures. During the previous year, 25% of colorectal resections were performed laparoscopically by the respondents. However, of those surgeons who were performing laparoscopic resections, only 30% performed more than half of all their resections laparoscopically. Right hemicolectomy, left-sided resections, and rectopexy were the most frequently performed laparoscopic resections. There was an even distribution throughout the country of consultants performing laparoscopic resections (regional IQR 48,60%). The main reason for consultants not performing laparoscopic procedures was a lack of training or funding. Conclusion, Laparoscopic colorectal surgery is being performed by more than half (53%) of colorectal consultants nationwide, although only a quarter of all procedures are being undertaken laparoscopically. [source]